1. Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002
Contributing to reaching the Millennium Development Goals and the Goals of the World Fit for Children: Health and Nutrition in UNICEF's Mid-Term Strategic Plan
Inter-Agency Working Group on Community IMCI,
Geneva, 3 September 2002

2. Under-five mortality rate, change over period 1990-2000
181
128 80 58 53 45
175
100 64 44 37 38 9 6 20 40 60
120
140
160
180
200
Sub-Saharan
Africa
South Asia
Middle East &
North Africa
East Asia and
Pacific
Latin America
& Caribbean
CEE/CIS and
Baltics
Industrialized
countries
U5MR (deaths per 1000 births)
1990
2000
Least
reduction 3%
Greatest
32%
UNICEF has very recently reviewed the progress made on achieving the World Summit for Children goals. The results of this review have been included in an update to the UN Secretary General’s 2001 report
The present slide is taken from this update and shows progress in the reduction of the under-five mortality rate (U5MR) during the 1990s. The region with the smallest reduction is where U5MR is highest, in sub-Saharan Africa, and the largest reduction is where U5MR is lowest, in the industrialized countries.
Source: UNICEF, 2001

3. U5MR disparity by asset quintile

4. Most deaths occur at home, before reaching health facilities … Implications for programming?

5. Bangladesh U5MR
This is an example for Bangladesh, showing the evidence for a sizeable reduction of U5MR

6. Immunization 1980-1999, DPT3 coverage

8. LOW BIRTHWEIGHT RATE One quarter of births in South Asia weigh less than 2500 grams
Source: UNICEF, 2001

9. 1 in 13 RISK OF DEATH A woman born in Sub-Saharan Africa faces a 1 in 13 chance of dying in childbirth. The risk for women born in industrialized countries is 1 in 4085.
Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.

10. Skilled attendants at delivery, 1995-20

11. The ultimate challenge: HIV
HIV - the worst pandemic in human history - risks reversing the progress of decades of development ...

12. Botswana U5MR
An example of a country with increasing U5MR, primarily a result of HIV/AIDS.

13. Estimated impact of AIDS on under-5 child mortality rates - selected African countries, 2010
with AIDS
per 1000 live births
250
200
150
100 50
without AIDS
Botswana
Kenya
Malawi
Tanzania
Zambia
Zimbabwe
Source: US Bureau of the Census
98036-E-25 – 1 December 1999

14. There are eight Millennium Development Goals (MDGs), divided into 18 targets. Social development is primarily represented by the first seven goals. These are listed in this and the following two slides.

17. Main Goals of A World Fit for Children (2000-2010)
Reduce infant and under-five mortality by at least one third by 2010 (and by 2/3 from 1990 to 2015)
Reduce maternal mortality ratio by at least one third by 2010 (and by 3/4 from 1990 to 2015)

18. Main Goals of A World Fit for Children (2000-2010)...
Reduce under-five child malnutrition by at least one third by 2010, with special attention to children under two and reduce the rate of low-birth weight by at least one third by 2010
Reduce proportion of households without access to hygienic sanitation facilities and affordable and safe water by at least one third by 2010

19. Main Goals of A World Fit for Children (2000-2010) ...
Develop and implement national early childhood development policies and programmes (children’s physical, social, emotional, spiritual and cognitive development)
Develop and implement national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health

20. Main Goals of A World Fit for Children (2000-2010) ...
Access through the primary health-care system to reproductive health for all individuals of appropriate ages as soon as possible and no later than 2015

21. Main Goals of A World Fit for Children (2000-2010)...
Reduce by 2005 HIV prevalence among young men and women age 15 to 24 in the most affected countries by 25 per cent and by 25 percent globally by 2010
By 2005, reduce the proportion of infants infected by HIV by 20%, and by 50% by 2010

22. Organizational Priorities 2002-2005: UNICEF’s Mid-Term Strategic Plan
Immunisation+
Integrated Early Childhood Development (Health, Nutrition, Water & Sanitation, Psychosocial Care and Early Learning, Child Protection)
HIV/AIDS
Girl’s Education
Child Protection

23. Immunization +
By 2010, ensure full immunization at least 90% of children nationally with at least 80% coverage in every district
Certify by 2005 the global eradication of polio
Reduce deaths due to measles by half by 2005
Eliminate maternal and neonatal tetanus by 2005

24. Immunization + ...
Extension of the benefits of new and improved vaccines and other preventive health interventions to children in all countries, especially vitamin A where appropriate

25. Integrated Early Childhood Development (IECD)
Health:
Major childhood killers (diarrhea, pneumonia, malaria)
Maternal and newborn health
Nutrition
Exclusive breastfeeding, complementary feeding, infant-feeding informed choices
Micronutrients (supplementation and fortification: iodine, vitamin A, anemia and iron, folic acid, others?)
Water and environmental sanitation
Psychosocial care and early learning

26. HIV/AIDS
PMTCT
Prevention among young people
Care and Support
Orphans

27. With business as usual, we will not reach the MDGs or those of the World Fit for Children
Need to redouble our efforts to support countries to reach these goals
How can we support countries to provide high coverage of a limited number of the most cost-effective interventions (the essential package) and support the development of sustainable national health systems?

28. Principles of good development
Seek maximal impact on human development (eg. health and education) and on poverty reduction
Evidence-based decision-making
High impact, low-cost interventions
Universal coverage, reaching the unreached, especially the poor
Home- and community-based strategies
Essential knowledge and commodities (vaccines, treated bednets against malaria, etc.)

29. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Challenge
11 million children die each year
Most of these deaths are preventable: they are from a limited number of conditions for which we have high impact, low cost interventions
The challenge is to go to scale, to reach every child

30. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward
Political commitment and national ownership by government, civil society and families
Clear time-bound goals: Reduce Under-five and Maternal Mortality by one-third during this decade (focus on outcomes and not just process)
High impact, low cost, focused programs with specific targets, standardised and taken to scale to reach every child (examples: immunisation, oral rehydration for diarrhea, treated bednets for malaria)

31. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward ...
Strong and well-coordinated partnerships supporting these programs: developing countries, civil society and NGOs, multilateral agencies (WHO, UNICEF, World Bank)
Both developing country and donor resources
Strong monitoring and evaluation systems tracking progress towards targets
Reaching the Child and Maternal Survival Goals is possible if we commit our energy and our resources to it

32. Progress - Summary
The UN Special Session on Children: A World Fit for Children goals
UNICEF’s Mid-term Strategic Plan
Global Consultation on Child and Adolescent Health, Stockholm, March 2002
Launch at Special Session on New Low-Osmolarity ORS Solution

33. Progress - Summary...
Consultation on the Community Management of Pneumonia, Stockholm, June 2002
Major effort on Roll Back Malaria
Major Measles results in Africa
A Secretariat for the C-IMCI IAWG
Increase child survival funding and staffing at UNICEF

34. The challenge…reaching global child survival, growth and development goals