Latin Americans Efforts to Achieve the Millennium Development Goals: An Update on
Progress
Dr. Yehuda BenguiguiSenior Advisor
Child and Neonatal HealthHealthy Living Course Project
Family and Community Health Area
Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
April 29, 2011Denver, Colorado
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Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
I. The Millennium Development Goals
II. Latin America Profile
III. An Update on Progress
IV. Efforts to Achieve the MDG-4
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Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
I. The Millennium Development Goals
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In 2000, 189 countries signed up to the Millennium Declaration—a global commitment to halve extreme poverty and achieve equitable and sustainable development for all. The agreement led to the creation of a historic framework revolved around eight goals: the Millennium Development goals (MDGs), which centre on targets around poverty, education, gender, health, environment, and global partnerships—to be met by 2015.
In the same year, world leaders met in New York to attend the UN MDG review summit, to reenergise commitments and determine how to accelerate progress in the coming years.
MILLENNIUM DEVELOPMENT GOALS
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MILLENNIUM DEVELOPMENT GOALS
End Poverty and Hunger
Universal Education
Gender Equality
Child Health
Maternal Health
Combat HIV/AIDS
Environmental Sustainability
Global Partnership
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Are required only 5 years to meet MDG-4, which proposed a two-thirds reduction in mortality in children under 5 years from 1990 to 2015.
1/3
1/3
1/3 1/3
1990 20152000 2005 2010
MILLENNIUM DEVELOPMENT GOALS
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0-28 days
From 29 days to < 1 year
From 1 year to
< 5 years
NEO
NA
TAL
POST
-NEO
NA
TAL
CH
ILH
OO
D
INFA
NT
MO
RTA
LITY
UN
DER
5 M
OR
TALI
TY
1990 2015
The countries have different degrees of progress in each of the life course stages
MILLENNIUM DEVELOPMENT GOAL - 4
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Will the countries of our hemisphere achieve the MDG-4 for 2015?
Poor development Countries with high childhood mortality rates, will achieve the MDG-4 for 2015?
Developing countries with low childhood mortality rates, will achieve the MDG-4 for 2015?
Which factors affect the achievement of MDG-4 for 2015?
QUESTIONS
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Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
II. Latin America Profile
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Malnutrition 3 %Pneumonia & ARI
12 %
Diarrhea 12 %
Respiratory & infectious diseases: 27%
Other 6 %
Accidents 6 %
Peri-neonatal
58%
Sepsis 32%
Asphyxia 29%
LWB & Prematurity
24%
Congenitalanomalies 10%
CAUSES OF DEATH IN CHILDREN < 5 IN THE AMERICAS REGION
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009 Pan AmericanHealthOrganization
42.4
33.6
27.423.8
2118
0
5
10
15
20
25
30
35
40
45
1990 1995 2000 2005 2010 2015
EVOLUTION OF MORTALITY IN CHILDREN UNDER 5 YEARS IN THE REGION OF THE
AMERICAS. RATES PER 1000 LIVE BIRTHSPe
r 100
0 liv
e bi
rths
ODM
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009
52%
14
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66%
0
50
100
150
200
250
300
350
< 5 years < 1 year
58% 71%
42%29%
NEONATAL MORTALITY RATE IN RELATION TO TOTAL NUMBER OF DEAD IN < 5 YEARS AND <
1YEAR
Neonatal mortality
Per 1
000
live
birt
hs Post neonatal mortality
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009Pan AmericanHealthOrganization
LAC PROFILE-1
Significant decrease in mortality in children under five years:
52% from 1990 to 2010
More than 306.000 deaths avoided
Changes in the Mortality:Decrease in post neonatal mortality (diarrhea,
respiratory and infectious diseases)
Greatest relevance of neonatal mortality in < 5
years and infants mortalityPan AmericanHealthOrganizationIMCI
LAC PROFILE-2
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Lack of priority in the political agenda of the neonatal component.
Absence of action plans.
Deficiency of the data by geographic area - only national averages available.
Deficient care in health facilities. No implementation of evidence-based neonatal interventions.
High proportion of people without access to health facilities – 30%.
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LAC PROFILE-3
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Low percentage of GDP for health.
Poor coordination among cooperation agencies in countries.
NGOs work in the community without adequate coordination with Ministries of Health.
Pre-Service, Training in health (medicine-nursing) misinformed the epidemiological reality and productivity in Public Health.
Poor monitoring, supervision and evaluation in the countries plan of actions.
