Bottlenecks, barriers, and solutions: Results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths - Dr. Shamim A Qazi
- 1. Childhood Pneumonia and Diarrhoea 3 Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion McNabb, Samira Aboubaker, Shamim Qazi and Zulfiqar A Bhutta
- 2. “Why are so many children still dying of preventable conditions, and how do we move forward?”
- 3. Specific Objectives 1. Identify key barriers to implementation of programmes targeting pneumonia/diarrheoa 2. Identify key bottlenecks impeding access to essential commodities – Diarrheoa: vaccines, zinc, ORS, – Pneumonia: vaccines, oral amoxicillin 1. Propose solutions to those barriers
- 4. Methods • A series of consultations with > 600 key stakeholders in 2010-12 • 3 work streams provided data for 39 Asian & African countries 1. Global Action Plan for Pneumonia (GAPP) – Led by WHO/UNICEF – Broad focus on programmatic barriers/solutions 1. Diarrheoa Global Action Plan (DGAP) – Led by Aga Khan University – Focus on programmatic barriers/solutions & 7 country case studies 1. Diarrheoa and Pneumonia Working Group (DPWG) – Led by UNICEF and CHAI – Focus on supporting scale up treatment in high burden countries.
- 5. Bottlenecks impeding access to vaccines Concentrated upstream •Policy guidelines •Resources Legend None Darker colorsconnote more significant bottlenecks Minor Moderate Major
- 6. Bottlenecks impeding access to zinc and ORS are concentrated ‘downstream’ zinc ORS
- 7. The Market Trap: Why zinc is so expensive in Nigeria
- 8. Prioritization of the Barriers
- 9. Inadequate monitoring and assessment • Data not of high quality and not analyzed properly • Data often not shared with those that need it most • Data not widely disseminated Result: Programmes are unaware of their progress Recommendation: Improve the quality and establish mechanism for sharing and using data for action
- 10. Poor coordination of efforts • Between programmes, across partners and sectors • Duplication of efforts • Failure to optimize available resources • Conflicting priorities Result: Fragmented efforts dilute effectiveness & efficiency Recommendation: Evidence based planning and management, joint development of plans and strategies for action
- 11. Inadequate human resources • Not enough health workers • Low incentives for recruitment and retention • Limited capacity building opportunities • Inadequate supervision and skills reinforcement Result: Chronic shortages of the skilled and motivated workers Recommendation: Explore and implement innovative ways for capacity building, motivation & supervision
- 12. Weak supply chain • Over-reliance on central supply systems • Supply not linked to need • Inefficient stock/restock systems • Limited local production of essential commodities Result: limited access to life saving commodities Recommendation: Strengthen systems for procurement and drug supply management and production of key commodities
- 13. Quality of care • Evidence based standards of care not always available • Access to care limited • Low uptake due to poor quality Result: Children die of preventable and treatable conditions Recommendation: Client feedback as part of health worker and clinic assessment; dissemination of guidelines
- 14. This is a solvable problem: The Bangladesh Story
- 15. The way forward
- 16. Conclusions • We can drastically reduce child mortality with tools already at hand – Solutions are affordable and not high tech • The ingredients of success start with – Coordinated action plan – Resources commensurate with the burden of disease – Accountability for results – Advocacy