Childhood Pneumonia and Diarrhoea 3
Bottlenecks, barriers, and solutions: results
from multicountry consultations focused on
reduction of childhood pneumonia and
diarrhoea deaths
“Why are so many children still
dying of preventable conditions,
and how do we move forward?”
Specific Objectives
1. Identify key barriers to implementation of
programmes targeting pneumonia/diarrheoa
2. Identify key bottlenecks impeding access to
essential commodities
– Diarrheoa: vaccines, zinc, ORS,
– Pneumonia: vaccines, oral amoxicillin
3. Propose solutions to those barriers
Methods
• A series of consultations with > 600 key stakeholders in 2010-12
• 3 work streams provided data for 39 Asian & African countries
1. Global Action Plan for Pneumonia (GAPP)
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Led by WHO/UNICEF
Broad focus on programmatic barriers/solutions
2. Diarrheoa Global Action Plan (DGAP)
–
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Led by Aga Khan University
Focus on programmatic barriers/solutions & 7 country case studies
3. Diarrheoa and Pneumonia Working Group (DPWG)
–
–
Led by UNICEF and CHAI
Focus on supporting scale up treatment in high burden countries.
Bottlenecks impeding access to
vaccines
Concentrated upstream
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•
Policy guidelines
Resources
Legend
None
Minor
Moderate
Major
Darker colors connote more significant bottlenecks
Bottlenecks impeding access to zinc and ORS
are concentrated ‘downstream’
zinc
ORS
The Market Trap: Why zinc is so
expensive in Nigeria
Prioritization of the Barriers
•Inadequate monitoring and assessment
•Poor coordination of efforts
•Inadequate human resources
•Weak supply chain
•Quality of care
Inadequate monitoring and assessment
• Data not of high quality and not analyzed properly
• Data often not shared with those that need it most
• Data not widely disseminated
Result: Programmes are unaware of their progress
Recommendation: Improve the quality and establish
mechanism for sharing and using data for
action
Poor coordination of efforts
•
•
•
•
Between programmes, across partners and sectors
Duplication of efforts
Failure to optimize available resources
Conflicting priorities
Result: Fragmented efforts dilute effectiveness & efficiency
Recommendation: Evidence based planning and
management, joint development of plans and
strategies for action
Inadequate human resources
•
•
•
•
Not enough health workers
Low incentives for recruitment and retention
Limited capacity building opportunities
Inadequate supervision and skills reinforcement
Result: Chronic shortages of the skilled and motivated
workers
Recommendation: Explore and implement innovative
ways for capacity building, motivation & supervision
Weak supply chain
•
•
•
•
Over-reliance on push/pull systems
Supply not linked to need
Inefficient stock/restock systems
Limited local production of essential commodities
Result: limited access to life saving commodities
Recommendation: Strengthen systems for procurement
and drug supply management and production of
key commodities
Quality of care
• Evidence based standards of care not always available
• Access to care limited
• Low uptake due to poor quality
Result: Children die of preventable and treatable conditions
Recommendation: Client feedback as part of health worker
and clinic assessment; dissemination of guidelines
This is a solvable problem:
The Bangladesh Story
The way forward
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•
•
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Evidence based strategic planning
Coordinated efforts are more effective
Data is key – analyze, utilize, disseminate
Ensure supplies and medicines are available
where and when needed
• Institutionalize Quality Improvement
• Build capacity, reinforce skills, motivate and
retain work force
Conclusions
• We can drastically reduce child mortality with
tools already at hand
– Solutions are affordable and not high tech
• The ingredients of success start with
– Coordinated action plan
– Resources commensurate with the burden of disease
– Accountability for results
– Advocacy