Presentation_Kumar - Breaking Barriers to Improve Health and Nutrition
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CORE Group Global Health Practitioner Conference 2019
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Presentation_Kumar - Breaking Barriers to Improve Health and Nutrition
- 1. 1 Breaking Barriers to Improve Health and Nutrition: Introduction Smita Kumar, MD, MPH Sr. Newborn Advisor USAID/Global Health Bureau/MCHN Office/MNH Division May 8, 2019
- 2. • Ethical imperative to provide comprehensive clinical services for children • Prevention mandate • Nutrition and Mortality – Nutrition related factors contribute to 45% of deaths in children under 5 years – Malnourished children die at higher rates from diarrhea, pneumonia and malaria 5/15/2019 FOOTER GOES HERE 2 Why provide nutrition and health services hand in hand for infants and young children
- 3. Why is this Discussion Important?
- 4. Changing Hydraulics of U5 Deaths
- 5. Moving from Survive to Thrive and Transform
- 6. Urbanization
- 7. • Family Planning and SRH Services • Antenatal Care • Labor and Delivery • Post Natal Care • Immunization • Sick Child Entry Points: IMNCI, ICCM, SAM, HIV, TB What programme platforms are we talking about?
- 8. • Integration – what does it mean? • You know this….SILOS – Potentially opposing perspectives of nutrition and health communities – Organization issues – funding streams, donor priorities, structure within national health programmes • Perceptions of value (family, curative vs preventive, cultural norms/care seeking) • Weak Implementation What stops nutrition services from being delivered within the health system?
- 9. • Policies Exist – There is global Normative Guidance • Nutrition Interventions are Addressed in the Sick Child Encounter including Counseling of the caregivers for feeding of the sick child • IMCI and iCCM Country Guidance Mirrors Global Guidance • Nutritional is MULTISECTORAL What do we know?
- 10. Illustrative Gaps in Policies and Guidelines • Moderate Wasting • Expanded Guidelines on growth failure in infants < 6 months • Updated LBW • Kangaroo Mother Care • Neo-BFHI • Weak articulation of feeding advice during and post illness
- 11. • Inequities in Coverage • Fragmentation of M&E Systems • Financing – poorly capitalized DHMTs • Weak Community Involvement • Health Workforce Challenges • Service Delivery Barriers to Operationalization: HSS Lens
- 12. Health Workforce and their many Challenges Shortages of Qualified Staff Difficult Work Environments Lack of Support Limited Training Poor Remuneration
- 13. Human Resources & Provider Skills Motivation Listen & Link to Communities, Families, & Women Communication & Teamwork Data & Surveillance for Decision-Making Leadership & Culture Commodities, Supplies, Equipment, & Facility Infrastructure Standards & Processes Beyond Training- Context Matters to Improve Quality and Service/Care
- 15. • Dr. Sascha Lamstein – USAID Advancing Nutrition • Dr. Nadeem Hasan - DFID • Dr. Nigel Rollins - WHO • Lynette Friedman and Cathy Wolfheim • Dr. Anne Detjen – UNICEF • Resource: – Child Health Task Force Institutionalizing Nutrition Services Meeting Acknowledgements
Editor's Notes
- Ghana Meeting: Institutionalizing Nutrition Health Services in the Care of the Ill and Vulnerable Newborn and Child Workshop Report was held in Ghana from October 30 – November 2018. This meeting brought together 115 participants including representatives from 7 countries (DRC, Ethiopia, Ghana, Kenya, Mali, Mozambique and Nigeria). The meeting had several key objectives related to sharing successful practices in implementing current policies, barriers at the various levels of the health system and for various age bands highlighting the LBW/SGA and/or premature babies. Countries developed country specific action plans. I would encourage you to go to the CH Task Force website where you can access the: Meeting Report Presentations Review of Policies and Guidelines Related to the Nutrition of Ill and Undernourished Children at the Primary Health Care Level
- The US was one of only 13 countries, including North Korea and Zimbabwe, that saw its maternal death rate increase since 1990.
- Some of the things that are highlighted from the Ghana meeting. These are by no means comprehensive.
- SERVICE DELIVERY: Assessing nutritional status of children under six months; clinic organization and flow; task shifting; etc INEQUITIES: Investments may focus on certain geographies; national coverage belies subnational inequities; M&E: Weak integration of M&E systems; vertical programmes FINANCING: line items; silo’d COMMUNITY: IMCI has focused mainly on the first component (HW skills) to the exclusion of strengthening systems and community engagement HW ; CHW overload; limited meaningful community engagement for augmentation of service delivery, but also to support CIVIC ENGAGEMENT
- Despite significant investment in training, this has been less effective than originally hoped for: One Third of ill children are stil lnot receiving appropriate treatment Causes include: Inadequate training budgets; staff turnover; retention and motivation issues; weak mentorship and supervisory systems; insufficient facility readiness