Professional Documents
Culture Documents
Unequal
progress
2/3 countries that have
made progress in
reducing U5MR have
shown worsening
inequalities
(i.e gaps between better
off and worse off have
increased)
Indicates : delivery and
financing of health and
nutrition services as well
as demand / use of
these
ese favor
a o the
e be
better
e o
off
UNICEF Progress for Children 2010
HYPOTHESIS
C
Conventional
ti
l wisdom
i d
h b
has
been th
thatt it iis ttoo costly
tl
and too difficult to go into poor, hard to reach
communities; reaching better off
off, easier to reach
children has been considered more cost effective.
Hypothesis tested : Because the needs are greatest
amongst the unreached, and new, innovative,
efficient strategies
g
and tools exist to reach them,, the
benefits of concentrating on them could outweigh the
additional costs of reaching them.
This would mean a greater equity focus would :
a) be more cost effective and
b) accelerate progress towards MDGs
Cost effective p
proven interventions are known
- strategies differ in the way these are
delivered, promoted and financed
Child
2003
Newborn
2005
Maternal
Series
2006
Child
develop
ment
series
2007
Reproductive
Health
Series
2006
Nutrition
series
2008
250
200
60%
150
40%
100
20%
50
0%
Fourth Highest
100
60%
80
40%
60
40
20%
40%
20%
0%
Lowest Second Middle Fourth Highest
Fourth Highest
100
90
80
70
60
50
40
30
20
10
-
100%
verage deficit
% Cov
60%
Wealth Quintiles
% Cove
erage deficit
80%
20
0%
100%
120
80%
Wealth Quintiles
Equity Typology B2
Equity Typology C
80%
60%
40%
20%
0%
Lowest Second Middle
Fourth Highest
Wealth Quintiles
140
70
60
50
40
30
20
10
-
80%
100%
% Coverage Deficit
E it Typology
Equity
T
l
A
% Coverrage Deficit
100%
Under 5 morta
ality per 1,00
birth
hs
SupplyBottleneck
75%
(esp.midwivesshortage)
Demand
Bottleneck(esp.
Financialaccess)
50%
25%
0%
COMMODITIES: % HUMAN RES: %
ACCESS: %
UTILISATION: % CONTINUITY: % EFFECTIVE COV:
health centres with
facilities with
families living near deliveries assisted deliveries with i) % of SBA deliveries
no perinatal supply sufficient workers health facility with by trained worker SBA ii) weighed & occur within a ANCstock-outs
daily service
iii) receive 3
qualified health
provision
postnatal care visits
facility
200
Others
Injuries
21.6
AIDS
4.9
36.7
150
Pneumonia
6.6
Measles
56.3
Malaria
100
50
50
8.8
16
1.6
13.9
1.6
22.1
11
40.7
26.9
0
Nigeria: Nigeria Q1
Diarrhea
Neonatal
Analytical Framework
Coverage
35%
30%
25%
20%
15%
10%
5%
Inputs/costs
35 30
25
20
15
Low
10
0
10
102
103
104
105
106
High
MDG
10
progress
7
Impact
5% 10% 15% 20% 25% 30% 35%
Under 5 m
U
mortality p
per 1,000 live births
Baseline
70
60
Current
50
40
30
Equity
Focused
20
10
Most Deprived Areas
Unde
er 5 mortaliity per 1,00
00 live birth
hs
160
140
141
120
Historical path
100
Current Path
88
80
Equity
q y
Focused
60
MDG Target
40
20
1990
1995
2000
2005
2010
2015
Equity Typology A
140
120
120
100
100
80
80
60
60
40
40
20
20
Current
Equity Focused
Current
Equity Focused
Equity Typology C
Equity Typology B2
30
70
25
60
20
50
15
40
30
10
20
5
10
Current
Equity Focused
Current
Equity Focused
Conclusion
An equity-focused approach improves returns on
investment, averting many more child and maternal deaths
and
d episodes
i d off stunting
t ti than
th th
the currentt path.
th
Using an equity focused approach,
approach a US $1 million
investment in reducing under-five deaths in a low-income,
high-mortality country would avert an estimated 60% more
d th th
deaths
than th
the currentt approach.
h
Because national burdens of disease
disease, ill health and
malnutrition are concentrated in the most excluded and
deprived child populations, providing these children with
essential services can accelerate progress towards the
health related MDGs and reduce disparities within nations.