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Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org
Progress for Children in the SDG Era
UNICEF
March 2018 :: 104 pages
PDF: https://data.unicef.org/wp-content/uploads/2018/03/Progress_for_Every_Child_03.08.2018_V3.pdf
Foreward [excerpt]
The Sustainable Development Goals embody our highest aspirations for a better world – and reflect our greatest responsibility as a global community: To provide children and young people today with the services, skills and opportunities they need tomorrow to build better futures for themselves, their families, and their societies.
This understanding – that a sustainable future depends on how we meet the needs of children and young people today – is at the core of the SDGs, which include 44 child-related indicators integrated throughout the 17 goals. Progress for Every Child in the SDG Era, the first report of UNICEF’s new SDG tracking series, provides a preliminary assessment of how the world is doing thus far on achieving these critical targets.
Even for early days, the outlook the report reveals is foreboding.
Most urgently, UNICEF’s comprehensive report on SDG progress for children reveals that more than 650 million children – approaching one-third of the world’s children – live in 52 countries that are off track on at least two-thirds of the child-related SDG indicators for which they have data.
The concerns raised by this news are compounded by the fact that these are only the children we know about. Progress for Every Child in the SDG Era also reveals that over half a billion of the world’s children live in 64 countries that lack sufficient data for us even to assess if they are on or off track for at least two-thirds of all child-related SDG indicators.
This is a critical juncture in the SDG era: A time when the decisions we take and the investments we make can pay enormous dividends – or extract an impossible price. While it would be both counterproductive and premature to predict failure, it is never too soon to calculate its potential costs.
Given current trends, unless we accelerate progress to meet the child-related SDG targets, between 2017 and 2030, 10 million children will die from preventable causes before reaching their fifth birthdays.
As many as 31 million children will be stunted, robbed of the opportunity to fulfil their potential for lack of adequate nutrition.
At least 22 million children will miss out on pre-primary education, so critical to their later ability to succeed in school and beyond.
And without faster progress, 670 million people worldwide will still be without basic drinking water, in turn threatening children’s survival and healthy development…
Immunization [p.35]
Immunization averts an estimated 2 million-3 million deaths every year. Vaccines against diphtheria, tetanus, pertussis, measles and other preventable diseases also prevent millions of additional health issues and disabilities. These benefits make immunization one of the most cost-effective public health interventions.
In 2016, global coverage rates for the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3) and the first dose of measles-containing vaccine (MCV1) reached 86 per cent and 85 per cent, respectively, up from 72 per cent for each in 2000. Despite this increased coverage:
:: About 20 million children did not receive three doses of DTP and about 21 million missed the first dose of MCV.
:: Regional disparities persist: West and Central Africa lags behind, with 67 per cent coverage for each.
Trajectories
Achieving the SDG target of universal coverage by 2030 will take sustained efforts. Progress in expanding DTP3 and MCV1 coverage has been slow during recent years, and uneven across countries and regions. Based on the average rate of progress during 2010-2016:
:: 74 countries are not on track to reach the SDG target for DTP3, and 87 are not on track to reach it for MCV1.
:: The countries needing acceleration represent 34 per cent in the case of DTP3, and 41 per cent in the case of MCV1, of the global population of surviving infants.
:: Sub-Saharan Africa accounts for nearly half of infants living in countries that need acceleration to reach the DTP3 target.
Disparities
Unequal access to immunization services within countries leaves millions of children from poor households at risk of vaccine-preventable diseases.
Data published in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) make it possible to examine trajectories towards universal immunization coverage by household wealth for 32 countries. Survey data are generally not available for high-income countries, so disparities between wealthier and poorer households cannot be calculated in the same way. Comparing progress among children living in the poorest and wealthiest fifth of households in the 32 countries shows larger disparities for DTP3 coverage than for MCV1 (see Figure 1.11):
:: For DTP3, acceleration is needed to achieve the target for 60 per cent of children in the poorest quintiles and just under 40 percent of the wealthiest.
:: For MCV1, acceleration is needed for nearly 80 per cent of children in the poorest quintiles and over 60 per cent in the wealthiest.
Among the poorest in the 32 countries, the difference between the trajectories for DTP3 and MCV1 is due to three large middle-income countries – Kenya, the Philippines and Viet Nam – that are on track to meet the DTP3 target but need acceleration to meet the MCV1 target.
Wealth inequality appears to be an important factor in the rates of coverage. In Nigeria, for example, children from the wealthiest households are more than seven times as likely as children from the poorest households to have received the DTP3 vaccine. In Namibia, an upper-middle income country, children from the poorest households are 20 per cent more likely to have been vaccinated than those in the wealthiest households.
Call to action [p.100]
An agenda for action on data
There are no easy fixes to addressing the data deficiencies exposed in this report. Good data on children depend on strong national data institutions and capacity, which take time and investment to develop. But much can be done – and done now. Putting systems in place to generate the data required to track and enable progress will take sustained efforts and support across a number of areas.
