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WHAT'S NEW THIS TUESDAY: PRESENTATIONS FROM THE CHILD SURVIVAL CALL TO ACTION EVENT, JUNE 2012

Sunday, 5th of August 2012

• PRESENTATIONS FROM THE CHILD SURVIVAL CALL TO ACTION EVENT,  JUNE 2012, WASHINGTON, DC

All presentations, including those by health ministers of Ethiopia, India and Nigeria (see also below) are available at

http://5thbday.usaid.gov/pages/ResponseSub/Event.aspx

Most are available both as video and text.

Panel Discussion, ‘Reducing Child Mortality: What have we Achieved?’

http://www.youtube.com/watch?v=HTHVOryiYFU&feature=youtu.be with presentations by Prof. Robert Black and colleagues

Presentation by Prof Hans Rosling

http://www.youtube.com/watch?v=6iyzyZaB8Es&feature=youtu.be

Transcript:

 

Thank you so much for the honor to be invited at this event and on this stage. I’m not here because I’m one of the leading global health professors in the world when it comes to research and developing institutions. I’m here because I have most views on YouTube. (Laughter, applause.) And the last panel addressed the importance of bringing the whole issue out on social media. And I will stretch my presentation from the analysis of data all the way to how we can communicate it and the enormous challenge especially among the public in the richest countries.

First, gratitude, and I’m here in America and I have to thank the taxpayers of the United States for demographic health survey. Thank you very much. (Applause.) And it is the ongoing activity over the decades that we appreciate so much and the stimulation it has led to others and that you have led the way to provide the data free and for use for the entire world.

We also thank UNICEF for following up with multiple indicator cluster surveys and of course all the researchers across the world who spearhead using this data and go on and do future surveys and who also challenge United Nation to provide this at the child mortality estimates in the best possible way.

So for United Nations are leading and that’s when WHO, UNICEF and all come together, we have seen that it becomes more functional and better in communication. I also have to thank, of course, the research community but especially researchers and institutions across the world that are leading now.

I’ve been so impressed to see in Karachi, to see in Ghana how new institutions are being built to address research on child mortality at the cutting edge highest level. That’s very promising that that is moving out to countries.

And why do I thank so much about that? Because I’m just a professor who stands on the shoulders of all these people who do the job, they who collect the data, who compile the data, who analyze it.

And I also today wear the tie of the Ugandan bureau of statistics – (scattered laughter) – to show that the civil servants even in the low income countries that play such an important role in giving us the data and evidence which we can use. So what is it we need to do?

Let me – let me immediately go in to show you the graph, one of my favorite graphs here. And each bubble here is a country. The size of the bubble is the size of the population. The big one is China. This one is India.

And this is – I hope you can see it – 1960. It’s 50 years approach of what happens. The color here of the continent is the color of the bubble. So the red is East Asia, the light blue South Asia, dark blue here is Africa. Whoops. (Laughter.) And I thought I fainted, so – (laughter).

The countries down here, the brown one is Europe, red one there is Japan, here United States of America. And what do I show here? I show the size of families or fertility rate – one,

two, three, four, five, six, seven, eight children per woman. If you say fertility rate, you are dead on social media. You have to say babies per woman. Then it’s understood.

On this is child mortality – 50, hundred, hundred and fifty, 200. I have to go all the way to 350 when I display the situation in 1960. And you can see at that time the talk or the categorization into a developed world and the developing world was fact-based because there was almost no country whatsoever in between.

Look here – a hundred children were dying per thousand up there and here there were six children per woman and more in that direction. It was worlds apart. What has happened? Have we progressed? We’ve heard today, and I will now show you this by giving you the rates. Here we go. Ready, set, go. Can you see how child mortality is dropping here? This is China. This is India.

And then family planning starts to work and child mortality drops even further. And all the countries follow. Africa is stretching out. Some African countries are very successful. And when we come into this century, all the world gathers down into this corner and here we are today. What a progress! (Applause.) Can you see the division between the developed and the developing world?

No, it’s gone. It’s only in our mind. It’s only in the mindset and in the cartoons of Tin-Tin you can see it. In the world as a reality, it has merged. And can you see people have an idea that sub-Saharan Africa is like this or is like that. What a difference within Sub-Saharan Africa. And what a progress even sub-Saharan Africa has made when we go up from here and you can see it’s a completely different world we have today.

Now, here I also show you there are strong relation between how many children a couple get or decide to get – how many the woman choose to have. And how many of them that dies. It’s a very clear relationship. And it goes both ways.

And we have come so far away from that idea when family planning should be promoted as the way to get out of poverty to making it a part of sexual and reproductive health and a right for women because it works just fine providing it that way. It works just fine because the families choose. As soon as they see their children surviving, look here for instance. Bangladesh was there 1972, at its independence. And what has Bangladesh done since?

It’s a miracle, isn’t it? It’s an absolute miracle. We have seen it come down here and you can see very clearly how better survival of children gets a higher demand for family planning and getting fewer children enables families to invest more in them as it is at the national level. There is no one way direction between those two.

And I want to show you the other indicator which I like. There’s one think I really love. It’s money. You don’t think that when you’re a professor in public health you shouldn’t love money. I think so because we in public health, we know so well how money should be used. (Laughter.) That’s why we want to talk about money.

And I noted that the honorable ministers here from India and Europe was very clear that economic growth was part of the equation of better health. And in both way also the direction goes. A healthier population, surviving children, smaller families that can invest means better opportunity for growth and better economic growth in the country gives more resources to invest.

Here, I put therefore dollar per person – $400, $4,000, $40,000. Our world is very unjust. I have to have two differences in zeroing income in the countries. If we say that there is a great disparity in child survival, it really is even more in money – one hundred-fold more money per person in the best country than in the worst. And here I have child mortality as in the other ones.

So what has happened? You can see that the Western world was indeed down here. What was called the developing world had more of a disparity when it came to money than when it was fertility rate. But you will see by what’s happening here is that child mortality is coming – look at – look at China.

China first made its population healthy and got education and got things in order, changed policy and then starts the economic growth, a little here – here we are in ’93 and ’94. See how they are growing? And the emerging economies are all gathering down here. India is joining very fast from up here. And healthy first, then wealthy. That’s how the world is going today. (Applause.)

