the catalytic initiative to save a million lives: overview ... · ci countries • countries where...
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The Catalytic Initiative to Save a
Million Lives: Overview and latest
update of the Catalytic Initiative
Global Immunization Meeting: 19 February 2009, New York
Dr. Mark W. YoungSenior Health Specialist, Policy and Evidence Unit,
Health Section, UNICEF New York
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The Catalytic Initiative: Principles, Aims and Objectives
• Intensify efforts to achieve MDGs 4&5 by supporting country-led systems to deliver a package of proven, high-impact and cost-effective interventions and to demonstrate the level of impact that can be achieved
• Intervention package may vary by country and will depend on local context and epidemiological profile
• Focus on “Human Resources for Health”: training, equipping and supervision of front-line health workers
• “Program Monitoring and Results Tracking”, in order to demonstrate lessons learned - “Learning by Doing”
• Existing country-level processes should be followed -alignment with national plans and M&E framework
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Initiating Partners
• Canadian International Development Agency (CIDA) – announcement of CDN $105 million in Nov. 2007
• UNICEF – matching CIDA contribution of $105M
• World Bank, WHO, UNFPA
• Bill and Melinda Gates Foundation (PMNCH)
• Norway, Australia, USAID, Doris Duke F. & others..
• Viewed within the context of the International Health Partnership (IHP+) as a concrete step for country-level scale-up
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CI Countries
• Countries where new funding has so far been allocated: Afghanistan, Burkina Faso, Benin, Ghana, Ethiopia, Malawi, Mali, Mozambique, Niger, Pakistan and Tanzania;
• Approximately $350 million of new money out of a total goal of $500 million has been allocated to date for this initial list of countries
• Cost-effectiveness of child survival package estimated at $500/life saved; therefore aims to “save a million lives” over the course of the initiative
• Plan to implement over 5 year period: 2008 - 2012
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Learning by Doing: Monitoring and Evaluation
• Major component of the CI activities is “learning by doing” to demonstrate impact that can be achieved: documentation of “what works” to expand the evidence base (build on lessons from ACSD Evaluation):
• Begin with solid evidence on causes of death and prioritize interventions that have greatest impact
• Rapid impact can be achieved through integrated package at community level and outreach (building on EPI and ANC platforms)
• Develop feasible and sustainable systems for monitoring inputs, outputs and outcomes, and use data to improve program performance
• Data will need to be collected frequently enough and quickly enough to modify plans based on analysis and results (“real-time monitoring”)
• Johns Hopkins University engaged to act as the focal agency for the CI to develop an overall comprehensive framework for CI Program Monitoring
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Integrated Health System Strengthening (IHSS):
CIDA-UNICEF Collaboration under the
Catalytic Initiative
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Integrated Health System Strengthening (IHSS) Summary
• Taking a “health systems approach” to deliver essential services at the front-line level; Build capacity to equip, train and supervise front-line workers to deliver packages of high-impact interventions;
• Build on ACSD experience – focus on community level activities and interventions that are expected to have large and rapid impact on major causes of child deaths
176Niger
168Mozambique
196Mali
111Malawi
115Ghana
119Ethiopia
U5MR (2007)Country
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Intervention Packages include:
1. Treatment for diarrheal disease, pneumonia and malaria; 2. Immunizations (in order to fill gaps not met by current or
imminent efforts);3. Tetanus immunization for pregnant women; 4. Long lasting insecticide treated bednets (LLIN) for both
pregnant women and U5s; 5. Intermittent preventative treatment for malaria in
pregnancy (IPTp);6. Vitamin A supplementation; 7. Breastfeeding promotion and counselling; 8. Birth spacing and/or contraceptive provision; 9. PMTCT (where appropriate)
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Country Implementation • Ethiopia – in context of Health Sector Development
Plan (HSDP III):– Training of Health Extension Workers (HEWs) to deliver health
extension package
• Malawi – in context of Malawi Poverty Reduction Strategy and Health SWAp:– Training of Health Surveillance Assistants (HSAs) to deliver
essential health package
• Ghana – in context of “High Impact, Rapid Delivery (HIRD)” component of 5-Yr POW:– Training of Community-Based Agents (CBAs) to deliver high
impact package of services
• Niger – in context of 5-Yr health sector plan (PDS):– Training of Community Health Agents for community case
management and essential services
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Implementation of CI/IHSS in Malawi: Implementation of CI/IHSS in Malawi:
Which Interventions will have the Which Interventions will have the
greatest Impact?greatest Impact?
