MCH Programme in Vietnam Experiences for post - 2015 Dinh Anh Tuan, MD, MPh MCH Dept. MOH, Vietnam
Current status: Under five mortality 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 58,0 45,8 26,8 24,4 24,1 22,5 24,1 23,8 23,3 23,2 23,1 19,3 1999 2001 2005 2006 2007 2008 2009 2010 2011 2012 2013 MDG 2015 (Source: General Statistics Office) Under-five mortality rate (U5MR):
Current status: Infant mortality 50,0 44,4 40,0 30,0 20,0 29,5 26,0 21,0 21,0 17,8 16,0 16,0 15,8 15,5 15,4 15,3 14,8 10,0 0,0 1999 2001 2002 2003 2006 2007 2008 2009 2010 2011 2012 2013 MDG 2015 Infant mortality rate (U1MR): (Source: General Statistics Office)
Current status: Maternal mortality 250 233 200 150 130 100 50 85 80 75,1 75 76 69 59 58,3 0 1990 2001 2004 2005 2006 2007 2008 2009 2013 MDG 2015 (Source: MDG report MPI and 2009 Population census report - GSO) Maternal mortality rate (MMR) in Vietnam
Current status:remarkable gaps between areas (Source: MMR & NMR survey, Statistic year book MOH 2011) Urban Plain rural Mountainous rural ANC 3+ (%) 99 88,5 77,9 Delivery supported by HW (%) 100 99,9 89,9 Post delivery Care 98 97 79 NMR (%o) 7,3 10,7 17,3 IMR (%o) 10.4 13.5 32.5 MMR (/100.000LB) 40 36 108
Current status: Coverage is low Source: tatistic year book MOH 2011, MISC 2011 100 80 60 40 20 0 Iron and folic in pregnant women HIV test in ANC Neonatal tetanus protection Institutional delivery Early initiation of breastfeeding Exclusive breastfeeding Hepatitis B birth dose Vitamin K BCG Skin-to-skin after birth
Best practices Nation wide: Policy making Maternal and Newborn mortality audit Hard-to-reach areas: Ethnic village birth attendant (VBA), Clean delivery kit (CDK) and Communitybased referral teams Commune level: MCH hand book, continuum of care at all levels, Basic Emergency Obstetric Care (BEmOC), IMCI, active management of third stage, VTM K1 for newborn and Early essential newborn care (EENC) District/provincial level: Comprehensive EmOC and intensive neonatal care unit (INCU)
Policy National strategy for Population and RH 2011-2020 National Strategy for reduction of child malnutrition 2011-2020 National strategy for HIV/AIDS control 2011-2020 Plan for development of SBA 2011-2015 Plan for RH care, focusing on SM and NC 2011-2015 Program for upgrading provincial/district hospitals by Govn. Bond Decree of Health Minister on Newborn Care (2010). National guideline for RH care (2009) Circular to accreditation of VBA as a type of VHW (2013). Enabling factors: Allowance priority to VHW/VBA in mountainous areas Free health insurance for the poor and ethnic in disadvantage area Free essential immunization for children and pregnancy woman Free nutrition education for mothers Free contraceptives for family planning. Free ANC check up and post-partum home visit (done by CHC and VHW, VBA)
Community-based MCH care 2006-2010: Training for VHWs on mothers and newborn care at home & home visit communication skill. Pilot training for VBA. Nutrition education Gaps identified: Home delivery rate is still high anf more complication for mother and children in hard-to-reach areas Children stunting rate is high (26-50%) Plans for 2011-2015 and post - 2015: for hard-to-reach areas: Training VBA Establishing and training community-based referent teams CDK for hard-to-reach areas for nation wide: MCH hand book Milk program for children
Essential MCH Care 2006-2010: Training for health workers at primary level on National Guideline on RH, focused on NC & essential EmOC. AMTS, IMCI, Vitamin K1 for NB Supervision after training by higher levels. Gaps identified: Percentage of SPs follow EENC procedure recommended by WHO. Breast feeding rate is low. Service providers (SPs) not enough competencies of SBA Hepatitis B rate is high Disruption on MCH care Plans for 2011-2015 and post - 2015: Expand EENC nationwide Issue standard and training for SBA HBV birth dose. Using MCH handbook to ensure continuum of care
Comprehensive MCH Care 2006-2010: Upgrading facility and equipment for districts hospitals Gaps identified: 40% district hospital is remote area couldn t provide CEmOC, and 75% couldn t provide treatment and care for NB with premature LW and complications Plans for 2011-2015 and post - 2015: Support district/provincial hospital establish NICU: Practise training for NC teams, upgrade room and equipment Support district/provincial hospitals to conduct caesarean and blood transfusion: practise training for surgical teams Addition of required equipment for emergency obstetric operation and safe blood transfusion.
Community based referent
Hard-to-reach area
Hard-to-reach area
Home visit by VBA
Survival mother and daughter
THANKS FOR YOUR ATTENTION