1. Elizabeth Mason Department of Child and Adolescent Health and Development New Strategic Directions Tracking progress in child survival Countdown to 2015 December 13-14 2005

2. Countdown to 2015 Child Surviva l Work in child health... …focused in the past on delivery of specific child health interventions for single diseases...  CDD and ARI programmes …but now and in the future will address the major causes of under five mortality through integration of care...  Integrated Management of Childhood Illness

3. Countdown to 2015 Child Surviva l ….. has moved forward …and also addresses health policies & services… …previously neglected or emerging areas …  Neonatal health  Infant and Young Child Feeding  HIV and infant feeding  Paediatric HIV …recognises the continuum of care… …and collaboration between partners through the Partnership for Maternal Newborn & Child Health

4. Countdown to 2015 Child Surviva l … Requiring a change of emphasis: Child survival and the big picture Source: World Health Report 2000 Stewardship (Managing resources, power and expectations) Financing (Raising, pooling & allocating revenues to purchase services) Fairness in financial contribution Responsiveness Resource development (Investing in people, infrastructure and supplies) Coverage Efficiency Inputs Outputs Outcomes Service delivery (provision of health services) Health Level and inequality Quality

5. Countdown to 2015 Child Surviva l New strategic directions 1 Policy, strategies, planning and partnerships Health systems support and management Community-based interventions for child survival Monitoring and evaluation

6. Countdown to 2015 Child Surviva l New strategic directions 2 Policies, strategies, planning & partnerships  Closing the policy-implementation gap, and promoting the "three ones" (one action plan, one financing mechanism, one M&E framework)  Developing strategies at regional and country level Child and Adolescent Health Strategy EURO Joint WHO/UNICEF Child Survival Strategy WPRO/EAPRO  Renewing commitments Innocenti 15+

7. Countdown to 2015 Child Surviva l New strategic directions 3 Health system support & management  Health systems are the backbone of service provision ( 3x5, RBM, Immunization, Stop TB )  Systematic system support for universal access to integrated delivery of interventions during the life course, across levels of care and at the programmatic and policy level  Role of the private sector to complement the public sector

8. Countdown to 2015 Child Surviva l Focus on System Strengthening Newborn and child survival also need a strong health system  Care of the mother, safe delivery – immediate newborn care  Prevention of illness and care of the newborn in the first month of life  Prevention of childhood illness and integrated management of childhood illness Continuum of Care

9. Countdown to 2015 Child Surviva l Increasingly, WHO is providing support to countries through integration at three levels Integration at the patient level:  Addressing co-morbidity (± 10% of children)  Using care seeking to address missed opportunities Integration between levels of care:  Promotion of key family practices  Management and care at community level  Integrated Management of Childhood Illness (IMCI) at first level facilities  Management of the child with a serious infection or severe malnutrition (Referral care management) Integration at the programmatic and policy level  Breastfeeding counselling and HIV  IYCF and IMCI (synergistic implementation)  Maternal, newborn and child health

10. Countdown to 2015 Child Surviva l New strategic directions 4 Community-based interventions for child survival  Promoting key family practices  Improving appropriate care-seeking  Ensuring universal access, utilisation and coverage of key interventions closest to home community management of pneumonia ORT ITNs and case management of malaria Community

11. Countdown to 2015 Child Surviva l Focus on the Continuum of Care Home Community Outreach First Level Health Facility Referral Facility Start with action at home

12. Countdown to 2015 Child Surviva l Community and facility implementation needs careful coordination & planning Source: MCE, Peru. MoH policy brief 0 20 40 60 80 100 120 0102030405060 Trained clinical HWs per 10,000 children Trained CHWs per 10,000 children

13. Countdown to 2015 Child Surviva l Community and facility implementation needs careful coordination & planning Source: MCE, Bangladesh 0 1 2 3 4 5 Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar Sick U5 Children per child per year IMCI InterventionIMCI Comparison -----2001----------------2002-------------- 2003------------ -------------2004-------------- Starting IMCI Staff training in IMCI Provision of supplies and job aids -2005

14. Countdown to 2015 Child Surviva l New strategic directions 5 Monitoring & evaluation  Ensuring evidence-informed decision making  Epidemiological Estimates – from global to country Focus  Agreed upon simple set of core indicators (with linkage to Health Metrics Network)  Regular programme reviews  Regular measurement – annual or biannual surveys  Monitoring financing and adequate resource allocation for moving towards universal access

15. Countdown to 2015 Child Surviva l Disaggregated country data for child health programming WPRO, WHO estimate China, MCH surveillance system

16. Countdown to 2015 Child Surviva l Integrated management is less expensive… Source: MCE, Tanzania. Bryce et al. HPP

17. Countdown to 2015 Child Surviva l... and can lead to rapid mortality reduction Sources: TEHIP and MCE

18. Countdown to 2015 Child Surviva l New Strategic Directions 6 Using available financing opportunities for Child survival  GAVI: Delivery of multiple interventions with immunisation – Vit A; ITNs  GFATM: Malaria in children; ITNs; Prevention and care of paediatric HIV/AIDS both now include health systems strengthening  PRSPs, SWAPs

19. Countdown to 2015 Child Surviva l New directions strengthen the outcome focus Policy, Strategy, Planning & Partnerships One plan Monitoring & Evaluation Regular feedback Improved Health Health system support and management Integrated delivery Community-based Interventions for child survival Continuum of care Coverage Efficiency Quality Inputs Outputs Outcomes Reduced child Mortality Continuum of MNCH care

20. Countdown to 2015 Child Surviva l Make Every Mother and Child Count Towards attaining the MDGs