Towards a Grand Convergence for Child Survival and Health

1. Towards a Grand
Convergence for
Child Survival and
Health
A strategic review of options for the future
building on lessons learnt from IMNCI
October 2016

2. Context
2
• Child mortality has more than halved in
the past quarter century, dropping from 91
to 43 deaths per 1000 live births between 1990 and
2015
• However, each year 5.9 million children die
before their 5th birthday – the leading causes
are preventable and treatable
• All countries have committed to reducing
under-five mortality to 25 or less and newborn
mortality to 12 or less per 1000 live births by 2030,
and to promote each child’s healthy growth and
development
Opportunity for a Grand Convergence within a generation

3. • Shifting epidemiology: double burden of malnutrition,
nearly half of child deaths during the newborn period,
environmental challenges to child health …
• New technology and innovations: mHealth, eHealth, new
vaccines, diagnostic and treatment innovations …
• Expanded scientific evidence on the best clinical
interventions and delivery strategies
• Greater emphasis on community engagement &
inequalities in child health
• New global architecture: MDGs  SDGs, Global Strategy 2.0,
new funding facilities such as the GFF…
Changes since IMNCI was introduced
3

4. Aim of the Strategic Review
Lessons from
20 years of IMNCI
implementation
State of the art in
care for children
A “big picture”
view of the best
investments in
child health
4

5. UNIQUE SOURCES OF DATA
IMNCI global survey report, with data from >90
countries
desk reviews of scientific publications and expert
opinions
global key informant interview report
in-depth country assessments in Africa, Asia, Europe
and the Middle East
vignettes of child health interventions and
innovations across the globe
quantitative analyses, using DHS, geo-coded and
IMNCI survey data
Data collected
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34
1
12
1
9
8
3

6. Formulating recommendations
6
OBJECTIVE
to end preventable newborn and child mortality
and promote each child’s healthy growth and
development
…to achieve a Grand Convergence in a generation”
CRITERIA
for
RECOMM-
ENDATIONS
- Specific
- Feasible
- Actionable
APPROACH
- Evidence-based
- Problem-solution
approach
- Reviewed by high-level
global experts

7. Findings

8. 8
Map of Global Implementation of IMNCI and iCCM
Widespread adoption of IMNCI

9. • Providers expressed appreciation for IMNCI
for its distillation of case management of the major
killers of children into a clinical algorithm, and
policy-makers praised its simplicity and
comprehensiveness.
• IMNCI’s holistic, child-centred approach
transformed how care for children is perceived at
global and country levels.
Benefits of IMNCI in design and impact
9
“IMNCI is very relevant
for the country. It is a
complete holistic module
with child health,
development, newborn,
etc. Nothing needs to be
taken out.”
- Policymaker (Myanmar)
* Cochrane review on IMCI
(2016)
• Although it’s difficult to measure, evidence suggests IMNCI was significantly
associated with a 15% reduction in child mortality* when activities
were implemented in health facilities and communities.
• Other data have shown positive effects on health worker practices
and quality of care.

10. • However, implementation was uneven with coverage at
scale rarely achieved.
• Failure to agree on sustainable funding and
fragmentation of support led to a loss of built-in
synergy around IMNCI’s three components.
• Implementation focused on health worker
training, more than health systems and
family/community practices.
• Insufficient attention was paid to programme
monitoring, targets and operational research.
Difficulties in implementing IMNCI
10
What is needed to
implement IMNCI?
“Manpower, materials,
and money,” alongside
an explicit
prioritization of child
health
- Policymaker (Nigeria)
• WHO and UNICEF did not provide sustained, focused leadership -
as time went on, interest and funding for IMNCI waned.
• IMNCI suffered from blind spots in the lack of explicit emphasis on
equity, community engagement and linkages to other sectors (education,
WASH…).

