Child survival: a strategy for the African Region

CHILD SURVIVAL A Strategy for the African Region The World Bank AFR/RC56/13 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N CHILD SURVIVAL A Strategy for the Afrcan Regon  C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N AFRO Lbrary Catalogung-n-Publcaton Data Chld survval: A strategy for the Afrcan Regon 1. World Health Organzaton 2. Health-care nformaton 3. Chld Health 4. Afrca ISBN 92 9 023 104 X (NLM Classfcaton: WA 541) © WHO Regonal Offce for Afrca, 2007 Publcatons of the World Health Organzaton enjoy copyrght protecton n accordance wth the provsons of Protocol 2 of the Unversal Copyrght Conventon. All rghts reserved. Copes of ths publcaton may be obtaned from the Publcaton and Language Servces Unt, WHO Regonal Offce for Afrca, P.O. Box 6, Brazzavlle, Republc of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mal: afrobooks@afro.who.nt). Requests for permsson to reproduce or translate ths publcaton – whether for sale or for non-commercal dstrbuton – should be sent to the same address. The desgnatons employed and the presentaton of the materal n ths publcaton do not mply the expresson of any opnon whatsoever on the part of the World Health Organzaton concernng the legal status of any country, terrtory, cty or area or of ts authortes, or concernng the delmtaton of ts fronters or boundares. Dotted lnes on maps represent approxmate border lnes for whch there may not yet be full agreement. The menton of specfc companes or of certan manufacturers’ products does not mply that they are endorsed or recommended by the World Health Organzaton n preference to others of a smlar nature that are not mentoned. Errors and omssons excepted, the names of propretary products are dstngushed by ntal captal letters. All reasonable precautons have been taken by the World Health Organzaton to verfy the nformaton contaned n ths publcaton. However, the publshed materal s beng dstrbuted wthout warranty of any knd, ether express or mpled. The responsblty for the nterpretaton and use of the materal les wth the reader. In no event shall the World Health Organzaton or ts Regonal Offce for Afrca be lable for damages arsng from ts use. Prnted n the Republc of Maurtus  C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N CONTENTS Page EXECUTIVE SUMMARY v Paragraphs INTRODUCTION 1–9 SITUATION ANALYSIS AND JUSTIFICATION 10–19 THE REGIONAL STRATEGY 20–32 ROLES AND RESPONSIBILITIES 33–34 MONITORING AND EVALUATION 35–36 CONCLUSION 37–40 ANNEX Page Resoluton AFR/RC56/R2: Chld Survval: A Strategy for the 12 Afrcan Regon v C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N vC H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N EXECUTIVE SUMMARY 1. The past 20 years have wtnessed mprovements n chld survval due to effectve publc health nterventons and better economc and socal performance worldwde. Nevertheless, about 10.6 mllon chldren de yearly, 4.6 mllon of these n the Afrcan Regon. About one quarter of these deaths occur n the frst month of lfe, over two thrds n the frst seven days. The majorty of under-fve deaths are due to a small number of common, preventable and treatable condtons such as nfectons, malnutrton and neonatal condtons occurrng sngly or n combnaton. 2. The average declne n under-fve mortalty experenced globally over the years s manly attrbuted to declne n rates n countres wth rapd economc development. The Afrcan Regon needs to ncrease ts average annual mortalty reducton rate to 8.2% per annum f Mllennum Development Goal 4 s to be acheved by 2015. A number of affordable recommended nterventons have been dentfed whch could prevent 63% of current mortalty. 3. The key to makng progress towards attanng the goal by 2015 s reachng every newborn and chld n every dstrct wth a lmted set of prorty nterventons. New and serous commtments are necessary to prortze and accelerate chld survval efforts and allocate resources wthn countres. 4. Prorty chld survval nterventons that wll be mplemented and scaled up nclude newborn care wth a lfe-course approach and contnuum of care; nfant and young chld feedng, ncludng mcronutrent supplementaton and dewormng; provson and promoton of maternal and chldhood mmunzaton and new vaccnes; preventon of mother-to-chld transmsson of HIV; and usng Integrated Management of Chldhood Illness to manage common chldhood llnesses and care for chldren exposed to or nfected wth HIV. v C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N 5. Ths document presents a strategy for optmal survval, growth and development of chldren 0–5 years of age and for reducton of neonatal and chld mortalty n the Afrcan Regon n lne wth the Mllennum Development Goals. 