The MNCH Roadmap
By Dr Caroline Phiri Chibawe
Ag Director MCH
MCDMCH
What is this MNCH Roadmap?
•
A strategic document identified
that highlights the need to address
the problems of high maternal,
neonatal, infant and under-5
mortality rates in Zambia over the
next 10 years.
Goal
• Accelerated reduction of maternal,
newborn and childhood morbidity and
mortality to attain set targets by 2015.
• (Thereafter focus on attaining universal coverage goals
from 2016 to 2019 and aim to attain universal coverage
(80% and above – nationally and within each district)
Objectives in MNCH Strategic
plan
• To reduce maternal mortality from 591 to
162 per 100,000 live births
• To reduce neonatal mortality from 34 to 20
per 1,000 live births
• To reduce Under-5 mortality rate from 119
to 64 per 1000 live births
(based on ZDHS 2007)
Specific Objective
• Provide skilled attendance during pregnancy,
childbirth, and the postnatal period, at all
levels of the health care delivery system
• Strengthen the capacities of individuals,
families, communities, line Ministries, and
the private sector to share responsibility and
play their role in efforts to significantly
improve MNCH outcomes for universal
coverage to attain the set MDGs.
Situational Analysis
Maternal and newborn
health situation in Zambia
• Maternal mortality ratio – 591/100,000 live births
• Neonatal mortality rate – 34/1000 live births
• Infant mortality Rate
– 70/1000 live births
• Under five mortality rate – 119/1000 live births
• Fertility rate
6.8
• HIV prevalence – 14 %
Men
– 12 %
Women
– 16 %
Comparison of MMR versus SBA
Progress & trends towards reducing the
Maternal Mortality Ratio [MMR] to attain the
MDG target of 162 by 2015 in Zambia
al mortality ratio (Zambia)
Proportion of women (%) attended to by
skilled health workers during birth in Zambia
52%
Maternal dealths/ 100,000 live births
800
729
700
50%
649
600
48%
591
500
46%
400
44%
300
42%
200
40%
200
162
100
38%
1992 1996 1999 2001 2007
0
1992
1996
2001
2007
Source: Zambia DHS data sets
2015
Source: Zambia DHS data sets
Issues around the high MMR and NMR in
Zambia
• TBA to train or not to train
• Three delay model
• Inadequate equipment Indirect effect of HIV,
malaria and TB.
• reduced funding affected out reach services
• Reduced Human resources
Rural versus Urban disparities
• Long distances to health facilities & high cost
of care
• Uneducated, poor and living in rural areas.
• Less likely to attend 4 FANC visits, rarely seek
ANC services in 1st trimester
• ANC services tend to be poor quality with
• inadequate drugs, laboratory services
• more likely to be seen by an unskilled health
worker and rarely by a physician.
Rural versus Urban disparities
• Poor, rural, uneducated and multigravida women
tend to deliver at home by unskilled TBA or relatives.
• No access to FP, postnatal and new born care
• No outreach services for Immunisation and GMP
• Schools have few teachers, high illiteracy rate,
poverty, (access to social welfare ??)
• Early age marriages leading
• Obstetric complications, malnutrition,
Key Strategies to be implemented
1. The continuum of care approach recognizes
five critical phases in the life cycle of women
and children which are:
– Adolescence and pre-pregnancy
– pregnancy,
– childbirth and the postnatal period,
– newborn and
– childhood
Key Strategies to be
implemented
2. Using a three dimensional approach in
coming up with strategies and
interventions;
– ensuring engagement and synergy between
the health system, communities, other line
ministries and the private sector
3. Strengthening partnerships with the donor
community and the private sector for
sustainable long-term predictable financing
to achieve universal coverage.
Advocacy and Resource Mobilization
• Advocacy efforts will :
– Increasing the budget allocation for MNCH
interventions from both internal and external
resources
– Revision of laws, policies that hinder effective
provision of maternal, newborn and childcare
services
– Improving the production, employment,
deployment and retention of a skilled health
work force at all levels
– Institutionalize the Maternal Death Reviews
and make maternal deaths to be made
notifiable events
Adolescence and pre-pregnancy
• investment in
– Information – to prevent sexually transmitted
diseases, HIV, and unwanted pregnancies
– Education
– Availability and easier access to contraceptive
services and supplies.
• The underlying thinking is that a good
outcome of pregnancy starts before
conception.
Pregnancy
• The thrust in interventions is ensuring
provision of skilled care during pregnancy.
• provide quality FANC
– promote birth plan
– helping the family prepare for good
parenting.
