This week we highlight the newly released Universal Health Coverage monitoring framework. Each Friday, we share a selection of global health Tweets, infographics, blog posts, videos and other content of note. For more, follow us @worldbankhealth.
Today, World Bank Group President Jim Yong Kim announced a special funding mechanism to enable donors to scale up their funding to meet the urgent needs related to Millennium Development Goals 4 and 5, leveraging the International Development Association (IDA), the World Bank's fund for the poorest.
Dr. Kim announced the special funding mechanism during his remarks at the Every Woman, Every Child event at the UN General Assembly.
His remarks, as prepared for delivery, are available on the World Bank's website (http://www.worldbank.org/en/news/2012/09/25/world-bank-president-kim-every-woman-every-child-un-general-assembly).
This week (August 1-7) is World Breastfeeding Week, an occasion to remind ourselves of the important role that optimal infant and young child feeding plays in the healthy growth and development of individuals, communities, and nations. For more than 30 years, the World Bank has championed the importance of breastfeeding. This includes investing in advocacy and communications to policymakers, strengthened health systems, and effective community-based outreach to provide the knowledge and support needed by women and their families.
To mark World Breastfeeding Week, World Bank nutrition experts have updated this helpful Q/A on the topic:
What are the health benefits of breastfeeding?
Breastfeeding is one of the most powerful tools available to a mother to ensure the health and survival of her child from the moment he/she is born. Optimal breastfeeding practices, which include initiating breastfeeding within an hour of birth, feeding only breast milk until 6 months, and continuing to breastfeed up to 24 months, are key elements in the fight against malnutrition. Breast milk provides all the nutrients a child needs for healthy development in the first six months of life. And the antibodies that are transferred from a mother to her child during breastfeeding help protect infants against common childhood illnesses that can lead to death, such as diarrhea and pneumonia.
The Lancet’s 2008 series on Maternal and Child Undernutrition has estimated that the relative risk of death (all cause mortality) is 14 times higher for a child who is not breastfed versus one who is exclusively breastfed. When broken down by disease, the relative risk of death from diarrhea and pneumonia is 10.5 and 15 times higher, respectively, for children who are not breastfed versus those that are exclusively breastfed.
While participating in a study of HIV spending efficiency in South Africa, I met a young HIV-positive mother who had just received the joyful news that her new-born daughter was healthy and HIV-free. Wiping away tears of relief, she described the gratitude she felt for the antenatal clinic staff, who had helped start her on antiretroviral treatment (ART) and thanks to whom she now had the hope of a bright future for her daughter. This encounter was just one among many similar incidents during the study – and, as our preliminary data show, is representative of the positive impact of the Government’s strong commitment to bringing down rates of HIV.
South Africa has mounted one of the strongest responses to HIV in the world. Its most dramatic success has been the scale-up of ART since 2003, growing from almost nothing to the country’s largest health program that treated about 1.5 million people in 2011 (out of a total HIV-infected population of 5.6 million).
The impacts of this treatment drive are already showing, with overall mortality, maternal and infant deaths all on a downward trend following their HIV-related peaks in the early-to mid-2000s. However, the cost of sustaining this success is huge: South Africa has committed to putting an estimated target of almost 10% of the entire population on a life-long course of expensive drug treatment. And, even with government negotiators bringing down ART drug prices by 65% since 2008, successful testing campaigns coupled with the worrying increase in resistance to first-line therapies look set to further raise the financial risk.
These challenges extend beyond South Africa. An analysis of the fiscal dimensions of HIV/AIDS released by the World Bank earlier this year in a number of countries concluded that without significant additional investments in prevention starting now, the cost of treatment will rapidly become unaffordable for even the most cash-rich countries on the African continent.
Le 11 juillet, lors de la Journée mondiale de la population, des acteurs mondiaux de premier plan dans le domaine de la santé se réunissent à Londres pour tenter de mettre la priorité sur l’enjeu de la planification familiale. Cet enjeu est au cœur des travaux du personnel de la Banque mondiale chargé des questions de santé en Asie du Sud, qui s’emploie à trouver les moyens qui lui permettront d’aider plus efficacement les femmes et les familles à espacer les naissances et à éviter les grossesses non désirées.
Même si les pays d’Asie du Sud ont progressé dans l’élargissement de l’accès à la contraception moderne et dans le recul global de la natalité, la région accuse la deuxième plus forte mortalité maternelle du monde. Dans ces pays, les ménages pauvres, marginalisés et non instruits n’ont pas accès aux services de santé génésique dont ils ont besoin, et notamment à la planification familiale.
En Inde, au Népal et au Pakistan en particulier, les taux de fécondité et d’utilisation de contraceptifs diffèrent considérablement d’une catégorie socioéconomique à l’autre : en Inde, alors que le taux de fécondité n’est que de 1,8 chez les femmes les plus aisées, il se maintient à 3,9 parmi les plus démunies. Au Népal, les femmes instruites ont, en moyenne, 1,9 enfant, contre 3,7 pour les femmes non instruites. Au Pakistan, la prévalence de la contraception atteint aujourd’hui 32 % chez les couples riches et seulement 12 % chez les couples pauvres. En Inde, dans l’État du Meghalaya, 36 % des couples désireux de recourir à la planification familiale n’ont pas accès à une contraception efficace.