And it goes that way for two reasons, because it’s the right thing to do ethically but it’s also a damned clever investment. It’s a very clever investment – easy to convince a minister of finance that that’s the way you should go. So now, to look this little carefully, you can see child mortality has come down to the level where I have to stretch this indicator. So I will do the following.

Look, I’ll do the following. I put it on this level where I stretch out the low mortality rate and I push them together, the high rates. This is called – (inaudible). I want to call it a rubber scale. It’s more relaxed. That’s what I did with money also. I took apart money for this with low income. I pressed it together. And can you see the amazing linear relation between money and child survival. If you are rich, kids survive.

But there is a difference of achievement. Some countries are down here. Some countries are up here on the same income level as they are here in the middle and they are up here. That’s the inequity in the countries and that’s the bad investments. That’s why you need to know how to invest to make the best possible out of your money.

But there is no country down here in the human right paradise where you don’t have money and you have child survival. That doesn’t exist. That is what I call end of equity line here. Can you see it? No country falls below this. But you can make your way down like this. And the other thing you see is there is also no clear-cut limit here between developing countries and developed countries.

There are countries all the way – all the way up here. The good thing is we have no country above that lien any longer. We have no country above that line any longer. So what I want to show you here is my own country. Swedes are quite obsessed about Sweden. We happen to be the country that export most arms per inhabitant in the whole world and we have had peace for 200 years.

So it’s very difficult for us to come to grip with those statistical facts. Yeah, it’s sad. We don’t understand why it is like this. Our country has gone through this very peaceful period. I go backwards with Sweden and I go backwards to the year when my grandmother was born, in 1890. She took care of me when I was a child and my mother had tuberculosis. And when she was born, Sweden had the same child mortality as the worst of countries today.

Isn’t it amazing? That means in my life, in my living memory in my family, I bridge the entire variation of child mortality in the world. And from there, with peace and Sweden more than anything else had luck in history. We’ve been so lucky, staying out of the war, having natural resources, having good neighbors, having good collaborations. So with all that luck, it wasn’t surprising that we managed to do this.

We reduced it and there my mother was born – 21. Sweden was like India. So my mother is actually Indian. My grandmother is Nigeria. (Laughter.) Grandmother was in Nigeria, mother was in India. And as things have changed, when I was born in 1948 here, we were in China.

So it didn’t surprise us much that China had this enormous progress. This year, they bought the Volvo Company. In 1948, the Volvo Company started to export cars. It’s really to grasp what it can make difference when you invest in children, what it pays off many, many decades later.

And then, our first daughter was born 1974 when Sweden was more or less like Chile and then I was lucky and – so lucky to have our grandchildren born when Sweden was almost like Singapore down here. This is an amazing tour Sweden have done. And you can see how one can understand it in this way. Grandma, mother, me, daughter and granddaughter.

Instead of thinking about developing countries and developed countries, we have to have several groups of socioeconomic progress. And those countries learn best from those which are a little ahead of them, who were at that level some decades ago. And there are many things which have happened which we never thought would happen.

Just look when I go back – I go back here and I’ll take Sweden to 1960 here, to 1960 – sorry, I let the world free there and the world moves up with me there to 1960 and then South Korea was there, very high child mortality. Singapore, Singapore was there, you know, and Sweden, lucky in peace we were actually ahead of everyone else and that got sort of problem with afterwards. Every country being ahead of something think they will be there forever.

So I take away the other countries and let me see a race to tell you how this developed. We should go a little quicker here like this. What would happen? Sweden progressed. We had

good economic development. We implemented more and more. Actions were this. And we saw and heard about Singapore coming up and we were happy that South Korea came up and we never thought it would come so close to us, you know.

And South Korea were down here. They were not so rich but they got richer than Singapore and we got very nervous. And there, they overtook us and we never ever thought that a tropical island could make it and come all the way down here. Honor to Singapore, honor to Singapore. (Applause.)

In doing that, they killed the concept tropical medicine, isn’t it? It’s gone. It’s not the climate that stops you, you know. You can overcome that and South Korea is down there. So this is very, very important to realize that it can look like this. And how is this? How did Sweden do this.

Was it fast? I calculated the annual rate of reduction. I really like that measure. I have some problem with this 25-year goal in the forward and you are on or off track. It’s not for conceptual understanding. The annual rate of reduction is so good to explain.

And where I talk at the corporate level, at the highest level and politicians outside the ministry of health, I just tell them you know what economic growth is – yeah, we know. You know how many percent you was – yeah, at least 3 (percent), they say. And if you get 6 (percent) you are happy – I’m very happy. It’s the same.

UNICEF is the same. It’s just that they hate child death so they don’t want them to increase. They want them to decrease. But they measure it in the same way – percent reduction per year. And if you have an economic growth with 6 percent, your child death should go down with 6 percent.

People understand it. I think it has great potential, this measure. And this means that Sweden had 3.4 (percent) the entire people, being honored like this – off-track. For all ministers, when you hear the development agent saying off-track, remember that they themselves has always been off-track. (Laughter.) They have always been off-track.

But the important thing to learn, can you see the Swedish line is on this side. How can countries be so more efficient with the same amount of money, technology? We have the measles vaccines. We have more knowledge about breastfeeding. We know the importance of diagnosing and treating and primary health care and we have antibiotics, all these other – so this relation between money and mortality can be pushed down.

And we are so hopeful for the pneumococcal vaccine and for some others. It can push it down. But don’t over-exaggerate it because those who have child mortality today, we just heard the reality from Congo. Those are not even getting those vaccines we have today. So we want – there is – the new technologies can increase in inequity.

Did you hear? If we don’t do and listen to what was said here about an integrated system, an investment in the health service and such, just providing the technology, these ones

will drop even further and these ones will remain up here. And they won’t benefit from it. it really has to go together all these investment. A vertical single intervention for this child mortality issues won’t work.

