8 November, RMNCAH Country Case-Studies: Summary of Findings from Six Countries

Transcription

1 8 November, 2012 RMNCAH Country Case-Studies: Summary of Findings from Six Countries

2 Country Case-Studies: September October countries Bangladesh, India, Indonesia, Nepal, Papua New Guinea and Solomon Islands Focus on implementation - 2 key successes, 2 key challenges and lessons learned Desk review of available data. Review and discussion by a multi-constituency stakeholder group, led by government

3 Country Case-Studies: Areas Reviewed RMNCAH policy, systems or intervention areas that have: Successes Used innovative or unique methods or solutions Demonstrated program impact or improvements Contributed to developing sustainable local systems Challenges Not responded to national strategies or programs and continue to pose a challenge in the country

4 Technical priorities

5 Fertility Reducing fertility identified in all countries as critical for reducing maternal and child deaths Contraceptive prevalence for modern methods increasing but highly variable by wealth, urban/rural residence, education and geographic area. More attention needed to reach underserved populations Adolescent pregnancies an important problem in several countries early marriage and early pregnancy are common

6 Adolescent Fertility Rate, 6 countries, 2012 Adolescents have a higher risk of maternal and child deaths; early childbirth also limits education and opportunity

7 Newborn Health Increasing proportion of under-5 mortality (range 39% - 60%) slower rate of decline than U5-mortality Primary causes of death similar across countries (pre-term/lbw, asphyxia, sepsis) Challenging to get ENC and PNC interventions to women and babies in the immediate post-delivery and early newborn period

8 Newborn Deaths as a Proportion of all Under-5 Deaths, 6 countries, 2012

9 Maternal and Newborn Intervention Coverage Along the Continuum of Care SBA deliveries remain around 50% or below in all countries except Indonesia and Solomon Islands It remains challenging to get ENC and early PNC (days 1, 3 and 7) contacts strategies need to reach mothers and babies in the immediate post-delivery period Missed opportunities to provide ENC and PNC at the time of facility deliveries are common

10 Inequities in Intervention Coverage Urban/rural residence (increasing pockets of urban poor) Wealth Education Geographic area Inequities greatest for interventions that require 24 service availability (skilled and facility delivery, c-section, early PNC); lower if service can be scheduled, can be given in the home or community (vaccinations, ORT, contraception)

11 Inequities in Facility Deliveries by Wealth Quintile, Bangladesh 2001 and 2011 Inequities by wealth reduced Percentage of mothers Equity gap remains substantial 6.6 x higher

12 Quality of Care Limited data on quality of care delivery, ENC, PNC and IMNCI are available. Available data and field reports suggest that quality is highly variable and needs improvement. Standards are guidelines generally in place, but not implemented on the ground Limited data available on quality of case-management of sick newborns Quality of referral care EmONC - critical

13 Implementation Priorities and Lessons Learned

14 Implementation Priorities and Lessons Learned: key areas Priority in all countries is developing systems that will increase access to, quality of and demand for facility and community-based services. In order to do this implementation should focus on: 1. Coordination for RMNCAH program implementation 2. Sub-national planning and management 3. Human resource capacity 4. Financing for RMNCAH 5. Systems for improving quality of service delivery 6. Availability and use of information for action

15 Access to and Demand for Facility-based Care examples of supply side approaches Service Availability Upgrade existing facilities staffing and capacity.e.g. Bangladesh, India, Nepal Use maternity waiting houses in areas with long distances women arrive before due date e.g. PNG Develop emergency response and patient transport systems locally available systems e.g. India Bring facilities closer to the community - e.g. Peripheral Birthing Centers, Nepal; Village Maternity Clinics, Indonesia Partnerships with private Providers to improve reach e.g. church groups (PNG), accredited private providers (India), and NGOs (Bangladesh)

16 Access to and Demand for Facility-based Care examples of demand-side approaches Improve demand Remove financial barriers - demand-side financing e.g. Bangladesh DSF, India JSY and national health insurance schemes e.g. Indonesia Improve community-based health promotion and behavior change activities to emphasize home care and care-seeking - delivery, delivery complications, newborn and child Illness. e.g. improvements in care-seeking noted in Bangladesh (obstetric complications) and Solomon Islands (facility deliveries)

17 Community-Based Care examples of supply side approaches CHW selection, training and deployment Important to ensure clear criteria for CHW selection including a requirement that they reside in communities. (e.g. ASHAs in India) Improved availability of CHWs CHW Incentives including PBF (FCHVs in Nepal), GO-salary (FWAs and HAs in Bangladesh) and other in-kind incentives (bags, equipment, bicycles etc) Establish community posts staffed by CHWs or volunteers to provide integrated services (e.g. Integrated health posts Indonesia, Community Health posts PNG, Community Health Posts - Bangladesh) Expand use of home-based intervention packages CHWs make home visits to mother, newborn and child. Give counseling on key messages, screen and refer for danger signs. (e.g. Community-based maternal and newborn package (Bangladesh FWAs and F-HAs; Nepal FCHVs); CCM and C-IMCI (Nepal)

18 For more information, please contact the Alliance for Reproductive, Maternal and Newborn Health at: