1. What’s happened since the Child
Survival Call to Action? (policy
review and a little background, too)
CORE Group Spring Meeting
April 26, 2013

2. Recall the Child Survival Call to Action in June 2012…
• Joint effort by
Ethiopia, India, USAID
and UNICEF
• Countries signed on to
commit to acclerating
reductions in child
mortality
• Presentations from the
countries with the
highest burden of
under-five
mortality, including
presentation of new
national plans
• A lot of momentum - A
Promise Renewed has
spawned major follow-
up events in
India, Ethopia
(regional), others

3. There have been many new MCH
data, estimates, policy documents since June
2012…

4. • Geography – numbers, severity, focus, graduation
• Equity – vulnerable/lagging (sub-)populations
• High-impact interventions – bottlenecks, research
• Connections to broader context –
“environment”, “empowerment”, etc.
• Accountability – country level, global level, for/to
ourselves and each other
Focus issues for the Call to Action
4

5. Under-five deaths 1990-2070
(actual and projected)
Current trajectory: ARR
2.5%
• MDG 4 achieved in 2035
• 4 million deaths annually in
2035
ARR 12.6%
• Achieve MDG 4
• Reach 2 million child
deaths annually in 2020
• Achieve average of
U5MR 15/1000 by 2020
ARR 5.2%
• 2 million deaths annually by 2035
• Every country reaches 20/1000 by
2035
• Many countries below 15/1000 by
then
Achieve
MDG 4
Under-5 deaths
millions
9.6 mm deaths
in 2000
7.6 mm
deaths in
2010
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065
13
12
11
10
9
8
7
6
5
4
3
2
0
1
Recall the key Child Survival Call to Action message – bend the curve to
reach MDG targets and accelerate progress on child survival
Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child
Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

6. “Sharpening plans”
• Understand structure of mortality, epidemiology, and most
vulnerable populations
• Use evidence-based models (e.g. LiST) with current and
projected/aspirational coverage levels to determine
possible intervention strategies to effect desired change in
mortality and epidemiology
• Understand the systems bottlenecks to achieving those
changes
• Develop a costed and prioritized investment strategy to
address the bottlenecks, change the outcomes, and reduce
mortality
• Ensure that a system of accountability (e.g. scorecard) is
established to track progress and make ongoing
adjustments (i.e. further "sharpening')

7. We have an inclusive and expansive understanding of
what it takes to end preventable child deaths
7
Prevention and
Treatment of
Infectious diseases
• Pneumonia
• Diarrhea
• Malaria
• AIDS/PMTCT
Child survival
Family planning
Neonatal causes
• Preterm birth
complications
• Intra-partum events
• Neonatal infections
Nutrition
Enabling Environment
▪ Education
▪ Empowerment of
women
▪ Economic growth
▪ Environmental factors
(e.g. water supply,
sanitation, hygiene)
Immunization
Maternal health

8. Diverse global initiatives contribute to the
goal of ending preventable child deaths
• FP2020 – ongoing
• Follow-up to the UN Commission on Life-Saving
Commodities – ongoing
• Global Action Plan for Pneumonia and Diarrhoea
(GAPPD) – just launched in Geneva, London, and
Washington
• Global Vaccine Summit – Abu Dhabi, April 2013
• Nutrition for Growth – London, June 2013

9. Family Planning
Summit
Born too soon A Promise Renewed
Country leadership & Implementation
Decade of Vaccines
Innovation Working Group
Key advocacy events and catalytic initiatives in support of
Every Woman Every Child
Commission on Live-saving Commodities
CoIA independent Expert Review Group
Need to Strengthen Global and National Leadership

10. APR Country activities:
launch events, refining strategies, building scorecards (highlights)
• Nigeria: Saving One Million Lives was launched in October 2012. GON moving forward in mobilizing States
on key actions.
• Ethiopia: Mobilized 22 countries at a regional event in January. Ethiopia itself has been central to
scorecarding and accountability efforts in the region, and the Federal Ministry of Health has launched a
community-based newborn care implementation plan.
• India: National Call to Action for Child Survival and Development launched in February, including a focus on
eight high-priority States. Ministry of Health and Family Welfare (MOHFW) to launch a "1000 day campaign"
from May/June 2013 - end 2015 to establish a plan to scale-up Reproductive, Maternal, Newborn and Child
Health services nationally.
• DR Congo: Acceleration Plan under development. Strong MoH interest in launch, possible May timeframe.
• Zambia: APR Country Launch with First Lady April 11
• Senegal: MOH mobilized all donors/stakeholders to develop sharpened, costed plan that integrates major
initiatives. Will host regional meeting with UNCoLSC “pathfinder” countries in late-June
• Bangladesh: working on an Action Plan and APR benchmarks for a press event with the Minister of Health
• Liberia: Strong push for community mobilization supporting 9 key child health messages to district level.
Planned April APR postponed.
• Malawi: UNICEF/USAID collaboration underway and launch with parliament and civil society planned for
August 2013. Strong focus on aligning key initiatives to support results.
• LAC regional event – Panama hosting, late 2013