That’s why I was so happy of the study of pneumonia and diarrhea, UNICEF back on track on realizing these are the most important and they can be done something about. So here we are and we can – we can look forward in the following way here. Let me see where we were. This is what we want to reach, the 20 per thousand. But let me reflect a little more on the MDG goals. This is child mortality estimate, the webpage. I’m live on the webpage now where we get not only the line.

I picked Rwanda for example. Not only the estimated line but what’s so interesting is that we get all the servers, the DHS servers which are behind the line. This is the place where it’s most easy to understand and I challenge all researchers to provide their data in as easy understandable ways. We know the tragedy in Rwanda. And then Rwanda has been so successful.

But look, it’s not fair to measure their performance from that point to this and say that they didn’t do millennium development goal. Not even Stalin had 25 years planning period. It’s too long. It’s too long. And I think when we’re discussing future goals and visions, we must make a difference between the final vision where we want to reach and how we monitor it on its way. It has to be broken down.

And Rwanda should have all credits for this fall in child mortality which is faster than the MDG rate. If you count like this, many more countries are on track now than if we count in this way. This is too rigid.

And besides, Rwanda, I could show here, Nigeria is a big country and it’s challenged to get the service done, representative for the whole country. It’s a subcontinent almost and you can see this obviously is more uncertainty. And you can see that the lost survey was here and the lost years is just an extrapolation.

So this dream many had. It’s 2014, 2015 we will know. No, you have to wait until 2019 to know if MDGs achieved. Otherwise, we are going to judge on surveys which were many years ago. So it’s time. That’s why it’s so appropriate now to think about the new vision and not sit and wait until 2015 because we will have such a communication problem to explain what this was.

Here, you have Ethiopia really doing well and we know that the new DHS is coming which confirms that it is even lower, even lower what is looking today. And here, we have Congo and you can see that the conflict, the tragedies that Congo has been passing through also has limited number of survey.

That’s why it’s so important if you want to focus on the poorest also to go there and measure among the poorest and to assist Congo even in that way. They are capable of doing it themselves but they would need the assistance for getting it done.

Now, when I go back and look at – sorry, I had to go here. And I take this away. I want to say is it possible to reach 20 per thousand in 25 years. My way of doing that, I’m very simplistic as you have understood by now, is to go and look at Peru which are on 20 now. Peru are on 20 now and not only Peru but I also find Egypt there and I find Turkey. Where were these countries 25 years ago? Uh-oh, I have to go here and I look at the world and I only take those countries backwards and I go to ’85, ’84-’85, and quite interesting, isn’t it.

They were at a very high level. Can you see, almost up there, indicating really that this drop seems possible, even if you don’t go in and do these advanced estimates. But think a little. Why could they drop so fast? Because they had huge inequities. They were at the position where they were using the money very badly. And then they got it and they really reformed it and started to use them very well and had slight economic growth and then faster economic growth.

So if you have huge inequities, you have accumulated a potential success and you could have done it easily. It’s much tougher for Vietnam. No, that was not Vietnam. This is Vietnam. Vietnam is already on that border due to its history of high equity and slow economic development up to the last decades.

See, if I take Vietnam backwards, you will see that they come from another direction. They come with high equity and now fast growth. They also made it. If you measure the last – here, they had a speed, so they can make it. But they can make it because they have the fast economic growth at the same time. And I was so happy hearing their excellencies from Ethiopia and India say succeeding with these social goals is linked to our economic growth. It’s closely linked to it.

And it will help us to achieve economic goals and the economic progress will help us to achieve these social goals. This is the reason. So is it possible now. I was told not to be a skeptic. I don’t accept that. I’m an analyst. We need not only aspirational goal.

We need achievable goals. I was told 48 hours ago that I should run my presentation from these screens. That would have been an aspirational goal, an aspirational presentation. And I’m very grateful to the team here and the organizer who got me this screen. This is an achievable presentation I do here. (Applause.)

That means you cannot only go with optimism and happiness to such an important measure. You have to measure. You have to know that you can deliver because if we go for aspirational goal, we only help the first rows. Within irrealistic aspirational goals, we maintain inequity. It was when UNICEF calculated on vaccination together with the countries and did the investments and developed the new technology.

That’s when kids got vaccinated. It was an achievable goal. It was not an aspirational goal. Even we still have to share – show our aspiration. We still have to have passion and vision. But it’s very good to combine it with what we can do because then we will have success

in the end. So why is this so important then? Well, it’s because we have so many things to show here.

Economic growth must be here. And when I calculate these countries cannot realistically reach 20 per thousand by then. So I strongly advise that you stick to this vision of ending preventable child death but give realistic way and goals for the different countries. Otherwise, we build up a disappointment in the future for those countries. (Applause.)

These are the people in the world. We are 7 billion. And we will be 2 billion more 2015. Africa will double its population and we will get 25 percent more in Asia. I jump over this. This is what we saw. In the old time, balance was maintained because children were dying. Then children were surviving and then in the future parents will get two children but both survive. We are quite close to achieving that.

I will end by showing you this graphic. This is in more detail. Every little dollop here is hundred million people. This is Europe, a boring place. Same amount of people in all age group. This is UNICEF’s group. The ministers of health have to take care of everyone. These are 15 to 30, 30 to 45, 45 to 60. This is me up here, 60-plus in Europe. This is America, almost as boring. They’re just going to add one old person up here.

This is dynamic Africa – 400 million below 15 years of age and then fewer because not so many were born there. And this is Asia, also still not so many old people but the number of children have stopped growing. Total number of children in the world is not growing. What will happen is this. Me and the old, we will die. The others will grow up and get 15 years older and then they’ll have their children. And then, the old will die and they will grow up and they will have their children.

It is a challenge on family level, community level, national level and continental level. This increase of people in Africa in the future will stop faster if children survive faster. This is one of the most important message. Child survival will help in stopping population growth, will help the family also having less pregnancies. And child health, maternal health and family planning goes together in the system. Asia will have less children like this.

And we will have a future which is possible. This is not to be a cynic, to put that line up. It’s to save you from disappointment. The problem with people in office and in politics is that they will not be around when reality comes. But we really have to make it right because the countries up there – Congo can do it. It’s no question that Congo can achieve 20 per thousand.

