UNICEF Asia & Pacific
An overview
The multi facet of Equity
Geography
Caste
Education
Ethnicity
Tribe
Citizen status
Religion
Migration
Gender
Disability
Location
Age
Mapping inequity in South Asia
Percentage of women age
20-24 married by age 18
Net enrolment ratio
in Primary education
Antenatal coverage
% women 15-49
Children 12-23 months with
all basic vaccinations
Underweight prevalence
moderate and severe
Child Protection – Girls education – Out of School WASH - ECD
Pre
Pregnancy
Antenatal
care
Childbirth
care
Early child
marriage being
prevalent in
most deprived
groups
forces
adolescents
into pregnancy
Most
deprived
pregnant
women do
not utilize
ANC services
Women will
not opt for
skilled birth
attendance
Lack of human
resources or lack
of quality of care
or no access
Those who opt
for SBA find poor
services
Postnatal
and
newborn
care
Will not use
ANC service
in next
pregnancy
Women will not
bring their
newborns for
post- natal visit
Newborn will
not be
breastfed. No
“skin to skin”
contact
Subsequent accumulation of a cascade of bottlenecks
Endangers
deprived
Mother’s and
Newborn’s
lives
Some success stories
India Polio Cases: 2007-2011 success
1000
900
India Total
800
Uttar Pradesh
700
600
500
400
300
200
100
0
2006
2007
2008
2009
2010
2011
10
Why success?
Uttar Pradesh- India
PolioSM
Cases
UNICEF
Net COVERED BLOCK - 53
CORE COVERED BLOCKS - 13
2009
Political
commitment
Uttarakhand
Communication
&
Social mobilization
Haryana
Delhi
Routine
Immunization Rajasthan
&
Maulana Mahmood Madni
Diarrhea
Jamait Ulema-e-Hind
control
Uttar Pradesh
Bihar
Khawja Sani NizamiWest Bengal
C.M.
Madhya Pradesh
of Uttar Pradesh
Ms. Mayawati
Jharkhand
Water & Sanitation
Nutrition
Muft Mahboob Ali
All India Muslim Personal Law Board
Maulana Khalid Rasheed
Islamic Centre of India
Yasin Usmani
All India Milli Council
Some unfinished agenda
Stagnating Diarrhea
Bangladesh
India
Nepal
Myanmar
Indonesia
Thailand
Stagnating Pneumonia
Bangladesh
Nepal
India
Myanmar
Indonesia
Thailand
Stagnating Neonatal mortality
Pertussis
4%
Injury
4%
Other
9%
Other non CD
4%
Pneumonia
13%
Diarrhoea
12%
Source: Black et al. The Lancet 2010
Globally:
Neonatal
deaths
54% (Preterm
complications
14%)
41% of all U5 deaths
take place in the
neonatal period
One of the most
important single
causes are preterm
birth complications
(12%)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Continuum of care in SA and SEA
(UNICEF regions)
1000 days window of opportunity
& worse coverage
Family
Planning
ANC 1
Pre Pregnancy
Source SOWC 2011
ANC 4+
Safe Delivery Postnatal
care
Pregnancy
Exclusive
breast
feeding
Postnatal
Vit A
Early Childhood
Strategies across theQUALITY
continuum of
OFcare
CARE
Antenatal
care
IS
NEEDED TO CREATE
DEMAND
Childbirth care
SUPPLY SIDE
o Commodities
o Human resources
o Accessibility
Postnatal
and
newborn
care
DEMAND SIDE
o Utilization
(e.g. 1 ANC visit)
o Continued
utilization
o (e.g. 4 ANC visits)
Strategies across the continuum of care
Antenatal
care
Childbirth care
Increase human resources
Increase commodities
Incentives for (pregnant) mothers?
Increase quality of care/ e.g. by performance based financing?
Communication strategies (Behavior Change Communication)?
Strengthen Community Health Workers for newborn care? etc?
Behavior change: target mother AND health care providers
Postnatal
and
newborn
care
Supply to match: services &
delivery
Demand Creation
Communication
Quality & sustainability
Steps 4-6: Identify bottlenecks, analyse causes and correct actions
Addressing causes
of
stunting
Community participation / dialogue;
General Food
Supply Bottlenecks
Distribution
to targeted
100% 40% difference in food security
deprived districts
80%
80%
Strengthened partnerships btw community &
services; Refresher training of CHW;
Demand bottlenecks
performance
incentives
quality IPC /
Utilisation
limited by food for
availability
& additional continuity and quality bottlenecks
counseling
on feeding practices to most
deprived
72%mothers and monitoring
63%
59%
60%
54%
43%
40%
20%
0%
Similar accessibility to CHW
& education
HYGIENE AND SANITATION
COMMODITIES: %
communities with
food security
HUMAN RES: %
villages with
sufficient CHWs
Source Bangladesh, Nepal, Pakistan
ACCESS: % Women
UTILISATION: %
CONTINUITY: %
EFFECTIVE COV: %
with primary
children 6-8 months
children 6-24
children 6-24
education or higher
receiving
months receiving months receiving the
complementary meals with minimum minimum acceptable
foods
frequency
diet
Type B2 most deprived
Type B2 least deprived
Beyond MDGs: challenges and way
forward
• Maintain focus on unfinished agenda and coping
with competitive environment
–
–
–
–
–
Decentralization process
Urbanization
Adolescent- Youth bulge
Non Communicable disease
Climate change and emergencies of un-precedent
scale
• Working cross sectors: Nutrition, Education,
Protection and Social policy
To the last child in Asia & Pacific
Rukhsar. The last case in India.