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Center for Population, Health and Nutrition
>> Return to Home Page >> Central Programs >> Global Programs >> Population, Health and Nutrition ACTIVITY DATA SHEET
PROGRAM: Central Programs
TITLE AND NUMBER: Increased use of key child health and nutrition interventions. 936-003
STATUS: Continuing
PLANNED FY 2001 OBLIGATONS AND FUNDING SOURCE: $3,750,000 DA; $40,403,000 CSD
PROPOSED FY 2002 OBLIGATIONS AND FUNDING SOURCE: $4,200,000 DA; $43,200,000 CSD
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION: ContinuingSummary: The Global Bureau Center for Population, Health, and Nutrition's (the Center) child survival program focuses on the major diseases and conditions responsible for the greatest share of illness, disability, and preventable death of children in developing countries. These are the key infectious diseases of children (respiratory infections, diarrheal diseases, diseases such as measles and polio preventable through immunization, and malaria), malnutrition and deficiencies of micronutrients (such as vitamin A), and survival of the newborn infant. The program provides technical leadership for the Agency's programming, carries out applied and operations research to develop new and improved interventions, and directly supports country level child survival activities. The Center is also the major focus for coordinating the Agency's child survival strategies and programming with other major international partners, including UNICEF, the World Health Organization (WHO), the World Bank, other bilateral donors, and major foundations.
In September 2001, the global community will review progress toward the goals set at the 1990 World Summit for Children. Since USAID and its development partners began the child survival program in the mid-1980s, annual child deaths from diarrheal diseases have fallen from over four million to one and a half million, and over four million children are saved each year from vaccine-preventable diseases like measles. Polio is on the verge of being eradicated. Globally, the number of deaths of children under age five has dropped from over 15 million to about 10.5 million, despite a much greater number of births. The nutritional status of the world's children has improved. However, countries with weaker health systems - especially in sub-Saharan Africa and southern Asia - have not seen substantial improvement in child survival or nutrition, and there are signs of leveling off or even reversals of past gains. Global immunization rates have not reached the 90% goal set at the World Summit for Children. Evidence has mounted that the most vulnerable children lose out on child health and nutrition interventions. In response, the Center leads the global dialogue about the unmet health and nutrition needs of children, and is developing new and accelerated approaches to address them.
Key Results: The Center supported the development and application of key child survival interventions such as Oral Rehydration Therapy (ORT) and simple treatment for pneumonia. These have become core elements in global child survival programming; ORT is now reaching about three-fourths of the world's children, and pneumonia treatment is available to over half. More recently, research has led to identifying vitamin A as a key nutrient capable of saving child lives. This has led to joint action by USAID, UNICEF, and other international agencies, now providing vitamin A supplements to almost half of the world's vitamin A deficient children. The Center leads the Agency's support to global Polio Eradication, the development of new vaccines against the major killer diseases of children, and participating in the new Global Alliance for Vaccines and Immunization (GAVI). The Center has helped develop the Integrated Management of Childhood Illness (IMCI) strategy, a new focus on injection safety through the Safe Injection Global Network (SIGN), research and guidelines to deal with the complex issues of breastfeeding in high HIV prevalence populations, and evaluating approaches to reduce newborn mortality.
Performance and prospects: The Center's efforts during FY 2000 focused on key areas most relevant to the unmet needs of child survival, such as the "Boost Immunization" initiative and the VITA initiative to reduce vitamin A deficiency, and program efforts with NGOs and governments aimed at improving childen's survival and health through actions at the household and community level. To increase impact, SO3 increasingly emphasized coordination with Agency and international partners who bring additional resources to these efforts. SO3 has also emphasized management for results: for example, major refocusing of the Center's breastfeeding project yielded demonstrated increases in breastfeeding rates in several countries. With the successful achievement of its original five-year Intermediate Result-level indicators, SO3 adopted an updated set of indicators, two of which are reported on here.
In research and evaluation, the Center supported development of key new technologies including immunization devices to increase injection safety and demonstration of 77% to 87% clinical efficacy of the pneumococcal vaccine. In micronutrients, the Center supported analyses demonstrating that simultaneous vitamin A administration with immunization did not diminish vaccine effectiveness and that the child health benefits of iron in malaria-endemic areas far outweigh adverse effects on malarial illness. Studies of zinc supplementation revealed 75% reduction in mortality among low birthweight infants in India, 50% reduction in all-cause child mortality in Bangladesh, and significant overall reduction in diarrhea morbidity and mortality. For newborn survival, a multi-site study identified the major pathogens causing neonatal infections. Efforts in 2002 will include further research on pneumococcal vaccine and on new rotavirus vaccines; analysis of preliminary results of the four major field trials of vitamin A on infant, child, and maternal mortality; and initiation of field tests of a community-based model for newborn care.
The Center's technical leadership has included development of assessment tools for immunization services and guidelines for introduction of new vaccines for the GAVI and collaboration with WHO to develop a global measles mortality reduction strategy. A Center-initiated working group of international organization partners and country programs developed a framework for scaling up Roll Back Malaria (RBM) and IMCI implementation in the African Region. The Center also continued active leadership in roll-out of the component of the global IMCI initiative aimed at improving household and community level child health care, with expanded involvement of U.S. private voluntary organizations. In Honduras, the Ministry of Health made the Center-supported community-based growth promotion approach a national strategy, and the World Bank and other partners supported replication of this approach in three other Latin American and Caribbean (LAC) countries. Technical leadership in FY 2002 will include developing the operational basis for new vaccine introduction into countries by GAVI; integrating measles mortality reduction into existing immunization programs; operationalizing the RBM/IMCI linkage in African countries; partnering with the Gates Foundation and others to launch a major micronutrient fortification initiative in at least six countries; expanding the community growth promotion approach developed in the LAC region to the Africa region; and supporting production of evidence-based recommendations for newborn interventions.
