Accelerating Child Survival
Dr. Sanjiv Kumar, Regional Adviser Health and Nutrition,
CEE/CIS
Second Subregional Workshop for Acceleration of Child
Survival, Tashkent, 10 – 14 September, 2007
External
Environment
Analysis
Global Agenda: Strategic Directions
Regional and country level
Knowledge Base
Alliance
National Policy
Building
Development
Reform Process
National Priority in A Country:
National Development Strategy
Poverty Reduction Strategy
Alliance
Building
Implementation
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UNICEF RMT CEECIS
9 MAY 2006
Accelerating Child Survival
RESULTS FOR CHILDREN
Health in CEE/CIS: General Trends:
Only region in the world where Crude Death Rate has
increased from 9 (1970) to 11 (1990) to 12 (2004)
Lowest Population Growth Rate 0.2% (1990 – 2004)
down from 1% (1970 -1990).One third of
industrialized countries and one seventh of global
rate.
Life expectancy is stagnating: 67 (1970), 68 (1990)
and 67 (2004)
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Accelerating Child Survival
Health in CEE/CIS: Child Health
7% babies do not have skilled attendant at birth
14% do not receive antenatal care
75% do not receive ORT in diarrhea
3.8% or 1 in 25 (212,000) U-5 die every year. 77% of
the deaths in nine countries
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Accelerating Child Survival
Health in CEE/CIS: Nutrition
78% are not exclusively breastfed
14% are stunted and 5% underweight
45% (2.4 million) newborns are not protected against
iodine deficiency.Russia (1.5 m), Turkey (1.5 m)
Ukraine, Belarus and which have 4 million newborn)
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Accelerating Child Survival
Continuum of Health Care-1
• Family/Home/Self management in conjunction with
primary care team
– Empower families/individuals
– Redefine the boundaries
– Timely Referral to appropriate level
• Home care indicators EBF rates, CF rates, ORT use
rate, Home management of Pneumonia…. are low.
Preventive and promotive care provided mainly at
home and home care plays an important role in
curative care as well.
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Accelerating Child Survival
Continuum of Health Care-2
• Primary care- has always been and continues
to be a poor relation of hospital care
• Hospital care: overspecialized, overstaffed,
overmedicalized..(WHO study in Russia,
Kazakhstan & Moldova)
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Accelerating Child Survival
Quality of care
• Adoption on international norms and standards
– Time gap in adoption and real implementation
– Skills of health care providers, upgrade basic
training
• Delegation of decision making and move from the old
command-and-control model
• Supportive environment to implement guidelines
through supportive supervision and on the job
training.
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Accelerating Child Survival
Summary of Findings Quality
KAZ
MDA
RUS
of Care
Areas assessed
No significant problems
Need for some improvement
Hospital network
Availability beds
Physical structure
Financial accessibility
Health personnel
Equipment
Drugs, supplies
Triage
Diagnosis
Treatment
Intensive care
Monitoring
Guidelines
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Child friendly attitude
Accelerating Child Survival
Need for substantial
improvement
Summary Findings - Structure &
Supplies
Existing hospital network
Good
Staffing
Generally adequate and dedicated
Physical structure and
equipment
Need renovation and updating
Essential drugs and supplies
Sometimes lacking
Accessibility
Partially limited due to need for
financial contribution
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Accelerating Child Survival
Unnecessary Admissions &
Treatment (WHO Study Rus, KZ, MDA)*
100
MDA N=45
KAZ N=53
80
60
%
40
20
0
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No need for hospitalization
Unnecessary therapies
Accelerating Child Survival
WHO study concluded
More effective and more child-friendly case
management could be provided within
existing structure, staff and facilities
Available resources now used for unnecessary
treatments could be used to improve
availability and access to essential drugs and
effective care
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Accelerating Child Survival
Use available health staff effectively
100
90
80
70
60
50
40
30
20
10
0
50
45
40
35
30
25
20
15
10
5
0
Africa
Asia
% of trained personnel
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Latin
Developed Tajikistan
America countries
Perinatal mortality
Accelerating Child Survival
Assumed
Health Reforms
• In all countries
• Rapid pace in many countries
• Insurance:
– Minimum Package for women and children
– Does it benefit those for whom free
• Staff Skills
• Staff Morale: Salaries, Move from punitive culture to openness
to learn from mistakes.
• Need to step back and reflect, how best the health can be
promoted rather than caring only for the sick through hospitals.
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Accelerating Child Survival
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Accelerating Child Survival
Focus on neonatal care
120
100
x 1000
80
mortality 1-4 y
PNMR
late NMR
early NMR
60
40
20
0
Arm
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Aze
Geo
Kaz
Kgz
Tjk
Tur
Accelerating Child Survival
Tkm
Uzb
What kills neonates?
100%
80%
Other
Congenital
Infection
Asphyxia
Preterm
60%
40%
20%
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Accelerating Child Survival
Uz
b
Uk
r
Tu
r
Tk
m
k
Tj
Ru
s
Se
m
Kg
z
M
kd
M
da
Ro
m
Ka
z
Bu
l
Cr
o
Ge
o
Bl
r
Bi
h
Az
e
Ar
m
Al
b
0%
Simple steps in preparing and
implementing child survival plan
Step 1. Set a goal
Step 2. Divide the goal into sub-goals
Step 3. Convert the (sub) goals into tasks.
Step 4. Task are manageable, assign them to
resources - who will do what and allocate resources.
Step 5. Plan the tasks regarding interdependencies.
Step 6. Manage the process
Step 7. Monitor the progress and take corrective action
where required
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Accelerating Child Survival
Monitor Progress
Reliable and accurate indicator:
Neonatal, Infant and child mortality,
Home care: EBF, CF, ORT use rate, home management of
pneumonia
Quality of institutional care
Timely information
Prompt action at every level
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Accelerating Child Survival
Strengths in CEE & CIS
• Vast infrastructure and health care
functionaries
• Almost all children come to health centres
(SVP) regularly and are weighed
• BFHI doing relatively well
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Accelerating Child Survival
Together we can do it!
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Accelerating Child Survival