1. Improving Child Survival MATERNAL AND CHILD HEALTH INDABA July 16 th 2012 Dr Siobhan Crowley UNICEF South Africa

2. Our major gaps to address QualityCoverageEquity

3. Closing in on CARMMA targets – known best buys IndicatorKey bottlenecksBest buys U5MRLimited preventionI nadequate coverage of RV/PCV Access to care for sick kids Poor diagnosis + access ped ART TB –older kids Breastfeeding, improve infant feeding, Vit A ETAT, NBC,Case Mx SAM + HIV PCV+ RV (EPI) EID /PICT ART INH IMRPoor access + quality of Neonatal care No routine post natal KMC, Neonatal resucit Post natal care EPI Immunisation coverage @1YR % immunised against measles Supply – poor forecasting planning and VM Demand – limited promotion, no f/up baby in community/PHCCS Micro-planning /coordination Enhance leadership /management Community outreach of services IEC Life expectancy at birth M+F Composite of aboveFor SA - and paediatric ART/TB Access to quality CS services Supply- limited IMCI providers Demand – poor care seeking/unsafe ETAT /NCP IMNCI SAM

4. Closing quality gaps CLINICAL GOVERNANCE WHO: DISTRICT CLINICAL SPECIALISTS (+DMT) IMPROVE CLINICAL PERFORMANCE AND EVALUATION REDUCE + MANAGE CLINICAL RISK DEVELOP + MAINTAIN PROFESSIONAL STANDARDS INVOLVE AND ENGAGE PATIENTS Apply NCP ETAT IMCI

5. Closing coverage gaps Demand Supply WHO: PHC outreach teams, PHC supervisors/facilitators WHO: DMT/PHC OP MANAGERS Promote knowledge of key family practices and care seeking Incentivize /reward health promoting activities Outreach and scheduled child health events Flexible responsive organization of services Consistent secure supplies Improve staff responsiveness Integration of services

6. Closing equity gaps Addressing inequity Know who, how many and where these children are REDUCE COST BARRIERS Insurance/vouchers/subsidy REDUCE LOCAL ATTITUDE BARRIERS Conditional cash transfers Understand why they are excluded or missing services REDUCE LOCAL PHYSICAL BARRIERS e.g. transport voucher, GLOBALLY- FOR SCEDULABLE/NON ACUTE SERVICES PHC/OUTREACH IS BEST BUY TO REACH EXCLUDED RESOURCES ALLOCATED by population size, local resources + healthcare needs

7. Other key ingredients Leadership and coordination ( why we are here!) Accountability (beyond clinical governance) Improving data quality + use within programming True integration - at point of service delivery and in planning Recognizing role of community + women Targeted communication on healthcare + health promotion messages