Accelerating Child Survival

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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

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Global Agenda Strategic Directions
External Environment Analysis
Regional and country level Knowledge Base
Alliance Building
National Policy Development Reform Process
National Priority in A Country National
Development Strategy Poverty Reduction Strategy
Alliance Building
Implementation
RESULTS FOR CHILDREN
UNICEF RMT CEECIS 9 MAY 2006
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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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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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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.

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Summary of Findings Quality of Care
KAZ
MDA
RUS
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Summary Findings - Structure Supplies
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Unnecessary Admissions Treatment (WHO Study
Rus, KZ, MDA)
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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

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Use available health staff effectively
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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.

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Focus on neonatal care
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What kills neonates?
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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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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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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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Together we can do it!