m Introduction

m Definition of terms
m Chapters
m Definition of terms
m Comparative statistics
m Challenges of the sub-
saharan region
m Challenges facing
Nigeria
m Suggestions
m Conclusion
m 2hat is a child·s life worth?
m SO2C is an Annual publication of UNICEF
in dec every year
m 2008 report published in december 2007,
contains data till dec. 2006
m Published every year since the 1960·s. This
year for the first time STATE OF AFRICAN
CHILDREN was also published
m Not just a collection of data!
m All the more important now because of the
MDGs
m 2008 is like mid-point to the 2015 end point
 Each edition has a
theme and subtheme.
 2008 edition
 164 page document
 Contains five chapters
 Ends with extensive
statistical annexure on
performance indicators
 Then ranks 191 countries
based on U5MR
 2009 edition focuses on
maternal and newborn
care
m Note that global
economic crisis hadn·t
yet occurred at this
time!
m SO2C helps to identify
countries with indices
that impede growth
m Other similar
publications include
2HO·s ¶2orld Health
Report·
m 9.7 million children died b4 their 5th birthday in 2006
m In 1960 it was 20 million
m 26,000 under 5 die every day
m 18 every minute! 810 b4 end of this 45 min seminar!
m Its not all gloomy, some regions have improved
m Causes and solutions are well known and documented
m Simple reliable and affordable solutions
m Challenge is to get them to the millions that need them
ÿ Insecticide treated nets
ÿ Mama packs for safe delivery
m Continuum of care
ÿ Time : pregnancy, childbirth, postpartum, infancy, childhood
ÿ Place : home, community, outreach, facility based care
m Interventions have
evolved over time
ÿ EPI (1974): disease
control e.g. small pox
ÿ Alma ata (1978):
comprehensive PHC
ÿ GOBI (1980·s): selective
PHC
ÿ Integrated approaches
(1990·s till date):
Bamako initiative, IMCI,
IMCNI etc
m Lesson learnt: No single
approach is applicable
in all circumstances.
m Based on:
ÿ Cohesive and inclusive community organisation
and participation
ÿ Support and incentives for community health
care workers
ÿ Adequate programme supervision and support
ÿ Effective referral systems
ÿ Cooperation and coordination with other
programmes and sectors
ÿ Secure financing
ÿ Integration with district and national
programmes
m [oint frame work dev by 2orld Bank, 2HO,
UNICEF
m 5 point action plan
ÿ ACTION 1: realign programmes for diseases
ÿ ACTION 2: make maternal and child health
central
ÿ ACTION 3: improve financing
ÿ ACTION 4: obtain national political commitment
ÿ ACTION 5: create conditions for harmonization
of global health progs.
m Central theme ² UNITY.
m MDGs are not utopian
targets! They are well
thought out.

m Currently represent
mankind·s best hope

m 30million children and 2

million mother·s lives can
be saved b/w 2005 ²
2015

m Reachable targets if
political will is there
m Six pivotal areas urgently need unified
response
1. Create a supportive environment for maternal,
newborn and child survival and health
2. Develop and strengthen the continuum of care
3. Scale up packages of essential services by
strengthening health systems and community
partnerships
4. Expand the data, research & evidence base
5. Leverage resources for mothers, newborn and
children
6. Make maternal, newborn and child survival a
global imperative.
1. Need to Focus on communities & counties
with highest child mortality rates
2. Merits of packaging essential services
together to improve coverage
3. Vital importance of community partnerships
4. Imperative of providing a continuum of care
5. Benefits of a strategic results oriented
approach to health system development
6. Crucial role of political commitment,
national & international leadership
7. Necessity for greater harmonization of global
health progs & partnerships.
m Nigerian examples of success not given
in report!
m Certain plans and projections now
affected by world economic crisis
m Too much technical stuff and data, little
in the way of practical implementations
m 2009 report shows even more damning
figures
m Prof Dora Akunyili·s rxn: Nigeria still in
denial
m UNICEF, UN, 2HO, 2ORLD BANK, UNDP
etc
m Demographic & health surveys
m Multiple Indicator Cluster Surveys (MICS)
ÿ Since 1995, nearly 200 surveys in 100
countries
ÿ 50 countries surveyed in 2005-2006.
m —