The accountability to generate the data – and achieve the goals – is held by countries. But the international community has an obligation to work in partnership with national governments.
In Goal 17, the SDGs include a call for a revitalized global partnership for sustainable development – and working together to develop countries’ statistical capacities is an essential part of that endeavour. Target 17.18 specifically calls for capacity-building support to developing countries “to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts.”
We identify three principles that should underpin this effort and that will guide UNICEF’s work over the next 12 years:
:: Data as the spine of system strengthening.
The effort to improve data collection and capacity is inseparable from the broader effort to build strong service delivery systems, whether in health or education, social services or border control. We will invest in long-term efforts to improve the quality, coverage and coordination of governments’ administrative data systems that concern children.
:: Leave no country behind.
Global support to data monitoring and capacity resembles a messy patchwork. We will urge systematic and coordinated efforts to ensure all countries have minimum data coverage for children, irrespective of their resources and capabilities. This will require greater cooperation with industrialized economies to ensure reporting to custodian agencies, and investing in new data solutions in conflict- and disaster-affected areas, where reliance on regular surveys and routine data systems may not be feasible.
:: Shared norms, beginning with open data.
The monitoring framework of the SDGs represents a formidable exercise in agreeing on universal approaches to measurement, while still recognizing the value of local adaption for country ownership. The need for stronger shared norms on data remains great, especially when it comes to children. We will advocate for common approaches to measuring emerging threats facing children, capturing missing child populations such as those in institutions or migrating, and to sharing data to enable vulnerable children to be more effectively identified, while protecting children’s privacy.
To support countries in mainstreaming data on children and adolescents into national statistical systems and plans, UNICEF is already working to develop needed indicators and measurement tools, and support national capacities to monitor and use SDG indicators, especially the 17 indicators that UNICEF has a particular duty to support (see Box 6.1). This work is undertaken as part of the United Nations Development Group and the broader development community.
The agenda is expansive, and only by working together can it be fulfilled.
Press release
UNICEF report: Over half a billion ‘uncounted’ children live in countries unable to measure SDG progress
Latest data on development progress for children shows over half a billion more live in countries where the SDGs are quickly falling out of reach.
NEW YORK, 7 MARCH 2018 – Early assessment of progress toward achieving the Sustainable Development Goals confirms an alarming lack of data in 64 countries, as well as insufficient progress toward the SDGs for another 37 countries where the data can be tracked.
The UNICEF report, Progress for Children in the SDG Era, is the first thematic report assessing performance toward achieving the SDG global targets that concern children and young people. The report warns that 520 million children live in countries which completely lack data on at least two-thirds of child-related SDG indicators, or lack sufficient data to assess their progress – rendering those children effectively “uncounted.”
Where sufficient data is available, the scale of the challenge posed by the SDG targets remains daunting. The report warns that 650 million children live in countries where at least two-thirds of the SDGs are out of reach without accelerated progress. In fact, in those countries, even more children could face bad outcomes in life by 2030 than now.
“More than half the world’s children live in countries where we either can’t track their SDG progress, or where we can and they are woefully off-track,” said Laurence Chandy, UNICEF Director for the Division of Data, Research and Policy. “The world must renew its commitment to attaining the SDGs, starting with renewing its commitment to measuring them.”
The report tracks progress on five dimensions of children’s rights: health, learning, protection from violence and exploitation, a safe environment and equal opportunity. The report quantifies how far short of the global goals the world is currently expected to fall, measured in human costs.
Projections show that between now and 2030:
:: 10 million additional children would die of preventable causes before their fifth birthday;
:: 31 million children would be left stunted due to lack of adequate nutrition;
:: 22 million children would miss out on pre-primary education;
:: 150 million girls will marry before their 18th birthday;
:: 670 million people, many of them children, will still be without basic drinking water.
“Two years ago, the world agreed on an ambitious agenda to give every child the best chance in life, with cutting-edge data analysis to guide the way,” said Chandy. “And yet, what our comprehensive report on SDG progress for children reveals plainly is an abject lack of data. Most countries do not have the information even to assess whether they are on track or not. Children around the world are counting on us – and we can’t even count all of them.”
The report calls for renewed efforts to address the global data-deficiency, while recognizing that strong national data institutions and capacity take time and investment to develop. The report identifies three principles to underpin this work:
:: Building strong measurement into service delivery systems, whether in health or education, social services or border control;
:: Systematic and coordinated efforts to ensure all countries have minimum data coverage for children, irrespective of their resources and capabilities;
:: Establishing stronger shared norms on data concerning children, including common approaches to measuring emerging threats facing children, capturing missing child populations, and sharing data to enable vulnerable children to be more effectively identified, while protecting children’s privacy.
While each government is ultimately accountable to generate the data that will guide and measure achievement of the goals, the international community has an obligation to partner with them to make sure the SDG targets are met.
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