But it may need another decade or two and it has well to have that realistically from the beginning. Here is the challenge, the final challenge. I got the opportunity to ask the Swedes what they know about the world.

Sida used to run a Gallup every year and ask them what they thought about the world, how they felt about the world and if they liked it. Then I was asked to put knowledge questions. I asked how many babies are there per woman in Bangladesh, what is the child mortality in Kenya. I gave them four options.

These are the Swedish answers – 43 percent – it was 4.5 children, 47 percent thought it was 30 percent dying in Kenya. Ten percent was only 7 percent here, 2.5 percent was only 5 percent out there. And of course, this is the right answer. The Swedes think the world is at it was 25 years ago. (Laughter.) Don’t laugh too much. I challenge you to go home and test your own people. (Laughter.)

But I went to the zoo in Stockholm and asked the chimps and they had 25 percent right in this. (Laughter.) So this is not ignorance. This is preconceived ideas that the progress had not been made. And these – most of the voters behind the age are like this. It’s shocking. And this is in the country with a YouTube professor.

We really have to do this. And we may achieve it by reshaping how we talk about the world. You talk in UNICEF about developed regions and developing regions. And Korea and Singapore is in the developing and Albania and Romania is developed. That’s strange. (Laughter.)

That’s where South Korea and Singapore is and that’s where Albania and developed is. What does it take to change categorization? Do you have to color your hair blonde and get birch trees or what is it? (Laughter.) No, I’m very serious on this. This is one of the things that stops understanding, this general talking about developing world.

We need to show the progress being done in countries and not to look – Sub-Saharan Africa cannot be looked at in one unit. We have some countries forging ahead, other countries remaining deep problems, you know. But there are fewer and fewer and more and more are successful.

We really have to work it out so we can understand it. These families want us to succeed. And this is how the world will look – happy, two-child families with surviving children. Thank you very much.

 

Dr Tedros Adhanom Ghebreyesus, Health Minister, Ethiopia

http://www.youtube.com/watch?v=fWxvJtZ8ZIU&feature=relmfu

Transcript:

Good morning. I think I look a bit grouchy in the photo. (Laughter.) It was very difficult to find this photo and it was my son who found it.

Excellencies, U.S. Secretary of State Ms. Hillary Clinton, USAID Administrator Dr. Rajiv Shah, Indian Minister of Health Ghulam Nabi Azad, UNICEF Executive Director Tony Lake; distinguished speakers, delegates, ladies and gentlemen.

The government of Ethiopia is honored to be convening this landmark forum together with the government of the United States of America and India as well as UNICEF. It’s such a great honor and pleasure to be here today before such a distinguished audience including so many good friends. I want to thank all those involved in organizing this event for this special opportunity.

Ladies and gentlemen, let me start by telling you what I find most exciting about this call to action, and three things in particular.

First, I’m pleased about this opportunity to highlight the substantial global progress we have seen on child survival, particularly over the last couple of decades. Global under-5 mortality has dropped 35 percent since 1990, and many countries, including Ethiopia, have achieved annual rates of decline of about 5 percent.

This achievement provides an opportunity to once again reenergize all countries to give their all in this final sprint towards the 2015 millennium development goals. With real commitment, these three remaining years can make a difference in the number of countries that reach their MDG targets.

Second is the bold and unifying post-2015 goal being proposed. Ending preventable disease is an inspiring objective which enables us to start looking forward and far ahead into the future. It’s a big challenge, to be sure, but let us not forget that even the MDGs were thought to be too ambitious, yet today so many countries are on track to achieving them.

And in Ethiopia, some eight years ago, when we first proposed to produce 30,000 community health workers in three years, some thought it was a crazy idea. Of course, we know today that the community-based Health Extension Program actually exceeded its target by training and deploying over 38,000 health extension workers countrywide, covering each and every village of our country. And this program has actually been key to our rapid progress on child survival in recent years.

Our 2010 demographic and health survey showed that under-5 mortality has declined by half in just one decade. This is simply unprecedented for Ethiopia, but it’s clear evidence of our government’s commitment and strong support of our partners. This new big objective on child survival actually bolsters our own development vision for Ethiopia. It emboldens us to aspire even higher.

Child survival is a powerful indicator of a country’s overall development, as you agree. So we see this call as a key contribution to our post-MDG vision, a roadmap to building on our collective gains not just on child health, but on all other MDGs.

Third, this is also a vital opportunity for reinforcing focus on maternal and newborn survival. The Countdown to 2015 initiative has been instrumental in sharpening our focus on maternal and child health. And through dedicated efforts, the global partnership has now achieved broad consensus on the importance of an integrated continuum of care strategy for addressing reproductive, maternal, newborn and child health in an integrated way. I believe this call to action effectively builds on this vital progress. It also further amplifies the laudable Every Woman Every Child campaign initiated by the U.N. secretary general, which has firmly placed the health of women and children on the global political agenda over the last couple of years.

In Ethiopia, we know that our progress on MDG five has been slower than our gains on MDG four and six, and we can see even more clearly now that it’s only through the continuum of care approach and by putting woman and girls at the center of all our efforts that we can close this gap.

Madame Secretary, your abiding words – I quote, “it takes a village to raise a child;” end of quote – have a special significance for us in Ethiopia. Today, in villages across our country health extension workers are empowering local women peer groups to actively follow up on the health of every mother and child in their communities. We want to build a truly women-centered health system from the bottom up. And so we are linking these village women’s groups to leaders at the district, regional and national levels.

And it’s by mobilizing the entire society in this way that we aim to bring the fundamental transformation needed to end preventable maternal newborn and child health.

A key part of reinforcing accountability at all levels is making all our efforts data driven. At the global level, we now have the Commission on Information and Accountability initiated by the U.N. secretary general as well as the Countdown Group’s country profiles for tracking our progress towards this MDG four and five. These efforts are very crucial, but a number of the key metrics used rely on data that can only be updated through large periodic surveys.

So as we accelerate our progress, we welcome the idea of having a complementary tool to track our progress more regularly by using data routinely gathered through our delivery systems.

