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Integrated maternal newborn & child health

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  • Note; MDG= Mil Dev Goals, RMNCH= Reproductive,Maternal,Newborn&Child Health “continuum of care”, IMCHI= Integrated Mgt of Childhood Illnesses, IMNCHS= Integrated Maternal,Newborn&Child Health Strategy, IYCF= Infant & Young Child Feeding, IDSR= Integrated Dx Surveillance & Response, ACSD= Accelerated Child Survival & Dev. Strategy.
  • MMR= Hem 23%,Inf 17%,PIH – Anaemia 11% each, others/HIV 5%U5 MR= Mal 24%, ALRI 20%, DDx 16%, Measles 6%, HIV/AIDS 5%, Neonatal 29%
  • NMR; BA=25.6%, NNS= 23.1%, Preterm birth=23.4%, NNT= 10.3%, Congenital= 6.5%, DDx=3.9%, Others=7.2%
  • MDG= 1000-700-550-400-250/100,000 @ 30/yr.Current Trend= 1000-816-724-622-540/100,000 @ 18.4/yr.
  • MDG= 230-168-138-107-77/1000 @ 6.12/yrIMNCH= 230-161-127-103-59/1000 @ 6.84/yr.Current Trend= 230-204-192-179-167/1000 @ 2.16/yr
  • NEEDS – National Economic & Empowerment Dev. Strategy
  • NACA – National Agency for the Control of AIDS
  • Transcript

    • 1. 12/1/2012 6:25 AMBYDR OKORO EUSEBIUS N.FAMILY MEDICINE DEPT. MMSH, KANO.INTEGRATED MATERNAL NEWBORN &CHILD HEALTH STRATEGY 1
    • 2. 12/1/2012 6:25 AM OUTLINE INTRODUCTION SITUATION ANALYSIS WHY IMNCHS? THE STRATEGY PRIORITY AREAS LEVELS OF INTERVENTION ANALYSIS OF BOTTLENECKS PHASES OF IMPLEMENTATION MONITORING & EVALUATION THE PARTNERSHIPS THE CHALLENGES CONCLUSION 2
    • 3. 12/1/2012 6:25 AM INTRODUCTION 1 Women and the young ones are essential for global development. Women are mothers of the nation while the newborn today are tomorrows decision makers. However as essential as they are, some factors including health risks, social and economic issues pose serious threat to them from childhood, adolescence, through pregnancy, childbirth and motherhood. 3
    • 4. 12/1/2012 6:25 AM INTRODUCTION 2 In order to tackle the dreaded challenges, world leaders have over the years tried to formulate strategies aimed at saving our mothers and the young ones. Some of the global strategies evolved so far include ; MDG, RMNCH “continuum of care”, IMCHI, IMNCHS, IYCF, IDSR, ACSD etc. Our discussion today is on IMNCHS which deals directly on MDGs 4&5 and indirectly on other MDGs. 4
    • 5. 12/1/2012 6:25 AM INTRODUCTION 3 The MDG (UN millennium summit-NY,2000) has 8 interconnected developmental goals/18 targets with 48 indicators to be achieved by 2015 viz - G1- eradicate extreme poverty & hunger. G2- achieve universal basic education. G3- promote gender equality & empowerment. G4- reduce child mortality. 4a= reduce by 2/3 U5 MR b/w 1990-2015. G5- improve maternal health. 5a=reduce by 3/4 MMR b/w 1990-2015. 5b=achieve by 2015, universal access to reproductive health. G6- combat HIV/AIDS, malaria & other diseases. G7- ensure environmental sustainability. G8- develop a global partnership for development. 5
    • 6. 12/1/2012 6:25 AM SITUATION ANALYSIS 1 So far, what is on ground? Nearly 9mil U5 die every year globally- WHO 2007 report. (Nigeria 2% of world population takes a lion share of 10% of these deaths). Approximately 70% of these deaths are due to preventable or treatable causes; with access to simple, affordable interventions. Leading causes of U5 mortality include - pneumonia, diarrhoeal disease, malaria, measles, HIV/AIDS & neonatal health problems. Over 1/3 of all U5 deaths are linked to malnutrition. MD4 is still long way ahead ( 1990-12mil ), 2/3 of 12mil reduction by 2015 is 4mil; presently we are still battling with 9mil. How can 3yrs make the difference? 6
    • 7. 12/1/2012 6:25 AM SITUATION ANALYSIS 2 Approximately 1000 women die daily & 358,000 annually from pregnancy related causes. (Nigeria again takes a lion share of 10% of these deaths). Ninety nine % of all MMR occur in sub-saharan Africa & south Asia.(rural areas/ignorance/poverty). Between 1990/2008, MMR dropped 1/3rd globally, about 2.3% average annual fall rate as against the expected 5.5% MDG fall rate. Causes of MMR include- haemorrhage, infection, hypertension/ecclampsia, obstructed labour, unsafe abortion. 7
