Cost-effective Interventions and Strategies to Accelerate Child Survival & Development in the context of Health Reform & Poverty ReductionGeneva September 2002

Causes of Under Five Mortality in very high U5MR areas in West/Central Africa (>150)

Malnutrition50%

Source: UNICEF 2001

Proportion of U5MR addressed by priority intervention packages at different U5MR levels

Chart1

1020102040

1225121734

1530101530

2035101223

EPI +

IMCI +

ANC

DELIVERY NNB

OTHER

U5MR

% U5MR addressed

Sheet1

< 100100 - 150>150>200

EPI +10121520

IMCI +20253035

ANC10121010

DELIVERY NNB20171512

OTHER40343023

TOTAL100100100100

Sheet1

1020102040

1225121734

1530101530

2035101223

EPI +

IMCI +

ANC

DELIVERY NNB

OTHER

U5MR / 1000 Births

% addressed U5MR

Sheet2

Sheet3

From conception to 5th birthday Antenatal intervention

Early childhood intervention up to 5 years of agePreventionCare

EPI PLUSIMMUNIZATIONVIT A Supplementation DewormingIntermittent presumptive Treatement ( linked with EPI once cleared with WHO TDR/ research action)

IMCI plusAnti Malarial drugs( early and adequate treatment at home WHO TDR research action)ITNSARI Treatment, pneumonia (home or community based, WHO TDR research action) Oral Rehydration Exclusif breastfeedingIodized saltHygien

Antenatal careTetanos immunizationIron Supplement Intermittent treatment against malariaITNSPMTCT / HIV AIDS

Cost effectiveness of the intervention packages on U5MR

Sheet1

InterventionsEvidence of medical efficacyefficacyCost effectiveness in US$U5MR control

1. EPI plus20%

ImmunizationConfirmed>80%12- 17

Vit A Suppl.Confirmed>80%4

Deparasitagegood>80%15- 30

Intermittent Presumptive treatmentStudy25% ?

2. IMCI plus30- 5050%

Anti malarial drugsGood>80%1315%

ITNsGood50%16- 4320-25%

IRA pneumoniagood>80%20- 5015%

Oral rehydrationConfirmed>80%25- 7515%

Exclusif breastfeedingConfirmed25%25- 30

Iodized saltConfirmed>80%8

HygienConfirmed25%20

3. ANC plus30-5012%

Tetanos vaccinationConfirmed>80%12- 173%

IronConfirmed40%13

Intermittent presumptif treatmentGood25% ?4- 494%

PTME/VIH-SIDAgood50%405%

Sheet2

Sheet3

Coverage ObjectivesIncrease effective coverage of :

EPI+ 80% (Immunization, Vit A)

IMCI + 50% (prevention and care of malaria, ARI, diarrhea and malnutrition)

ANC 80% (malaria and anemia prevention HIV AIDS)

Reduction of U5MR through high impact package

Priority Diseases

U5MR%

Interventions

Efficacy

Expected coverage

Impact on U5MR

Measles

Vitamin A deficiency

De worming

20%

EPI +

95%

+ 50%

10%

Malaria

Diarrheoa

Pneumonia

Malnutrition

50%

IMCI

80%

+30%

12%

C IMCI

25%

+45%

10%

Malaria/ Anemia

Tetanus

PMTCT-VIH

12%

ANC

40%

+50%

4%

Total

82%

3 packages

36%

Impact Objectives: WCARReduce under-five mortality by: 15% after 3 years of full implementation of high impact intervention packages & strategies; 25 % after 5 years of full implemen-tation of the interventions/strategies 35% after 7 years of full implemen-tation of the interventions/strategies (after 7 years a full cohort will have benefitted from -9 months-5 years)

Monitoring effective coverage determinants

EMBED PowerPoint.Slide.8

_1063177708.ppt

Visualizing Coverage Indicators facilitates identification of bottlenecks (indicated below by the green arrow)

Service Delivery Strategies for the proposed intervention packages.to 25-50% of population with access to HC(

Support Strategies for effective coverageSocial mobilization & communication to improve service use and family care A results based approach to financing service delivery including performance bonuses (monetary or in kind),contracting with community groups, health staff etc.Community based monitoring & micro-planning to increase effective coverage and empower communities

Complementarity of Child Survival, SWAp &PRSP1. Health Sector reforms increase Health System Capacities through enabling health policies, decentralization and partnerships2. PRSP/HIPC provides opportunities for:Increased Financing for HealthIncreasing Health Staff Availability/SalariesFocussing on poorest=high U5MR regions 3. Accelerated Child Survival & Development:Accelerates Impact of Health Reforms on childrenEnsures poverty/disparity reduction for childrenMakes the case for additional health sector funding

4 demonstration countriesDistricts of demonstration: 3 millionsRegion for expansion: 7 millionsSenegal GhanaMaliBenin

7 expansion countriespopulation: 4 millions GambiaBurkina FasoCamerounTchadNigerGuinea BissauGuinee Conakry

Scenario C: Expansion to 8 other west African countries

Population

4.000.000

Year

Intervention packages

Expected results and means of verification

2002

EPI +

Baseline data

cost analysis

2003

EPI + ITNs IPT

EPI + 80% coverage

Household sample survey

2004

HIGH IMPACT PACKAGE

EPI + 80% coverage

ITNs 60% coverage

Household sample survey

2005

EPI + 80% coverage

ANC 60% coverage

IMCI + (50%)

Household sample survey

2006

2007

2008

25% U5MR reduction,

(DHS or MICCS)

2009

2010

35% U5MR reduction

DHS and MICCS

Cost analysis and

Cost per life saved

ELIGIBLE CRITERIAHigh Under five mortality rateSuccess insurance linked with strong commitment of national authorities and indepth involvment of UNICEF officeAccessibility and quality of health system and services in the selected districtsCommunity participation capacity

CONDITIONALITIESEPI + coverage between 12 and 24 months should reach 60% for DPT3 and Measles After 1 year of implementation, EPI+ coverage should reach 80% Before addind malaria prevention (through ITNs and IPT for pregnant women) Coverage of 60% to be reached and maintained.