In Ethiopia, we have started testing the country score card proposed by this initiative and can see how it can help us to identify and quickly respond to gaps at the local level. Going forward, we should aim to have a simple, practical and harmonized tool for countries to regularly track their progress.

Let me now turn to the vision we have for Ethiopia and how we plan to make it a reality.

Ladies and gentlemen, we have in Ethiopia a grand vision to transform our country into a vibrant middle-income economy by 2025, and our government’s resolve to realizing this vision

is steadfast. This call to action is proposing a bold new goal to reduce under-5 mortality to a global average of 20 per 1,000 live births by 2035. Ethiopia is prepared to take on this big challenge. In fact, we want to get there even faster – not run, by flying. (Laughter.)

We have done some analysis, and even at current rates we expect to exceed on 2015 MDG four targets. With accelerated efforts, we believe we can reduce under-5 mortality to the set target by 2035 – even as I said, faster.

So how do we plan to do this? By systematically tackling all service delivery bottlenecks and aggressively pursuing the key strategic shifts set out in the proposed – in the proposed global roadmap. And we have already started.

First, our geographic focus. We’re now directing special attention to our regions with largely pastoral populations where progress has been modest. We have in place a whole-of-government strategy that provides capacity-building, funding and technical support to those regions across all sectors. At the same time, we’re scaling up best practices in our larger and much more densely-populated regions, with particular attention to the more hard-to-reach communities.

Second, focusing on key interventions and causes. We have already started rollout of evidence-based interventions in four key areas: integrated community case management of leading child illness, skilled child delivery and perinatal care, improved nutrition, and rapid scale up of family planning interventions, which we expect will have a particularly unprecedented impact.

The special Golden Moment Summit on Family Planning, which the U.K. will be hosting next month together with the Gates Foundation and the UNFPA, will call attention to the major impact which expanded contraceptive use can have on MDG four and five.

I want to thank – to take this opportunity to thank Melinda Gates and the Right Honourable Andrew Mitchell, U.K. secretary of state for international development, for his leadership on this and the substantial support we have been receiving from his government on all our health sector priorities in Ethiopia.

Going forward, in Ethiopia we know that our biggest impact will come from defeating three big culprits: pneumonia, diarrhea, and neonatal complications. This brings me to the third decisive shift.

In Ethiopia, neonates now account for 40 percent of our child mortality burden, hence our urgent focus on mothers and newborns. I spoke earlier about our village women’s group. These local leaders are boosting health service utilization, particularly during the critical period from pregnancy to the first minutes after birth. This will really turn things around.

We’re also rapidly expanding access to emergency obstetrics and newborn care, and keeping all districts with ambulances and accelerating training and deployment of thousands of midwives and other health professionals.

Above and beyond these efforts in the health sector are the major transformations we can expect from our rapidly growing economy. Now ranked among the world’s top fastest-growing economies, Ethiopia has registered an annual growth average of about 11 percent over the past seven years.

Ladies and gentlemen – simply put, slow progress is no longer an option in Ethiopia. And our hugest strides in every sector will have major added impacts on health.

Education is key among those. By 2020, we aim to ensure that all girls have secondary level schooling, and by 2015 all villages throughout our country will be connected to an all-weather road. Mobile telephone use in Ethiopia is also expanding fast. It has almost tripled over the last three years and is targeted to reach 40 million by 2015.

Our agriculture transformation plan program will lift millions more out of poverty and significantly improve the livelihoods of our rural populations. At the same time, we are making unprecedented investments to intensify our green energy production, and reaching even half of our targets will dramatically expand access to electricity and further propel all our efforts.

Ladies and gentlemen, all of this of course requires increased investments. Our rapid progress in recent years would not have been possible without the unprecedented flow of international resources for health over the last decade, including the generous support of the United States. We’re profoundly grateful for the continued support of so many partners even in these difficult economic times.

A growing number are now channeling their support to our health sector’s flexible pool funding mechanism which affords us optimal flexibility and cost, effectively allocating resources to our most pressing priorities. And we believe we have been investing these resources prudently by building up our health system and focusing on low-cost, high-impact primary health care interventions. The integrated strategy will be key to sustaining our efforts in the current global economic climate of shrinking budgets and multiple competing priorities.

We’re also working to generate more domestic resources and maximize efficiencies across all sectors. Our government’s budget for health is increasing every year and we’ve beginning to see the economic benefits of a healthier and more productive population.

We’re also preparing to introduce a comprehensive national health insurance system which will help further contain costs and broaden access to a continuum of quality services.

In short, ladies and gentlemen, we believe that Ethiopia can bend the curve on child survival even faster through increased efficiencies, improved quality of services, a growing and better skilled health workforce as well as a better educated healthier and more productive population.

We have said in Ethiopia, enough is enough to poverty and the needless suffering of our people. And given our current trajectory of progress, we know that we are moving in the right direction.

So how best can we move forward with this proposed global roadmap? Ethiopia is committed to do its part to sustaining the momentum. Six months from now, we are proposing to host a follow-up session with African health ministers around the upcoming AU Summit in Addis. And together with UNICEF, we would also like to host the second year follow-up of this forum in Addis in 2014.

In closing, let me add one – one final personal note. The Every Child Deserves a Fifth Birthday campaign planned as part of this initiative made me think of my own daughter, Blen (ph), who just had her fifth birthday three months ago. I’m grateful beyond words for the inestimable gift of a healthy child. I’m grateful also that her birthday, by some amazing providence, it happens to be the same as mine.

Like every father, of course, I find it difficult to imagine that she will be almost 30 in 2035. But what I find far, far more unimaginable is the thought that she and her peers around the globe would inherit from us a world in which millions of mothers and children continue to die of preventable causes. If anything is impossible, it should be that dreadful scenario. I repeat: If anything is impossible, it should be that dreadful scenario.

What I do very much look forward to is telling my daughter Blen (ph) well before her 30th birthday that Ethiopia together with the global community is doing everything humanly possible for all children to have both a healthy mother and a fifth birthday.

I thank you.

 

Ghulam Nabi Azad, Minister of Health and Family Welfare, India

http://www.youtube.com/watch?v=gfmniv7CZoM&feature=relmfu

 

 His Excellency, Mr. Tedros, honorable minister of Ethiopia, your excellencies, ministers from across the globe, Madame Margaret Chan, senior officers, honorable ambassadors, ladies and gentlemen.

