Implementing Health Reforms for Implementing Health Reforms for Rapid Reduction of Maternal & Rapid Reduction of Maternal &

Neonatal MortalityNeonatal MortalityNeonatal MortalityNeonatal Mortality( A.O. No. 2008 ( A.O. No. 2008 –– 0029)0029)

Honorata L. Catibog, MD, MNSA

March 4, 2010

AssessmentAssessment� very slow decline of MMR in the past 20 years

(209/100,000 LB in 1990 to 162/100,00 LB in 2006);

� maternal deaths account for 14% of deaths among women of reproductive age;

� maternal death triggers other adverse consequences in families: orphans, loss of family care provider

� 17 infants die per 1000 LB within first 28 days of life (neonatal mortality rate); mostly within first week after birth; half die during the 1st 2 days

Four Risks Associated with Four Risks Associated with Maternal and Neonatal DeathsMaternal and Neonatal Deaths� Risk of having mistimed, unplanned, unwanted,

unsupported pregnancy

� Risk of not securing adequate care during pregnancypregnancy

� Risk of delivery not attended by skilled birth attendant or access to EmONC services

� Risk of not securing proper postpartum & postnatal care for mother & neonate

STATEMENT OF POLICYSTATEMENT OF POLICY

- An Integrated MNCHN Strategy shall :

• guide development, implementation and evaluation of various programs aimed at women, mothers and children, with the women, mothers and children, with the ultimate goal of rapidly reducing maternal and neonatal mortality in the country.

• Guide in the engagement, assistance and empowerment of LGUs and other partners.

GoalGoal

� Rapidly reduce maternal & neonatal mortality through local implementtion of an integrated MNCHN strategy.integrated MNCHN strategy.

General principlesGeneral principles

� The goal shall be achieved through effective population-wide provision & use of integrated MNCHN services as of integrated MNCHN services as appropriate to any locality in the country

Intermediate resultsIntermediate results

� Every pregnancy is wanted, planned & supported

� Every pregnancy is adequately managed throughout its course

� Every delivery is facility-based & attended by SBA

� Every mother & NB care secures proper postpartum & postnatal care with appropriate package of services

Fourmula 1 in MNCHNFourmula 1 in MNCHN

� Service Delivery - addressing the direct causes ofmortality during childbirth

� Health Regulation- enforcement of regulatory measures and guidelinesmeasures and guidelines

� Health Financing- application of combined financing strategies

� Good Governance for health- political commitment of local stakeholders and accountability for results

Objectives Objectives 1. Develop, adopt, promote, implement & evaluate an

integrated MNCHN strategy2. Engage all province-wide or city-wide health systems to

adopt & implement the integrated MNCHN strategy3. Provide targeted support to areas where maternal &

neonatal deaths is severeneonatal deaths is severe4. Achieve national MNCHN program targets for the ff. key

indicators by 2010a. Increase CPR from 35.9% to 60%b. Increase percentage of pregnant women with 4 antenatal visits

from 70% to 80%c. SBA & facility-based deliveries from 40% to 80%d. And FIC from 70% to 95%

*(2003 NDHS)

General GuidelinesGeneral Guidelines

� Province-wide & city wide health system as the unit for planning, integrating & implementing MNCHN strategy

� Engaging local stakeholders & strengthen public � Engaging local stakeholders & strengthen public & private partnership

� Mobilize the service delivery network for the continuum of services

� Improve the delivery of component services in the maternal and neonatal service package

General guidelinesGeneral guidelines

� Develop & support demand-side interventions

� Monitoring & evaluation systems� Monitoring & evaluation systems

� National support to local planning & development for the MNCHN strategy

SPECIFIC GUIDELINES SPECIFIC GUIDELINES

1.Province-wide and city-wide health system shall be delineated by politico-geographic jurisdictions of its geographic jurisdictions of its components LGUs

2. Three Tiered operations of service delivery

SPECIFIC GUIDELINES SPECIFIC GUIDELINES

3. Province-wide and city-wide health system shall be supported by an adequate communication and adequate communication and transportation system

4. With specifically defined Integrated MNCHN Services

Minimum standard of integrated MNCHNservicesMinimum standard of integrated MNCHNservicesLife Cycle Stage Mother Newborn

Pre-pregnancy Iron and folate acid supplementation

Promotion of HL

IEC/counseling on FP/Responsible Parenting /FP services, especially for the poor; Fertility awareness , identifying population segments with unmet needs