11. IMNCI successes
11
IMNCI was best
implemented when:
a) the health system
context was favourable
& suited to guidelines,
b) a systematic approach
to planning and
implementation was
used,
c) political commitment
allowed for
institutionalization.
Health workers in Bihar (India), with their IMNCI
booklets
A health
information
expert
surrounded by
child health data
in Makelle
(Ethiopia)

12. 12
1. Fragmentation of global child health strategies undermines
programming and
limits impact.
2. Child health goals will not be met without adequate funding and
delivery to
marginalized populations.
Problems in past implementation
3. Evidence is not systematically generated, captured and integrated into
policy
and programming.
4. Strategies are insufficiently tailored to country context, and tools need
improved end-user design.
5. There is a lack of accountability and corresponding need for clear
targets and
strong monitoring

13. Recommendations

14. Problem Recommendations
14
1. Fragmentation of
global child health
strategies undermines
programming and limits
impact.
a) WHO-Unicef issue joint statement to reposition
IMNCI, child health;
b) Partners consolidate around one leadership body;
c) Country stakeholders advocate for high-level
representation in coordination mechanisms.
2. Child health goals will
not be met without
adequate funding and
delivery to marginalized
populations.
a) Global partners develop innovative strategies to
target poor populations and support removal of
user fees;
b) Country leaders mobilize support and resources
and use GFF investment cases to develop ambitious,
costed plans;
c) WHO-Unicef develop less resource-intensive
training.

15. 15
3. Evidence is not
systematically generated,
captured and integrated
into policy and
programming.
a) WHO-Unicef establish a global expert advisory
group to gain consensus on state-of-the art
recommendations;
b) Partners create an online resource hub and forum;
c) Regional actors provide technical & policy support;
d) Countries use implementation science and facilitate
shared learning among district teams.
4. Strategies are
insufficiently tailored to
country context, and
tools need improved end-
user design.
a) WHO-Unicef harmonize tools into a one flexible,
adaptable set w/ input from users, design
specialists;
b) Expert advisory group recommends strategies to
build upon country strengths (private sector,
community …);
c) Combined approach for facility, systems,
community.
Problem Recommendations

16. 16
5. There is a lack of
accountability and
corresponding need for
clear targets and strong
monitoring
a) WHO-Unicef establish a joint leadership process to
develop and adopt clear IMNCI targets, alongside
global accountability processes;
b) Partners strengthen country capabilities to
routinely monitor and evaluate progress using
scorecards;
c) Countries scale up monitoring alongside improved
community engagement, using data to enhance
accountability.
Problem Recommendations

17. 17
Joined at
the hip!

18. Report available
soon:
http://www.who.int/maternal_ch
ild_adolescent/en/

19. Strategic Review study team
Dr Tim Colbourn
Lecturer in Global Health
(University College London, U.K.)
Dr Tanya Doherty
Chief Specialist Scientist,
Health Systems
(South African Medical
Research Council)
Dr Youssouf Gamatié
Independent consultant
Dr Rasa Izadnegahdar
Senior Program Officer on Pneumonia
(Bill & Melinda Gates Foundation)
19
Dr Samira Aboubaker
Medical Officer, Policy, Planning,
Programmes (WHO/MCA)
Dr Rajiv Bahl
Coordinator, Health Research
and Development Team (WHO/MCA)
Dr Cynthia Boschi-Pinto
Medical Officer, Epidemiology,
Monitoring and Evaluation (WHO/MCA)
Dr Bernadette Daelmans
Coordinator, Policy, Planning,
Programmes (WHO/MCA)
Dr Theresa Diaz
Chief, Knowledge Management for
Implementation Research (UNICEF)
Dr Elizabeth Mason
Independent consultant
Dr Smruti Patel
Independent consultant
Dr Alexander Rowe
Medical Officer, Malaria Branch
(Centers for Disease Control
and Prevention, U.S.A.)
Dr Eric Simoes
Professor of Paediatrics
(University of Colorado, U.S.A.)
Expert Advisory Group
Study Coordinator
Dr Sarah Dalglish
Independent consultant
Coordinating Group
Mr Nick Oliphant
Health Specialist, Monitoring
and Evaluation (UNICEF)
Dr Jonathon Simon
Scientist (WHO/MCA)
Ms Joanna Vogel
Technical Officer (WHO/MCA)
Dr Wilson Were
Medical Officer, Policy, Planning,
Programmes (WHO/MCA)
Dr Mark Young
Senior Health Specialist (UNICEF)
Principal Investigator
Dr Anthony Costello
Director, Department of Maternal, Newborn, Child and Adolescent Health (WHO/MCA)

20. Thank you!