At the outset, I would like to thank the U.S. secretary of state, Madame Hillary Clinton, for the warm personnel invitation to represent the government of India in convening a child survival call to action, to raise global awareness on child survival challenges, celebrate the 70 percent reduction in child mortality for the past half century and establish a global roadmap to end the preventable child deaths in a generation.

I would also like to acknowledge the role played by other member partners of the steering committee – from Norway the United Kingdom, Canada, UNICEF, the World Health Organization and the United Nations’ secretary general, and particularly Madame Clinton and Kathleen Sebelius in putting together this initiative with the support health minister of Ethiopia, Mr. Tedros.

Ladies and gentlemen, India is indeed honored to co-convene this global call to action on child survival jointly with the United States of America and Ethiopia.

On this momentous occasion, let me thank government representatives, international agencies, experts, civil society and NGOs for being present today. I’m sure that each one of you is in a unique position to make a difference in the lives of children.

It saddens me that every year more than 7.5 million children around the global die before fifth – before their fifth birthday despite the fact that most of these deaths are preventable with simple and cost-effective interventions. It is time that we rise to the occasion and get into a mission mode with a sense of urgency to prevent such deaths.

Excellencies, for the next two days we’ll reflect on many initiatives that countries are taking to save their children from dying. We’ll share the many lessons that we have learned in the process and decide new ways in which we can move forward to protect and promote children’s right to life.

For India, the challenge is particularly formidable constantly though we are the second most populist country, with one-point billion population in the world. We have the largest annual birth rate 26 million babies.

Due to a wide area of geographical climate and socio-cultural conditions, we have also the additional challenge of dealing with significant sub-national disparities. However, we have been able to make steady progress.

In 1990, when the global under-5 mortality rate was 88 per 1,000 live births, India carried a much higher burden of child mortality at 118 per 1,000 live births. In 2010, we had a child mortality rate that almost equals the global average. Though the annual rate of declining child mortality rate was 2.2 percent during the period 1990 to 2008, it has since registered a sharp decline, reaching 7.8 percent in 2010.

What is also extremely heartening, too, is the fact that the decline in rural India vis-à-vis urban India is now much sharper, and the provinces with high child mortality have shown impressive improvement.

Excellencies, ladies and gentlemen, this remarkable acceleration follows the massive and strategic investment that the Indian government has made under the national rural health mission. Though, health is a state subject in India where the federal government has stepped in to help the state governments in a big way by providing additional funding to the tune of almost $15 billion U.S. dollars since the launch of the mission in 2005-2006.

Reducing child mortality is one of the topmost goals of this mission, which has significantly fostered plans for child health at not just the national level but also at the sub-national and district level.

The flexible need-based financing under the mission has fostered several innovations across our diverse country. Neonatal deaths remain a cause of worry for us as they constitute 52 percent of our under-5 mortality. Therefore, we are paying utmost attention to saving newborn lives by bringing in a new thrust to the continuum of newborn care at both facility and community level.

Besides ensuring essential newborn care, in all institutions where births take place we are establishing state-of-the-art facilities for care of the sick newborn as important prongs of this strategy. Already, 374 special newborn care units, 1,638 stabilization units and 11,432 newborn care units have been set up and many more are being added – since this scheme is hardly a year-and-a-half old, so we are still in the process of setting up more such units at different levels.

At the community level, a new initiative of home-based newborn care has been rolled out throughout the country. More than 800,000 – 860,000 community health workers positioned in each village of the country under the mission are now being additionally trained to undertake home visits to promote improved newborn care practices and detect early signs of danger for prompt referral to institutions for which free to and from transport will be provided. We believe these steps will yield rich dividends.

Excellencies, addressing deaths on account of pneumonia and diarrhea are expanding and strengthening (rectal ?) immunization are also important elements of our strategy.

We are greatly encouraged by our success in polio. In 2009, India accounted for more than half of the global polio cases. In 2010, we’ve made special efforts to reach every child using the innovative Bio-Link vaccine developed in India and achieved more than 99 percent to 100 coverage, including in very difficult to reach polio endemic areas.

The rise in scale can be gauged by the fact that nationwide immunization campaign for polio covers about 174 million children of less than 5 years of age in one single round and about

800 million children annually. More than 2.3 million volunteers participate in this massive national effort with about 150,000 supervisors monitoring quality and coverage of the immunization activity.

As a result of the government’s commitment to do whatever it takes, there has been no poliomyelitis case during the last 17 months now. I am encouraged by this historical public health achievement.

We are now targeting to eliminate measles-related child deaths and have embarked on a special vaccination drive covering more than 135 million children besides introducing second dose of measles in our national immunization program.

In order to expand the school coverage of immunization, particularly in high-focus areas, year 2012 has been declared as the year of intensification of routine immunization by the government of India.

Excellencies, ladies and gentlemen, the challenge of nutrition is being addressed at the highest levels. The prime minister’s nutrition council is working vigorously on the multisectoral plan to improve overall nutritional status particularly of children.

Our efforts to control anemia now encompass adolescent boys and girls in addition to children, pregnant and lactating women. A nationwide program for weekly supplementation of iron and folic acid has recently been initiated. It will cover 130 million adolescents.

Excellencies, I would like to emphasize here that the child cannot be viewed in isolation. Since we all know that safe motherhood is prerequisite for newborn health and that maternal health in turn is impacted by adolescent health, ignoring any one link in this chain can weaken impact and lead to suboptimal outcomes. In recognition of this life cycle approach, we have taken steps to add reproductive sexual health and nutritional needs of our adolescents as means to improve maternal and child health.

Under a unique initiative – probably the first of its kinds, particularly for a county of the size of India – more than 860,000 community health workers are promoting birth spacing in homes through education and door-to-door distribution of contraceptives – both male and female contraceptives. This scheme is a reflection of the commitment of the government of India to provide universal access to family planning communities and services free of cost.

Excellencies, we have had a major success in promoting institutional births with the launch of innovative scheme of providing cash assistance to pregnant women delivering in public health facilities.

