Countdown to 2015:
Peru
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• Data presented are based on best available data up
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studies or data. (2013 mortality on slide #18 added)
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audience and purpose
Purpose of this presentation
• To stimulate discussion about Peru country data,
especially about progress, where we lag behind, and
where there are opportunities to scale up
• To provide some background about Countdown to
2015 for MNCH, the indicators, and data sources in the
country profiles
• To showcase the country profile as a tool for
monitoring progress, sharing information and
improving accountability
Outline
1. Countdown to 2015: Background
2. Peru Countdown profile
Part I
Countdown to 2015:
Background
What is Countdown?
A global movement initiated in 2003 that tracks
progress in maternal, newborn & child health in
the 75 highest burden countries to promote action
and accountability
Countdown aims
•
To disseminate the best and most recent
information on country-level progress
•
To take stock of progress and propose new
actions
•
To hold governments, partners and donors
accountable wherever progress is lacking
What does Countdown do?
•
Analyze country-level coverage and trends for
interventions proven to reduce maternal, newborn and
child mortality
•
Track indicators for determinants of coverage (policies and
health system strength; financial flows; equity)
•
Identify knowledge and data gaps across the RMNCH
continuum of care
•
Conduct research and analysis
•
Support country-level Countdowns
•
Produce materials, organize global conferences and
develop web site to share findings
9
75 countries that together account for > 95% of maternal
and child deaths worldwide
Who is Countdown?
• Individuals:
scientists/academics,
policymakers, public health
workers, communications
experts, teachers…
• Governments:
RMNCH policymakers,
members of Parliament…
• Organizations:
NGOs, UN agencies,
health care professional
associations, donors,
medical journals…
12
Countdown moving forward
Four streams of work to promote accountability,
2011-2015
• Responsive to global accountability frameworks
-Annual reporting on 11 indicators for the Commission on
Information and Accountability for Women’s and Children’s
Health (COIA)
-Contribute to follow-up of A Promise Renewed/Call to
Action
• Production of country profiles/report and global
event(s)
• Cross-cutting analyses
• Country-level engagement
Part 2
Peru Countdown
country profile
Main findings
data on the profile
WhatRange
doesofCountdown
monitor?
• Progress in coverage for critical interventions across
reproductive, maternal, newborn & child health
continuum of care
• Health Systems and Policies – important context for
assessing coverage gains
• Financial flows to reproductive, maternal, newborn
and child health
• Equity in intervention coverage
Sources of data
The national-level profile uses data from global databases:
• Population-based household surveys
• UNICEF-supported MICS
• USAID-supported DHS
• Other national-level household surveys (MIS, RHS and
others)
• Provide disaggregated data - by household wealth, urbanrural residence, gender, educational attainment and
geographic location
•
Interagency adjusted estimates
U5MR, MMR, immunization, water/sanitation
•
Other data sources (e.g. administrative data, country reports
on policy and systems indicators, country health accounts, and
global reporting on external resource flows etc.)
National progress towards
MDGs 4 & 5
Mortality data through 2012:
2013 child mortality data was released in late 2014:
Under-five mortality rate (U5MR)= 17 deaths per 1000 live births
Infant mortality rate (IMR) = 13 deaths per 1000 live births
Neonatal mortality rate (NMR) = 8 deaths per 1000 live births
Why do mothers in the LAC
region die?
Leading direct causes:
Hypertension –23%
Haemorrhage – 22%
Unsafe abortion – 10%
Sepsis – 8%
Embolism – 3%
Understanding the cause of death distribution is
important for program development and monitoring
Per u
Why do Peruvian children die?
DEMOGRAPHICS
Ca
Causes of under-five deaths, 2012
Leading causes:
Neonatal – 51%
Pneumonia – 8%
Injuries – 6%
Diarrhoea – 4%
HIV/AIDS – 1%
Pneumonia
8%
2%
Preterm 19%
Other 30%
Neonatal
death: 51%
Globally nearly
half of child
deaths are
attributable to
undernutrition
Asphyxia* 7%
Other 5%
Congenital
12%
HIV/AIDS 1%
Malaria 0%
Injuries 6%
Measles 0%
* Intrapartum-related events
Sepsis** 6%
4%
0%
Diarrhoea
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
MATERNAL AND NEWBORN HEALTH
Undernutrition isAntenatal
a major underlying
cause of child
care
Percent women aged 15-49 years attended at least once by a
deaths
skilled health provider during pregnancy
Dem
Ante
Demographics
Countdown to 2015 Report. 2014.
