Maternal, Newborn and Child Health: Global initiatives and priority products for MNCH Dr. Mark W. Young Senior Health Specialist, UNICEF-New York

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1 Maternal, Newborn and Child Health: Global initiatives and priority products for MNCH Dr. Mark W. Young Senior Health Specialist, UNICEF-New York Copenhagen, Denmark 23 September 2013

2 Visit Unprecedented Commitment for Maternal and Child Health Country leadership & Implementation Key advocacy events and catalytic initiatives in support of Every Woman Every Child Born too soon A Promise Renewed Decade of Vaccines Innovation Working Group Family Planning Summit Commission on Live-saving Commodities Global Action Plan for Pneumonia and Diarrhoea (GAPPD) CoIA independent Expert Review Group

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4 90 million lives saved in 22 years 2012: 17,000 fewer children died each day than in million children died before their 5 th birthday

5 Progress, but not fast enough.

6 Sub-Saharan Africa: a unique and urgent challenge SSA is the only region in which the under 5 population has increased since 1990, and has shown the least progress on U5MR. With the U5 population set to grow rapidly, the total number of U5 deaths may stagnate or even increase if greater progress is not made.

7 Most children die from preventable causes

8 Therefore, accelerated efforts against these main causes of child deaths are needed along the continuum of care EVERY NEWBORN: an Action Plan to end preventable deaths and The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD)

9 RMNCH Continuum of Care

10 TOOLS medicines, diagnostics COMMUNITY CARE HEALTH SYSTEM TRUST Putting CHWs at the center: CHWs are crucial links connecting the communities they serve and the health system. SERVICES To be empowered and activated CHWs need to be provided and regularly resupplied with commodities, SUPPORT medicines, diagnostic devices, information and other job aids To be empowered and activated CHWs need to be provided with a well-orchestrated set of activities and services that support them all along their journey, from the moment they are recruited and trained to the day-to-day service they deliver to their communities, to the incentives and growth plans that are meant to keep them motivated.

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12 1 2 3 Preterm birth We can reduce the main causes of death Newborn Survival Solutions 3 by 2 1. Preterm labor management including antenatal corticosteroids* 2. Care including Kangaroo mother care, essential newborn care Birth complications (and intrapartum stillbirths) 1. Prevention with obstetric care - Oxytocin, Misoprostol, MgSO4* 2. Care - essential newborn care, resuscitation equipment* Neonatal infections 1. Prevention, essential care, breastfeeding, Chlorhexidine * 2. Case management of neonatal sepsis injectable antibiotics, Amoxicillin Dispersible tablets* * Prioritized by the UN Commission on Life Saving Commodities for Women and Children Over two-thirds of newborn deaths preventable actionable now without intensive care

13 Global momentum and support for ending preventable deaths from childhood pneumonia and diarrhoea Recent events highlighting global focus: Just a few of the partners with ongoing global support for scale-up of Amoxicillin DT & ORS/zinc: UN Commission on Life Saving Commodities Global coordinated effort to scale up priority commodities, including Amoxicillin DT, ORS & zinc WHO/UNICEF: Ending preventable child deaths from pneumonia and diarrhoea by 2025 The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) Lancet Series on Childhood Pneumonia and Diarrhoea launched on April 12, 2013 Lancet series focused on opportunities in treating childhood pneumonia & diarrhoea

14 GAPPD Vision, Goals and Targets for 2025 Vision - Ending preventable child deaths from pneumonia and diarrhoea by 2025 Goals - For children under 5 years of age: reduce mortality from pneumonia to fewer than 3 per 1000 live births; reduce mortality from diarrhoea to fewer than 1 per 1000 live births Targets by the end of 2025: 90% access to appropriate pneumonia and diarrhoea case management (with 80% coverage in every district)

15 Framework for Protect, Prevent, Treat

16 Integrated Solutions

17 The World Health Organization has established dispersible amoxicillin as the recommended first-line treatment for pneumonia in children under five Oral amoxicillin is preferred over co-trimoxazole as first-line treatment, because it is effective against both non-severe and severe pneumonia in low-hiv settings, because of increased resistance to cotrimoxazole and lower efficacy of co-trimoxazole than amoxicillin; In high-hiv settings, amoxicillin is also preferred because oral cotrimoxazole is recommended for Pneumocystis pneumonia prophylaxis Details can be found in the WHO Recommendations for Management of Common Childhood Conditions. _conditions/en/. p

18 Up to 71 million cases of suspected childhood pneumonia may not currently receive antibiotics THE GROWING GLOBAL MARKET FOR AMOXICILLIN DT COPENHAGEN, DENMARK; Suspected childhood pneumonia cases in 50 low/middle income countries 1 ( ) * Untreated Treated Total Cases of Childhood Pneumonia (M) See next page for detail *Note: Treatment rates estimated using a combination of the latest DHS, MICS or NFHS data depending on what was available for each country. In some cases, like India, antibiotic usage may be higher and the size of the untreated population may be an overestimate. Notes: 1) Estimates by John Snow, Inc for the 49 Every Woman, Every Child countries + India 2) Updated July 2013 with 2010 CHERG estimates of incidence of clinical pneumonia (published 2013) - Using latest DHS/MICS estimates of those children 5 and under receiving antibiotics for treatment of ARI