IMCI
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80 60 40 20 0 20 40 60 80
70.0 10.0
10.0 75.0
15.0 10.0
5.0
5.0
Hospital (Internment)
Ambulatory (primary care))
Ambulatory specialized
Hospital (Emergency care)
Other
Proportion of student time for the various training activities
Proportion of graduates working in each type of facility
PROPORTION OF TIME SPENT AT VARIOUS ACTIVITIES DURING THE PEDIATRIC TRAINING COMPARED TO THE BACK OF GRADUATE WORK
Source: OPS/ALAPE, 2000
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LAC 500,000 CHWs
> 400 NGOs
30,000 students of medicine in rural areas
400 Schools of Medicine
> 1000 training centers for nurses and auxiliary
Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
III. An Update on Progress
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-25 -20 -15 -10 -5 0
ARG ATG BHS BLZ BOL BRA BRB CAN CHL COL CRI CUB DMA DOM ECU GTM GUY HND HTI JAM LCA MEX NIC PAN PER PRY SLV SUR TTO URY USA VCT VEN
DECREASE (%) OF INFANT MORTALITY RATE (IMR) DURING PERIOD 2004-2009 AND ANNUAL PORCENTUAL VARIATION REQUIERED TO ACHIVE MDG-4 BY 2015 IN THE REGION OF
THE AMERICAS
% 2004 – 2009 annual (IMR)
% 2010 -2015 annual (IMR)
Source: Estimates of PAHO/HSD/HA data, 2010
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FACTORS AFFECTING THE ACHIEVEMENT OF MDG-4 IN THE COUNTRIES OF THE REGION
2.6
2.4
2.2
2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
TM<5a TM<1a TM<28d
Rate of reduction in mortality from 1990 to 2010
%
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009 and www.thelancet.com Vol 375 June 5, 2010
0
50
100
150
200
250
300
350
< 5 years < 1 year
58% 71%
42%29%
NEONATAL MORTALITY RATE IN RELATION TO TOTAL NUMBER OF DEAD IN < 5 YEARS AND <
1YEAR
Neonatal mortality
Per 1
000
live
birt
hs Post neonatal mortality
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009Pan AmericanHealthOrganization
2.6
2.2
2.4
2.2
Infant Mortality Rate in Various Indigenous & Non-IndigenousCommunities in Latin America
0102030405060708090
100
Bolivia Guatemala Ecuador Honduras Peru Venezuela Mexico
Source: Estimations FCH, PAHO/WHO
Rat
e pe
r 100
0 Li
ve B
irths
IndigenousNI
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76
5957
3935
3129 28
2624 24 23 22 22 21 20 19
16 1614
119 8 7 6
HAI GUY BOL GUT NIC JAM DOR MEX Total ELS HON PAN PAR ECU COL BRA VEN ARG BLZ URU COR CHI USA CUB CAN
8% of births18% of deaths
32% of births13% of deaths
Source: Estimations from FCH/CA with a data base from HIA-PAHO, 2008
80
70
60
50
40
30
20
10
0
> 30 < 15
RR = 5
Under 5 Mortality Rate in the Latin American Region x 1000 lb
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Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
IV. Efforts to Achieve the MDG-4
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ADVOCACY: NEONATAL HEALTH PRIORITY IN PUBLIC HEALTH AGENDA
An Interagency Strategic Consensus
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REGIONAL STRATEGY AND PLAN OF ACTION FOR NEONATAL HEALTH WITHIN THE CONTINUUM OF
MATERNAL, NEWBORN, AND CHILD CARE
Strategic Areas
1. Create an enabling environment for the promotion of peri-neonatal health.
2. Strengthen health systems to improve access to maternal, newborn, and child health services.
3. Promote community-based interventions.
4. Develop and strengthen monitoring and evaluation systems.
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EVIDENCE-BASED INTERVENTIONS
The interventions that are presented in this document, they were selected on the basis of the current scientific evidence and in the analysis of its feasibility and its potential to reduce neonatal morbidity.
These interventions can be included in a package in accordance with the level of care that health systems offer.
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Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals
Establishment of New WHO Collaborations Centers to support LAC priority Country.
• Texas Children’s Hospital, Houston, TX• University of Colorado, Center for Global Health• Maimonides University,
Buenos Aires, Argentina
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IMCI AS A KEY STRATEGY FOR IMPROVING CHILD HEALTH
Nutrition Immunization Other diseaseprevention
Promotion ofgrowth and
development
Managementof sick
children
Integrated Managementof Childhood Illness
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50
55
60
65
70
75
80
85
90
95
100
Brazil Cono Sur CentralAmerican
Andean Area Latin Caribbean Mexico
IMMUNIZATION COVERAGES IN CHILDREN UNDER TWO YEARS IN
LATIN AMERICA REGIONS
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2010
%
DPT3 Polio3 MMR
1990 2000 2015
Necessary decline for fulfilling MDG: annual 4.4%
Necessary increase in
decline speed
671.300
522.600
40
30
20
10
Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009
Gap to achieve MDG # 4 for mortality in children less than 5 years old by 2015
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THE CHALLENGEEffective
Evidence BasedInterventions
ImpactChildhoodMortality
Reduction MDG#4
Public Health
Vulnerable Population
Priority Areas
Strategies
BIG