Coming to the MDGs Proof on High Effect Intercessions.

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Coming to the MDGs Proof on High Effect Mediations Agnes Soucat, World Bank and Netsanet Walelign, UNICEF Kigali June 23-27 What are we doing here today ? Progress towards MDGs: insufficient Pattern in Less than Five Passings, 1960-2015 (Millions passings every year) Development is insufficient
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Coming to the MDGs Evidence on High Impact Interventions-Agnes Soucat, World Bank and Netsanet Walelign, UNICEF Kigali June 23-27

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Why are we here today ?

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Progress towards MDGs: deficient Trend in Under-Five Deaths, 1960-2015 (Millions passings every year)

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Growth is insufficient Sources: World Bank 2003a, Devarajan 2002. Notes: Average yearly development rates of GDP per capita expected are: EAP 5.4; ECA 3.6; LAC 1.8; MENA 1.4; SA 3.8; AFR 1.2. Versatility expected in the middle of development and neediness is –1.5; essential culmination is 0.62; under-5 mortality is –0.48.

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Yet we realize that a few mediations are very viable

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Most mortality causes still avoidable with ease intercessions

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Insecticide Treated Mosquito Nets Safe water frameworks Use of sterile latrins Hand washing by mother Indoor Residual Spraying (IRS) Clean conveyance and line mind Early breastfeeding and temperature administration Universal additional group based consideration of LBW babies Breastfeeding Complementary bolstering Therapeutic Feeding Oral Rehydration Therapy Zinc for looseness of the bowels administration Vitamin A - Treatment for measles Chloroquine for jungle fever (P.vivax) Artemisinin-based Combination Therapy Antibiotics for U5 pneumonia Community based administration of neonatal sepsis Household and group level interventions(1)

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Family arranging HPV inoculation Preconceptual folate supplementation Tetanus toxoid Deworming in pregnancy Detection and treatment of asymptomatic bacteriuria Treatment of syphilis in pregnancy Prevention and treatment of iron lack sickliness in pregnancy Intermittent preventive treatment (IPTp) for intestinal sickness in pregnancy Balanced protein vitality supplements for pregnant ladies Supplementation in pregnancy with multi-micronutrients PMTCT VCT Cotrimoxazole prophylaxis for HIV+ Measles vaccination BCG inoculation OPV vaccination DPT inoculation Hib inoculation Hepatitis B vaccination Yellow fever inoculation Meningitis vaccination Pneumococcal vaccination Rotavirus vaccination Neonatal Vitamin A supplementation Vitamin A - supplementation Zinc preventive Population situated intercessions (2)

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Skilled went to conveyance Basic crisis obstetric consideration (B-EOC) Resuscitation of asphyctic infants during childbirth Antenatal steroids for preterm work Antibiotics for Preterm/Prelabour Rupture of Membrane (P/PROM) Detection and administration of (pre)ecclampsia (Mg Sulfate) Management of neonatal diseases Antibiotics for U5 pneumonia Antibiotics for the runs and enteric fevers Vitamin A - Treatment for measles Zinc for the runs administration Clinical administration of neonatal jaundice Management of extremely wiped out youngsters (referral IMCI) Chloroquine for jungle fever (P.vivax) Artemisinin-based Combination Therapy Management of convoluted jungle fever (second line drug) Individual clinical mediations (3)

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Management of sharp contaminations Male circumcision Second-line ART Adult second-line ART Comprehensive crisis obstetric consideration (C-EOC) Other crisis intense consideration Individual clinical mediations (3) Detection and administration of STI Management of astute contaminations First line ART Detection and treatment of TB with first line drugs (classification 1 and 3) Re-treatment of TB patients with first line drugs (class 2) MDR treatement with second line drugs

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Saving 1.3 million lives every year for $ 400 for each life spared: kicking off group care & outreach

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Saving 2.5 million lives every year for $ 800 for each life spared: Full Minimum Package at scale:

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Saving 5.5 million lives every year for $ 1,500 for each life spared: greatest bundle at scale .