    • 8. 12/1/2012 6:25 AMCAUSES OF MMR CAUSES OF U5 MR Hemorage Infection Eclampsia Malaria Obst.Lab. ALRI-Pn Unsafe Ab DDx Malaria Measles Anaemia HIV Others NN DIRECT CAUSES OF MMR/U5 MR 8
    • 9. 12/1/2012 6:25 AM CAUSES 0F NMRTarget is from 48/1000 to 18/1000 by 2015 Birth Asp. Severe NNS Preterm B. NNT Congenital DDx Others 9
    • 10. 12/1/2012 6:25 AM TREND IN MMR (1990-2015)12001000800 MGD Trend(1000 to 250)600 Current Trend(1000 to 540)400 Series 3200 0 1990 2000 2005 2010 2015 10
    • 11. 12/1/2012 6:25 AM TREND IN U5 MR (1990-2015)250200 MDG Trend(230 to 77)150 IMNCH Trend(230 to 59)100 Current Trend(230 to 167) 50 0 1990 2000 2005 2010 2015 11
    • 12. 12/1/2012 6:25 AM WHY IMNCHS ? 1. Mother, newborn & child are inseparable. 2. High MMR, NMR & U5MR are due to weak health system & low coverage of MNCH intervention. 3. Maternal deaths, stillbirths & neonatal deaths are strongly linked in terms of cause, time & place of death and delays in access to care. 4. They have similar solutions and so must be linked. 12
    • 13. 12/1/2012 6:25 AM THE STRATEGY (IMNCHS) IMNCHS is an initiative of paradigm shift in the health care services involving health resource distribution and utilization, with emphasis on continuum of health care service delivery in a cost-effective, impact-maximizing ways. It was developed within the framework of National Health Sector Reforms & in the context of NEEDS. Goal – To reduce MNC morbidity and mortality in line with MDG 4&5. Targets – 1. Reduce MMR by 3/4 in 2015 2. ↓ U5MR by 2/3 in 2015 13
    • 14. 12/1/2012 6:25 AM STRATEGIC OBJECTIVES 1. Improve access to good quality Health Services. 2. Ensure adequate provision of medical supplies, drugs etc. 3. Strengthen family & community capacity to take necessary MNCH actions. 4. Improve capacity for organization & mgt. of MNCH services. 5. Establish financing mechanism that ensures adequate funding & efficient use of funds. 6. Strengthen monitoring & evaluation systems. 7. Establish & sustain partnerships to support implementation of IMNCH strategy. 14
    • 15. 12/1/2012 6:25 AM PRIORITY AREAS Focused ANC Intrapartum Care EmONC Routine Postnatal Care Newborn Care Infant & Young Child Feeding strategy Use of ITN & IPT Immunization Plus PMTCT Management of common Childhood illness & care of HIV exposed or infected children Water, Sanitation & Hygiene 15
    • 16. 12/1/2012 6:25 AM LEVELS OF INTERVENTIONS 1. Family Oriented/Community Based Interventions. 2. Population Oriented Interventions. 3. Individual Oriented Clinical Interventions. Note; The vision of these interventions is to build up the Health Practices from what is obtained now to the 2015 Goal. 16
    • 17. 12/1/2012 6:25 AM FAMILY ORIENTED/COMMUNITY BASED INTERVENTIONS. 1. Family preventive services; ITN, clean water/environment, hand wash, condom use. 2. Family neonatal care; Clean delivery/cord care, early BF, care of LBW/temperature mgt. 3. Infant & child feeding; Proper B/F , complementary/supplementary feeding 4. Community mgt of illnesses; ORT, ZnSo4 for DDx, Vitamin A for measles, use of ACT for malaria. 17
    • 18. 12/1/2012 6:25 AMPOPULATION ORIENTED INTERVENTIONS. 1. Preventive care for adolescents/adults; Reproductive health/Family planning. 2. Preventive pregnancy care; ANC, TT, Deworming, Detection & Rx of asymptomatic bacteriuria / Syphilis, Prevention & Rx of Fe def. anaemia, IPT. 3. HIV/AIDS prevention & care; PMTCT(testing & counseling), AZT + sd NVP & infant feeding counseling, Condom use, SP prophylaxis for HIV mothers & their exposed children. 4. Preventive Infant & child care; Vaccines(EPI), Hep B, Hib, Pentavalent(DPT-Hib- Hep B), Vit A supplementation. 18