6. Governments wll take the lead n ensurng an ntegrated and focused approach to programme plannng and servce delvery to scale up newborn and chld health nterventons. WHO and partners wll support countres n ths effort. 7. The Regonal Commttee revewed the proposed WHO, UNICEF and World Bank strategy and adopted t along wth the attached resoluton for use by countres n the Afrcan Regon. 1C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N INTRODUCTION 1. Chld survval, whch refers to survval of chldren aged 0–5 years, s a major publc health concern n most countres n Afrca. The past 20 years have wtnessed mprovements n chld survval due to effectve publc health nterventons and better economc and socal performance worldwde. Nevertheless, about 10.6 mllon chldren de yearly, 4.6 mllon of these n the Afrcan Regon. About one quarter of these deaths occur n the frst month of lfe, over two thrds n the frst seven days. The majorty of under-fve deaths are due to a small number of common, preventable and treatable condtons. 2. In 2000, the natons of the world met and agreed to the Mllennum Development Goals (MDGs). One of the targets s to reduce by two thrds between 1990 and 2015, the under-fve mortalty rate (MDG 4). A few countres have made progress, but overall, countres n sub-Saharan Afrca are not on track to acheve MDG 4. The Afrcan Regon needs to ncrease ts average annual mortalty reducton rate to 8.2% f MDG 4 s to be acheved by 2015.1 3. Internatonal treates and conventons such as the Conventon on the Rghts of the Chld (1990), the UN Specal Sesson on Chldren (2002) and the WHO/UNICEF Global Consultaton on Chld and Adolescent Health and Development (2002) emphasze the nherent rght to lfe and the urgency of reducng chld mortalty for future prosperty. 4. The Mllennum Declaraton and the MDGs provde a framework for addressng the hgh mortalty rates n the Regon. The pertnent goals call for reducton n hunger (MDG 1), reducton n under-fve mortalty rates (MDG 4) and mprovement n maternal health (MDG 5) and combatng HIV/AIDS, malara and other dseases (MDG 6). 5. A number of affordable recommended nterventons have been dentfed whch could prevent 63% of current mortalty f mplemented at very hgh levels of coverage.2 New and ncreased commtments are necessary to prortze and accelerate chld survval efforts and allocate resources wthn countres. 1 WHO, The world health report, 2005: Make every mother and child count, Geneva, World Health Organzaton, 2005. 2 Jones G et al, How many chld deaths can we prevent ths year? Lancet 362: 65–71, 2003. 2C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N 6. Partnershps, resources and more effectve programmes at all levels are ncreasngly needed to reach the MDGs. Only a focused, coordnated effort and approprate acton by the nternatonal communty and Member States can brng newborns and chldren the health care they need n a more effcent way. 7. In Afrca, the Organsaton of Afrcan Unty Afrcan Charter on the Rghts and Welfare of the Chld (1990), the adopton of the Integrated Management of Chldhood Illness strategy by the WHO Regonal Commttee for Afrca (1999) and the Afrcan Unon Declaraton on Chld Survval (2005) recognze the duty to accelerate acton for chld survval. 8. The Afrcan Unon requested all Member States to manstream chld survval nto ther natonal health polces. Health and chld survval have been prortzed by the New Partnershp for Afrca’s Development. The Delh Declaraton (2005) on maternal, newborn and chld health and the subsequent Ffty-eghth World Health Assembly resoluton3 call for the hghest poltcal commtment. 9. Ths document provdes strategc drecton for Member States of the Afrcan Regon to address chld survval and development, decrease the unacceptably hgh chld mortalty rates and attan Mllennum Development Goal 4. SITUATION ANALYSIS AND JUSTIFICATION 10. The average declne n under-fve mortalty experenced globally over the years can be manly attrbuted to the declne n rates n countres wth rapd economc development.4 11. The stuaton of most Afrcan chldren remans crtcal and s exasperated by the serous poverty on the contnent. A number of factors contrbute to the slow reducton n the average annual mortalty rate and the large dspartes n chld survval between and wthn developng countres. These nclude socoeconomc, cultural, tradtonal and developmental crcumstances as well as natural dsasters, armed conflct, explotaton 3 Resoluton WHA58.31, Workng towards unversal coverage of maternal, newborn and chld health nterventons. In: Fifty- eighth World Health Assembly, Geneva, 16–25 May 2005. Volume 1: Resolutions and decisions, and list of participants. Geneva, World Health Organzaton, 2005 (WHA59/2005/REC/1), pp. 118–121. 