Covering the Maternal and Child Health needs

of the populations in Sub-Saharan Africa

The persisting challenges

OUTLINE PRESENTATION

1. MMR and U5MR in Sub-Saharan Africa, trends,

causes, coverage

2. Specific Challenges

3. The way forward

4. Key messages

GLOBAL U5M TRENDS

• Global U5MR declined by nearly by half, from 90 per 1,000 live births in 1990 to 48 per 1,000 in 2012

• Annual number of under-five deaths reduced from 12.6 million to 6.6 million over the same period

• 17,000 fewer children died each day in 2012 than did in 1990

Under-five mortality rate has declined

in all regions since 1990…BUT TOO SLOW IN SS-Africa

Under-five mortality rate by region, 1990 and 2012, and % declines

Source: IGME 2013.

Burden of under-five deaths increased in Sub-Saharan

Africa from 1990 to 2012

48%

75%

68%

67%

55%

52%

14%

30%

-0,1%

-20% 0% 20% 40% 60% 80% 100%

World

East Asia and Pacific

CEE/CIS

Latin America and the Caribbean

South Asia

Middle East and North Africa

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

% decline in under-five deaths, 1990-2012 % share of under-five deaths

Sub-Saharan Africa has substantially accelerated

its reductionAnnual rates of reduction (ARR) in the under-five mortality rate, %,

by region, since 1990

Source: IGME 2013.

Trends in Under-five mortality rates Africa, 1990 to 2012

1990 2000 2012

Less than 40

40 - 99

100 - 149

150 or more

U5MR (deaths per 1,000 live births)

Less than 40

40 - 99

100 - 149

150 or more

U5MR (deaths per 1,000 live births)

Analysis based IGME estimates,2013

CAUSES OF CHILD DEATHS IN AFRICA, 2010

Neonat-pneumonia3%

Preterm birth complications

10%

.Intrapart.related events* 8%

sepsis/menin./tet.5%

Other conditions 1%

Congenital abnormalities 2%

Neonat-diarrhoea1%

Diarrhoea11%

Measles1%

Injury4%

Malaria15%

AIDS4%

Meningitis2%

Other conditions19%

Pneumonia14%

Neonatal death:

30%

BURDEN OF U5M IN WCAR 2000-2010

as a %

of total

child

deaths

Annual

U5

deaths

('000)

No. of

U5

deaths

per day

No. of

U5

deaths

per

minute

as a %

of total

child

deaths

Annual

U5

deaths

('000)

No. of

U5

deaths

per day

No. of

U5

deaths

per

minute

Total under-five deaths

in WCA100% 2,058 5638 3.92 100% 2,096 5742 3.99

Pneumonia 12% 247 677 0.47 14% 293 804 0.56

Malaria 20% 412 1128 0.78 20% 419 1148 0.80

diarrheoa 12% 247 677 0.47 11% 231 632 0.44

Measles 11% 226 620 0.43 1% 21 57 0.04

Neonatal 26% 535 1466 1.02 29% 608 1665 1.16

Injury 2% 41 113 0.08 3% 63 172 0.12

AIDS 3% 62 169 0.12 2% 42 115 0.08

Meningitis 2% 41 113 0.08 2% 42 115 0.08

Other disorders 12% 247 677 0.47 18% 377 1034 0.72 Source: Lancet 2012

2000 2010

Causes of child deaths in

West and Central Africa

MMR TRENDS BY REGION 1990-2010

-

100

200

300

400

500

600

700

800

900

1.000

1990 1995 2000 2005 2010

De

ath

s p

er

10

0,0

00

liv

eb

irts

World

Sub-Saharan Africa

Asia

Latin America and the Caribbean

Africa

Source: UN Maternal Mortality Estimation Group (MMEIG)

MMR BY REGION 2010

Globally, 287,000 Maternal deaths in 2010

IHME ( Lancet 2011), Liu et al (2012)

Coverage of high impact interventions across the continuum of care, ESAR and WCAR

Source: Regional analysis based on SOWC 2013 (most recent DHS or MICS)

OUTLINE PRESENTATION

1. MMR and U5MR in Sub-Saharan Africa, trends,

causes, coverage

2. Specific Challenges

3. The way forward

4. Key messages

1: Insecurity, Epidemics and malnutrition

1: Insecurity, Epidemics and malnutrition

>=50 000

<10 000

Cas attendus de MAS en 2013

1: Insecurity, Epidemics and malnutrition

2: The demographic growth:

Population prospect (1950-2050)

0

500

1000

1500

2000

2500

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Po

pu

lati

on

s in

Mil

lio

ns

Sub-Saharan Africa

Eastern Africa

Middle Africa

Western Africa

Southern Africa

Source: UNICEF WCA analysis based on World Population Prospects: The 2012 Revision, United Nations Population Division.

Source: UNICEF analysis based on World Population Prospects: The 2012 Revision,

United Nations Population Division, New York, 2013.

Number of children under age 5, by region,

1950-2050

3: Equity: Wealth disparities on key

interventions: ESAR and WCAR

Source: Regional analysis based on SOWC 2013 (most recent DHS or MICS)

4: Governance….

Not enough money for health ,

Not enough health for money

OUTLINE PRESENTATION

1. MMR and U5MR in Sub-Saharan Africa, trends,

causes, coverage

2. Specific Structural Challenges

3. The way forward

4. Key messages

The Goal: Universal health Coverage

• Quality,

• Equity,

• Affordability,

• Set specific quantitative goals:

– By pledging to support the goals of A Promise Renewed,

partners vowed to redouble efforts to reduce the deaths of

children under five in all countries to 20, or fewer, per

1,000 live births by 2035.

Services Populations démunies

$

Services Communautaires

Activités programmables

Participation Communautaire

23

Elimination des Barrières

Narrowing the gaps

We Know the Road to the Goal

7. Monitor and report progress in Universal Coverage

6. Support implementation of evidence based strategies and interventions

6. Support implementation of evidence based strategies and interventions

5. Leverage of budgets and fund allocation

4. Develop/Support Stakeholders coordination

3. Sharpen national strategies and plans.

2. identify major bottlenecks to Universal Coverage

1.Commit to Mother and Child Health

7 BENCHMARKS TOWARDS EFFECTIVE IMPLEMENTATION

ADDRESSING SPECIFIC CHALLENGES

• Communities and Systems Resilience

• Adolescents’ wellbeing, Girls Education, social norms, Urban Strategies

• Community Based Approach, Barriers Elimination

• More Money for Health, more Health for Money

• All levels Monitoring

Emergencies

Insecurity

Climate Change Natural Disasters

Population Growth

Young Population, Urbanization

High Maternal Mortality

Increasing Disparities

Adverse Gender Norms

Access Barriers

Weak Governance and Accountability

OUTLINE PRESENTATION

1. MMR and U5MR in Sub-Saharan Africa, trends,

causes, coverage

2. Specific Structural Challenges

3. The way forward

4. Key messages

KEY MESSAGES

1. U5M and MMR decline slowly in SSA particularly in WCAR

2. We Know the Road to the Goals, we can accelerate progress in the health sector to reach them,

3. But we have to address some structural challenges are affecting HS performance to achieve Universal Coverage

1. Build systems and communities Resilience

2. Adolescent health, education and protection

3. Bring services to communities and communities to services

4. More Money for health and more health for money

MERCI!