Nurturing children in body and mind Dr Rachel Devi National Advisor for Family Health Ministry of Health and Medical Services, Fiji 11 th Pacific Health Ministers Meeting 15-17 April 2015 Yanuca Island, Fiji
Contents 1) Background 2) Progress and Achievements 3) Issues 4) Future Directions for Consideration
Background Improvementsin health care services Decreased maternal and under five mortality Increased immunization coverage Sexually transmitted infections and unplanned pregnancies Pneumoniaand diarrhoeal diseases Double burden of malnutrition Better health outcomes for mothers, infants and children Progressvaries amongst PIC s At least 13 countries achieving more than 90% DPT 3 coverage in 2010-2013 Remain high Remain the most common causes of preventable death Under-nutrition persists and childhood overweight and obesity is a significant growing problem
Progress and achievements (1) Improvements in reproductive, maternal, newborn, child and adolescent health (RMNCAH) a) Improved accessibility and integration to health care services have contributed to a well developed RMNCAH programs in PICS which are part of primary health care. b)there has been improvements in midwifery and obstetric care (including skilled birth attendant access) c)family planning programme contributes to child spacing and fewer children. d)reductions in teenage pregnancy rates e)progress in immunization program
Measles outbreaks in PICs in 2013-2015 2013 May 2014 June 2014 Sept 2014
Progress and achievements (2) f) High burden of cardiac surgeries for Rheumatic heart disease (RHD) placing a high burden on our economy have led to the establishment of RHD programs in a number of PICs. g) Baby friendly hospital initiative and food fortification have increased. h)vitamin A supplementation in selected PICs occurs during organized campaigns amongst children i) Health promoting schools have adopted a broad approach
Issues (1) 1. Unmet needs in maternal & child health and family planning Quality of antenatal care in rural and remote settings needs improvement. Availability of emergency obstetric and new born care needs strengthening. Changing socio-cultural dimensions Communicable diseases outbreaks (recent measles outbreak shows the need to close immunity gaps and improve sensitivity in surveillance). Nutritional support (poor Integration in the RMNCAH programmes)
Issues (2) 2. Effects of globalization and social changes affect child growth and development. 3. Health systems and policy concerns Increasing demands for health services with limited budget has been a challenge for Governments. Turnover and inadequate human resources Weak referral system Reliance on external funding for vertical programmes National policy and guidelines need updating with implementation plans. 4. Mental health issues: Services are not well developedeg., suicide and depression 5. Poor data availability and use Limited reporting of key indicators such as neonatal mortality Critical need for greater coverage of Civil registration and Vital Statistics to improve health information.
Future directions A) Strengthening service provision to ensure child health B) Building on success stories in programme implementation and health outcomes C) Strengthening integrated management of childhood illness (IMCI) and early child development monitoring D) Ensure a holistic, life-course approach to protecting and nurturing children
A) Strengthen service provision to ensure child health 1) Undertake continuum of care country assessment at country level 2) Ensure strong perinatal services and enhanced emergency obstetric and new-born care 3) Ensure availability and accessibility of family planning services 4) Reduce teenage pregnancies 5) Eliminate congenital syphilis and prevent parent-to-child transmission of HIV 6) Consider rational introduction of new vaccines & strengthen effective vaccine management 7) Agree on core set of indicators- Strengthen data
Build on success stories in programme implementation and health outcomes 1) Strengthening Nutrition including revitalisation of the Baby friendly hospital initiative (BFHI) target full accreditation 2) Develop strong partnerships between ministries of health and education 3) Share best practice stories on programme delivery 4) Conduct in-depth studies or monitoring tools of inequitably delivered activities
Strengthen integrated management of childhood illnesses (IMCI) and early childhood monitoring 1) Review existing child development monitoring and strengthening it. 2) Incorporate monitoring milestones in patient information systems 3) Incorporate IMCI fundamentals in primary health care settings 4) Develop body mass index monitoring system for school/preschool children 5) Raise profile of nutrition by including nutritional activities in MCH clinics. 6) Improve breastfeeding and complementary feeding practices
Ensure a holistic, life-course approach to protecting and nurturing children 1) Adopt holistic approach in national strategy development 2) Develop or strengthen legislative protection for children including adolescents 3) Support continuum of care and life-course approaches
Proposed questions for the working group How to improve maternal and child health care and expand successful programmes, examples like Integrated management of childhood illnesses (IMCI) and Baby friendly hospital initiative (BFHI)? What are the main issues to be focussed on at all levels of the health systems (including service delivery and human resources for health)? Could PICs build on and sustain the successes of vertical programs through better integration?
Expected outcomes Recommendations for strengthening integrated service provision for mothers and children Common to all PICs Targeted for countries where service delivery is not well established Recommendations to address issues which are feasible and achievable. Recommendations for building and sustaining successes of vertical programs through integration.
Thank You