Strategies for Ending Preventable Newborn Deaths: Target Setting for 2035

1. Lily Kak, USAID GhazalehSamandari, KMS On behalf of the ENAP Core Team Asia Regional Meeting Kathmandu, Sept 1, 2013 Target-Setting Ending preventable newborn deaths

2. Outline Recall global consensus on Millennium Development Goal and A Promise Renewed to end preventable child deaths Consider options to recommend targets for the Every NewbornAction Plan to end preventable newborn deaths

3. Millennium Development Goal 4 Reduce under-five mortality by two-thirds Relative Target: 66% reduction

5. Accelerating progress on child survival – what can the world achieve if countries increase their annual rate of reduction? Under-5 deaths millions 13 Under-five deaths 1990-2070 (actual and projected) 12 9.6 mm deaths in 2000 11 10 7.6 mm deaths in 2010 9 8 • Current trajectory: ARR 2.5% • MDG 4 achieved in 2035 • 4 million deaths annually in 2035 7 • ARR 5.2% • 2 million deaths annually by 2035 • Every country reaches 20/1000 by 2035 • Many countries below 15/1000 by then • ARR 12.6% • Achieve MDG 4 • Reach 2 million child deaths annually in 2020 • Achieve average of U5MR 15/1000 by 2020 6 5 4 3 Achieve MDG 4 2 1 0 Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

6. Target-Setting “Every Newborn” Action Plan

7. A Promise Renewed Target for U5MAbsolute target of 20 by 2035 Mortality rate (per 1,000 live births) • U5M current trajectory: ARR 2.5% • MDG 4 achieved in 2035 • 4 million deaths annually in 2035 9.6 mm deaths in 2000 • U5M ARR 5.2% • 2 million deaths by 2035 • Every country reaches 20/1000 • Many countries below 15/1000 6 m deaths in 2011 MDG 4 U5M 20 NMR current trajectory of ARR 2.2% Absolute target : U5MR 20 by 2035 Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

8. Option1: Absolute Target Source: The UN Inter-agency Group for Child Mortality Estimation

9. Every Newborn target by 2035 Option 1: Absolutetarget NMR 5? 9? 10?

10. Example: Absolute target of NMR 5? some regions will have to work much harder than others Africa & S. Asia require an ARR of over 7% Newborn mortality rate (per 1,000 live births) OECD Upper Limit (Turkey) : NMR 9 Source: The UN Inter-agency Group for Child Mortality Estimation

11. Example: Absolute target of NMR 9? some regions will have to work much harder than others Africa & S. Asia require an ARR of over 5% Sub-Saharan Africa South Asia Newborn mortality rate (per 1,000 live births) Middle East/ North Africa CEE/CIS East Asia/ Pacifica Latin America/ Caribbean 9 Source: The UN Inter-agency Group for Child Mortality Estimation

12. Option 2: Relative Target

13. Every Newborn target by 2035 Every Newborn target by 2035 Option 2: Relative Reductionof NMR by 66% or 75% Option 2: Relative target 66% reduction? 75% reduction? NMR

14. Example: Relative target of 66% reduction from 2011 All regions require an ARR of 4.4% Sub-Saharan Africa South Asia Inequity across regions Middle East/ North Africa CEE/CIS East Asia/ Pacifica NMR Latin America/ Caribbean Africa 13.5 12.1 Asia 2.9 LAC

15. Example: Relative target of 75% reduction from 2011 All regions require an ARR of 5.6% Sub-Saharan Africa South Asia Inequity across regions Middle East/ North Africa CEE/CIS East Asia/ Pacifica Latin America/ Caribbean NMR Africa 8.6 Asia 8.1 2.8 LAC

16. Target-Setting: What do you recommend? • 1. What is the most important issue for you: • A global target that aims at achieving equity across all countries, even if some countries have to work harder (absolute)? • A global target that aims at feasibility based on country’s capacity, but resulting in inequity across regions (relative)? • 2. Would you recommend additional targets: • Intermediate mortality targets (every five years)? • Coverage targets for high impact interventions?

18. Example: Absolute target of NMR 5? Newborn mortality rate (per 1,000 live births) OECD Upper Limit (Turkey) : NMR 9 Source: The UN Inter-agency Group for Child Mortality Estimation

19. Example: Absolute target of NMR 9? Newborn mortality rate (per 1,000 live births)

20. Example: Relative target of 66% reduction from 2011 All countries require an ARR of 4.4% Newborn mortality rate (per 1,000 live births)

21. Example: Relative target of 75% reduction from 2011 All regions require an ARR of 5.6% Newborn mortality rate (per 1,000 live births)

22. Relative Target

23. Absolute Target