Childbirth and the postnatal period
• Focus on skilled, professional care during childbirth
•
– providing access to professional skilled care before,
during and after childbirth;
– Train Health workers to provide quality Emergency
obstetric and newborn care
– Skilled and professional care should also be available
to the mother during the postnatal period
Newborn (neonatal):
• bridging the postnatal and postpartum gap,
ensuring no interruption in the continuum of
care, and
– establish mechanisms for communication and
handover between maternal and child
programmes
– mix of approaches, from the improved care of
newborns within the home, through home visits
by health workers, better uptake of services in
case of problems and referral when needed.
Childhood
•
•
•
•
•
•
The Expanded programme on Immunisation
“Integrated Management of Childhood Illness”
(IMCI)
Management of the newborn,
nutrition promotion,
the strengthening of school health
programmes,
shifting focus from health centres alone to a
continuum of care that implicates families and
communities, health centres, and referral-level
hospitals
Health System Strengthening and Capacity
Development
• Health system strengthening for MNCH will comprise
of improving service delivery by strengthening:
–
–
–
–
The health workforce,
Adopting Results Based Management (RBM) approaches,
The health management information system (HMIS),
The logistics management of medical products, vaccines
and technologies,
– Increased financing to comply with Abuja target of 15%,
– Improving the infrastructure for service delivery, and
– Strengthened planning, leadership and governance
Referral System
• Improve referral system through:
• appropriate transportation and improving
linkages between community and referral
facilities
• Communications equipment (e.g., radio calls
and mobile phones).
• Community structures for handling MNCH
emergencies
• Mothers’ waiting shelters
Community Mobilization
– Educating and sensitising communities on
community-based MNCH interventions
– Mobilizing resources at the village level for
MNCH including emergency referral as well
as building and strengthening health
facilities.
– Orienting the facility governing committees
to the MNCH Strategic Plan to ensure
effective
– implementation of the plan at the health
facility and community levels
– Institutionalizing ‘village health days’
Behaviour Change Communication (BCC)
• Use of BCC approaches for quality MNCH
including nutrition and adolescent sexual
reproductive health.
• Target community-based initiatives
• Use of targeted mass campaigns
Fostering Partnerships and
Accountability
• Effective implementation of this MNCH Strategic
Plan will require
• stimulating and establishing strategic partnerships
• improve coordination and collaboration between
communities, partners
• galvanizing political will and mobilizing resources
for long-term sustainable MNCH interventions.
• Coordinate regular planning, implementation,
monitoring and evaluation of MNCH interventions
to assess progress towards attainment of the
MDGs.
Monitoring and Evaluation Framweork
• One agreed indicator of maternal, newborn
and child health interventions will be evaluated
• 33 operational targets developed
• Include nutrition, water and sanitation and
systems strengthening
• Quantitative indicators
• Qualitative indicators obtained through
periodic and commissioned studies.
• Sources of data will include both the routine
and non-routine health information systems
• The indicators will be updated from time to
time as need arises
Operational targets
Indicator
Current status
Target
Unmet need for Contraceptives
27%
14%
Modern Contraceptive rate for women of
Reproductive age
33%
58%
Teenage Pregnancy
28%
18%
% of women accessing ANC in first Trimester
19%
58%
% of women accessing 4 or more ANC visits
60%
80%
% of women on IPT 2 or more
66%
80%
Proportion of women delivered by skilled HW
47%
75%
Proportion of women accessing postnatal care
within 2 days weeks
39%
55%
% of women accessing PMTCT
Operational targets
Indicator
Current
status
Target
% of women initiating early and exclusive
breastfeeding
63%
90%
% of districts with 50% HF implementing
kangaroo care
%
80%
% of children receiving correct treatment for
fever
38%
80%
% Vitamin A supplementation
60%
80%
% of households women accessing improved
drinking water
24%
80%
% of households accessing improved
sanitation
42%
80%
% of districts conducting maternal death
reviews
50%
100%
Implementation Arrangements
• Involvement of a multisector approach to
increase access to health services
• MCDMCH and Ministry of Health
• Other Ministries such as Finance, Information,
chiefs and traditional affairs, Local
Government, Agriculture, Work and supply,
Education, gender, DMMU
• Cooperating partners- NGO and private sectors
Conclusion
• The strategies are packages of interventions
for each phase of life cycle and at each level
of intervention within each selected
intervention.
• The interventions have been costed
• Implementation of the MNCH plan should
not be done in silos but comprehensively.
For a healthy nation,
invest in us now!
A prosperous,
middle income Zambia
requires healthy mothers
and healthy newborns.
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Dr. Caroline Phiri - Zambia UK Health Workforce Alliance