El 11 de julio, Día Mundial de la Población, mientras los líderes mundiales de la salud se reúnen en Londres para debatir sobre el otorgamiento de una mayor prioridad a la planificación familiar, el personal del Banco Mundial que trabaja en el sector de salud en Asia meridional estará pensando en cómo respaldar más eficazmente a las mujeres y las familias de esta región para espaciar los nacimientos y evitar los embarazos no deseados.
Aunque los países de Asia meridional lograron aumentar el acceso a la planificación familiar moderna y reducir los índices totales de fecundidad, la región sigue teniendo la segunda tasa más elevada de mortalidad materna. Los hogares pobres, marginados y sin educación no cuentan con los servicios de salud reproductiva que necesitan, incluida la planificación familiar.
En India, Nepal y Pakistán, en particular, las diferencias en la fertilidad y el uso de anticonceptivos entre los grupos socioeconómicos son sorprendentes: en India, la tasa de fecundidad en la parte más rica de la población es de 1,8, mientras que sigue siendo de 3,9 entre los más pobres; en Nepal, las mujeres con educación tienen en promedio 1,9 hijos, mientras que las menos educadas tienen un promedio de 3,7; en Pakistán, la prevalencia de anticonceptivos es del 32% en las parejas más ricas y de apenas el 12% entre las parejas pobres, y en el estado indio de Meghalaya, el 36% de las parejas que quiere practicar la planificación familiar carece de acceso a métodos anticonceptivos eficaces.
We’ve got something to smile about this week at the World Bank: Our baby Maya, who has shown us the importance of having a strong health system and access to quality maternal and child health care, has reached her second birthday!
To mark this special occasion, we’re launching a new video about the things that helped Maya achieve this milestone, including access to family planning and proper nutrition. These are two key services provided by well-functioning health systems that create healthy futures for mothers and their children—along with other affordable services, trained health workers, clean water, vaccines, well-equipped clinics, and many other moving parts.
The video—the second in a series that began with Maya’s birth—comes as the global health community holds a summit on family planning this week in London. I hope Maya’s story underscores what a difference access to effective family planning can make. By giving women the means to space the births of their children by three years, for example, deaths of children under-five would decrease by 35%.
On July 11, World Population Day, while global health leaders meet in London to discuss giving greater priority to family planning, World Bank health staff in South Asia will be thinking about how to more effectively support women and families in this region to space births and avoid unwanted pregnancies.
While the countries of South Asia have made progress in increasing access to modern family planning, and reducing total fertility rates, the region still accounts for the second highest burden of maternal deaths. Poor, marginalized and uneducated households do not have access to the reproductive health services they need, including family planning.
In India, Nepal and Pakistan in particular, the differences in fertility and use of contraception across socioeconomic groups are striking: In India, the fertility rate among the wealthiest part of the population is only 1.8, while it remains 3.9 among the poorest. In Nepal, educated women have on average 1.9 children while the least educated have an average of 3.7.In Pakistan, contraceptive prevalence is 32% among wealthier couples and yet only 12% among poor couples. In the Indian state of Meghalaya, 36% of couples who want to practice family planning lack access to effective contraception.
New estimates released today by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Bank show that the number of women dying due to complications in pregnancy and childbirth has almost halved in 20 years—from more than 540,000 in 1990 to less than 290,000 in 2010.
This is good news, but it doesn’t tell the whole story. While substantial progress has been achieved at the global level, many countries, particularly in sub-Saharan Africa, will still fail to reach the Millennium Development Goal (MDG 5) target of reducing maternal mortality by 75% from 1990 to 2015.
I recently attended a community paralegal training on promoting accountability in health care delivery in Makeni, Sierra Leone. During the training, a community paralegal named Elizabeth Massalay talked about bringing her niece to a clinic in Moyamba district to receive immunizations that the government provides free of charge thanks to the Free Health Care Initiative (FHCI), which offers free health services to pregnant and breastfeeding women and children under five. Mothers queued for free immunizations, painting a hopeful picture for a country that ranks 180 out of 187 in the 2011 Human Development Index and where almost one in three children die before reaching the age of five.
However, against this promising backdrop, Elizabeth saw that the nurse was demanding six cups of rice from each mother before providing the immunization. Elizabeth was witnessing how breakdowns within state institutions—including absent nurses, improper user fees, and “leakage” of up to 30% of FHCI drugs (according to government and UNICEF statistics)—undermine health care delivery. Responding to such breakdowns requires an understanding of health policy and regulations—what the state must provide and to whom—and knowing where and how to apply pressure when the state fails to do so.