4 Ahmad OB, Lopez AD, Inoue M, The declne n chld mortalty: a re-apprasal, Bulletin of the World Health Organization 78(10): 1175-1191, 2000. 3C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N and hunger. Poverty s the sngle most mportant factor accountng for low coverage of effectve nterventons. 12. In the Afrcan Regon, nfectons are the man drect cause of chld mortalty. Although the relatve mportance of nfectons vares from country to country, on average, more than 70% of chld deaths are attrbuted to just a few manly preventable causes, namely, acute respratory nfectons, darrhoea, malara, measles, malnutrton and neonatal condtons (asphyxa, prematurty, low brth weght and nfectons), sngly or n combnaton. HIV/AIDS may account for up to 57% of under-fve deaths n countres wth the hghest HIV prevalence. 13. The HIV pandemc has contrbuted to ncreased poverty, the eroson of the famly and communty support needed for chld survval, and the human resource crss n the health and other sectors. Although t s known that HIV treatment for chldren can reduce mortalty and mprove qualty of lfe, very few countres have comprehensve approaches to paedatrc HIV care and support. 14. Indrect determnants of health may vary between countres; however, malnutrton s a crtcal rsk factor n most countres, and food and nutrton securty reman fundamental challenges to chld survval.5 Lack of water and santaton, poor lvng condtons, and nadequate chld spacng are assocated wth hgh mortalty. In Afrca, water, santaton and hygene are seldom lnked to natonal chld survval strateges. 15. There are a few cost-effectve nterventons that could sgnfcantly reduce mortalty, and these nterventons vary greatly between and wthn countres. In some countres, progress acheved n the early 1980s and 1990s has not been sustaned, and coverage rates have actually regressed. For example, use of nsectcde-treated nets can reduce chld deaths from malara by about 17%,6 but coverage remans low at about 15%7 n Afrca. Interventons such as oral rehydraton therapy and treatment of acute respratory nfectons seem to have lost ther momentum. Newer nterventons such as those for mprovng newborn health have receved lttle attenton because of msconceptons about ther complexty and cost.8 16. There are multple constrants n health systems that hamper effectve scalng up of nterventons. Insuffcent human, fnancal and materal resources coupled wth 5 Resoluton WHA58.32, Infant and young chld nutrton. In: Fifty-eighth World Health Assembly, Geneva, 16–25 May 2005. Volume 1: Resolutions and decisions, and list of participants. Geneva, World Health Organzaton, 2005 (WHA59/2005/REC/1), pp. 121–124. 6 Schellenberg JRA et al, Effect of large-scale socal marketng of nsectcde-treated nets on chld survval n rural Tanzana, Lancet 357: 1241–1247, 2001. 7 WHO/UNICEF, World malaria report 2005, Geneva, World Health Organzaton, 2005. 8 Schellenberg JRA et al, Effect of large-scale socal marketng of nsectcde-treated nets on chld survval n rural Tanzana, Lancet 357: 1241–1247, 2001. 4C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N lmted manageral capablty, out-of-pocket payments and nadequate mechansms for famles to access health care are just some of the factors that lead to poor servce delvery and low coverage of nterventons. Insuffcent avalablty of essental drugs and supples, and nadequate supervson of health-care provders are among the persstent problems of the health systems n many countres. 17. Fnancal resources for chld survval programmes are far from adequate for reachng every communty n every dstrct wth low-cost nterventons. Globally, US$ 52.4 bllon are needed to reach unversal coverage n addton to current expendtures. Ths corresponds to US$ 0.47 per ndvdual ntally, ncreasng to US$ 1.48 n year 10 when 95% of the chld populaton would be covered.9 18. In 1999, the WHO Regonal Commttee for Afrca adopted Integrated Management of Chldhood Illness (IMCI) as the major strategy for chld survval and the reducton of the hgh chld mortalty rate n the Regon.10 IMCI has been found to be an effectve delvery strategy for varous chld survval nterventons and has contrbuted to a 13% mortalty reducton over a two-year perod n dstrcts n Tanzana where t has been mplemented.11 19. For greater mpact, however, t s mperatve to mplement the IMCI strategy by applyng the lfe-course approach and to coordnate ts mplementaton wth strateges for other relevant nterventon areas. Growth and development durng pregnancy s essental to ensure a healthy neonatal perod. Reducng newborn morbdty, on the other hand, s essental to healthy growth and development durng chldhood, adolescence and adulthood. Ths requres a holstc approach whch combnes a comprehensve chld survval strategy wth strateges for eradcatng extreme poverty and hunger, mprovng maternal health, and combatng HIV/AIDS, malara and other dseases. 