Meeting of South-East Asia Regional
Programme Managers on Child Health,
Kathmandu, 15 – 18 Nov 2011
Progress in Implementation of Child
Health Programme
Country: BANGLADESH
16 Nov 2011
Regional CH Meeting, Kathmandu
1
Epidemiology / burden of childhood
diseases:
Under five mortality
Figures
Year
Under five mortality Rate
54 (SVRS 2008)
2008
Infant Mortality Rate
41 (SVRS 2008)
2008
Neonatal Mortality Rate
37 (BDHS 2007)
2007
Nutrition Status
Low Birth Weight
22 % (UNICEF)
2009
Underweight
41 % (BDHS)
2007
Stunting
43% (BDHS)
2007
16 Nov 2011
Regional CH Meeting, Kathmandu
2
Declining U5 mortality
160
Deaths per 1,000 live-births
140
120
100
80
Age groups:
60
12-59 months
40
1-11 months
-2.6% per year
20
0-28 days
0
1989-93
1992-6
1995-9
1999-2003
2002-6
Source: BDHS 1993-2007
3
Deaths per 1,000 live-births
Declining under-5 child mortality in Bangladesh…..
But, proportion of neonatal mortality increasing……
39%
12-59 months old children
42%
45%
47%
1-11 months old infants
57%
Neonates (0-28 days)
1989-93
1992-6
1995-9
1999-2003
Source: Bangladesh Demographic and Health Surveys
2002-6
4
Cause of death distribution of neonatal
deaths in Bangladesh: 1994-2003
Source: Bangladesh Demographic and Health Survey 2004
5
Causes of U5 deaths
6
Trend in U5 mortality (1990-2008)
151
7
IMCI Implementation
IMCI implementation started (If yes, year)
2002
Newborn Added (If yes, year)
2000 (From day 1)
2009 (From 0 day)
Number and Proportion of districts implementing IMCI
54 (84%)
Number and proportion of MOs trained
2,866
Number and proportion of Nurses/other workers
trained
7,924
Proportion of districts (out of IMCI districts) with 60 %
or more health providers trained
na
IMCI supervisory checklists introduced
2004
Proportion of first-level health facilities that had at
least one supervisory visit over a period of 6 month
na
during previous year
Proportion of districts (out of IMCI districts) covered
with Follow-up IMCI training
na
IMCI implementation
IMCI implementation review conducted (If yes, year;
National or sub-national)
2003
IMCI Health Facility Survey conducted (If yes, year;
National or sub-national)
2008
Proportion of first-level health facilities with at least
one health worker who cares for children trained in
IMCI
>90% (approx)
Sub-national
Sub-National
Pre-Service IMCI teaching/training:
Number and proportion of Medical Schools teaching
IMCI
48 (88%)
2010
Number and proportion of Nursing Schools teaching
IMCI
nil
ICATT introduced (If yes, year and scale)
No
Expansion of IMCI guided by evidence of need
PANCHAGARH
NILPHAMARILALMONIRHAT
THAKURGAON
FIMCI
KURIGRAM
2002
2003
2004
2005
2006
RANGPUR
DINAJPUR
INDIA
GAIBANDHA
*
JOYPURHAT
SHERPUR
JAMALPUR
NAOGAON
SUNAMGANJ
NETRAKONA
BOGRA
NAWABGANJ
SYLHET
MYMENSINGH
SIRAJGANJ
NATORE
TANGAIL
KISHOREGANJ
HABIGANJ
GAZIPUR
INDIA
PABNA
NARSINGDI
BRAHAMANBARIA
KUSHTIA
MEHERPUR
MANIKGANJ
RAJBARI
INDIA
JHENAIDAH
MAGURA
FARIDPUR
NARAIL
JESSORE
MUNSHIGANJ
COMILLA
*
SHARIATPURCHANDPUR
MADARIPUR
FENI
LAKSHMIPUR
KHULNA BAGERHAT JHALOKATI
PIROJPUR
PATUAKHALIBHOLA
BARGUNA
NOAKHALI
• All 159 upazillas of 20 districts in the “red”
(high mortality) areas covered by 2007
• As of now, IMCI is in facilities in:
• 54 districts
• 400upazilas
• IMCI in the community is in 71 upazilas
and some urban areas
KHAGRACHHARI
GOPALGANJ
BARISAL
SATKHIRA
2010
2010
DHAKA
NARAYANGANJ
CHUADANGA
INDIA
2009
2007
2008
2009
MAULVIBAZAR
RAJSHAHI
CIMCI
RANGAMATI
CHITTAGONG
*
BANDARBAN
Bay of Bengal
COX'S BAZAR
MYANMAR
Bangladesh Maternal Mortality Survey, 2001: Provided District Under-5 Mortality
Estimates
IMCI Implementation
Key factors that helped scaling up