Variable coverage along the continuum of care
Maternal and newborn health
Maternal and newborn health
Diarrhoea
* Intrapartum-related events
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Maternal and newborn health
MATERNAL AND NEWBORN HEALTH
Antenatal care
Demand for
Percent women aged 15-49 years attended at least once by a
skilled health provider during pregnancy
Antenatal c
100
Percent
80
84
64
91
94
96
Malaria dur
treatment (
C-section ra
67
(Minimum tar
60
Neonatal te
40
Postnatal vi
(within 2 days
20
Postnatal vi
(within 2 days
0
1992
DHS
1996
DHS
2000
DHS
2004
DHS
2009
DHS
2012
DHS
Women wit
(<18.5 kg/m2
Source: WHO 2014
HERG 2014
ephalitis
Kangaroo
birthweig
Other maternal and newborn health indicators
HEALTH
a
96
Antenata
managem
Demand for family planning satisfied (%)
90
(2012)
Antenatal care (4 or more visits, %)
94
(2012)
-
-
25, 33, 11
(2012)
Low osm
managem
85
(2012)
-
-
SYST
Malaria during pregnancy - intermittent preventive
treatment (%)
C-section rate (total, urban, rural; %)
(Minimum target is 5% and maximum target is 15%)
Neonatal tetanus vaccine
Postnatal visit for baby
(within 2 days for home births, %)
Postnatal visit for mother
93
(2012)
1
(2007-2008)
(within 2 days for home births, %)
2012
DHS
Women with low body mass index
(<18.5 kg/m2, %)
Countdown to 2015 Report. 2014.
Internati
Breastmi
Commun
with anti
Costed n
plan(s) fo
child hea
Life Savin
Reprodu
Matern
Child health
Child health
DHS
DHS
DHS
DHS
DHS
DHS
Child health
CHILD HEALTH
Women w
(<18.5 kg/m
Malar
Percent of children <5 years with diarrhoea:
receiving oral rehydration therapy/increased fluids
with continued feeding
treated with ORS
Percent c
those rec
Percen
Percent
Diarrhoeal disease treatment
100
80
60
40
20
0
64
60
20
1992
DHS
26
1996
DHS
22
2000
DHS
32
25
2004-2006
DHS
64
2010
DHS
WATER AND SANITATION
31
2012
DHS
Child health
Child health
Child health
DHS
DHS
DHS
DHS
DHS
DHS
Water
and
sanitation
WATER AND SANITATION
Improved drinking water coverage
Improve
Percent of population by type of drinking water source, 1990-2012
Piped on premises
Other improved
Surface water
Unimproved
Percent of po
Improved
Unimprov
80
17
60
20
4
9
5
1
8
4
15
100
16
27
82
73
54
80
12
9
29
40
20
1
11
Percent
Percent
100 9
87
33
60
20
0
1990
2012
Total
Source: WHO/UNICEF JMP 2014
1990
2012 1990
Urban
7
6
40
63
11
33
54
0
2012
1990
Rural
Source: WHO/U
S
expenditure
DHS
Out of pocke
expenditure
Water and sanitation
Reproductiv
and child he
Improved sanitation coverage
1990-2012
Percent of population by type of sanitation facility, 1990-2012
Improved facilities
Shared facilities
Open defecation
Unimproved facilities
100
16
80
Percent
12
9
60
8
7
6
15
6
8
Out-of-p
23
28
4
81
71
9
54
45
1
16
1990
2012
Total
Source: WHO/UNICEF JMP 2014
Other
ODA to child
0
2012
General
74
73
20
Rural
33
40
63
1
6
13
1
9
9
External
1990
2012
Urban
1990
2012
Rural
ODA to mate
per live birth
Note: See annex
MNCH policies
• PARTIAL - Maternity protection in accordance with
Convention 183
• YES - Specific notifications of maternal deaths
• -- - Midwifery personnel authorized to administer core set of
life saving interventions
• YES - International Code of Marketing of Breastmilk
Substitutes
• YES - Postnatal home visits in first week of life
• YES - Community treatment of pneumonia with antibiotics
• YES - Low osmolarity ORS and zinc for diarrhoea management
• YES - Rotavirus vaccine
• YES - Pneumococcal vaccine
Systems and financing for MNCH
• Costed national implementation plans for MNCH: -• Density of doctors, nurses and midwives (per 10,000
population): 26.5 (2012)
• National availability of EmOC services: - (% of recommended minimum)
• Per capita total expenditure on health (Int$): $555 (2012)
• Government spending on health: 18% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 36% (2012)
(as % of total health spending)
• Official development assistance to child health per child
(US$): $4 (2011)
• Official development assistance to maternal and newborn
health per live birth (US$): $13 (2011)
Who is left behind?
Peru
The wide bars for some
indicators show important
inequalities in coverage.
Inequality is greatest for
skilled birth attendant.
Other indicators show
much smaller gaps in
coverage.
Thank you!
Optional additional slides
Equity profiles
Peru
Coverage levels in poorest and richest
quintiles
Coverage levels in the 5 wealth
quintiles
Co-coverage of health interventions
Composite coverage and coverage gap