Cost-effective Interventions and Strategies to
Accelerate Child Survival & Development in the
context of Health Reform & Poverty Reduction
Geneva
September 2002
From conception to 5th birthday
• Antenatal intervention
• Early childhood intervention up to
5 years of age
– Prevention
– Care
EPI PLUS
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IMMUNIZATION
VIT A Supplementation
Deworming
Intermittent presumptive Treatement (
linked with EPI once cleared with WHO
TDR/ research action)
IMCI plus
• Anti Malarial drugs( early and adequate
treatment at home WHO TDR research
action)
• ITNS
• ARI Treatment, pneumonia (home or
community based, WHO TDR research
action)
• Oral Rehydration
• Exclusif breastfeeding
• Iodized salt
• Hygien
Antenatal care
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Tetanos immunization
Iron Supplement
Intermittent treatment against malaria
ITNS
PMTCT / HIV AIDS
Coverage Objectives
Increase 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%
Measles 20%
Vitamin A
deficiency
De worming
Malaria 50%
Diarrheoa
Pneumonia
Malnutrition
Malaria/ Anemia 12%
Tetanus
PMTCT-VIH
Total
82%
Interventions Efficacy
Expected
coverage
EPI +
95%
+ 50% 10%
IMCI
80%
+30% 12%
C IMCI
25%
+45% 10%
ANC
40%
+50% 4%
3
packages
Impact on U5MR
36%
Impact Objectives: WCAR
• Reduce under-five mortality by:
• 15% after 3 years of full
implementation of high impact
intervention packages & strategies;
• 25 % after 5 years of full implementation of the interventions/strategies
• 35% after 7 years of full implementation of the interventions/strategies (after
7 years a full cohort will have benefitted
from -9 months-5 years)
Monitoring effective coverage determinants
Visualizing Coverage Indicators
facilitates identification of bottlenecks
(indicated below by the green arrow)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Availability
Access
Utilization Continuity
Quality
Service Delivery Strategies for the
proposed intervention packages.
• to 25-50% of population with access to
HC(<5km)
– Health Centre Based Strategy: integrated
delivery of all priority interventions
• for 50-75% of population without access to
HC.
– Community based strategy for IMCI+ (home
based prevention and care)
– Outreach/Mobile Strategy: (three) monthly
delivery of EPI+ and ANC services
Support Strategies for effective coverage
• Social 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 & microplanning to increase effective coverage and
empower communities
Complementarity of Child Survival, SWAp &PRSP
1. Health Sector reforms increase Health System
Capacities through enabling health policies,
decentralization and partnerships
2. PRSP/HIPC provides opportunities for:
• Increased Financing for Health
• Increasing Health Staff Availability/Salaries
• Focussing on poorest=high U5MR regions
3. Accelerated Child Survival & Development:
• Accelerates Impact of Health Reforms on children
• Ensures poverty/disparity reduction for children
• Makes the case for additional health sector funding
4 demonstration countries
Districts of demonstration: 3 millions
Region for expansion: 7 millions
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Senegal
Ghana
Mali
Benin
7 expansion countries
population: 4 millions
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Gambia
Burkina Faso
Cameroun
Tchad
Niger
Guinea Bissau
Guinee Conakry