1. Conducive policy environment-HNPSP (206-11), HPNSDP (201116); Lessons from MCE of IMCI
2. Continued commitment and support from DPs/GOB
(Financial/Supplies)
3. Strong partnership, networking and pro-active role of child
health group (Professional bodies, NWT)
Key challenges to scaling up:
1. Lack of supervision and monitoring system
2. Utilization of pool fund for scaling up IMCI (Facility/Community)
3. Weak health system support to scale up integrated approach
16 Nov 2011
Regional CH Meeting, Kathmandu
11
Newborn Health
• ENC Course adapted: 2009
• Other training courses: ETAT and Sick Newborn
Care; BHW package
• Healthcare providers trained:
Healthcare providers
Total no.
No. Trained
MO
650
1500
222
247
Nurses
CHW
16 Nov 2011
%
34%
17%
80,000 (GoB) 12000 (NGO)
NGO-na
Regional CH Meeting, Kathmandu
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In-Patient (Hospital) care of sick
newborns and children
•
•
•
•
WHO Pocket Book introduced: 2009-10
Training courses for Hospital care done: Yes
Details, If yes:(ETAT and Sick Newborn Care part);
Number and proportion of Healthcare providers
trained: Given in previous slide
• Proportion of hospitals providing pediatric care
having oxygen: 82%, 483(589)
• Hospital assessment using WHO tools carried out:
– Year/s: 2009
– How many hospitals covered:6 DH+ 12 UHCs
16 Nov 2011
Regional CH Meeting, Kathmandu
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CHW approach for care of sick
newborns and children
District implementing CHW
approach
Total No.
of Distt
Implementing
Districts
%
Home based newborn care
64
25
39%
Sick child package
64
35
55%
Healthy child package
(ECD)
Any review of the
experience
16 Nov 2011
Individual project MTR done
Regional CH Meeting, Kathmandu
14
Programme Review and Management
• CH Short Programme Review introduced,
if yes :
– Year:2010
– National or sub-national:National
• Programme Management Course
introduced, if yes:
– Year:2010
– National or sub-national: National
16 Nov 2011
Regional CH Meeting, Kathmandu
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Health Management Information Systems
(HMIS) and DHS/MICS
• List the key indicators for newborn and child health
included in HMIS and DHS/MICS?
– Thermal care (Wiping/Wrapping/Delayed bathing)BDHS
– EBF-BDHS, MICS
– LBW-BDHS, MICS
– Care seeking for suspected pneumonia-BDHS, MICS
– ORS and Zinc for diarrhoea-BDHS
– IMCI Case management by age and sex-HMIS
15 Nov 2011
Regional CH Meeting, Kathmandu
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Health Management Information Systems
(HMIS) and DHS/MICS
• How and at what level are the data for these key
programme indicators analysed and used by the
programmes?
– desktop based application: Data entry using software
at UHCs
– web-based application: Data uploading in the HMIS
server at HQ
– Analysis at national level and used by IMCI section
– Publication of Newsletter by the HMIS, DGHS
16 Nov 2011
Regional CH Meeting, Kathmandu
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Future Plans
Strengthening and scale-up plans for Next 2
years
• IMCI: Full saturation of upazilas/districts with IMCI
• ICATT use: Planned in the next Biennium
• CHW Packages:
– Home Based NB Care package:35 districts
– Sick child package:35 districts
– Healthy Child (ECD) package:
• Referral (Hospital) Care: Distribution, Developing
training package
• Programme Review and Management:
– CH Short Programme Review: 2014
– Programme Managers Course: Not yet planned
16 Nov 2011
Regional CH Meeting, Kathmandu
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Thank You
16 Nov 2011
Regional CH Meeting, Kathmandu
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