9 WHO, The world health report 2005: Make every mother and child count, Geneva, World Health Organzaton, 2005. 10 Resoluton AFR/RC49/R4, Integrated Management of Chldhood Illness (IMCI): Strategc plan for 2000–2005. In: Forty- ninth Session of the WHO Regional Committee for Africa, Windhoek, Namibia 30 August–3 September 1999, Final Report. Harare, World Health Organzaton, Regonal Offce for Afrca, 1999 (AFR/RC49/18), pp. 9–10. 11 Armstrong Schellenberg, J et al, The effect of Integrated Management of Chldhood Illness on observed qualty of care of under-fves n rural Tanzana, Health Policy and Planning 19(1): 1–10, 2004. 5C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N THE REGIONAL STRATEGY Objectve 20. The objectve of the strategy s to accelerate the reducton of neonatal and chld mortalty n lne wth the Mllennum Development Goals by achevng hgh coverage of a defned set of effectve nterventons. Gudng prncples 21. The strategy s founded on the followng prncples: (a) Life-course approach: Ths strategy promotes optmal growth and development of the fetus and across the 0 to 5 age group to prepare each ndvdual for a healthy, well-adjusted, productve adult lfe, through coordnated mplementaton wth other strateges amed at achevng the MDGs and promotng health. (b) Equity: Emphass wll be on ensurng equal access to chld survval nterventons for all chldren. (c) Child rights: Rghts-based plannng wll be ncorporated n chld health nterventons to ensure protecton of the most vulnerable. (d) Integration: All efforts wll be made to mplement the proposed prorty nterventons at varous levels of the health system n a coherent and effectve manner that s responsve to the needs of the chld. (e) Multisectoral collaboration: Consderng that health ssues are development ssues, achevng health outcomes requres contrbutons from other sectors. (f) Partnerships: Emphass wll be put on developng new partnershps and strengthenng exstng ones to ensure that chld survval nterventons are fully ntegrated n natonal and dstrct health systems n a sustanable way. Strategc approaches 22. The strategc approaches are: (a) Advocating for harmonization of child survival goals and agendas n order to promote, mplement, scale up and allocate resources to acheve the nternatonally-agreed goals and targets; 6C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N (b) Strengthening health systems by buldng capacty at all levels of the health sector and ensurng qualty servce delvery to acheve hgh populaton coverage of chld survval nterventons n an ntegrated manner; (c) Empowering families and communities, especally the poor and margnalzed, to mprove key chld-care practces and to make the treatment of malara, pneumona, darrhoea and HIV/AIDS avalable wthn the communty; (d) Forming operational partnerships to mplement promsng nterventons wth government n the lead, and donors, NGOs, the prvate sector and other stakeholders engaged n jont programmng and co-fundng of actvtes and techncal revews; (e) Mobilizing resources at nternatonal, regonal and government levels for chld survval to scale up proven nterventons. Essental package of servces 23. Integrated Management of Childhood Illness wll reman an mportant delivery mechanism for most of the prorty nterventons lsted below. In addton, strong lnkages wth Road Map for acceleratng the attanment of MDG 5 and Makng Pregnancy Safer (MPS) servces wll be promoted, especally for newborn care and Preventon of Mother-to-Chld Transmsson of HIV (PMTCT). 24. Newborn care. Takng nto consderaton the lfe-course approach and contnuum of care, neonatal nterventons that need to be scaled up wll nclude access to sklled care durng pregnancy, chldbrth and the mmedate postnatal perod at communty and faclty level. Capacty buldng of professonal and non-professonal staff wll nclude optmal newborn care practces of newborn resusctaton, early and exclusve breastfeedng, warmth, hygenc cord and skn care as well as tmely and approprate care-seekng for nfectons and care of low-brth-weght nfants. The Makng Pregnancy Safer ntatve through Integrated Management of Pregnancy and Chldbrth offers opportuntes for addressng early newborn health. Integrated Management of Chldhood Illness wll also be expanded to nclude newborns n the frst seven days of lfe. 25. Infant and Young Child Feeding, including micronutrient supplementation and deworming. Key nterventons to be emphaszed are exclusve breastfeedng for the frst sx months of lfe, ncludng colostrum, tmely and approprate complementary feedng, and adequate mcronutrent ntake (partcularly vtamn A, ron and odne). Regular dewormng throughout chldhood and durng pregnancy 7C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N wll be promoted for ts functonal and developmental beneft. Specal emphass wll be gven to preventon and treatment of malnutrton. Integraton of Infant and Young Chld Feedng n other chld health servces, such as Baby Frendly Hosptal Intatve, IMCI, PMTCT, and Growth Montorng Promoton and Referral, provdes crtcal entry for scalng up these nterventons. 