Under this scheme, the number of women chosen to access – the number of the pregnant women, as a matter of fact, choosing to access to deliver in public health institutions at primary, community, district and tertiary hospitals rose from 700,000 in 2005-2006 to around 11 million in 2010 and 2011.

Building on the fundamental progress of the safe motherhood scheme, we have added another major intervention in 2011 to eliminate totally out-of-the-pocket expenses for both pregnant women and sick neonates.

Under this new scheme, every pregnant woman is now entitled to absolutely free delivery in public health institutions. Should a pregnant woman choose to access a public health institution for delivery, she’s provided free transport to the facility and brought back. Besides the free antenatal and postnatal checkups, this new scheme provides for free diagnosis, free consumables, free medicines, free food during hospital stay, and free cesarean section, and free blood if required. Similar entitlements are also available to the sick newborn up to 30 days after birth.

Excellencies, ladies and gentlemen, public spending on health in India is increasing at a pace not witnessed before, with utmost emphasis being laid on health system standard.

Large-scale creation of physical infrastructure, major augmentation of human resources at all levels, assured drugs, supplies of logistics, mobile medical units to take health service to remotest areas and mainstreaming of Indian system of medicines are among key achievements under the nation’s rural health mission.

Following these investments, greater accountability for results is now a key priority. One example is the name, telephone and address-based mother and child tracking system which has been put in place to ensure and monitor timely delivery of full complement of services to pregnant women and children, including immunization. As of now, 30 million pregnant women and children are already registered in the web-enabled system and are being closely monitored by the federal ministry, government of India. Our goal is to reach every woman, every child.

Excellencies, vaccines and drugs manufactured in India have had a far reaching impact not only improving the global access, on life-saving interventions, but also on dramatically reducing the cost by making high-quality drugs and vaccines highly affordable.

It is a matter of great pride and satisfaction that two out of every three children in the world receive an Indian vaccine in the case of measles and DPT. Meningococcal vaccine produced in India has saved many lives in Africa that are the most affordable cost of merely 50 cents. In many developing and developed countries, antiviral HIV drugs supplied by India have transformed the quality of lives of millions of people living with HIV/AIDS. Women and children facing the suffering of TB from across the globe have been benefited greatly and anti-TB drugs made in India.

Excellencies, ladies and gentlemen; today, in this August gathering I would like to assure you that India shall remain in the forefront of the global war against child mortality. India shall raise global awareness of child survival challenge and strategies; shall assess in preparing a global roadmap to end preventable child deaths in a generation; shall do its utmost to reduce maternal and child mortality and morbidity; shall focus on special requirements of vulnerable and marginalized groups, particularly children; and shall give an urgent priority to convergence of health and child services under universal health coverage.

I will personally be advocating this worthy cause at all fora including the upcoming BRICS conference being held at New Delhi in 2012. For – (inaudible) – of the Partners of Population Development, an alliance of 25 countries, India will strive for increase also cooperation on child survival as well.

Let me once again, excellencies, ladies and gentlemen, thank you for this opportunity to renew India’s commitment to child survival. I thank you.

Dr Muhammad Ali Pate, Health Minister, Nigeria

http://www.youtube.com/watch?v=rgE0zgmEIqM&feature=youtu.be

 

 Good afternoon. Let me first thank the organizers for giving us the opportunity to share what we are doing in Nigeria. And what I’m going to discuss is an achievable goal that we believe is possible in Nigeria, to save a million lives. And I don’t have bigger projector, but I believe some of you who are close to the podium might be able to follow the discussion.

Now, I will share with you – OK, now, let’s see. OK, I’ll share with you approach, giving you a case study of what we have started to do and how we would like to partner with all willing partners in Nigeria to achieve that achievable goal of saving 1 million lives in our country. OK, sorry, the technology is failing me here.

But this is our country, a country of 36 states, federal capital territory and 167 million people. The diversity within this country in terms of health outcomes is significant. It reminds me of the physician who went into the ward and asked for the average temperature of the patients in the ward. Now, in our country, the health outcomes are also equally diverse in terms of geographical areas, rural/urban, socioeconomic areas within the country.

And the health system challenges that we face in terms of the poor outcomes, poor maternal health outcomes – although it’s improving – we’ve got 545 per hundred thousand maternal deaths per year according to 2008 demographic and health survey. That’s the true situation of the problem as of 2008, infant mortality of 75 per thousand live births, which is also according to the DHS of 2008.

We’ve got child mortality ratio of 157 per thousand live births, which is roughly 10 percent of the global total. And we’ve got in terms of health system infrastructure almost 23,000 health facilities all over Nigeria, of which 14,000 are primary health care facilities located in rural areas.

The supply challenges that we have include the infrastructure that has evaporated over time, commodity stock outs and equipment inadequacies. This is the reality that we have in our country. And demand for critical services is weak.

For example, only 38 percent of our women have skilled births and 58 percent attend antenatal care. Specifically, in order to meet the MDG, Nigeria needs to accelerate its progress in reducing under 5 (year old) mortality rate by 13 percent per year. That’s the under 5 (year old) mortality rate to achieve the MDG goal four.

At the moment, from the slide that we have there which is copied from The Economist, we’re achieving at 4.8 percent annual reduction in terms of under 5 (year old) mortality in Nigeria. Although we are achieving this, we need to significantly accelerate the progress that we have in achieving the mortality reduction in our country.

In summary, even though we’ve actually the most fairly consistent reduction in child mortality over the last few years, the current trajectory challenges us to achieve the MDGs by 2015. It’s almost impossible. But we do believe that the path we are taking, the curve like was mentioned by Mr. Tedros, can be altered. The majority of the causes of child mortality are preventable and easily managed.

However, several factors, including poor access to essential primary health care services, remain a challenge. The government of Nigeria has made a significant stride in tackling this problem politically as well as financially. However, there’s an opportunity to rapidly reduce newborn and under 5 (year old) mortality by fully implementing key high impact evidence-based interventions.