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Nationwide CoverageNational baseline
Target
2006/7 2011
Antenatal care 57% 90%
IPTp 47% 81%
Skilled care at birth 54% 67%
Postnatal visit after delivery 21% 60%
Sleeping under insecticide treated net 23% 69%
Vitamin A supplementation 80% 80%
Exclusive breastfeeding 56% 70%
85%55%Treatment of diarrhoea
69%27%Treatment of malaria
67%29%Treatment of pneumonia
85%71%Immunization
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The challenge: To prioritiseinterventions with greatest impact
Nationwide CoverageNational
baselineTarget
2006/7 2011
Sleeping under insecticide treated Net
23% 69%
Treatment of pneumonia 29% 67%
Treatment of malaria 27% 69%
Treatment of diarrhoea 55% 85%
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How to get there…
� Focus initially on ten districts to ensure coverage targets are achieved
� Scale up of Village Clinics across all hard-to-reach areas
� Ensure quality IMNCI in first level facilities
� Community mobilisation for improved care seeking and ITN use
� Link with ongoing PMTCT and nutrition activities (complementary feeding; management of severe malnutrition) for maximum impact
� Consider additional interventions such as postnatal visits for newborn care, WASH etc . . .
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Implementation of CI/IHSS in Mozambique: Use of
the “RED Approach”
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Use of RED Approach: “Reaching Every District”
Building capacity at district, health facility and community level:
1. Planning and resource management
2. Supportive supervision
3. Re-establishing Outreach services
4. Linking services with communities
5. Monitoring for action
Improve access and utilization of immunization services and create a platform for the integration of maternal and child survival interventions with immunization services.
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Implementation of RED in Mozambique in context of CI/IHSS (1)
• Initial implementation in 33 Districts (three in each of 11 Provinces) in 2007/08 (criteria est. by MOH and partners)
• Deliver expanded components of the Maternal and Child Survival Package with a strong involvement of the communities, through routine services and a bi-annual Integrated Child Survival catch up interventions
• Using the EPI package as an “entry point” (through fixed, outreach and mobile strategies) for all Maternal & Child Health Survival Interventions in the district (C-IMNCI, ANC+, Targeted home visits to deliver key family practices, home treatment for newborn, etc)
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Implementation of RED in Mozambique in context of CI/IHSS (2)
• Data Collection and Analysis - Database for each district has been elaborated
• Microplanning - Action plans involving all 5 RED components developed for all districts and for 350 health zones (including mapping of hard to reach areas)
• Monitoring and Supervision – 69% of planned supervisions were implemented in 1st half of 2008
• Re-establishing Outreach – only 50% of planned outreach were implemented in 1st half of 2008 (resource limitation)
• Linking Services with communities – meetings with community leaders and CHWs (>80% completed)
• Integration - activities during vaccination sessions in the health centers and outreach services are integrated with other child survival interventions such as VitAsupplementation and Antenatal care etc.
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Role of Catalytic Initiative and Next Steps in Mozambique
• Accelerate policy status related to community-based services to ease implementation of community case management (e.g. pneumonia), and population oriented interventions needing inputs from Community Health Workers
• Mobilize financial assistance for scale-up and roll-out, and accelerate administrative procedures for transfer of funds to districts
• Institutionalize integration of RED in annual work plans of provinces, districts and national level
• Strengthen support to supervision, monitoring and evaluation - use of data at district and health zone levels for improved program delivery
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Thank You!Thank You!