GIVS and UNICEF: Strategic Priorities For Immunization and Child Survival

1
GIVS and UNICEF Strategic Priorities For
Immunization and Child Survival

• Dr. Peter Salama,
• Chief Child Survival and Immunization Unit
• Health Section, Programme Division
• UNICEF
• GIM, March 28th 2006

2
Outline

• UNICEF context
• UNICEF and GIVS
• Progress in 60 countries
• Programme models
• CS indicators- some examples
• Next steps

3
New UNICEF Context

• UN reform
• Paris Principles
• Child survival and MDG 4
• New partnerships
• GIVS and strategic frameworks
• New Executive Director

4
Health and Nutrition StrategyConceptual
implementation framework
5
Global Causes of Under 5 Mortality
Malnutrition Contributes to about 50 of this
mortality
Source Lancet Child Survival Series, (measles
data revised). Total 10.8 million deaths per year
6
Global Causes of Under 5 Mortality By
Vaccine-Preventable Status
Source WHO/UNICEF Total 10.8 million deaths
per year
7
GIVS and UNICEF

• 1) Reaching the unreached
• Complete ADC agenda
• Large countries, marginalized pops, complex
  emergencies
• 2) New vaccines
• 3) Linking child survival interventions
• 4) Global interdependence
• Forecasting, supply and procurement
• Financing

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Priority Countries
Child Survival Countdown - 60 priority countries
Criteria Either total number of under-five
deaths 50,000 Or under-five mortality rate
90 per thousand
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Where we are.
We know ? How many children are dying ?
What they are dying of ? Which interventions
can prevent most child deaths Need to know ?
What are current coverage levels of
interventions ? Is progress being made ?
Where do we need to focus programs
10
Under 5 Mortality
Progress for 60 Countdown priority countries in
lt5 MR
11
Immunization
12
Measles and DTP3

• Major progress during the 1980s
• Coverage stagnated since 1990

DPT3
Developing World 76
Target
Measles
Developing World 74
13
Measles and DTP3
60 Countdown priority countries
10 countries with 90 or more coverage
Most countries still below target and need
intensified efforts
Measles
DPT3
CAR, Chad, Cote dIvoire, Eq. Guinea, Gabon,
Haiti, Liberia, Nigeria, PNG, Somalia
CAR, Cote dIvoire, Liberia, Nigeria, PNG, Somalia
gt90
lt50
gt90
lt50
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Prevention
Insecticide-treated Nets
Vitamin A Supplementation
15
Vitamin A Supplementation

Developing World
61
3-fold increase in children fully protected
by two doses Greatest gains in least
developed countries Among the 60 priority
countries, 26 have 70 or more coverage with at
least one dose, and 7 have unacceptably low
coverage
16
ITNs
Sub-
Saharan Africa
3
Sub-Saharan Africa malaria endemic countries

• Low rates of ITN use
• Major investments in
• recent years
• Rapid increases expected soon 10-fold increase
  in nets distributed in
• Sub-Saharan Africa
• (1999-2003)

Abuja target 2005
17
Case Management
?80 (1 dose)
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Pneumonia Case Management
Pneumonia kills more children than any other
illness, accounting for 19 of all under five
deaths
Neonatal pneumonia/sepsis is estimated to cause
26 of all neonatal deaths.
Only 1 in 5 caregivers know the danger signs
of pneumonia cough and fast or difficult
breathing 54 of children with pneumonia
are taken to an appropriate health care provider
Neonatal causes 27
Pneumonia 19
?80 (1 dose)
19
Pneumonia Case Management
Roughly 20 of children with pneumonia received
antibiotics (based on limited data from the
early 1990s)
? Current estimates not available ?
Questions on antibiotic use for pneumonia
included in current round of MICS and DHS ?
Rapid progress is possible
?80 (1 dose)
20
Nutrition
21
Exclusive Breastfeeding
Developing World 36

• Significant progress has been made since 1990
• Sub-Saharan Africa, in particular, has made
  significant
• gains during the 1990s
• Rates continue to be low across the developing
  world

