The multi facet of Equity Geography Caste Education Ethnicity Tribe Citizenstatus Religion Migration Gender Disability Location Age
Mapping inequity in South Asia Percentage of women age 20-24 married by age 18
Antenatal coverage % women 15-49
Underweight prevalence moderate and severe
Child Protection – Girls education – Out of School - WASH - ECD Pre Pregnancy Antenatal care Will not use ANC service in next pregnancy Childbirth care Postnatal and newborn care Women will not opt for skilled birth attendance Early child marriage being prevalent in most deprived groups forces adolescents into pregnancy Most deprived pregnant women do not utilize ANC services Women will not bring their newborns for post- natal visit Newborn will not be breastfed. No “skin to skin” contact Lack of human resources or lack of quality of care or no access Those who opt for SBA find poor services Endangers deprived Mother’s and Newborn’s lives Subsequent accumulation of a cascade of bottlenecks
Maulana Khalid Rasheed Islamic Centre of India Maulana Mahmood Madni Jamait Ulema-e-Hind Yasin Usmani All India Milli Council MuftMahboob Ali All India Muslim Personal Law Board Khawja Sani Nizami Why success? Uttar Pradesh- India Polio Cases 2009 UNICEF SM Net COVERED BLOCK - 53 CORE COVERED BLOCKS - 13 Political commitment Communication & Social mobilization Routine Immunization & Diarrhea control C.M. of Uttar Pradesh Ms. Mayawati Water & Sanitation Nutrition
Stagnating Diarrhea Bangladesh India Indonesia Nepal Thailand Myanmar
Stagnating Pneumonia India Indonesia Bangladesh Nepal Myanmar Thailand
Stagnating Neonatal mortality Globally: 41% of all U5 deaths take place in the neonatal period One of the most important single causes are preterm birth complications (12%) Source: Black et al. The Lancet 2010
Continuum of care in SA and SEA (UNICEF regions) 1000 days window of opportunity & worse coverage Pre Pregnancy Pregnancy Postnatal Early Childhood Source SOWC 2011
QUALITY OF CARE IS NEEDED TO CREATE DEMAND Strategies across the continuum of care Antenatal care Childbirth care Postnatal and newborn care • Commodities • Human resources • Accessibility SUPPLY SIDE • Utilization • (e.g. 1 ANC visit) • Continued utilization • (e.g. 4 ANC visits) DEMAND SIDE
Strategies across the continuum of care Antenatal care Childbirth care Postnatal and newborn care WE NEED TO THINK BEYOND THE “SUPPLY SIDE” AND ASK OURSELVES WHY BENEFICIARIES DO SOMETIMES NOT USE SERVICES ALSO WE NEED TO CONSIDER COMMUNITY BASED INTERVENTIONS for ANC and PNC WHERE IS ENOUGH THE EVIDENCE THAT THIS APPROACH WORKS?
Supply to match: services & delivery Demand Creation Communication Quality & sustainability
Addressing causes of stunting Steps 4-6: Identify bottlenecks, analyse causes and correct actions Community participation / dialogue; Strengthened partnerships btw community & services; Refresher training of CHW; performance incentives for quality IPC / counseling on feeding practices to most deprived mothers and monitoring General Food Distribution to targeted deprived districts Supply Bottlenecks 40% difference in food security Demand bottlenecks Utilisation limited by food availability & additional continuity and quality bottlenecks 80% 72% 63% 59% 54% 43% Similar accessibility to CHW & education HYGIENE AND SANITATION Source Bangladesh, Nepal, Pakistan
Beyond MDGs: challenges and way forward • Maintain focus on unfinished agenda and coping with competitive environment • Decentralization process • Urbanization • Adolescent- Youth bulge • Non Communicable disease • Climate change and emergencies of un-precedent scale • Working cross sectors: Nutrition, Education, Protection and Social policy
To the last child in Asia & Pacific Rukhsar. The last case in India.