In FY 2001, the Center collaborated with missions and bureaus to program "Boost Immunization" funds in 14 countries that represent almost 70 million children under age five and the Center also provided technical assistance to six African countries and two Asian countries to enable them to apply to GAVI for new vaccines. The VITA Initiative was expanded and cooperative vitamin A activities implemented in 13 countries, with the Center leading the transition from dependence on National Immunization Days (NIDS) to other approaches for delivering vitamin A supplements. In IMCI, the center staff and projects directly supported implementation in 12 LAC and AFR countries, and worked with WHO and UNICEF and others; the Center's approach to improve availability and use of essential drugs for child illness was adapted and applied in African countries; two Regional Technical Advisors are being supported to expand these activities in Africa. In 2002, the Program will expand technical support for immunization programs, including establishing long-term advisors in six "Boost" countries and continuing support to polio efforts; expanding investment in IMCI, involving private voluntary organizations and new partners such as the United Kingdom Department for International Development (DfID); helping priority countries develop sustainable approaches to vitamin A supplementation that do not depend on polio NIDS; working with countries and international partners to improve availability and use of basic child health drugs and expanding application of innovative health sector financing approaches.
Possible Adjustments to Plans: If the U.N. Special Session on Children generates increased demand for accelerated child survival activities, the Center would look at the Boost Immunization and VITA initiatives, combining additive resources with technical guidance and assistance to initiate expanded field programming in a limited number of technical areas. Potential focus areas of such expanded efforts would include reduction of pneumonia and neonatal mortality, improved availability and use of child health drugs and commodities, and an expanded effort to increase prevention and treatment of child illness at the community level in partnership with U.S. PVOs and partner organizations.
Other Donor Programs: The Center works in close collaboration with major organizations including: UNICEF, WHO, the World Bank, U.S. private voluntary organizations, European donors, the US-Japanese Common Agenda, the Gates Foundation and other U.S. private sector partners and foundations.
Major Contractors and Grantees: ABT Associates, Academy for Educational Development, African Medical & Relief Foundation, Boston University, CARE, Centers for Disease Control and Prevention, Clapp & Mayne, Inc., PVO CORE Group/World Vision, Global Health Council, Helen Keller International, International Centre for Diarrhoeal Disease Research/Bangladesh, International Clinical Epidemiology Network, International Science and Technical Institute, Johns Hopkins School of Public Health, John Snow Inc., LTG Associates, Management Sciences for Health, Manoff Group, Massachusetts Public Health Biologic Laboratories, Department of Health and Human Services, Partnership for Child Health Care Incorporated, PATH, Population Services International, Save the Children, U.S. Bureau of Census, U.S. Pharmacopeial Convention, Incorporated, UNICEF, WHO.
Selected Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY01 (Plan) FY02 (Plan) Indicator 1: Technologies evaluated: ARI conjugate vaccines: HIB A-1 A-1 A-1 NA NA NA Indicator 2: Percent of children under age five receiving ORS, recommended home fluids or increased fluids for diarrhea 60.4 62.2 NA NA 65 NA Indicator 3: Percent of children fully immunized by age 1 41.8 43.3 43.0 NA 46 NA Indicator 4: Number of selected countries with program guidelines in place for: Micronutrient deficiencies 12 16 23 NA NA NA Indicator 5: Number of selected countries with program guidelines in place for: ICM of sick children 17 50 66 NA NA NA Indicator 6: Technologies evaluated: ARI conjugate vaccines: Pneumo D/E-1 D/E-1 D/E-1 NA NA NA Indicator Information
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR IDEA Scheme: Identified, Developed, Evaluated, Available: HIB G/PHN ARI vaccines being developed in various combinations Indicator 2: S Children under five with diarrhea DHS Proportion of all cases of diarrhea in children under 5 treated with ORS and/or recommended home fluids or increased fluids Indicator 3: S Children 12-23 months of age immunized by age 1 DHS Children receiving 3 doses of DPT and Polio, as well as one dose of measles before 1 year of age Indicator 4: IR Number of countries Micronutient deficiencies PHNC program records Clearly defined micronutrient implementation strategy in place Indicator 5: IR Number of countries: ICM of sick children WHO ICM strategy in place Indicator 6: IR IDEA Scheme: Identified, Developed, Evaluated, Available: Pneumo G/PHN ARI vaccines being developed in various combinations U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 71,524 DA 64,308 DA 7,216 DA 132,750 CSD 100,953 CSD 31,797 CSD 0 ESF 0 ESF 0 ESF 1,597 SEED 1,597 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 7,868 DA 9,716 DA 47,963 CSD 33,575 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 79,392 DA 74,024 DA 5,368 DA 180,713 CSD 134,528 CSD 46,185 CSD 0 ESF 0 ESF 0 ESF 1,597 SEED 1,597 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 2,424 DA 1,264 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 3,750 DA 40,403 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 6,174 DA 41,667 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 4,200 DA 0 DA 89,766 DA 43,200 CSD 361,797 CSD 627,377 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 1,597 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
