Operationalizing UNICEF’s equity approach in the

context of APR, SUN., etc.

81

244

49

84

0

50

100

150

200

250

300

Reductions inchild deaths

Reductions instunting cases

Equity focusedapproach

Mainstreamapproach

# Child deaths & Stunting cases averted per $1 million invested

97

279

61

188

0

50

100

150

200

250

300

Reduction in childdeaths

Reduction instunting cases

Most deprivedgroups

Least deprivedgroups

Level 1: All Country Offices review the equity-focus of their situation

analysis, the quality of causal and bottleneck analysis of child

deprivations and the alignment of policies, strategies and plans

Level 2: Where one or more specific child deprivation are prevalent and

addressed by the country programme, the Country Office monitors UNICEF

inputs and outputs

Level 3: As countries show measurable progress in

programme implementation, the Country Office, jointly with

partners, assesses, analyses and addresses bottlenecks to

estimate progress towards outcomes in representative areas or

groups

Supply side

determinants

Demand side

determinants

Level 4: As countries show good progress

in reducing bottlenecks, the Country

Office validates the achievement of

outcomes and estimates progress

towards reducing child deprivations

Guide

programmatic

adjustments

and

management

decisions

Enabling

environment

Monitoring Results for Equity

Levels 1 + 3: Equity focused strategy

reviews and decentralized monitoring

Step 1. Analyze deprivations & epidemiological causes Step 2. Prioritize interventions Step 3. Select Service Delivery Platforms Step 4. Identifying cross cutting bottlenecks Step 5: Analyze causes of bottlenecks Step 6: Identify corrective actions , partner support to & tracking mechanism(s) Step 7: Design system to monitor the reduction of priority bottleneck(s)

Step 1

Step 2

Step 3

Step 4 Step 5

Step 6

Step 7

Step 1: WHAT do poor children in Nigeria die

from compared to richer children

40.7 26.9

50

11

56.3

22.1

6.6

1.6

36.7

13.9

4.9

1.6

21.6

8.8

0

50

100

150

200

250

Nigeria: Nigeria Q1 Nigeria: Nigeria Q5 (richest)

(Rate per 1000 Live Births)

Others

Injuries

AIDS

Pneumonia

Measles

Malaria

Diarrhea

Neonatal

Steps 2+3: selecting Priority Intervention

packages + delivery platforms

Life cycle stages Community based Schedulable Services Clinical (non-schedulable)

3.1 Preventive delivery care

(Corticosteroids for Preterm, Antibiotics

for PROMs, MgS for Pre-eccalmpsia)3.2 Uncomplicated Delivery: (Partog. +

Apgar/Suction/AMTSL + Early BF & temp

Mngt).)3.3 EmONC: Management of obstetric

(Hemorrhage, sepsis, eccalmpsia and

obstructed labor) and neonatal

complications (incl. Asphyxia)

1.2 Infant and Young Child Feeding

(Breastfeeding, Complementatry Feeding)

1.3 Community based-IMNCI (Pneumonia

Malaria, ORS+Zinc, Mngt. SAM,

VLBW/Prematurity, NN Sepsis)

2.3 Preventive Adolescent Care &

Practices (IFA supplementation,

HIV prevention, Adolescent

immunization)

2.4 Family Planning

Adolescents and families

1.4 Environmental Health (Adequate

Sanitation, hand washing with soap,

Improves water supply, ITNs, IRS)

*Future development: Adolescent-friendly

curative services; HIV testing, counselling

and treatment for Adolescents, etc.

Delivery Platform (Service Delivery Mode)

Pregnancy and child

birth

1.1 Community based delivery

(Suction/clean delivery/cord care/AMTSL)2.1 ANC (Routine, PMTCT)

Newborn/ Child2.2 Immunization (Full

immunization and Vit. A)

3.4 Facility based IMNCI (Pneumonia,

Newborn Sepsis, Malaria, Dehydration,

SAM, VLBW/Prematurity, Pediatric AIDS)

Step 4: Identification of bottlenecks

Causal analysis

Priority areas of re-focus

Examples of Strategic Shifts

What

Deprivation analysis

Deprivations Stunting (Egypt)

For Whom

Equity analysis

Groups & areas (right holders)

2/3 of deprived populations (DRC)

Why

Immediate causes

Services and practices Neonatal interventions (India, B’desh) Theory of change for early marriage (B’desh)

Why

Underlying causes= Bottlenecks

Operational strategies (system strengthening / downstream)

Financial barriers (DRC) and quality (India, B’desh); delivery channels (India, B’desh)

Why

Basic causes= Barriers

Shifts in policies, social norms, etc. (upstream)

Community/social norms (Nigeria, India); National policy (DRC, B’desh); Legal framework and social norms for preschool (B’desh)

By Whom

Stakeholder analysis

Partners/stakeholders (Duty bearers + right holders)

Private sector (Nigeria), Religious organizations (DRC, Nigeria), Governors for Birth Registration (Nigeria)

UNICEF role

Capacity analysis

Direct actions & leveraging (up + downstream) + Support L3M design

State-level strategic shifts (India, Nigeria)

Steps 5 + 6: Analyzing causes and selecting

corrective actions

Evolving Role of Monitoring

MAF

Conventional Monitoring Monitoring for reporting

Increased equitable effective coverage of basic services and health/nutrition promotion

MDGs with equity & beyond

Strengthen Capacities and

systems for improved delivery of

services

UN(ICEF) Institutional Reporting (internal & external)

UN(ICEF): - Programmatic

adjustments -Operational/management

decisions

Empower deprived

populations

Enhance equity-focused policies, plans and budgets

National Bottleneck analysis with

partners (MAF, MBB)

Decentralized monitoring

Strengthen Decentralized

Planning

Step 7: Decentralized Monitoring of bottlenecks

0%

20%

40%

60%

80%

100%

COMMODITIES: %communities with

food security

HUMAN RES: %villages with

sufficient CHWs

ACCESS: % Womenwith primary

education or higher

UTILISATION: %children 6-8 months

receivingcomplementary

foods

CONTINUITY: %children 6-24

months receivingmeals with minimum

frequency

EFFECTIVE COV: %children 6-24

months receiving theminimum acceptable

diet

Decentralized Monitoring helps identify + remove bottlenecks

Supply Bottlenecks 40% difference in food security

Demand bottlenecks Utilisation limited by food availability & additional continuity and quality bottlenecks

Community participation / dialogue; Strengthened partnerships btw community & services; Refresher training of CHW; performance incentives for quality IPC / counseling on feeding practices to most deprived mothers and monitoring

General Food Distribution to targeted deprived districts

Source Bangladesh, Nepal, Pakistan

80%

72%

54% 43%

63% 59%

0 10 20

Health

Nutrition

HIV

WASH

Edu., including ECD

Protection

number of countries (of 27 MoRES first wave countries)

Decentralized monitoring is applicable and useful in all sectors and regions

WCARO

ESARO

ROSA

EAPRO

TACRO

MENA

CEECIS

Decentralized monitoring can use a great variety

of existing and innovative Information Sources

0

5

10

15

20

25

30

Service information Survey basedinformation

BeneficiaryInformation

Nu

mb

ers

of

cou

ntr

ies

Routine + Rapid SMS

Other survey

based info

LQAS

Routine

Decentralized monitoring can stimulate multiple

strategic responses and partnerships

0%

20%

40%

60%

80%

100%

% o

f w

ork

-str

eam

on

e c

ou

ntr

ies

84% 76% 92%

56%

0%20%40%60%80%

100%

Main strategic responses

Partnerships