1 Roots of the Second Child Survival Revolution Cesar Victora Federal University of Pelotas, Brazil Bellagio Child Survival Study Group Countdown to 2015 London, December 2005

2 The Child Survival Revolution New UNICEF leadership: Jim Grant 1982: Child Survival Revolution Focused on 4 interventions: –Growth monitoring –Oral rehydration –Breastfeeding –Immunisation 1990: World Summit for Children

3 Global coverage of DPT3 vaccine Source: Bryce et al, Lancet 2003

4 Deaths by selected causes, 2003 Source: World Health Report Source: WHO, 2003

5 Global R&D investments per DALY Global average (all diseases): US$73 HIV/AIDS, malaria and TB: US$8.4 Acute respiratory infections: US$0.51 Diarrhea: US$0.32 Source: GFHR 2004 Source: Global Forum for Health Research, 2004

6 The Lancet Child Survival Series

7 Where do over 10 million children die every year? copyright Oxford Cartographers 2003 Source: Black, Morris, Bryce, Lancet 2003 Leading causes Neonatal Diarrhoea Pneumonia Malaria Undernutrition

8 13% 17% 15% 7% 39% 2% 20% % CURRENT COVERAGE Low-cost interventions can save many lives Source: Jones et al, Lancet 2003

9 Can health systems deliver? 6 million lives could be saved every year by simple, cost-effective interventions But scaling up may be difficult –Weak health systems –Lack of trained human resources –Inadequate care seeking and low utilization –Hard to reach those who need most Inappropriate delivery channels Source: Bryce et al, Lancet 2003

10 The gap between the rich and the poor is widening Children born in Sub- Saharan Africa are 29 times more likely to die by the age of 5 years than those from developed countries –In 1990 this ratio was equal to 20 times 40% of under-five deaths would be prevented by eliminating socioeconomic differentials within low and middle- income countries Source: Victora et al, Lancet 2003

11 The Child Survival Revolution of the 1980’s saved millions of child lives Child deaths outnumber HIV, malaria and tuberculosis deaths combined. Child survival has fallen off the international agenda Funding for child survival is decreasing in relative terms; and for some donors in absolute terms Cost-effective interventions could prevent 6 million (63%) child deaths if they reached all mothers and children We now need a Second Child Survival revolution to complete this unfinished agenda Need for global leadership Rolling Conference every 2 years Paper 5 – Call to action Source: Bellagio Group, Lancet 2003

12 What has happened since 2003?

13 Progress in child survival advocacy UNICEF and Child Survival UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan.UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan. UNICEF welcomes and supports an important series of articles on child survival published in the medical journal Lancet. The series began with the Lancet edition of 27 June The series highlights the fact that more than 10 million children die each year under the age of five, most from causes which are preventable. The articles, to which UNICEF contributed, explore where these deaths are occurring, what the causes are, what solutions we can apply, and the kind of efforts needed to further reduce child deaths. UNICEF and Child Survival UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan.UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan. UNICEF welcomes and supports an important series of articles on child survival published in the medical journal Lancet. The series began with the Lancet edition of 27 June The series highlights the fact that more than 10 million children die each year under the age of five, most from causes which are preventable. The articles, to which UNICEF contributed, explore where these deaths are occurring, what the causes are, what solutions we can apply, and the kind of efforts needed to further reduce child deaths. UNICEF and Child Survival UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan.UNICEF Executive Director Carol Bellamy immunizes a girl against polio,during a National Immunization Day campaign in the south-central town of Kananga,Sudan. UNICEF welcomes and supports an important series of articles on child survival published in the medical journal Lancet. The series began with the Lancet edition of 27 June The series highlights the fact that more than 10 million children die each year under the age of five, most from causes which are preventable. The articles, to which UNICEF contributed, explore where these deaths are occurring, what the causes are, what solutions we can apply, and the kind of efforts needed to further reduce child deaths. January 8, 2004 UNICEF to focus on child survival UNICEF Executive Director Ms. Carol Bellamy stated that there is “...a global imperative to do more for children in 2004.” UNICEF names top 5 concerns for children in 2004

14 Paper 1: 4 million deaths: When? Where? Why? The Lancet Neonatal Survival Series Paper 2: What interventions work? How many babies can we save? Paper 3: How can we scale up newborn care in countries? Paper 4: The cost and proposed actions

15 Lancet Health Systems Series Equity Financing Human Resources Scaling up Health systems research priorities

16 Millennium Project Task Force Health systems Financing Human Resources Sexual/reproductive health and rights Child mortality Maternal mortality Global mechanisms Information systems Targets and indicators

17 The World Health Report 2005 The situation in 2005 Programme strategies System and policy implications

18 Growing concern about maternal mortality

19 The Lancet series: two years later Renewed interest in child survival Launch of the Partnership for Maternal, Newborn and Child Health But so far, little evidence of increased investments at country level

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21 Countdown, Day 1 1.The second child survival revolution 2.Make every mother and child count 3.Making progress at country level (Senegal, Nepal, Tanzania, Pakistan, Zambia, Bolivia) 4.Debate: Are we doing the right things? Are we doing things right?

22 Countdown, Day 2 5.Tracking progress in child survival (monitoring, finances, human resources, equity) 6.New strategic directions in child survival (evaluation, new interventions, research) 7.What needs to be done? (price tag, action plan, role of the media, accountability) 8.The Partnership for Maternal, Neonatal and Child Survival 9.Going to action for child survival

23 Paper 5, Child Survival Series … we commit ourselves to ensuring that there is an overall mechanism for improving accountability, re- energizing commitment, and recognizing accomplishments in child survival. … this proposal for rolling conferences is not enough, but it is a long-term commitment to change and improve the state of child health.