    • 19. 12/1/2012 6:25 AM INDIVIDUAL ORIENTED CLINICAL INTERVENTIONS. 1. Clinical 1º level skilled M & N care; Skill del care, Resusc. of asphyctic NB, Steroids for preterm labour, Antibiotics for P/PROM, Mgt. PIH(use of MgSo4), Mgt. of NNS @ PHC. 2. Mgt of illness @ 1º clinical level; Antibiotics for U5 pneumonia/DDX/Enteric fever, Vit A for measles, ZnSo4 for DDx, ACT for children & pregnant women, Mgt. of complicated malaria (2nd line drugs), ART for children & pregnant women with AIDS. 3. Clinical 1st referral illness mgt; B-EONC, Mgt. of severely sick children (referral IMCI), Mgt. of NNJ, Universal emergency Neonatal Care (asphyxia after care, mgt. of serious infections, mgt. of VLBW), Mgt. of complicated malaria. 4. Clinical 2nd referral illness mgt; C-EONC, other emergency acute care, Mgt. 19
    • 20. 12/1/2012 6:25 AM ANALYSIS OF BOTTLENECKS 1 The Marginal Budgeting for Bottlenecks(MBB) identifies Health Care Delivery System bottlenecks @ 5 progressive levels viz; 1. The AVAILABILITY of critical Health system inputs such as Drugs, Vaccines, Supplies & Human Resources. 2. The physical ACCESSIBILITY of people to Health services viz the presence of skilled staff @ community level, villages reached @ least once/month by outreach services, and the time taken to reach a facility providing B-EONC services. 20
    • 21. 12/1/2012 6:25 AM ANALYSIS OF BOTTLENECKS 2 3. The UTILIZATION of Health Care Services which can be proxied by 1st use of multi-contact service i.e. members of catchment population actually using the services when it is available (e.g. ANC / Immunization). 4. The CONTINUITY (or adequate coverage) in utilization of services or adherence. E.g. % of children receiving DPT3, or % of women attending 3ANC. 5. The QUALITY (or effective coverage) of the services provided or received. I.e. skill for correct diagnosis/intervention/use of equipment & advise appropriately. Also that potential users are using services in a correct & effective manner. 21
    • 22. 12/1/2012 6:25 AM PHASES OF IMPLEMENTATION Phase 1 – 2007 to 2009 Immediate removal of bottlenecks. Phase 2 – 2010 to 2012 Implementation reinforced @ service delivery modes. Phase 3 – 2013 to 2015 - 80% effective coverage of clinical intervention @ basic health care. - 70% @ 1st & 2nd referral care. 22
    • 23. 12/1/2012 6:25 AM STEPS FOR ROLLING OUT IMNCHS 1. Formation of IMNCH national team & national partnership. 2. Targeted advocacy, communication & social mobilization for IMNCH. 3. Development of IMNCH State/LGA-specific roll out Plan of Action. 4. Establish State/LGA level IMNCH p/ship. 5. State/LGA specific situation analysis & needs assessment. 6. Development of States/LGAs IMNCH plans. 7. IMNCH enhancing capacity building for paradigm shift. 8. Supervision, monitoring & evaluation plan. 9. Technical support to States & LGAs for IMNCH initiation. 23
    • 24. 12/1/2012 6:25 AM MONITORING & EVALUATION Critical to make this a continuous process. Key indicators used for tracking progress (Mortality, Maternal/Child/Newborn Health Immunization, Case mgt., Water & Sanitation Health Facility, Supervision, Costing, Improved stewardship Role of Government). Data to be collected @ all levels including routine data, supervisory visits, follow up after trainings, population based national surveys (Demographic & Health Survey-DHS, Multiple Indicator Cluster Survey-MICS, National HIV/AIDS & Reproductive Health Survey-NARHS). The flow of data & their mgt to be strengthened through capacity building @ all levels. Tools & appropriate mechanism including an IMNCH data base to be developed for tracking. 24
    • 25. 12/1/2012 6:25 AM PARTNERSHIPS All tiers of the Govt. Agencies, parastatals e.g. NACA, MDG Medical institutions Professional associations Private sectors, NGOs etc Donors & international dev. Partners All relevant stakeholders (traditional/religious) 25
    • 26. 12/1/2012 6:25 AM THE CHALLENGES Government structures – 3 tiers Political commitment / corruption Govt. funding Coordination – The FP should come in for efficient coordination. Human resources skills & number 26
    • 27. 12/1/2012 6:25 AM CONCLUSION Only a focused & well coordinated effort in health care delivery / universal access can save the mothers, newborns & the young child. May we all rise up to the clarion call. 27