China’s Success Stories and UNICEF’s Contribution: From Pilots-to-Policy-to-Results at Scale

China is home to 279 million children, the world’s second largest child population. The Government of China has always attached great importance to maternal and child health. Clear MCH targets were set up in the National Plan of Action for Women ( ) and National Plan of Action for Children ( ) : Reduce maternal mortality ratio to 20/100,000 live births; reduce the disparities among rural and urban areas, and among migrant population. Reduce the infant mortality rate and under-five mortality rate to 10/1,000 live births and 13/1,000 live births respectively, especially among the migrant population. Reduce the incidence of low birth rate to 4%. Reduce the prevalence of anemia among children under 5 years old to 12%. Reduce the stunting rate to 7%. Reduce the incidence of psychological behavioral problems, and the prevalence of mental disorders among children. Minimize the impact of environment pollution to children. The Government of China’s goals in maternal & child health

China’s achievements in maternal & child health In 2014, the Government of China achieved the MDG4 and MDG5 targets ahead of schedule. China’s progress is acknowledged worldwide as a remarkable achievement. China has eliminated maternal and newborn tetanus, eradicated polio, and achieved near universal salt iodination, hospital delivery and vaccination coverage. China also achieved near universal health insurance coverage, benefiting more than 900 million people in 2015, up from 80 million in 2003 From 2000 to 2014 The maternal mortality rate dropped from 53.0 to 21.7 per 100,000 live births. The under-five mortality rate and the infant mortality rate dropped from 39.7 to 11.7 per 1,000 live births, and 32.2 to 8.9 per 1,000 live births, respectively.

UNICEF has helped to translate those ambitions into results: Pilots-to-Policy-to-Results at Scale To improve the realization of all children’s rights, especially the most disadvantaged children, UNICEF works closely with the Government to support the development of national policies, legislation and guidelines to promote services reach women and children with better health care and sanitation, and reduce inequities of access, opportunity and outcomes. The UNICEF approach in China begins with research and gathering data to develop evidence-based models. Using the evidence, we engage with policy-makers, and develop and advance policy guidelines. Once policies are in place the evidence gathered can be further used to advocate for programs to reach all the women and children in China.

pilots coverage 40 rural pilots $8 million UNICEF investment Community mobilisation 378 counties (2000) MMR changes noticed 1000 counties (2005) Hospital Delivery part of GOC Health Sector Reform Centre & west counties Careful M&E Provision of incentives Improved HD policies Local financing schemes Monitor equity HR studies Financing studies Quality assurance Scaled out HD HD part of HSR 2008 $1.9 billion GOC investment Pilots to policy breakthrough Supporting GOC results at scale 2014 – 99.6% HDR coverage From Pilots to Policy to Results at Scale Example: hospital delivery

Small scale success stories create convincing evidence and experience, which allows major policy breakthroughs to happen, accompanied by securing of funds, which are necessary to go to scale. Maternal and Child Health - Hospital Delivery – Since 1999, UNICEF supported a Safe Motherhood project in 10 counties. When UNICEF project evaluation results showed a reduction in the Maternal Mortality Ratio (MMR), the Government of China adopted a hospital delivery policy in 378 counties in 2000 with an allocation of 10 million RMB, which was gradually expanded. Now, near- universal hospital delivery (99.6%) is achieved (with exceptions in remote rural areas), which have led to reductions in maternal and newborn mortality all over China. Expanded Programme on Immunization – In 1978, the Expanded Programme on Immunization (EPI) was introduced with UNICEF support. In 1999, China was declared polio free, and confirmed again in From 2011 onwards vaccine coverage was near-universal (DPT3 99.6%), except in migrant and remote populations. Nutrition -Ying Yang Bao – In 2008, UNICEF provided Ying Yang Bao (YYB) to more than 30,000 infants and young children aged 6-24 months in 8 Wenchuan earthquake-affected counties. In Qinghai Province, YYB was implemented by the Government’s Maternal and Child Health system, with rigorous monitoring and evaluation supported by UNICEF. Substantive reductions in anaemia and respiratory infection prevalence were observed. This provided convincing evidence for further expansion in poverty areas of China. Now YYB is scaled up in 341 poverty counties, benefiting more than 4 million children. Integrated Early Child Development for children 0-3 – International experience has shown that early interventions can be a highly effective way to break the intergenerational transmission of poverty, address social exclusion, and enhance school readiness. Since 2013, UNICEF supports an Integrated Early Child Development (IECD) project in 80 remote villages in Shanxi and Guizhou Provinces, aiming to reduce the many risk factors that prevent children to develop to their full potential. Preliminary results show government commitment, engagement by parents and children, and substantive intervention coverage improvements. In 2016, the project will be expanded to another 80 villages. Through strong monitoring and evaluation, UNICEF aims to demonstrate success of the integrated strategy, which will be the basis for evidence- informed advocacy to promote the scaling up of IECD by the Government.

In 2015 the era of the Millennium Development Goals is transitioning to the Sustainable Development Goals (SDGs). SDGs further draw attention to women, children, adolescents and the disparities and discrimination they face. The Government of China is launching an increasingly transformative health and development agenda in China as well as abroad. UNICEF is ready to work with NHFPC to meet the new challenge of achieving the SDGs, to continue tackling inequities, to promote innovative and high-impact health, nutrition and WASH approaches and interventions, and to help take these to scale with Government support for the benefit of all women and children in China.