26. Prevention of malaria using insecticide-treated nets and intermittent preventive treatment of malaria. Use of nsectcde-treated nets (ITNs) for both under-fves and pregnant mothers and ncorporatng ntermttent preventve treatment of malara (IPT) durng pregnancy n malara-endemc areas are prorty nterventons for reducng low brth weght, chld morbdty and chld mortalty. One mechansm to ensure unversal access to ITNs s to provde free or subsdzed ITNs on a regular bass or through campagns. ITNs and IPT should be ntegrated wth the Expanded Programme on Immunzaton (EPI), antenatal care and IMCI actvtes to ncrease coverage rapdly. 27. Immunization of mothers and children. Provson of tetanus toxod to pregnant women n antenatal clncs and chldhood mmunzatons, ncludng new vaccnes, at communty and faclty levels through outreach and fxed servces wll be promoted. Proven ways of mprovng access to and coverage of servces nclude outreach campagns to provde servces to the remote and ntegraton of EPI wth other chld survval nterventons such as vtamn A, dewormng and ITN dstrbuton. The mplementaton of ths chld survval strategy wll be closely coordnated wth the mplementaton of the WHO/UNICEF Global Immunzaton Vson and Strategy. 28. Prevention of Mother-to-Child Transmission of HIV. The key to ensurng an HIV-free start n lfe s the preventon of HIV transmsson to chldren by preventng HIV nfecton n mothers. Other nterventons are famly plannng, antretrovral therapy, counsellng n nfant feedng and support for HIV-nfected women and ther nfants n countres wth hgh HIV prevalence. Integraton of PMTCT nterventons n antenatal care, nutrton programmes, IMCI and other HIV/AIDS servces enhances opportuntes for reducng paedatrc HIV and the assocated deaths. 29. Management of common childhood illnesses and care of children exposed to or infected with HIV. Interventons nclude oral rehydraton therapy and znc supplementaton for the management of darrhoea; effectve and approprate antbotc treatment for pneumona, dysentery and neonatal nfectons; and prompt and effectve treatment of malara at health faclty and communty levels. Care of HIV-exposed and HIV-nfected chldren s the key to mproved qualty of lfe. Integrated Management of Chldhood Illness provdes an approach for addressng these common llnesses n an ntegrated manner. 8C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N Implementaton Framework 30. To acheve unversal coverage wth these nterventons, ths strategy proposes that countres base ther health system and long-term plans on a sutable mx of delvery channels based on the followng servce delvery modes: (a) Family-oriented, community-based servces that can be delvered on a daly bass by traned communty health or nutrton promoters wth perodc supervson from more sklled health staff; (b) Population-oriented scheduled servces that requre health staff wth basc sklls (e.g. auxlary nurses, mdwves and other para-medcal staff) and can be delvered ether by outreach or n health facltes n a scheduled way; (c) Individually-oriented clinical servces that requre health workers wth advanced sklls (such as regstered nurses, mdwves or physcans) avalable on a permanent bass. 31. Not all countres can currently ensure full coverage of the whole range of nterventons. Obstacles to comprehensve mplementaton of the contnuum-of-care concept across servce delvery modes wll need to be addressed n the medum and long term. To facltate long-term plannng, the strategy dentfes a phased approach that allows each country to defne and mplement an essental package of servce nterventons that, over tme and wth ncreasng coverage, can then be expanded to arrve at an optmal (or maxmum) package of nterventons. The essental packages nclude: (a) A minimum package of hgh-mpact, low-cost nterventons that need to be mplemented at scale mmedately. The mnmum package may nclude ITNs for pregnant women and nfants; antenatal care ; promoton of early, exclusve and prolonged breastfeedng; neonatal care; routne mmunzaton of mothers and chldren; vtamn A supplementaton; dewormng; complementary nfant feedng; oral rehydraton therapy and znc supplementaton for darrhoea; malara treatment, ncludng artemsnn-based combned therapy; management of pneumona n newborns and chldren; antretrovral drugs for the management of paedatrc AIDS; and brth spacng; (b) An expanded package equvalent to the mnmum package plus addtonal evdence-based nterventons such as expanded neonatal care, Haemophilus influenzae type B vaccne, and emergency obstetrc care; (c) A maximum package equvalent to the expanded package plus new planned nterventons such as rotavrus and pneumococcal vaccne, and ntermttent preventve treatment of malara n young chldren. 