19 10 focus countries account for 77% of all untreated suspected childhood pneumonia cases THE GROWING GLOBAL MARKET FOR AMOXICILLIN DT COPENHAGEN, DENMARK; 2013 Childhood pneumonia in 50 low/middle income countries 1 (2013) Total = 96M cases Childhood pneumonia cases (M) treated and untreated % of all untreated cases Total cases Untreated All 50 countries: 96M 71M 10 focus countries: 74M 56M Untreated * Treated 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% - India Nigeria Pakistan Bangladesh DRC Ethiopia Tanzania Uganda Kenya Niger Afghanistan Vietnam Yemen Mozambique Myanmar Burkina Faso Madagascar Cote d'ivoire Mali Ghana Nepal Uzbekistan Malawi Chad Zambia Senegal Guinea Somalia Rwanda Benin Cambodia Korea Burundi Zimbabwe Haiti Sierra Leone Togo Tajikistan Liberia Eritrea Lao PDR Central African Papua New Guinea Kyrgyz Republic Mauritania The Gambia Guinea-Bissau Comoros Solomon Islands Sao Tome and Principe *Note: Treatment rates estimated using a combination of the latest DHS, MICS or NFHS data depending on what was available for each country. In some cases, like India, antibiotic usage may be higher and the size of the untreated population may be an overestimate. 0% Notes: 1) Estimates by John Snow, Inc for the 49 Every Woman, Every Child countries + India 2) Updated July 2013 with 2010 CHERG estimates of incidence of clinical pneumonia (published 2013) - Using latest DHS/MICS estimates of those children 5 and under receiving antibiotics for treatment of ARI

20 New pneumonia diagnostic support aids for respiratory rate and pulse oximetry are needed to improve the accuracy and effectiveness of diagnosing pneumonia in resource-poor contexts

21 Malaria Case Management Artemisinin-based combination therapy (ACT) is the recommended first-line treatment for malaria (artemether-lumefantrine; artesunate-amodiaquine); Home management of malaria (HMM) is a strategy to expand availability to ACT treatment in communities that have no easy to health care, and in many cases has been integrated with treatment for pneumonia and diarrhea (iccm) Since WHO policy on testing of all suspected malaria cases with RDTs and/or microscopy; A substantial proportion of fever cases are malaria neg. and thus incorrectly treated with anti-malaria drugs; Also significant overlap in symptoms between malaria and pneumonia - pneumonia often undertreated in primarily malaria-supported treatment programs Scale up of RDT use by CHWs is now imperative, coupled with support for comprehensive management of the sick child at the community level (iccm)

22 Intermittent Preventive Treatment for Malaria in Children (IPTc) Seasonal Malarial Chemoprophylaxis (SMC) A complete treatment course of AQ+SP at monthly intervals to a maximum of four doses during the malaria transmission season should be given to children aged 3-59 months as Seasonal Malaria Chemoprevention in areas of highly seasonal malaria transmission across the West Africa Sahel Sub-Region (where both drugs retain sufficient antimalarial efficacy); Target areas for implementation are areas where more than 60% of clinical malaria cases occur within a maximum of 4 months; Where possible, integration into existing integrated Community Case Management and Community Health Workers programs is recommended.

23 Visit Unprecedented Commitment for Maternal and Child Health Country leadership & Implementation Key advocacy events and catalytic initiatives in support of Every Woman Every Child Born too soon A Promise Renewed Decade of Vaccines Innovation Working Group Family Planning Summit Commission on Live-saving Commodities Global Action Plan for Pneumonia and Diarrhoea (GAPPD) CoIA independent Expert Review Group

24 Fund raising and financing efforts RMNCH Trust Fund (UN Commission on Life Saving Commodities) H4+: ~$200M for Maternal and Newborn Health GFATM Replenishment: $15 billion for (public and private sector activities) Nutrition Summit Scaling Up Nutrition (SUN) : $4.15B in new commitments; $19B for improved nutrition outcomes ( ) UN Secretary General's Special Envoy for Financing the Health MDGs: announcements during UNGA on significant investments in RMNCH in the final push towards the MDGs ( last 830 days ) Strong push to have the private sector as core partners in this effort to accelerate reductions in maternal and child mortality

25 Effective, efficient supply operation for programmes UNICEF Supply Division s work is a direct input to development programmes and emergency response Expertise on strategic-essential supplies and supply chains to programmes, governments and other Procurement Services partners Timely and responsive delivery and service to countries and partners Achieving value for money for procurement, quality assurance, warehousing, logistics Establishing and monitoring performance objectives

26 Where we are Dubai Shanghai Panama 855 staff 135 nationalities 163 offices 99 countries

27 Increasing access to life-saving commodities Supply is working with industry and partners to increase affordability, achieve market expansion for quality products, and introducing new products for children via: Market influencing Supply chain optimisation Innovation

28 Supply outcome targets Innovation Better diagnostic equipment Improved product QA Products for children with disabilities Market influencing Affordability of strategic products More countries self-procuring Increased capacity of local suppliers Diversified, expanded supplier base Supply chain optimisation Access to strategic essential supplies improved Technical guidance published Local kit-packing increased. Excellence in direct delivery in fragile states

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