1. Child Health: How Have We Been Doing; Where to Now? An Update on MDG 4 and 5: Maternal and Child Health By Dr. Mickey Chopra, Chief, Health and Associate Director, Programme Division, UNICEF, NYHQ Presented by Dr. Festo P. Kavishe, Deputy Regional Director, UNICEF East Asia and Pacific, Bangkok 9 th March 2010

2. Overview of presentation  Update on MDG4 and 5  Challenges and gaps  What can be done and what is new

3. Source: SOWC 2009 MDG 4: Trends in U5MR Significant declines in under-five mortality rates between 1990 and 2008 in all regions

4. Trends in Immunization Coverage: The Measles Story Vaccine coverage has increased Measles deaths have declined

5. Trends in ITN Use, 2000-2006 Source: UNICEF Global malaria databases 2009, based on 22 countries with trend data for around 2000 and 2006, covering 53 % of children under age five.

6. Percentage of pregnant women with HIV receiving antiretrovirals for preventing mother-to-child transmission of HIV in low- and middle- income countries by region, 2004-2007 UNICEF The bar indicates the uncertainty range around the estimate. Source: Data reported by countries to WHO, UNICEF and UNAIDS in response to the annual reporting form for monitoring the health sector response to HIV/AIDS, 2009

7. Challenges and Gaps

8. Despite overall progress in reducing U5MR, little progress in reducing newborn deaths  Still almost 9 million children dying every year - of which more than 3 million are newborns  Almost no decline in early neonatal mortality in decades Source: Lawn JE et al, Lancet 2005

9. Time of Newborn deaths Up to 50% of neonatal deaths occur in the first 24 hours Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)

10. Newborn deaths are highest in Sub-Saharan Africa and South Asia Source: Lawn JE et al Lancet 2005

11. MDG 5 - Trends in Maternal Mortality Source: UNICEF: Progress for Children 2008  Half a million women continue to die annually from childbirth- related causes  Another 15 million are left with lifelong debilitating effects

12. HAEMORRHAGE CAUSES MORE THAN ONE THIRD OF MATERNAL DEATHS IN AFRICA Per cent distribution of maternal deaths in Africa, by cause (1997-2002) Source: UNICEF: Progress for Children 2008

13. Maternal mortality is highest in countries of Sub- Saharan Africa and South Asia Maternal mortality ratios (MMR) per 100,000 live births (2005)

14. GAP 1 GAP 2 GAP 3 Whilst we know what works, there as coverage gaps along the Continuum of Care for MNH Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

15. What can be done?

16. Some innovation  Community-based case management and care of the newborn  Alternative cadres for obstetric care  Newborn skin/cord cleansing with clorhexidine

17. Some innovation for post-partum hemorhage  Uniject for Oxytocin  a prefilled injection device - delivers a specified dose of drug  making it possible to be administered by auxiliary midwives and other cadres of personnel with minimal training  Misoprostol  Anti-shock garment

18. Some innovation for eclampsia and pre-eclampsia  Magnesium Sulphate  simple low-cost anticonvulsant  A pre-packed kit to facilitate its application in resource-limited settings  Calcium supplementation requires further operations research to guide application in low-resource

19. In conclusion We know the epidemiology We know the evidence-based interventions that need to scaled-up We know existing delivery modes: eg. Immunization to deliver essential child survival interventions Antenatal care to deliver key interventions including PMTCT We also know the coverage gaps So, What to do? We need to ensure Health Systems Strengthening results in improved outcomes for mothers and children We need to ensure linkages with other programmes such as HIV/AIDS and malaria control (integrated approach) We need to use the data to improve access and quality and reach those who are not being reached (better and strategic use of evidence) We need to continuously monitor to inform decision-making and focus of our strategies (track progress and improve feedback loop to decision makers.

20. Thank you for your attention and all your support!!!!