Dr. Shamim A Qazi: Bottlenecks, barriers, and solutions: Results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths World Health Organization Geneva As presented at Launch of The Lancet Series on Childhood Pneumonia and Diarrhoea, at the Royal College of Pediatrics and Child Health - 12 April 2013 In support of the UNICEF & WHO Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea View the film accompanying the presentation at: www.wateraid.org/news/news/global-action-plan-for-pneumonia-and-diarrhoea

1. Childhood Pneumonia and Diarrhoea 3
Bottlenecks, barriers, and solutions: results from
multicountry consultations focused on reduction of
childhood pneumonia and diarrhoea deaths
Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion
McNabb, Samira Aboubaker, Shamim Qazi and Zulfiqar A Bhutta

2. “Why are so many children still
dying of preventable conditions,
and how do we move forward?”

3. Specific Objectives
1. Identify key barriers to implementation of
programmes targeting pneumonia/diarrheoa
2. Identify key bottlenecks impeding access to
essential commodities
– Diarrheoa: vaccines, zinc, ORS,
– Pneumonia: vaccines, oral amoxicillin
1. Propose solutions to those barriers

4. Methods
• A series of consultations with > 600 key stakeholders in 2010-12
• 3 work streams provided data for 39 Asian & African countries
1. Global Action Plan for Pneumonia (GAPP)
– Led by WHO/UNICEF
– Broad focus on programmatic barriers/solutions
1. Diarrheoa Global Action Plan (DGAP)
– Led by Aga Khan University
– Focus on programmatic barriers/solutions & 7 country case studies
1. Diarrheoa and Pneumonia Working Group (DPWG)
– Led by UNICEF and CHAI
– Focus on supporting scale up treatment in high burden countries.

5. Bottlenecks impeding access to
vaccines
Concentrated upstream
•Policy guidelines
•Resources
Legend
None Darker colorsconnote more significant bottlenecks
Minor
Moderate
Major

6. Bottlenecks impeding access to zinc and ORS
are concentrated ‘downstream’
zinc ORS

7. The Market Trap: Why zinc is so
expensive in Nigeria

8. Prioritization of the Barriers

9. Inadequate monitoring and assessment
• Data not of high quality and not analyzed properly
• Data often not shared with those that need it most
• Data not widely disseminated
Result: Programmes are unaware of their progress
Recommendation: Improve the quality and establish
mechanism for sharing and using data for
action

10. Poor coordination of efforts
• Between programmes, across partners and sectors
• Duplication of efforts
• Failure to optimize available resources
• Conflicting priorities
Result: Fragmented efforts dilute effectiveness & efficiency
Recommendation: Evidence based planning and
management, joint development of plans and
strategies for action

11. Inadequate human resources
• Not enough health workers
• Low incentives for recruitment and retention
• Limited capacity building opportunities
• Inadequate supervision and skills reinforcement
Result: Chronic shortages of the skilled and motivated
workers
Recommendation: Explore and implement innovative
ways for capacity building, motivation & supervision

12. Weak supply chain
• Over-reliance on central supply systems
• Supply not linked to need
• Inefficient stock/restock systems
• Limited local production of essential commodities
Result: limited access to life saving commodities
Recommendation: Strengthen systems for procurement
and drug supply management and production of
key commodities

13. Quality of care
• Evidence based standards of care not always available
• Access to care limited
• Low uptake due to poor quality
Result: Children die of preventable and treatable conditions
Recommendation: Client feedback as part of health worker
and clinic assessment; dissemination of guidelines

14. This is a solvable problem:
The Bangladesh Story

15. The way forward

16. Conclusions
• We can drastically reduce child
mortality with tools already at
hand
– Solutions are affordable and not
high tech
• The ingredients of success start
with
– Coordinated action plan
– Resources commensurate with the
burden of disease
– Accountability for results
– Advocacy