Cost-effective Interventions and Strategies to Accelerate Child Survival & Development in the context of Health Reform & Poverty Reduction Geneva September 2002

Proportion of U5MR addressed by priority intervention packages at different U5MR levels

From conception to 5th birthday Antenatal intervention Early childhood intervention up to 5 years of age –Prevention –Care

EPI PLUS IMMUNIZATION VIT A Supplementation Deworming Intermittent presumptive Treatement ( linked with EPI once cleared with WHO TDR/ research action)

IMCI plus Anti Malarial drugs( early and adequate treatment at home WHO TDR research action) ITNS ARI Treatment, pneumonia (home or community based, WHO TDR research action) Oral Rehydration Exclusif breastfeeding Iodized salt Hygien

Antenatal care Tetanos immunization Iron Supplement Intermittent treatment against malaria ITNS PMTCT / HIV AIDS

Cost effectiveness of the intervention packages on U5MR

Coverage Objectives Increase effective coverage of : EPI+ 80% (EPI+ 80% (Immunization, Vit A) IMCI + 50%IMCI + 50% (prevention and care of malaria, ARI, diarrhea and malnutrition) ANC 80%ANC 80% (malaria and anemia prevention HIV AIDS)

Reduction of U5MR through high impact package

Impact Objectives: WCAR Reduce under-five mortality by: 15% after 3 years of full implementation of high impact intervention packages & strategies; 25 % after 5 years of full implemen- tation of the interventions/strategies 35% after 7 years of full implemen- tation of the interventions/strategies (after 7 years a full cohort will have benefitted from -9 months-5 years)

Monitoring effective coverage determinants

Service Delivery Strategies for the proposed intervention packages. to 25-50% of population with access to HC(<5km) –Health Centre Based Strategy: integrated delivery of all priority interventions for 50-75% of population without access to HC. –Community based strategy for IMCI+ (home based prevention and care) –Outreach/Mobile Strategy: (three) monthly delivery of EPI+ and ANC services

Support Strategies for effective coverage Social mobilization & communication to improve service use and family care A results based approach to financing service delivery including performance bonuses (monetary or in kind),contracting with community groups, health staff etc. Community based monitoring & micro- planning to increase effective coverage and empower communities

Complementarity of Child Survival, SWAp &PRSP 1. Health Sector reforms increase Health System Capacities through enabling health policies, decentralization and partnerships 2. PRSP/HIPC provides opportunities for: Increased Financing for Health Increasing Health Staff Availability/Salaries Focussing on poorest=high U5MR regions 3. Accelerated Child Survival & Development: Accelerates Impact of Health Reforms on children Ensures poverty/disparity reduction for children Makes the case for additional health sector funding

4 demonstration countries Districts of demonstration: 3 millions Region for expansion: 7 millions Senegal Ghana Mali Benin

7 expansion countries population: 4 millions Gambia Burkina Faso Cameroun Tchad Niger Guinea Bissau Guinee Conakry

ELIGIBLE CRITERIA -High Under five mortality rate -Success insurance linked with è strong commitment of national authorities and indepth involvment of UNICEF office èAccessibility and quality of health system and services in the selected districts èCommunity participation capacity

CONDITIONALITIES -EPI + coverage between 12 and 24 months should reach 60% for DPT3 and Measles -After 1 year of implementation, EPI+ coverage should reach 80% -Before addind malaria prevention (through ITNs and IPT for pregnant women) -Coverage of 60% to be reached and maintained.