Remarks of Ann M. Veneman, UNICEF Executive Director to WHA
58th World Health Assembly
16 May 2005 - Geneva, Switzerland
Ann M. Veneman, UNICEF Executive Director:
Dr. Lee, Excellencies, Distinguished Colleagues:
Thank you very much for the warm welcome. Dr. Lee, my thanks for your kind invitation.
I am pleased to share the stage with President Gayoom and Mr. Gates.
Your partnership and commitment to public health, especially among the world’s most vulnerable, are essential to our ultimate success.
Twenty-five years ago, one of my predecessors at UNICEF and one of Dr. Lee’s predecessors at the World Health Organization provided leadership in what was known as the first child survival revolution.
They envisioned a world where oral re-hydration salts were widely available, and 80 percent of the children received basic immunization.
To a large degree, their vision was fulfilled.
But in some places, it was not sustained, and in others it reached a plateau and stagnated.
Today we have our own vision to realize.
The Millennium Development Goals provide a strategic plan, but it is up to us to ensure success.
There are still nearly 11 million children who die every year of preventable causes. Almost always they are the poorest and most marginalized.
In the two weeks I have been at UNICEF, I have heard lots of numbers, but that one … 11 million … stands out.
So do two others:
The first is “10” … because 10 is how many years we have to fulfill the promise of the Millennium Declaration and the Millennium Development Goals.
The second is “1 million” Because in relatively short order we can start saving 1 million children every single year from dying before the age of 5 in sub-Saharan Africa alone.
The task before us is daunting, but I come here today to say that remarkable results can be achieved.
They can be achieved by starting with sound science, and using an integrated approach to target the most effective interventions.
I would return to sub-Saharan Africa as an example, because we simply cannot achieve the Millennium Development Goals without making substantial progress there.
In the case of the fourth Millennium Goal – child survival –
sub-Saharan Africa faces the greatest challenges.
There have been some notable successes at country level, but over the past 15 years, this region on average has lost ground in keeping children alive and healthy.
In fact, while sub-Saharan Africa has only about 12 percent of the world’s population, the region accounts for 42 percent of all deaths under age five around the world.
The health threats to children are much like a dam, we plug one leak only to find that another one springs up.
We must address the entire structure of this dam.
A few years ago, the Government of Canada came to UNICEF with a challenge:
For $30 million, design a project in several African nations that will reduce child mortality by at least 15 percent, at a cost of less than $1,000 per life saved.
With those goals in mind, UNICEF developed and piloted an accelerated approach to saving children’s lives in
11 African countries, including Mali, Senegal, Benin, Ghana, Guinea Bissau, Chad, Guinea Conakry, Burkina Faso, Niger, Gambia and Cameroon.
The program relied on three specific packages of high-impact interventions … and three different delivery methods.
The first package involved Integrated Management of Childhood Illness, or IMCI, a joint strategy with the World Health Organization.
IMCI addresses the most common life-threatening conditions, such as diarrhea, acute respiratory infections and malaria, through prevention and early treatment.
The second package involves ante-natal care for mothers, and includes measures such as tetanus immunization and presumptive treatment against malaria.
And the third is an immunization plus package that includes DPT3 and measles, as well as distribution of vitamin A.
These interventions were delivered in three settings:
At health centers, where the integrated management of child illnesses and immunization were conducted.
Through community outreach services, linking immunization with other interventions such as distribution of bed nets and vitamin A supplements.
And through improvement of parenting practices at the household level.
This included teaching health skills, such as how to re-hydrate children with diarrhea, exclusive breastfeeding, and the management of pneumonia and malaria in community settings.
What really contributed to the success of the project was its implementation.
The strategy included performance contracts that were negotiated at the local level with all the key players, and which were based on the accountability of each player delivering specific results.
Partners at community level conducted rolling monitoring of
so-called “tracer interventions,” such as distribution and treatment of bed nets and immunization coverage.
This helped to identify bottlenecks such as inadequate access, low demand or insufficient compliance, so that we could determine what was working and where to target the improvements.
The early results of this initiative – just finalized last week after months of review – are very encouraging.
In fact, they exceed the benchmarks that were established at the outset of this project.
We can report that in just three years, the dramatically increased coverage of these high-impact interventions is estimated to reduce child deaths by 20 percent across a range of countries and settings.
The sound science contained in the recent Lancet papers predicts the effectiveness of this type of integrated approach.
The program – which now covers a population of 17 million children and women and is estimated to save nearly
18,000 child lives per year – shows us how it can work on the ground.
By integrating and bundling a limited range of high impact interventions over a compact period we can get important results very quickly.
The total additional cost of this effort amounted to about $500 per life saved.
So for a relatively modest investment, the return in terms of human potential can be vast.
Importantly, this approach has now been adopted by countries like Ghana and Mali as a major pillar of their national health strategies.
We offer our gratitude and thanks to the Government of Canada for its vision, leadership and support of this program, and to the countries of West and Central Africa whose commitment has made these results possible.
Countries around the world are demonstrating that progress in reducing child mortality is all about such leadership.
In Madagascar, India, Cambodia and many other countries, leadership is making the difference between lives lost … and lives saved.
One striking lesson of the West Africa initiative is that it was implemented precisely in districts that were the hardest to reach, often with the highest rates of mortality.
Perhaps even more importantly, the program has been easily expanded and replicated, meaning it is not just another pilot, but a start to something much bigger.
We believe that we can reach 60 percent of children across
sub-Saharan Africa by 2009 with these integrated community-based interventions.
It is estimated that doing so would save the lives of an additional 1 million children every year, in that region alone.
It will cost an additional $500 million per year, or about a dollar per capita across the region.
And if we add other breakthrough tools, such as inexpensive antibiotics, we can save even more lives in a region where HIV/AIDS is a major factor in child survival.
At a cost of just 3 U.S. cents a day, one particular antibiotic has been shown to reduce mortality in HIV-infected children by as much as 43 percent.
These are the fundamental measures that we know will improve child survival.
I personally believe that alongside this basic package of interventions, we can do much more in the next 10 years to expand access to safe water and provide better nutrition.
Every day, 4,000 children die of water-related diseases, diseases that are preventable.
And malnutrition shares the blame for about half of the nearly 11 million children who die needlessly every year.
Through the tireless work of organizations like the Gates Foundation and others, we are finding creative and innovative approaches – and the resources to achieve the results.
Mr. Gates, we are grateful for your enormous support.
UNICEF applauds the commitment of all of those involved in child survival, including the World Health Organization, governments, NGOs, private partners and health experts.
Your enthusiasm … and your focus not only on threats but on solutions ... are critical if we are to succeed.
There are just 10 years left in which to achieve the ambitious promise of the Millennium Development Goals.
When it comes to child survival and public health, we have seen what it takes to make progress. We have seen the interventions in action. And we have seen a growing focus on these issues around the world.
Our aim must be to help ensure that children are not just surviving, but thriving.
Ladies and Gentlemen, we can see success, just ahead of us.
Our task now is to reach out and grasp it, in hand.
Thank you very much.