1. Childhood Pneumonia and Diarrhoea 3 Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths

2. “Why are so many children still dying of preventable conditions, and how do we move forward?”

3. Specific Objectives 1.Identify key barriers to implementation of programmes targeting pneumonia/diarrheoa 2.Identify key bottlenecks impeding access to essential commodities – Diarrheoa: vaccines, zinc, ORS, – Pneumonia: vaccines, oral amoxicillin 3.Propose solutions to those barriers

4. Methods A series of consultations with > 600 key stakeholders in 2010-12 3 work streams provided data for 39 Asian & African countries 1.Global Action Plan for Pneumonia (GAPP) – Led by WHO/UNICEF – Broad focus on programmatic barriers/solutions 2.Diarrheoa Global Action Plan (DGAP) – Led by Aga Khan University – Focus on programmatic barriers/solutions & 7 country case studies 3.Diarrheoa and Pneumonia Working Group (DPWG) – Led by UNICEF and CHAI – Focus on supporting scale up treatment in high burden countries.

5. Bottlenecks impeding access to vaccines Concentrated upstream Policy guidelines Resources

6. Bottlenecks impeding access to zinc and ORS are concentrated ‘downstream’ zinc ORS

7. The Market Trap: Why zinc is so expensive in Nigeria

8. Prioritization of the Barriers Inadequate monitoring and assessment Poor coordination of efforts Inadequate human resources Weak supply chain Quality of care

9. Inadequate monitoring and assessment Data not of high quality and not analyzed properly Data often not shared with those that need it most Data not widely disseminated Result: Programmes are unaware of their progress Recommendation: Improve the quality and establish mechanism for sharing and using data for action

10. Poor coordination of efforts Between programmes, across partners and sectors Duplication of efforts Failure to optimize available resources Conflicting priorities Result: Fragmented efforts dilute effectiveness & efficiency Recommendation: Evidence based planning and management, joint development of plans and strategies for action

11. Inadequate human resources Not enough health workers Low incentives for recruitment and retention Limited capacity building opportunities Inadequate supervision and skills reinforcement Result: Chronic shortages of the skilled and motivated workers Recommendation: Explore and implement innovative ways for capacity building, motivation & supervision

12. Weak supply chain Over-reliance on push/pull systems Supply not linked to need Inefficient stock/restock systems Limited local production of essential commodities Result: limited access to life saving commodities Recommendation: Strengthen systems for procurement and drug supply management and production of key commodities

13. Quality of care Evidence based standards of care not always available Access to care limited Low uptake due to poor quality Result: Children die of preventable and treatable conditions Recommendation: Client feedback as part of health worker and clinic assessment; dissemination of guidelines

14. This is a solvable problem: The Bangladesh Story

15. The way forward Evidence based strategic planning Coordinated efforts are more effective Data is key – analyze, utilize, disseminate Ensure supplies and medicines are available where and when needed Institutionalize Quality Improvement Build capacity, reinforce skills, motivate and retain work force

16. Conclusions We can drastically reduce child mortality with tools already at hand – Solutions are affordable and not high tech The ingredients of success start with – Coordinated action plan – Resources commensurate with the burden of disease – Accountability for results – Advocacy