9C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N 32. The total resources requred to mplement the strategy for each of the proposed packages through the varous delvery modes s ndcated n a separate document to be fnalzed. ROLES AND RESPONSIBILITIES Countries 33. Governments wll take the lead n ensurng an ntegrated and focused approach to programme plannng and servce delvery to scale up newborn and chld health nterventons. They wll ensure certan prorty nterventons for unversal access and hgh coverage among under-fve chldren, ncludng newborns. Specfc roles of countres wll be: (a) Policy development: To put n place the necessary polces that allow effectve scalng up of nterventons; (b) Capacity building: To strengthen natonal capacty to effectvely plan, mplement and montor actvtes, ncludng mplementaton of polces that address chld survval and related health system constrants; (c) Communication and social mobilization: To ensure relevance and consstency of messages for prorty chld survval nterventons, countres wll develop a natonal communcaton strategy to support ntegrated health promoton actvtes wth a focus on empowerng famles, households and communtes, ensurng clear lnks wth effectve delvery of essental servces by dfferent sectors, nsttutons and players; (d) Advocacy and partnership development: To advocate and develop partnershps wthn the framework of the Maternal, Newborn and Chld Health Partnershp by ensurng consensus buldng, harmonzaton of nterventons and resource moblzaton from wthn and outsde the country; ths ncludes chld survval nterventons n the varous global and natonal development ntatves such as Poverty Reducton Strategy Papers, sector-wde approaches and the Global Fund to Fght AIDS, Tuberculoss and Malara as well as close collaboraton wth partners n the health sector and lnkages wth other programmes such as malara control, HIV/ AIDS, Maternal and Neonatal Health, EPI, Integrated Dsease Survellance and Response, and Health System Development; 10 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N (e) Operational research: To conduct operatonal research n prorty areas n order to mprove polcy, plannng, mplementaton and scalng-up of cost-effectve chld survval nterventons; (f) Documentation: To assess, document and share ther experences and programme efforts to acheve set goals and apply the lessons durng the expanson phase and for advocacy purposes; (g) Development of a framework for monitoring and evaluation: To develop a framework for montorng and evaluaton that ncludes gatherng baselne data, trackng progress, documentng and sharng experences wth countres and regons. WHO, UNICEF, World Bank and other partners 34. WHO, UNICEF, World Bank and other partners wll: (a) advocate for the prorty nterventons and moblzaton of resources; (b) provde techncal support to countres to scale up chld survval nterventons by strengthenng country and ntercountry capacty, montorng and evaluaton mechansms, and health management nformaton; (c) support countres to dentfy, document and dssemnate best practces n mplementng these nterventons; (d) support countres to develop capacty for operatonal research; (e) facltate coordnaton and collaboraton. MONITORING AND EVALUATION 35. A mnmum set of process and mpact ndcators to track progress wll be agreed upon wth partners and stakeholders. 36. The montorng process wll conform to chld rghts prncples. Informaton and results wll be stratfed by varous groups so that comparsons can be made about the mpact of dfferent polcy and programme measures. Evaluaton wll be conducted every two years. 11 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N CONCLUSION 37. Chldren represent the future of Afrca. Hence, nvestng n chldren’s health s mperatve n ensurng healther and more productve future generatons who wll gude the socoeconomc development of the contnent. 