Egypt Ministry of Health & Population MDG 4 and Beyond Lessons Learnt Emad Ezzat, MD Head of PHC Sector EMRO high-level meeting, Dubai, Jan 2013
Trends of Under 5, Infant and Neonatal Mortality (1990 2008) Under 5 Infant Neonatal Egyptian DHS
Signed June 2012, Washington DC Ten years ago, the United Nations General Assembly passed the landmark resolution on A World Fit for Children, and in doing so, helped save and enhance the lives of millions of children. Today, we renew this promise to the world s children. Therefore, we the undersigned heads of State and Government and representatives of States, reaffirm our commitment to children. Consistent with the Secretary-General s Every Woman Every Child initiative, we pledge our support for the global movement to end preventable child deaths. The world has made tremendous strides in reducing child mortality. Over the past 40 years, new vaccines, improved health care practices, investments in education, and the dedication of governments, civil society and other partners have contributed to reducing the number of child deaths by more than 50%. The momentum generated by this unprecedented progress, and the scientific and social advances that underpin it, present an historic opportunity for dramatic declines in preventable child deaths in high, middle and low-income countries alike. Through national action and international cooperation, we pledge to take action to accelerate progress on newborn, child and maternal survival. We hold ourselves accountable for our collective progress towards this goal. And on behalf of all children everywhere, we recommit the efforts of our respective governments to give every child the 3 best possible start in life.
How did Egypt address the issue of under-five mortality? Reduction of child mortality, where the 2015 target of MDG4 has been achieved in 2008. (Average Annual Rate of Reduction 1990 2011 is 6.7%), in 2011, Egypt has gone beyond MDG4, a 75% reduction in under-five mortality between 1990 and 2011 through: Full (or almost full) coverage of children by child care programs (e.g. IMCI including EPI, CDD, ARI, growth monitoring,, Micronutrient supplementation) Neonatal care units in all general and 10% of district hospitals (total of 242 hospitals) National neonatal screening for congenital hypothyroidism 4
100 98 96 94 92 90 88 86 84 82 80 5 EPI program Coverage % 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Coverage of DPT3 vaccine 100 95 90 85 Coverage % 80 75 ١٩٩٠ ١٩٩١ ١٩٩٢ ١٩٩٣ ١٩٩٤ ١٩٩٥ ١٩٩٦ ١٩٩٧ ١٩٩٨ ١٩٩٩ ٢٠٠٠ ٢٠٠١ ٢٠٠٢ ٢٠٠٣ ٢٠٠٤ ٢٠٠٥ ٢٠٠٦ ٢٠٠٧ ٢٠٠٨ ٢٠٠٩ ٢٠١٠ ٢٠١١ 6
How did Egypt address the issue of under-five mortality? Early introduction of Zinc preparation and Low- osmolarity ORS for diarrhea treatment since 2007 Starting perinatal and nutritional health care program Landscaping Analysis study for assessment of willingness and readiness for scaling up of nutritional interventions Conducting Perinatal Surveillance System Establishing Nutritional Surveillance System 7
How did Egypt address the issue of under-five mortality? Ante-natal care program (73% coverage for any ANC visit and 66% for 4 ANC visits) Strong family planning program: 58% use of modern contraceptive methods. Midwifery training to ensure equity to access to safe deliveries to poor women that improved delivery outcomes. 8
IMCI Program Includes cost effective package of interventions to address main causes of U-5 mortality at PHC level: Pre-referral management of severe conditions. Case management of: Sick newborn Pneumonia Diarrhea Malnutrition. Breastfeeding and complementary feeding counseling. Checking vaccination and vitamin A supplementation status. Improving care-seeking. 9
How did Egypt address the issue of under-five mortality? Introducing Health insurance for under 5 years children Inclusion of IMCI programs in the medical education curriculum at universities since year 2000 Scaling-up implementation of IMCI in a relatively short time by adopting a systematic approach (started 1999 and nearly full coverage 2012) 10
5000 Health facilities im mplementing IMCI A systematic approach for IMCI scaling up enabled reaching high coverage (94% PHC 4645 4731 facilities) 4478 4500 4000 3500 3000 2500 2000 1500 1000 500 0 28 150 569 1114 1652 2301 2992 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 3524 4024 4211 Health facilities implementing IMCI Cumulative total Improved quality of services as proven by the survey and follow up reports. 11 11
However, Egypt is facing challenges High turnover of trained staff: overburden on in-service training. Inequities in coverage of interventions (geographic and socio-economic), and distribution of human resources. Multiple planning processes for child health with different partners. A lot of investments are required to scale up the community based interventions. 12
However, Egypt is facing challenges (cont.) Private sector is expanding, not necessarily complying with the technical protocols of the public sector (regulations). Inadequate budget allocation for MCH. Inadequate Government health expenditure and High outof-pocket expenditures. 13
Key drivers of success Political commitment and strong leadership High accessibility to a wide and well staffed PHC network High coverage with child health interventions. Utilize cost effective interventions and adopting standardized protocols within the BBP Institutionalized EPI, CDD and ARI Programs (IMCI) prioritized under-privileged areas and high risk groups 14
Key drivers of success Adoption of community based initiatives (Raedat Refeyat) to increased demand and coverage with health services Surveillance Systems (Maternal and Child mortality) Capacity building at all levels (to ensure quality care) Efficient partnership: Private sector Academia Civil society and community Partners for development 15
Way Forward Renewal of commitment to child survival (Call to Action) Sustain our gains (e.g. IMCI and Perinatal Care Program) Mobilizing enough resources to achieve this target. Addressing inequities as a major approach to further reduce mortality. Providing emphasis on the neonatal mortality while sustaining the attention to the post-neonatal period. 16
Way Forward (cont) Emphasize efficient partnership with private Sector, academia, civil society and donors (getting everyone on board) Expand community based interventions workforce capacity building and motivation (medical students, pre-service and in-service) with fair distribution Innovation (mobile technology, telemedicine and introduction of new vaccines) 17
Way Forward (cont) Scaling up the Family Health Model. Strengthening the MOHP regulatory role over the private sector practices. Shifting the multiple planning processes into one integrated national planning process to which all partners contribute. Making more efforts in pre-service education to ensure sustainability and reduction of the overburden of in-service training. 18
Thank You 19