Elizabeth Mason Department of Child and Adolescent Health and Development New Strategic Directions...
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Transcript of Elizabeth Mason Department of Child and Adolescent Health and Development New Strategic Directions...
Elizabeth MasonDepartment of Child and Adolescent Health and Development
New Strategic Directions
Tracking progress in child survival Countdown to 2015 December 13-14 2005
Countdown to 2015Child Survival
Work in child health ...
…focused in the past on delivery of specific child health interventions for single diseases... CDD and ARI programmes
…but now and in the future will address the major causes of under five mortality through integration of care ... Integrated Management of Childhood Illness
Countdown to 2015Child Survival
….. has moved forward
…and also addresses health policies & services…
…previously neglected or emerging areas … Neonatal health Infant and Young Child Feeding HIV and infant feeding Paediatric HIV
…recognises the continuum of care…
…and collaboration between partners through the Partnership for Maternal Newborn & Child Health
Countdown to 2015Child Survival
… Requiring a change of emphasis:Child survival and the big picture
Source: World Health Report 2000
Stewardship(Managing resources, power
and expectations)
Financing (Raising, pooling &
allocating revenues to purchase services)
Fairness in financial contribution
Responsiveness
Resource development(Investing in people,
infrastructure and supplies)
Coverage
Efficiency
Inputs Outputs Outcomes
Service delivery(provision of
health services)
HealthLevel and inequality
Quality
Countdown to 2015Child Survival
New strategic directions 1
Policy, strategies, planning and partnerships Health systems support and management Community-based interventions for child
survival Monitoring and evaluation
Countdown to 2015Child Survival
New strategic directions 2
Policies, strategies, planning & partnerships Closing the policy-implementation gap, and
promoting the "three ones" (one action plan, one financing mechanism, one M&E framework)
Developing strategies at regional and country level Child and Adolescent Health Strategy EURO Joint WHO/UNICEF Child Survival Strategy
WPRO/EAPRO Renewing commitments
Innocenti 15+
Countdown to 2015Child Survival
New strategic directions 3
Health system support & management Health systems are the backbone of service
provision (3x5, RBM, Immunization, Stop TB) Systematic system support for universal access to
integrated delivery of interventions during the life course, across levels of care and at the programmatic and policy level
Role of the private sector to complement the public sector
Countdown to 2015Child Survival
Focus on System Strengthening
Newborn and child survival also need a strong health system Care of the mother, safe delivery –
immediate newborn care Prevention of illness and care of the newborn
in the first month of life Prevention of childhood illness and
integrated management of childhood illness
Con
tinuu
m o
f C
are
Countdown to 2015Child Survival
Increasingly, WHO is providing supportto countries through integration at three levels
Integration at the patient level: Addressing co-morbidity (± 10% of children) Using care seeking to address missed opportunities
Integration between levels of care: Promotion of key family practices Management and care at community level Integrated Management of Childhood Illness (IMCI) at first level
facilities Management of the child with a serious infection or severe
malnutrition (Referral care management) Integration at the programmatic and policy level
Breastfeeding counselling and HIV IYCF and IMCI (synergistic implementation) Maternal, newborn and child health
Countdown to 2015Child Survival
New strategic directions 4
Community-based interventions for child survival Promoting key family practices Improving appropriate care-seeking Ensuring universal access, utilisation and
coverage of key interventions closest to home community management of pneumonia ORT ITNs and case management of malaria Community
Countdown to 2015Child Survival
Focus on the Continuum of Care
Home Community Outreach First Level Health Facility Referral FacilityS
tart
with
act
ion
at h
ome
Countdown to 2015Child Survival
Community and facility implementationneeds careful coordination & planning
Source: MCE, Peru. MoH policy brief
0
20
40
60
80
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0 10 20 30 40 50 60
Trained clinical HWs
per 10,000 children
Tra
ine
d C
HW
sp
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,00
0 c
hil
dre
n
Countdown to 2015Child Survival
Community and facility implementationneeds careful coordination & planning
Source: MCE, Bangladesh
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2
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5
Jul
Sep
No
v
Jan
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May Ju
l
Sep
No
v
Jan
Mar
May Ju
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May Ju
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Sic
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IMCI Intervention IMCI Comparison
-----2001---- ------------2002-------------- --------------2003------------ -------------2004--------------
Starting IMCI
Sta
ff t
rain
ing
in
IM
CI
Pro
vis
ion
of
su
pp
lies
an
d j
ob
aid
s
-2005
Countdown to 2015Child Survival
New strategic directions 5
Monitoring & evaluation Ensuring evidence-informed decision making Epidemiological Estimates – from global to country Focus Agreed upon simple set of core indicators (with linkage to
Health Metrics Network) Regular programme reviews Regular measurement – annual or biannual surveys Monitoring financing and adequate resource allocation for
moving towards universal access
Countdown to 2015Child Survival
Disaggregated country data for child health programming
Cause specific under five mortality distributionChina whole country, MCH surveillance (2004)
59%
15%
4%
0%
0%
0%
7% 15% Neonatal
Pneumonia
Diarrhoea
Malaria
Measles
HIV/AIDS
Injuries
Other
Cause specific under five mortality distributionChina inland provinces, MCH surveillance (2004)
58%
14%3%
0%
0%
0%
9%
16%
Neonatal
Pneumonia
Diarrhoea
Malaria
Measles
HIV/AIDS
Injuries
Other
WPRO, WHO estimate China, MCH surveillance system
Cause specific under five mortality distributionWPRO, WHO estimates (2000-2003)
13%
7%0%
1%
0%
17%
13%
47%
Neonatal
Pneumonia
Diarrhoea
Malaria
Measles
HIV/AIDS
Injuries
Other
Cause specific under five mortality distributionChina remote, MCH surveillance (2004)
49%
23%
7%
0%
0%
0%
6% 15% Neonatal
Pneumonia
Diarrhoea
Malaria
Measles
HIV/AIDS
Injuries
Other
Countdown to 2015Child Survival
Integrated management is less expensive…
Districts Measure
IMCI Comparison
Input data:
Standardized1 total annual district cost for child health care $ 393,193 $ 416,825
Quality measure (proportion of children managed correctly) 0.65 0.16
Standardized1 annual under-five consultations at government
primary care facilities
150,745 101,991
Effectiveness (Number of children managed correctly)2 97,834 16,217
Cost per child managed correctly: $ 4.02 $ 25.70
1Consultations and costs have been standardized to a district with 50,000 children under age five. 2Annual consultations multiplied by proportion managed correctly.
Source: MCE, Tanzania. Bryce et al. HPP
Countdown to 2015Child Survival
... and can lead to rapid mortality reduction
Sources: TEHIP and MCE
Countdown to 2015Child Survival
New Strategic Directions 6
Using available financing opportunities for Child survival GAVI: Delivery of multiple interventions with
immunisation – Vit A; ITNs GFATM: Malaria in children; ITNs; Prevention and
care of paediatric HIV/AIDS both now include health systems strengthening
PRSPs, SWAPs
Countdown to 2015Child Survival
New directions strengthen the outcome focus
Policy, Strategy, Planning & Partnerships
One plan
Monitoring & Evaluation
Regular feedback
Improved HealthHealth system support
and managementIntegrated delivery
Community-based Interventions for
child survival Continuum of care
Coverage
Efficiency
Quality
Inputs Outputs Outcomes
Reduced child
Mortality
Con
tinuu
m o
f M
NC
H c
are
Countdown to 2015Child Survival
Make Every Mother and Child Count
Towards attaining the MDGs