accelerating child survival dr. sanjiv kumar, regional adviser health and nutrition, cee/cis second...

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

UNICEF


RESULTS FOR CHILDRENUNICEF RMT CEECIS9 MAY 2006

Global Agenda: Strategic Directions

Regional and country level Knowledge Base

National Priority in A Country:National Development Strategy

Poverty Reduction Strategy

AllianceBuilding

AllianceBuilding

National Policy DevelopmentReform Process

Implementation

External Environment Analysis

UNICEF


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)

UNICEF


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

UNICEF


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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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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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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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.

UNICEF


Summary of Findings Quality of Care

Areas assessed No significant problems Need for some improvement Need for substantial improvement

Hospital network

Availability beds

Physical structure

Financial accessibility

Health personnel

Equipment

Drugs, supplies

Triage

Diagnosis

Treatment

Intensive care

Monitoring

Guidelines

Child friendly attitude

KAZKAZ MDAMDA RUSRUS

UNICEF


Summary Findings - Structure & Supplies

Existing hospital network GoodGood

Staffing Generally adequate and dedicatedGenerally adequate and dedicated

Physical structure and equipment

Need renovation and updatingNeed renovation and updating

Essential drugs and supplies Sometimes lackingSometimes lacking

Accessibility Partially limited due to need for Partially limited due to need for financial contributionfinancial contribution

UNICEF


Unnecessary Admissions & Treatment (WHO Study Rus, KZ, MDA)*

0

20

40

60

80

100

%

No need for hospitalization Unnecessary therapies

MDA N=45KAZ N=53

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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

UNICEF


Use available health staff effectively

0102030405060708090

100

Africa Asia LatinAmerica

Developedcountries

Tajikistan05101520253035404550

% of trained personnel Perinatal mortality Assumed

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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.

UNICEF


UNICEF


Focus on neonatal care

0

20

40

60

80

100

120

Arm Aze Geo Kaz Kgz Tjk Tur Tkm Uzb

x 10

00

mortality 1-4 y

PNMR

late NMR

early NMR

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What kills neonates?

0%

20%

40%

60%

80%

100%

Other

Congenital

Infection

Asphyxia

Preterm

UNICEF


Simple steps in preparing and implementing child survival plan

Step 1. Set a goal Step 2. Divide the goal into sub-goalsStep 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 processStep 7. Monitor the progress and take corrective action

where required

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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

UNICEF


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

UNICEF


Together we can do it!

accelerating child survival dr. sanjiv kumar, regional adviser health and nutrition, cee/cis second...

Documents

child health

acceleration of child

child survival plan

neonatal care slide

effective care slide

child mortality

curative care

promotive care