Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002 Contributing to reaching the Millennium Development Goals and the Goals of the World Fit for Children: Health and Nutrition in UNICEF's Mid-Term Strategic Plan 2002-2005 Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002

Under-five mortality rate, change over period 1990-2000 181 128 80 58 53 45 175 100 64 44 37 38 9 6 20 40 60 120 140 160 180 200 Sub-Saharan Africa South Asia Middle East & North Africa East Asia and Pacific Latin America & Caribbean CEE/CIS and Baltics Industrialized countries U5MR (deaths per 1000 births) 1990 2000 Least reduction 3% Greatest 32% UNICEF has very recently reviewed the progress made on achieving the World Summit for Children goals. The results of this review have been included in an update to the UN Secretary General’s 2001 report The present slide is taken from this update and shows progress in the reduction of the under-five mortality rate (U5MR) during the 1990s. The region with the smallest reduction is where U5MR is highest, in sub-Saharan Africa, and the largest reduction is where U5MR is lowest, in the industrialized countries. Source: UNICEF, 2001

U5MR disparity by asset quintile

Most deaths occur at home, before reaching health facilities … Implications for programming?

Bangladesh U5MR This is an example for Bangladesh, showing the evidence for a sizeable reduction of U5MR

Immunization 1980-1999, DPT3 coverage

LOW BIRTHWEIGHT RATE One quarter of births in South Asia weigh less than 2500 grams Source: UNICEF, 2001

1 in 13 RISK OF DEATH A woman born in Sub-Saharan Africa faces a 1 in 13 chance of dying in childbirth. The risk for women born in industrialized countries is 1 in 4085. Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.

Skilled attendants at delivery, 1995-20

The ultimate challenge: HIV HIV - the worst pandemic in human history - risks reversing the progress of decades of development ...

Botswana U5MR An example of a country with increasing U5MR, primarily a result of HIV/AIDS.

Estimated impact of AIDS on under-5 child mortality rates - selected African countries, 2010 with AIDS per 1000 live births 250 200 150 100 50 without AIDS Botswana Kenya Malawi Tanzania Zambia Zimbabwe Source: US Bureau of the Census 98036-E-25 – 1 December 1999

There are eight Millennium Development Goals (MDGs), divided into 18 targets. Social development is primarily represented by the first seven goals. These are listed in this and the following two slides.

Main Goals of A World Fit for Children (2000-2010) Reduce infant and under-five mortality by at least one third by 2010 (and by 2/3 from 1990 to 2015) Reduce maternal mortality ratio by at least one third by 2010 (and by 3/4 from 1990 to 2015)

Main Goals of A World Fit for Children (2000-2010)... Reduce under-five child malnutrition by at least one third by 2010, with special attention to children under two and reduce the rate of low-birth weight by at least one third by 2010 Reduce proportion of households without access to hygienic sanitation facilities and affordable and safe water by at least one third by 2010

Main Goals of A World Fit for Children (2000-2010) ... Develop and implement national early childhood development policies and programmes (children’s physical, social, emotional, spiritual and cognitive development) Develop and implement national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health

Main Goals of A World Fit for Children (2000-2010) ... Access through the primary health-care system to reproductive health for all individuals of appropriate ages as soon as possible and no later than 2015

Main Goals of A World Fit for Children (2000-2010)... Reduce by 2005 HIV prevalence among young men and women age 15 to 24 in the most affected countries by 25 per cent and by 25 percent globally by 2010 By 2005, reduce the proportion of infants infected by HIV by 20%, and by 50% by 2010

Organizational Priorities 2002-2005: UNICEF’s Mid-Term Strategic Plan Immunisation+ Integrated Early Childhood Development (Health, Nutrition, Water & Sanitation, Psychosocial Care and Early Learning, Child Protection) HIV/AIDS Girl’s Education Child Protection

Immunization + By 2010, ensure full immunization at least 90% of children nationally with at least 80% coverage in every district Certify by 2005 the global eradication of polio Reduce deaths due to measles by half by 2005 Eliminate maternal and neonatal tetanus by 2005

Immunization + ... Extension of the benefits of new and improved vaccines and other preventive health interventions to children in all countries, especially vitamin A where appropriate

Integrated Early Childhood Development (IECD) Health: Major childhood killers (diarrhea, pneumonia, malaria) Maternal and newborn health Nutrition Exclusive breastfeeding, complementary feeding, infant-feeding informed choices Micronutrients (supplementation and fortification: iodine, vitamin A, anemia and iron, folic acid, others?) Water and environmental sanitation Psychosocial care and early learning

HIV/AIDS PMTCT Prevention among young people Care and Support Orphans

With business as usual, we will not reach the MDGs or those of the World Fit for Children Need to redouble our efforts to support countries to reach these goals How can we support countries to provide high coverage of a limited number of the most cost-effective interventions (the essential package) and support the development of sustainable national health systems?

Principles of good development Seek maximal impact on human development (eg. health and education) and on poverty reduction Evidence-based decision-making High impact, low-cost interventions Universal coverage, reaching the unreached, especially the poor Home- and community-based strategies Essential knowledge and commodities (vaccines, treated bednets against malaria, etc.)

Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Challenge 11 million children die each year Most of these deaths are preventable: they are from a limited number of conditions for which we have high impact, low cost interventions The challenge is to go to scale, to reach every child

Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward Political commitment and national ownership by government, civil society and families Clear time-bound goals: Reduce Under-five and Maternal Mortality by one-third during this decade (focus on outcomes and not just process) High impact, low cost, focused programs with specific targets, standardised and taken to scale to reach every child (examples: immunisation, oral rehydration for diarrhea, treated bednets for malaria)

Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward ... Strong and well-coordinated partnerships supporting these programs: developing countries, civil society and NGOs, multilateral agencies (WHO, UNICEF, World Bank) Both developing country and donor resources Strong monitoring and evaluation systems tracking progress towards targets Reaching the Child and Maternal Survival Goals is possible if we commit our energy and our resources to it

Progress - Summary The UN Special Session on Children: A World Fit for Children goals UNICEF’s Mid-term Strategic Plan Global Consultation on Child and Adolescent Health, Stockholm, March 2002 Launch at Special Session on New Low-Osmolarity ORS Solution

Progress - Summary... Consultation on the Community Management of Pneumonia, Stockholm, June 2002 Major effort on Roll Back Malaria Major Measles results in Africa A Secretariat for the C-IMCI IAWG Increase child survival funding and staffing at UNICEF

The challenge…reaching global child survival, growth and development goals