Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002

1. Contributing to reaching the Millennium Development Goals and the Goals of the World Fit for Children: Health and Nutrition in UNICEF's Mid-Term Strategic Plan 2002-2005 Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002

2. 200 1990 181 175 180 2000 Least reduction 160 3% 140 128 120 U5MR (deaths per 1000 births) 100 100 Greatest reduction 80 80 32% 64 58 60 53 45 44 38 37 40 20 9 6 0 Sub-Saharan South Asia Middle East & East Asia and Latin America CEE/CIS and Industrialized Africa North Africa Pacific & Caribbean Baltics countries Under-five mortality rate, change over period 1990-2000 Source: UNICEF, 2001

3. U5MR disparity by asset quintile

4. Most deaths occur at home,before reaching health facilities … Implications for programming?

5. Bangladesh U5MR

6. Immunization 1980-1999, DPT3 coverage

8. LOW BIRTHWEIGHT RATEOne quarter of births in South Asia weigh less than 2500 grams Source: UNICEF, 2001

9. 1 in 13 RISK OF DEATHA woman born in Sub-Saharan Africa faces a 1 in 13 chance of dying in childbirth. The risk for women born in industrialized countries is 1 in 4085. Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.

10. Skilled attendants at delivery, 1995-20

11. The ultimate challenge: HIV • HIV - the worst pandemic in human history - risks reversing the progress of decades of development ...

12. Botswana U5MR

13. Estimated impact of AIDS on under-5 child mortality rates - selected African countries, 2010 with AIDS per 1000 live births 250 200 150 100 50 0 without AIDS Botswana Kenya Malawi Tanzania Zambia Zimbabwe Source: US Bureau of the Census 98036-E-25 – 1 December 1999

17. Main Goals of A World Fit for Children (2000-2010) • Reduce infant and under-five mortality by at least one third by 2010 (and by 2/3 from 1990 to 2015) • Reduce maternal mortality ratio by at least one third by 2010 (and by 3/4 from 1990 to 2015)

18. Main Goals of A World Fit for Children (2000-2010)... • Reduce under-five child malnutrition by at least one third by 2010, with special attention to children under two and reduce the rate of low-birth weight by at least one third by 2010 • Reduce proportion of households without access to hygienic sanitation facilities and affordable and safe water by at least one third by 2010

19. Main Goals of A World Fit for Children (2000-2010) ... • Develop and implement national early childhood development policies and programmes (children’s physical, social, emotional, spiritual and cognitive development) • Develop and implement national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health

20. Main Goals of A World Fit for Children (2000-2010) ... • Access through the primary health-care system to reproductive health for all individuals of appropriate ages as soon as possible and no later than 2015

21. Main Goals of A World Fit for Children (2000-2010)... • Reduce by 2005 HIV prevalence among young men and women age 15 to 24 in the most affected countries by 25 per cent and by 25 percent globally by 2010 • By 2005, reduce the proportion of infants infected by HIV by 20%, and by 50% by 2010

22. Organizational Priorities 2002-2005: UNICEF’s Mid-Term Strategic Plan • Immunisation+ • Integrated Early Childhood Development (Health, Nutrition, Water & Sanitation, Psychosocial Care and Early Learning, Child Protection) • HIV/AIDS • Girl’s Education • Child Protection

23. Immunization + • By 2010, ensure full immunization at least 90% of children nationally with at least 80% coverage in every district • Certify by 2005 the global eradication of polio • Reduce deaths due to measles by half by 2005 • Eliminate maternal and neonatal tetanus by 2005

24. Immunization + ... • Extension of the benefits of new and improved vaccines and other preventive health interventions to children in all countries, especially vitamin A where appropriate

25. Integrated Early Childhood Development (IECD) • Health: • Major childhood killers (diarrhea, pneumonia, malaria) • Maternal and newborn health • Nutrition • Exclusive breastfeeding, complementary feeding, infant-feeding informed choices • Micronutrients (supplementation and fortification: iodine, vitamin A, anemia and iron, folic acid, others?) • Water and environmental sanitation • Psychosocial care and early learning

26. HIV/AIDS • PMTCT • Prevention among young people • Care and Support • Orphans

27. With business as usual, we will not reach the MDGs or those of the World Fit for Children • Need to redouble our efforts to support countries to reach these goals • How can we support countries to provide high coverage of a limited number of the most cost-effective interventions (the essential package) and support the development of sustainable national health systems?

28. Principles of good development • Seek maximal impact on human development (eg. health and education) and on poverty reduction • Evidence-based decision-making • High impact, low-cost interventions • Universal coverage, reaching the unreached, especially the poor • Home- and community-based strategies • Essential knowledge and commodities (vaccines, treated bednets against malaria, etc.)

29. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Challenge • 11 million children die each year • Most of these deaths are preventable: they are from a limited number of conditions for which we have high impact, low cost interventions • The challenge is to go to scale, to reach every child

30. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward • Political commitment and national ownership by government, civil society and families • Clear time-bound goals: Reduce Under-five and Maternal Mortality by one-third during this decade (focus on outcomes and not just process) • High impact, low cost, focused programs with specific targets, standardised and taken to scale to reach every child (examples: immunisation, oral rehydration for diarrhea, treated bednets for malaria)

31. Consensus from the Global Consultation on Child and Adolescent Health in Stockholm, March 2002: the Way Forward ... • Strong and well-coordinated partnerships supporting these programs: developing countries, civil society and NGOs, multilateral agencies (WHO, UNICEF, World Bank) • Both developing country and donor resources • Strong monitoring and evaluation systems tracking progress towards targets • Reaching the Child and Maternal Survival Goals is possible if we commit our energy and our resources to it

32. Progress - Summary • The UN Special Session on Children: A World Fit for Children goals • UNICEF’s Mid-term Strategic Plan • Global Consultation on Child and Adolescent Health, Stockholm, March 2002 • Launch at Special Session on New Low-Osmolarity ORS Solution

33. Progress - Summary... • Consultation on the Community Management of Pneumonia, Stockholm, June 2002 • Major effort on Roll Back Malaria • Major Measles results in Africa • A Secretariat for the C-IMCI IAWG • Increase child survival funding and staffing at UNICEF

34. The challenge…reaching global child survival, growth and development goals