 :
probability of dying b/w
birth & exactly 5 years of
age expressed per 1000 live
births
m 6 
 :
probability of dying b/w
birth & exactly 1 yr of age
per 1000 live births
m u 

 :
probability of dying during
the 1st 28 completed days of
life per 1000 live births
m K 

 :
annual no of deaths of
women from pregnancy
related causes per 100,000
live births.
m h   :
no of yrs newborn
children would live if
subject to the mortality
risks prevailing for a cross
section of the population
at the time of birth
m m

  : Annual
no of deaths per 1000 of
the population
m m
 : Annual
no. of births per 1000 of
the population
m Î
  : No of
literate persons aged 15 ²
24 expressed as a % of
the total population in
that age group.
m _


 : GDP is the sum of
value added by all resident producers + any
product taxes (less subsidies) not included in
the valuation of output. GDP per capita =
GDP/ mid yr pop.
m _
 



: GDP + net receipts of
primary income (compensation of employees
and property income) from abroad. GNI per
capita = GNI/ mid yr pop. Expressed in dollars
m ð
   : No of children who would
be born per woman if she had lived to the end
of her childbearing yrs & bore children at each
age in accordance with age specific fertility
rates.
m Sub saharan Africa: all counties south of the sahara
desert except Djibouti, Sudan and South Africa
m S.S Africa + South Asia = 95% of maternal deaths, 90% of
neonatal death & 82% of U5M
m Nigeria & India singlehandedly contribute 1/3 of all
maternal deaths worldwide
m 1 in 9 maternal deaths occur in Nigeria
m 1 million under 5 children die annually in Nigeria
m 71% of population live on < 1$ a day
m In Nigeria
ÿ Only 48% have access to clean water
ÿ Only 44% use improved sanitation facilities
ÿ 6% of under 5 sleep under mosquito nets
ÿ 1% sleep under ITN
ÿ 34% suffering malaria receive proper antimalarial drugs
m MDGs are far from sight!
m Corruption
m Lack of political will
m Disruption of health systems by:
ÿ HIV, natural disasters and armed conflict
m 2eak links b/w communities & health systems
m Shortage of trained skilled health workers
m Poor funding
m Poor coordination
m Lack of laws to protect children
m Poor female education & empowerment
m Global economic meltdown
m The world seems to have given up on us!
m Are the 2015 goals still achievable? YES.
m 2e must start now with:
1. Concerted & holistic intergovt, interagency, interministerial approach
2. 2ork harder on IMNC Health strategy
Immunization
Nutritional supplements e.g vitamin A
ITNs
PMTCT
Safe drinking water
Basic sanitation
Care for pregnant women
3. Public enlightenment
4. Curb corruption
5. Upgrade and equip health facilities
6. Provide extra incentive for health workers
7. More funding for health, less dependence on aid
8. Child protection laws
m Be informed
m Brainstorm on ways to bridge the gap b/w
problem & solution
m Form partnerships
m Educate those around you
m Never keep quiet! Be an advocate for
children
m Never be part of the problem be part of the
solution
m BELEIVE that things can and will change
m SO2C 2008 is not just a collection of
depressing statistics. It should be a call to
arms.
m Basis for action which are RESEARCH &
DATA evaluation 2ELL ESTABLISHED!
m The frame work which are COMMUNITY
PARTNERSHIPS, THE CONTINUUM OF CARE,
AND HEALTH SYSTEM STRENGHTENING
2ELL DEFINED!
m The means are thus in our hands
m All that is needed is will and action!
m 2hat is a child·s life worth?
m How many children have died
worldwide in the course of this seminar?
m ¶there is no enterprise more noble or
reward more precious than saving the
life of a child·
m UNICEF, The State Of the 2orld·s Children 2008:
Child Survival. New York, Dec 2007
m UNICEF, The State of the 2orld·s children 2008
in 20 questions (and answers)
m UNICEF, The State of African Children 2008:
Child Survival. Dec. 2007
m 2orld Health Organisation: 2orld Health
Reports 1996-2007. Home page.
m Indian Pediatrics: vol 45 pg 222-223, Mar 17
2008
m All Africa.com: Nigeria: Country and high
maternal and child mortality, Feb 11 2009.