The Wold Health Report 2005
İÇİNDEKİLERMessage from the Director-GeneralOvervsew Patchy progress and widening gaps - what went wrong? Making the right technical and strategic choices Moving towards universal coverage: access for ali, with financial protection Chaptersummaries Chapter 1 İVlothers and ciıildren matter - so tioes their health The early years of maternal and child health Where we are now: a moral and political imperative Mothers, children and the Millennium Development Goals Uneven gains in child health The nevvborn deaths that went unnoticed Few signs of improvement in maternal health A patchvvork of progress, stagnation and reversal The numbers remain high Chapter 2 ObsîacSes to progress: conîeıt or poiicy? Context matters Poverty undermines progress The direct and indirect effects of HIV/AIDS Conflicts and emergencies set systems back The many faces of exclusion from care Sources of exclusion Patterns of exclusion Different exclusion patterns, different challenges Are districts the right strategy for moving tovvards universal coverage? A strategy vvithout resources Have districts failed the test? Chapter 3 Great expectations: making pregnancy safer Realizing the potential of antenatal care Meeting expectations in pregnancy Pregnancy - a time with its own dangers Seizing the opportunities Critical directions for the future Not every pregnancy is vvelcome Planning pregnancies before they even happen Unsafe abortion: a majör public health problem Dealing with the compiications of abortion Valuing pregnancy: a matter of legal protection Chapter 4 Attending to 136 milliorı births, every year Risking death to give life Skilled professional care: at birth and aftervvards Successes and reversals: a matter of building health systems Skilled care: rethinking the division of labour Care that is close to vvomen - and safe A back-up in case of compiications Rolling out services simultaneously Postpartum care is just as important Chapter 5 Newborns: no longer going unnoticed The greatest risks to life are in its beginning Progress and some reversals No longer falling betvveen the cracks Care during pregnancy Professional care at birth Caring for the baby at home Ensuring continuity of care Planning for universal access Benchmarks for supply-side needs Room for optimism, reasons for caution Closing the human resource and infrastructure gap Scenarios for scaling up Costing the scale up Chapter 6 Redesigning child care: survival, grovvth and development Improving the chances of survival The ambitions of the primary health care movement The successes of vertical programmes Time for a change of strategy Combining a vvider range of interventions Dealing with children, not just with diseases Organizing integrated child care Households and health workers Referring sick children Bringing care closer to children Rolling out child health interventions The cost of scaling up coverage From cost projections to scaling up Chapter 7 Reconciliog maternal, newS3orn and child heaittı wsth health systern development Repositioning MNCH Different constituencies, different languages Sustaining political momentum Rehabilitating the vvorkforce Not just a question of numbers Recovering from the legacy of past neglect Destabilization with the best of intentions Tackling the salary problem Financial protection to ensure universal access Replacing user fees by prepayment, pooling and a refinancing of the sector Making the most of transitory financial protection mechanisms Generalizing financial protection Channelling funds effectively StatisîioaS annex Explanatory notes AnnexTabie 1 Basic indicators for ali WHO Member States Annex Table 2a Under-five mortality rates: estimates for 2003, annual average percent change 1990-2003, and availability of data 1980-2003 Annex Table 2b Under-five mortality rates (per 1000) directly obtained from surveys and vital registration, by age and latest available period or year Annex Table 3 Annual number of deaths by cause for children under five years of age in WHO regions, estimates for 2000-2003 Annex Table 4 Annual number of deaths by cause for neonates in WH0 regions, estimates for 2000-2003 Annex Table 5 Selected national health accounts indicators: measured levels of expenditure on health, 1998-2002 Annex Table 6 Selected national health accounts indicators: measured levels of per capita expenditure on health, 1998-2002 Annex Table 7 Selected immunization indicators in ali WH0 Member States Annex Table 8 Selected indicators related to reproductive, maternal and nevvborn health lndex Figures Figüre 1.1 