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Child survival and development

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Accelerated child survival and development (ACSD):  strengths and challenges

UNICEF, in collaboration with national governments, is supporting the active implementation of the Accelerated Child Survival and Development  programme to reduce infant, under-five and maternal mortality in West and Central Africa. The  programme currently focuses on more than 16 million people in selected districts in 11 countries in West and Central Africa that have high under-five mortality rates.

A focus on advocacy to revise national health policies and strategies

Innovative interventions such as the Intermittent Presumptive Treatment against malaria for pregnant women, or community management of pneumonia, will be introduced through operational research in select districts, and in collaboration with World Health Organization (WHO) Tropical Disease Research and various other partners.

Activities complementary to ongoing health sector reform initiatives

Local government Ministry of Health representatives at district, regional and national levels have been actively involved in implementation. In the four high-impact package countries, the programme is increasingly being integrated into the Poverty Reduction Strategies and the Medium Term Expenditure Frameworks to improve the financing of health interventions and to increase staff motivation at health facilities.An innovative convergence of interventions

An innovative convergence of interventions

Based on preliminary data presented by district health teams in Ghana, the integrated approach, which includes Immunization Plus, infant and young child feeding, Integrated Management of Childhood Illness plus and ANC plus, is already having a positive impact on routine immunization coverage. Subsidized bednets are being distributed in conjunction with immunization plus activities. Similarly, in Senegal, routine monitoring is also demonstrating a significant increase in immunization coverage in selected districts.

Strong national- and district-level ownership

Each of the 11 countries implementing the programme has finalized their plan of action for accelerating child survival and development within identified districts. The regional plans outlining project objectives, identifying indicators to monitor progress, expanding on operational strategies for implementation and underscoring the foreseeable bottlenecks have been completed.

Active promotion of a family- and community-oriented approach

The programme is considered a behaviour-centred programme as the majority of interventions promote changed behaviours such as utilization of treated bednets by target populations, re-treatment of nets with insecticide every six months, and promotion of hygiene, breastfeeding and complementary feeding. As a result, a communication strategy on strengthening community capacity to promote healthy behaviours is a critical part of programming efforts.

Community-based activities

Mali has adopted a dynamic, participatory, village approach in the selected ACSD districts. Problems and constraints are collectively identified and a needs assessment is carried out. Solutions to address the identified problems are discussed and implemented in the context of health, nutrition, water and sanitation. 

Ghana has undertaken a strategy drawing on the service delivery provided by a variety of community-based volunteer teams. Together, these teams work to strengthen the interface with communities, including social mobilization activities. Some examples of the different teams involved are the community weighing team, which targets children under three years; the community-based surveillance teams; the mother-to-mother support groups; and the water, hygiene and sanitation teams. 

Senegal is implementing activities through a de-centralized, multi-sectoral framework approach. The key components of this approach are the reinforcement of local capacities, de-centralization of activities, and community-based surveillance and follow-up.

Benin's community-based initiatives are focused on anchoring a partnership with a variety of community organizations, in particular women's groups, as they facilitate a key point of entry into a community. As the key caregivers in communities, women play a critical role in the promoting the knowledge, care and treatment of childhood illness.  

Strengthening the supplies procurement process

UNICEF's strategy for distributing insecticide-treated nets is to use pre-treated nets with re-dipping campaigns to treat these and existing nets. In 2003, more than 2.6 million bed nets were required for programme implementation activities. Just over 2 million of this total was for Benin, Ghana, Mali and Senegal, the four high-impact package countries. 

Advances in monitoring and evaluation

In close collaboration with the US Centers for Disease Control and Prevention (CDC) , UNICEF has developed indicators for monitoring progress in programme implementation. Routine monitoring (including community-based monitoring) is being reinforced in active implementation districts while coverage surveys. Impact surveys will be conducted following two years of full implementation of the high-impact package in selected districts.

Challenges

Bottlenecks in implementation have included the timely delivery of supplies, especially insecticide-treated bednets . In response, UNICEF developed a key model to forecast the requirements for treated nets and insecticide. UNICEF's Supply Division, programme partners, and other UNICEF regions are also using the central components of this model to facilitate overall planning and procurement of treated nets and insecticides. 

UNICEF continues to work closely with the private sector. In fact, for this programme, UNICEF worked to secure bids for a bulk purchase order of treated nets and insecticides.  This is expected to speed up the supply process and to significantly reduce prices. Commodity price reduction is often attributable to aggressive public procurement coupled with donor funding and widespread political commitment. 

Along with promoting availability and utilization of supplies and appropriate service delivery mechanisms (both fixed and outreach), a key goal is to ensure that there is a sufficient number of staff and volunteers in place in hard-to-reach districts. This ensures that these people have the access necessary to ensure continuity in service delivery and of access to key interventions. Active outreach and mobile strategies are essential to reaching the most remote areas.