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INTEGRATED MATERNAL NEWBORN & CHILD HEALTH STRATEGY

BYDR OKORO EUSEBIUS N.FAMILY MEDICINE DEPT. MMSH, KANO.

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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

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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.

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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.

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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.

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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?

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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.

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DIRECT CAUSES OF MMR/U5 MR

CAUSES OF MMR CAUSES OF U5 MR

HemorageInfectionEclampsiaObst.Lab.Unsafe AbMalariaAnaemiaOthers

MalariaALRI-PnDDxMeaslesHIVNN

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CAUSES 0F NMR

Target is from 48/1000 to 18/1000 by 2015

Birth Asp.Severe NNSPreterm B.NNTCongenitalDDxOthers

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TREND IN MMR (1990-2015)

1990 2000 2005 2010 20150

200

400

600

800

1000

1200

MGD Trend(1000 to 250)Current Trend(1000 to 540)Series 3

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TREND IN U5 MR (1990-2015)

1990 2000 2005 2010 20150

50

100

150

200

250

MDG Trend(230 to 77)IMNCH Trend(230 to 59)Current Trend(230 to 167)

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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.

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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

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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.

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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

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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.

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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.

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POPULATION 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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)

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THE CHALLENGES

Government structures – 3 tiers Political commitment / corruption Govt. funding Coordination – The FP should come in

for efficient coordination. Human resources skills & number

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CONCLUSIONCONCLUSION

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. Thank you all.