11. Global Causes of Child Deaths, 2010
Source: CHERG, 2012

12. USAID MCH funding increasingly focused on 24
MCH “priority” countries responsible for 75% of
maternal and child mortality
150 +
100-149
40-99
20-39
U5M Rate (per 1000 live births):
10-19

13. MDG 4 Assessment of Progress for 24 priority
countries: Under-Five Mortality Rate Average
Annual Rate of Reduction(%) 1990-2011
DR Congo, 0.4
Kenya, 1.4
Sudan, 1.7
Mali, 1.8
Ghana, 2.1
Yemen, 2.4
Pakistan, 2.5
Nigeria, 2.6
India, 3.0
Afghanistan, 3.1
Uganda, 3.3
Haiti, 3.4
Senegal, 3.5
Mozambique, 3.7
Tanzania, 4.0
Zambia, 4.0
Ethiopia, 4.5
Indonesia, 4.5
Madagascar, 4.6
Malawi, 4.8
Nepal, 4.9
Rwanda, 5.1
Bangladesh, 5.3
Liberia, 5.4
0.0 1.0 2.0 3.0 4.0 5.0 6.0
On Track
Insufficient
Progress
4.3% (on target)
Little/No
Progress
Source: Level and Trends in Child Mortality Report 2012

14. Regional Causes of Child Deaths, 2010:
Sub-Saharan Africa and South/East Asia
Africa: 3.6 million deaths Asia: 2.1 million deaths
Source: CHERG, 2012

15. Reducing deaths
from pneumonia
and diarrhea will
be critical to end
preventable child
deaths, especially
in countries with
higher under-five
mortality rates.
GAPPD: By 2025, <3 deaths /1000 live births from child
pneumonia, <1/1000 diarrhea deaths
Under-5 mortality rate (per 1000) versus percentage of
under-5 deaths attributed to pneumonia and diarrhoea in
2010

16. Source: WHO/UNICEF/UNFPA/World Bank. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. Geneva, World Health Organization, 2012.
24 USAID Priority
Countries, 27%
24 USAID Priority
Countries, 55%
24 USAID Priority
Countries, 61%
24 Non-Priority
Countries, 31%
24 Non-Priority
Countries, 18%
24 Non-Priority
Countries, 10%
Centrally Managed, 28%
Centrally Managed, 15%
Centrally Managed, 12%
GAVI, 14%
GAVI, 12%
GAVI, 17%
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
FY 2002 FY 2008 FY 2012
$inmillion
USAID Maternal and Child Health
Accounts: GHP/USAID, AEECA, and ESF
$391.7 Million
$773.4 Million
$577.3 Million
MCH funds have been increasingly
strategically focused….

17. Under-Five Child Mortality in Lowest and Highest Wealth Quintiles -
USAID MCH priority countries, 2004-2009
149.9
97.3
90.291.5
40.5
30.5
0
20
40
60
80
100
120
140
160
Africa Asia & Middle East Latin & America
Caribbean
DeathsPer1000LiveBirths
Lowest Quintile Highest Quintile
Source: U5MR: Demographic and Health Survey Statcompiler, latest available data. Data older than 2004 include
Mozambique 2003. Data by wealth quintile are not available for Afghanistan, Angola, Sudan and Yemen.
Substantial inequity in child survival exists
in all regions
17

18. Problems in measuring change
on an annual basis…

19. Take-aways…
• Setting priorities is critical – geography, target
populations, interventions
• Using a systematic evidence-based process is critical to
setting priorities
• There has been lots of country action since June 2012
• There is a need for better coordination at the
international and national levels
• Decreasing inequity in outcomes and impact needs
continued attention
• Accountabilty/”Scorecards” very important but
mortality measurement in “near real time” is
problematic