41
9
21
450
22
Exclusive Breastfeeding
Rapid progress is possible
Rapid progress Rates still low
Rapid progress Higher rates achieved
23
Exclusive Breastfeeding
60 Countdown priority countries23 countries with
unacceptably low rates
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Newborn Health
?80 (1 dose)
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Summary of Findings
? Coverage levels remain too low for most
indicators ? Rapid progress is possible ?
Analysis needed of why rapid progress occurs in
some countries, and for some interventions, but
not others
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Summary of Findings
Coverage too low for most causes of child death
Cause of death
Intervention coverage
Malaria Pneumonia Diarrhea Undernutrition
Neonatal Measles
ITN use
ORT
Antibiotics
ORT/continued feeding
Exclusive breastfeeding
Vitamin A supplementation (gt 1 dose)
Exclusive Breastfeeding
Skilled attendant at birth
Measles vaccine
27
Surveys for 2005-6
national household survey activity
2005-2006
MICS
DHS
Other surveys
28
GIVS Strategy 3

• Integrating immunization, other linked
  interventions and surveillance in the health
  systems context
• UNICEF Approach
• Using immunization to deliver evidence-based
  packages of child survival interventions at
  country level

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Evidence-Based Selection will Lead to a Mix of
Interventions and Operational Strategies
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SELECTION OF EVIDENCE BASED HIGH IMPACT
INTERVENTION PACKAGES

• EPI
• Strengthening routine EPI
• Vitamin A supplementation
• ITNs
• Cotrimoxazole prophylaxis
• IPTi
• Antenatal care
• Refocused ANC
• Tetanus immunization
• Intermittent presumptive treatment (IPT) against
  malaria
• Vitamin A (post partum)
• PMTCT
• IMCI
• Exclusive Breastfeeding
• ORT
• ITNs (pregnant and under 5 children)
• Community management of Malaria and ARI

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Systematic Scaling Up of Proven Interventions and
Appropriate, Situation-Specific Strategies that
Benefit Children and Womens Health and Nutrition
Under 5 Mortality Rate
32
Impact of ACSD package on DPT3 coverage in
selected districts of 3 West African Countries
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ACSD and Malaria
34
Using immunization as a platform for delivery of
package of child survival interventions

• Help countries to tailor integrated packages of
  interventions at immunization contacts with
  priority on outreach and strategies for hard to
  reach
• Ensure selected additional interventions are
  included in the multi-year plan
• Assist in effective implementation and monitoring
  of the joint interventions
• Continue to learn and adapt packages and
  implementation

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Why is T/S Prophylaxis Important for HIV-Infected
Children in Resource-Poor Settings? CHAP Study
43 Decrease Death with T/S
1.00
0.80
Proportion Alive
0.60
0.40
0
.5
1
1.5
2
Years from randomisation
Source Chintu C et al. Lancet 20043641865-71
36
Afghanistanunder five child survival indicators
as of 2004U5MR 257 per 1000 live births- Ranked 4
Source SOWC 2006
37
DR Congounder five child survival indicators as
of 2004U5MR 205 per 1000 live births- Ranked 8
Source SOWC 2006
38
Rwandaunder five child survival indicators as
of 2004U5MR 203 per 1000 live births- Ranked 10
Source SOWC 2006
39
Ethiopiaunder five child survival indicators as
of 2004U5MR 166 per 1000 live births
Source SOWC 2006
40
Nigeriaunder five child survival indicators as
of 2004U5MR 197 per 1000 live births- Ranked 13
Source SOWC 2006
41
ACSD Booster Initiative Sub Saharan Africa
lt5 MR 1000 LBs
Year
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Next Steps

• Formal independent evaluation ACSD
• Refine costing tool
• Mobilize partners WHO, WB, AU, GAVI, GFATM,
  CIDA, USAID, Norway, PMNCH
• Investment case
• Implementation plan
• Continue to support government scale-up
• Monitoring framework
• Lessons learned