38. Ths strategy reflects a lfe-course and comprehensve approach to chld health ssues and health-care servce delvery. It underscores the need for mplementng cost-effectve maternal newborn and chld health nterventons for reducng newborn deaths by three fourths and chld deaths by two thrds n the largest populaton possble. 39. The key to makng progress towards attanng Mllennum Development Goal 4 by 2015 s reachng every newborn and chld n every dstrct wth a few prorty nterventons. The nterventons descrbed above are not new; however, ths strategy calls for a strong commtment to prortze nterventons, allocate resources and accelerate a few known cost-effectve chld survval nterventons for mplementaton at hgh levels of populaton coverage. 40. The Regonal Commttee revewed the Regonal Chld Survval Strategy proposed by WHO, UNICEF and the World Bank, and adopted t along wth the attached resoluton for use by countres. 12 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N ANNEX AFR/RC56/R2: Child Survival: A Strategy for the African Region The Regonal Commttee, Alarmed that of the 10.6 mllon chldren who de every year globally, 4.6 mllon are from the Afrcan Regon, and that the majorty of these under-fve deaths are due to a small number of common, preventable and treatable condtons; Takng due account of the fact that Mllennum Development Goal number 4 ams to reduce under-fve mortalty by two thrds by 2015 compared to 1990 levels; Recognzng that nternatonal treates and conventons, ncludng the 1990 Conventon on the Rghts of the Chld, the Unted Natons Specal Sesson on Chldren (2002) and the WHO/UNICEF Global Consultaton on Chld and Adolescent Health and Development (2002), emphasze the nherent rght to qualty lfe and the urgency to reduce chld mortalty; Consderng that chldren represent the future of Afrca and that nvestng n ther health s mperatve to ensure a healther and more productve generaton for the socoeconomc development and prosperty of the Regon; Mndful of the fact that the OAU Afrcan Charter on the Rghts and Welfare of the Chld (1990), the strategy for Integrated Management of Chldhood Illness (IMCI) adopted by the WHO Regonal Commttee for Afrca n 1999, and the Trpol Declaraton on Chld Survval adopted by the Afrcan Unon Assembly n 2005, recognze the urgent need to accelerate acton for chld survval; Havng carefully examned the document enttled “Chld survval: a strategy for the Afrcan Regon”, jontly developed by WHO, UNICEF and the World Bank, proposng a strategy on chld survval for the Afrcan Regon; 13 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N 1. APPROVES the proposed strategy for chld survval n the Afrcan Regon; 2. URGES Member States: (a) to put n place the polces needed for effectve mplementaton of the chld survval strategy; (b) to strengthen natonal capacty to effectvely plan, mplement and montor actvtes, ncludng mplementng polces that address the ssue of chld survval n the context of health-care delvery systems; (c) to ensure the relevance and consstency of messages for prorty chld survval preventve nterventons and develop natonal communcaton strateges to support ntegrated health promoton actvtes wth a focus on empowerng ndvduals, famles and communtes; (d) to ensure consensus-buldng, harmonzaton of nterventons and resource moblzaton from wthn and outsde the country, wthn the framework of maternal, newborn and chld health partnershps; (e) to conduct operatonal research n prorty areas n order to mprove polcy, plannng, mplementaton and scalng up of cost-effectve chld survval nterventons; (f) to assess, document and share experences and programmatc efforts to acheve set goals so as to apply the lessons learnt durng the expanson phase and for advocacy purposes; (g) to develop a montorng and evaluaton framework, ncludng gatherng baselne data and trackng progress, documentng the data and sharng them among countres and regons; 3. REQUESTS the Regonal Drector: (a) to stmulate partnershps and work wth UNICEF, the World Bank and other relevant partners to support the mplementaton of ths strategy; (b) to advocate for the scalng up of prorty nterventons and moblzaton of resources; (c) to provde techncal support to countres to scale up chld survval nterventons by strengthenng country and ntercountry capactes, montorng and evaluaton mechansms, and health management nformaton; 14 C H I L D S U RV I VA L : A S T R AT E G Y F O R T H E A F R I C A N R E G I O N (d) to support countres to dentfy, document and wdely dssemnate best practces n mplementng these nterventons; (e) to support countres to develop capacty for operatonal research; (f) to facltate coordnaton and collaboraton wth the Afrcan Unon and regonal economc communtes; (g) to report every other year on progress n the mplementaton of the chld survval strategy for the Afrcan Regon.