What have we done? As government, the government of Nigeria has initiated some interventions as we observe our own commitment to achieving the MDG goals. First, the essential medicines scale-up plan, a national scale-up plan for essential medicines was recently developed and fully endorsed by the government and partners focusing on the leading causes of under 5 (year old) deaths: pneumonia, diarrhea and malaria using ACT’s – (inaudible) – for diarrhea and antibiotics for pneumonia.

If fully scaled up, this will save estimated 221,000 lives by 2013 – by the end of 2013, and an additional 500,000 lives by 2015. Second area is long-lasting insecticide-treated nets. The LLINs began to be distributed in 2009 and as of 2012 April, 46 million nets have been distributed in 36 states of our federation. The demonstrable impact on child mortality is estimated that 178,000 child lives have been saved by this intervention.

And collaboration with private sector players is beginning to be galvanized in cooperation with the MDG Health Alliance. We have established our own domestic private sector health alliance in collaboration with our key corporate leaders in Nigeria. Immunization is another area. Although – (inaudible) – has mentioned area, I will not dwell on that.

Routine immunization has gone from 42 percent to 67 percent. Measles immunization has been fully integrated into the primary health care services, reaching almost 70 percent of coverage in 2010 under routine immunization system. And an introduction of new vaccine, the pentavalent vaccine with support of GAVI which was introduced in the last one week protect our children against haemophilus influenza alongside the other antigens in the pentavalent vaccine.

And plans are underway for pneumococcal vaccine to be introduced in 2013. The government has already paid up its counterpart contribution for all these vaccines. Nutrition – the committee to manage nutrition was started in two states in 2009 and has been scaled up to 11 states and 67 local governments by 2011.

And annual admissions have increased from 6,900 in 2009 to 44,000 in 2010 and 141,000 children in 2011 with a cure rate of 61 percent. We have also introduce biannual maternal newborn and child health weeks which deliver high impact, low cost interventions targeted to newborns, under 5 (year old) children, breastfeeding mothers and women of reproductive age in conformity with the continuum of care approach.

Then finally, we started a program which is the midwifery service scheme which is one of the largest public sector-led human resources for health intervention schemes in Africa. We’ve deployed 4,000 midwives in a thousand primary health care centers all over rural Nigeria

in all the states. But going forward, we are anchoring our efforts on a target to save a million lives mostly through enhancing access to basic primary health care interventions.

The pillars of this effort are the maternal newborn and child health interventions, the elimination of mother-to-child transmission, strengthened routine immunization, scaling up of the essential medicines as well as other interventions.

We will strengthen our primary health care system through human resource deployment to the front lines, performance management, improving the quality of care and ensuring availability of medicines and supplies as well as generating demand. This is going to be revitalizing our primary health care system.

The PHCs, which are the front line – the retail outlets, so to speak, of health care service in our country will provide a strong platform and existing vertical programs can then build on it and integrate within that context.

The engine of this train that we’ve demonstrated here has the human resources, which is the front-line health workers, village health workers, community health workers, midwives, nurses and doctors in health facilities in the rural areas, the infrastructure and equipment, the quality aspect which includes the patients’ safety and other aspects of the quality of care and the supply chain.

And then the programmatic aspects, the incidence of care, skilled birth attendance, postnatal family planning, PMT and immunization as a first coach of this maternal and child health training. Other interventions can ride on the back of this platform, like the HIV/AIDS interventions, the malaria, tuberculosis, ORS and zinc as well as antibiotics for pneumonia. We aspire to scale up to 3,000 modern primary health care centers that deliver outstanding primary health care.

At the moment, we have a thousand primary health care centers which were built basically and refurbished, deployed with human resources from 2009 to 2011. Our goal is to get to 3,000. And by 2015, we expect that at least 3,000 subset of the primary health care centers will be staffed, upgraded and resourced to deliver quality basic services to millions of Nigerians.

Eight thousand trained midwives should be deployed. Four thousand trained community health workers and 12,000 village health workers promoting material and neonatal health in the villages will be staffing those facilities. We expect to upgrade the infrastructure, provide equipment such as very adapted to the rural context and to have adequate supplies of commodities and to ensure that this quality program, that the standards of care that are being offered in those facilities are actually those that will save lives.

On our demand side, we expect and are already finding additional cash transfer system built on what has been done in India and other countries like Mexico to see how we can incentivize mothers to attend facilities, to attend and have scalable attendance. I give you an example of what we did in the midwifery service scheme which I mentioned in terms of reduction of maternal outcomes.

We’ve reduced over the two-year period of the midwifery service scheme maternal mortality has gone down by 26 percent. Neonatal mortality in areas where this scheme has been implemented by 22 percent and focus A&C attendance has increased by 22 percent while skilled birth attendance has increased by 33 percent in those particular facilities. This is a scheme that we are expanding as a way of scaling up access to basic services and saving the million lives.

And additional resources have been mobilized under the subsidy investment program to build on the impact of the midwifery service scheme through both supply side as well as demand side interventions along the continuum of care. So on the supply side inputs, I’ve mentioned them. And on the demand side, it’s mostly in the conditional cash transfer side of the equation. And this gives you a sense of the targets we have.

I’m running out of time. So I’m not going to go through them. But I’ve already discussed the deployments that we will have over the period to come. But the model is a hub-and-spoke model whereby rural facilities are selected around general hospitals with a referral system between them with acute facilities and trained human resources to deliver services to the population.

So in terms of the approach to partnership, obviously we cannot achieve this as a government alone. We need a coalition of willing partners to join hand with us in country to manifest this ambition of saving a million lives. And that coalition of partners comprises both public as well as private sector players.

We need to have a multisector collaboration, a good understanding of the local context which government not only at the federal level but also at the subnational level actually have with clear accountability mechanisms to ensure that what we commit to we actually delivering on those commitments together.

And I present to you here a pictorial of the coalition which is both public as well as private sector coalition that we have in the country to achieve this objective. In essence, to save the lives that we anticipate we will, will take a coalition and a social movement, so to speak, that will galvanize the country towards reduction of child morbidity and mortality alongside the mothers also of those children.

So we are very committed to this effort. And I want to thank you once again for giving us the opportunity to share this vision that we have. (Applause.) Thank you.