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So why is it not happening ?

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Countries utilize very much planned arrangements to accomplish development and human improvement results Services Governments/givers Health, Education, Poverty But… *

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But, what looks great on paper appears to separate in practice… Government Leakage of Funds Bad approach Poor spending plan taking care of Local Govt. Problematic spending (Big compensation charges yet deficient course books & materials) Providers Financing issues Information & observing Local govt. motivating forces skewed Local limit issues Communities Low quality guideline Provider motivators hazy, non-appearance Hard to screen, clients vulnerable Quality improper Primary training Lack of interest Clients Externalities Community standards Budget requirements Intra-family conduct

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Budgeting for results

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Results-based Financing Donors Sub-National Government District National Government Results Based Aid Results Based Planning and Budgeting Results Based Contracting for CCT, RB rewards Hospitals, Health Centers, Ass Households or Individuals

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Steps in Results-Based Budgeting Step 1: Health Systems and High Impact Interventions Analyze wellbeing frameworks. Distinguish major U5MR, NNMR, MMR causes. Distinguish high effect wellbeing, nourishment, AIDS, & intestinal sickness mediations (level 1-2 proof). Sort out mediations into 3 administration conveyance modes: Family situated group based; Population arranged schedulable; and individual arranged clinical administrations. Select delegate tracer mediations for every sub-bundle of intercessions. Step 2: System Bottlenecks to Coverage Analyze family unit reviews and administration insights, utilizing six scope determinants, to distinguish framework bottlenecks to scope & causes. Supply side: accessibility of vital products, accessibility of HR, and physical access. Interest side: introductory and auspicious constant Utilization; Effective quality scope. Dissect systems to address bottlenecks and set new scope wildernesses . Step 5: Budgeting and Fiscal Space Translate minimal expense into yearly extra spending plan figures. Connection spending plan figures to national division arranges, MTEF, PRSP, and different projects. Encourage examination on financing sources. Assess extra financing prerequisite against the monetary space for wellbeing. Step 3: Estimating Impact Epidemiometric model. Gauge the effect (decrease in mortality) of beating the bottlenecks in view of neighborhood reasons for NNMR, U5MR and MMR. Sources include: MDG1 (Emory), MDG4 (Bellagio), MDG 5 (WHO/WB Cochran; BMJ), and MDG 6 (RBM, UNAIDS). Step 4: Estimating Marginal Cost Estimate negligible expenses to beat the bottlenecks and accomplish new execution outskirts. District/nation particular inputs and expense structures.

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Removing Coverage Bottlenecks in Ethiopia: scaling up ITN

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Inputs (Health & WSS Inputs) to Release Bottlenecks Health Output MDGs Outcome 1 Essential medications things, safe water framework, and/or HR and so forth. Accessibility ∆C of wellbeing & nourishment intercessions conveyed by Family/Community Support for group meeting, inputs for a versatile group, development of wellbeing post and so on. Sway on MDG wellbeing markers: Reduction in U5MR and MMR Accessibility ∆C of wellbeing & sustenance intercessions conveyed by Outreach group Drugs and supplies, endowments for protection for referral consideration per client and so on. Use Demand side sponsorship, execution based motivating forces for wellbeing specialists, specialists, and IEC inputs and so on. ∆C of wellbeing & sustenance between ventions conveyed by Clinics/Hospitals Continuity Cost of uprooting bottlenecks to accomplish certain MDG target Training, supervision and observing of group mobilizers, essential and referral clinical consideration and so forth. Quality Aggregate Cost of Inputs Linking Flow of Funds to Impacts

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The Challenge of Scaling Up in Ethiopia

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The Challenge of Scaling Up in Rwanda Current Health Expenditures

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Results ?

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Malaria out patient Non Malaria out patient Dramatic reduction of intestinal sickness in Rwanda

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Rwanda 2005-2008

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Rwanda: back on track for the MDGs .:tsli

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