Slovving progress in child mortaiity: how Africa is faring worst Figüre 1.2 Neonatal and maternal mortaiity are related to the absence of a skilled birth attendant Figüre 1.3 Changes in under-5 mortaiity rates, 1990-2003: countries shovving progress, stagnation or reversal Figüre 1.4 Patterns of reduction of under-5 mortaiity rates, 1990-2003 Figüre 1.5 Maternal mortaiity ratio per 100 000 live births in 2000 Figüre 1.6 Neonatal mortaiity rate per 1000 live births in 2000 Figüre 2.1 A temporary reversal in maternal mortaiity: Mongolia in the early 1990s Figüre 2.2 Levelling off after remarkable progress: DTP3 vaccine coverage since 1980 Figüre 2.3 Different patterns of exclusion: massive deprivation at low levels of coverage and marginalization of the poorest at high levels Figüre 2.4 From massive deprivation to marginal exclusion: moving up the coverage ladder Figüre 2.5 Survival gap betvveen rich and poor: vvidening in some countries, narrovving in others Figüre 3.1 Coverage of antenatal care is rising Figüre 3.2 The outcomes of a year's pregnancies Figüre 3.3 Grounds on which abortion is permitted around the vvorld Figüre 4.1 Causes of maternal death Figüre 4.2 Maternal mortaiity since the 1960s in Malaysia, Sri Lanka and Thailand Figüre 4.3 Number of years to halve maternal mortaiity, selected countries Figüre 5.1 Deaths before five years of age, 2000 Figüre 5.2 Number of neonatal deaths by cause, 2000-2003 Figüre 5.3 Changes in neonatal mortality rates betvveen 1995 and 2000 Figüre 5.4 Neonatal mortality in African countries shovvs stagnation and some unusual reversals Figüre 5.5 Neonatal mortality is lower when mothers have received professional care Figüre 5.6 The proportion of births in health facilities and those attended by medical doctors is increasing Figüre 5.7 The human resource gap in Benin, Burkina Faso, Mali and Niger, 2001 Figüre 5.8 Cost of scaling up maternal and nevvborn care, additional to current expenditure Figüre 6.1 An integrated approach to child health 1 Figüre 6.2 Proportion of districts vvhere training and system strengthening for İMCİ had been started by 2003 1 Figüre 6.3 Cost of scaling up child health interventions, additional to current expenditure 1 Boxes Box 1.1 Milestones in the establishment of the rights of vvomen and children Box 1.2 Why invest public money in health care for mothers and children? Box 1.3 A reversal of maternal mortality in Malawi Box 1.4 Counting births and deaths Box 2.1 Economic crisis and health system meltdown: a fatal cascade of events Box 2.2 How HIV/AIDS affects the health of vvomen and children Box 2.3 Health districts can make progress, even in adverse circumstances Box 2.4 Mapping exclusion from life-saving obstetric care Box 2.5" Building functional health districts: sustainable results require a long-term commitment Box 3.1 Reducing the burden of malaria in pregnant vvomen and their children Box 3.2 Anaemia - the silent killer Box 3.3 Violence against women Box 4.1 Obstetric fistula: surviving with dignity Box 4.2 Maternal depression affects both mothers and children Box 4.3 Screening for high-risk childbirth: a disappointment Box 4.4 Traditional birth attendants: another disappointment Box 4.5 Preparing practitioners for safe and effective practice Box 5.1 Explaining variations in maternal, neonatal and child mortality: care or context? Box 5.2 Sex selection Box 5.3 Overmedicalization Box 5.4 A breakdown of the projected costs of extending the coverage of maternal and nevvborn care Box 6.1 What do children die of today? Box 6.2 How households can make a difference Box 6.3 A breakdovvn of the projected cost of scaling up Box 7.1 International funds for maternal, nevvborn and child health Box 7.2 Building pressure: the partnerships for maternal, nevvborn and child health Box 7.3 MNCH, poverty and the need for strategic information Box 7.4 Sector-vvide approaches Box 7.5 Rebuilding health systems in post-crisis situations Box 7.6 Civil society involvement reguires support TabSes Table 1.1 Neonatal and maternal mortality in countries vvhere the decline in child mortality has stagnated or reversed Table 2.1 Factors hindering progress Table 4.1 Incidence of majör complications of childbirth, worldwide Table 4.2 Key features of first-level and back-up maternal and nevvborn care Table 5.1 Filling the suppiy gap to scaie up first-level and back-up maternal and nevvborn care in 75 countries (from the current 43% to 73% coverage by 2015 and full coverage in 2030) Table 6.1 Core interventions to improve child survival NOTLARMake every mother and child count |