Provision of other services;treatment of Diseases, as indicated; referral

Ante-natal care 8 essential ante-natal care functions

Deworming

Id of early signs and symptoms of risks

Administration of steroids for pre-term babies

Early detection and management of danger

signs and complications of pregnancy

Health caring and seeking behavior, Responsible parenting

Delivery Clean and Safe Delivery: Monitoring progress of labor, & immediate referral to facilities with BEmONC & CEmONC functions ; transport priority for women with birth complications

Minimum Standard of Integrated MNCHN ServicesMinimum Standard of Integrated MNCHN ServicesLife Cycle Stage Mother Newborn

Post partum & Postnatal care

Identification of early signs and symptoms

of postpartum complications

Maternal Nutrition: Iron and folate, Vit A, dewormingtablet, promotion of iodized salt

Family Planning: Latching on; IEC/Counseling on: (i) birth spacing; (ii) return to fertility; (iii) all FP methods especially LAM

Responsible parenting

Exclusive BF up to 6 months/LAM

IEC/Counseling on Healthy Lifestyle

Prevention and Management of Other Diseases

Identification of early signs and symptoms of newborn problems (e.g. respiratory distress, change in color, etc.)

Immediate Newborn Care: cord care/dressing; warming/skin to skin contact; Initiation of BF; Vitamin K injection; eye prophylaxis; delayed bathing; Hepa-B Immunization

Emergency Newborn Care:

treatment of neonatal sepsis/

infection; oxygen supply; resuscitation and Prevention and Management of Other Diseases

as indicated

Prevention and Management of Abortion

Complications: removal of retained products of conception and treatment of infection as well as correction of anemia, and Anti-tetanusserum (ATS) injection

Diagnostic Test: cervical cancer screening,

(acetic acid wash) for >40 years old women

Follow-up visit and care: all post-partum

women

infection; oxygen supply; resuscitation and stabilization; kangaroo Care

Intensive newborn care for low

birth weight (LBW), preterm,

IUGR, babies born with

congenital anomalies, and sick

newborn

Newborn Screening

Rooming-in or bedding-in/

exclusive BF up to 6 months

BCG Immunization

Birth Registration

Home visit and follow-up

SPECIFIC GUIDELINES SPECIFIC GUIDELINES 5. DOH shall support universal local implementation

of the MNCHN strategy considering the local conditions and capacities

6. Assessment of coordination across the various 6. Assessment of coordination across the various MNCHN-related activities and functions within and outside the health service system shall be in accordance with specific criteria and made part of a local monitoring and evaluation system

The MNCHN Manual of The MNCHN Manual of OperationsOperations

� Contains the following components of the MNCHN strategy:a. Key indicators to measure progress of a. Key indicators to measure progress of

intermediate results

b. Integrated list of MNCHN Services

c. Core list of MNCHN Interventions

d. Budget execution guidelines for the MNCHN grant facility

Key outcome indicatorsKey outcome indicators1. MMR reduced to 52/100,000 Live births

(Baseline: 162/100,000 LB FPS 2006)

2. CPR increased to 65%

(Baseline: 36% FPS 2006)(Baseline: 36% FPS 2006)

3. Newborn mortality reduced to 10/1,000 LB

(Baseline: 13/1,000 LB FPS 2006)

3. Infant mortality rate reduced to 19/1,000 LB

(baseline: 24/1,000 LB FPS 2006)

4. Under 5 mortality reduced to 27/1,000 LB

(Baseline: 32/1,000 LB FPS 2006)

Key result indicatorsKey result indicators� 90% of births are facility-based

� 90% antenatal care coverage

� 80% reduction in unmet need

(baseline: 15.7% FPS 2006)

� 100% of facilities with FP services

� 90% of newborns initiated to breastfeeding “within 1 hour after � 90% of newborns initiated to breastfeeding “within 1 hour after birth”.

� 80% exclusive breastfeeding of infants up to 6 months of age

� 95% of infants are fully immunized

� 95% of children 0-59 months old with diarrhea treated with ORT.

� 90% of children with S/S of ARI & fever treated at health facilities

Critical Activities in support to the local Critical Activities in support to the local MNCHN implementationMNCHN implementation

� Infrastructure upgrading of CEmONC; BEmONC

� Procurement of equipment for BEmONCs/ CEmONCsCEmONCs

� HRTD (human resource training & development) – Establishment of the Training Consortium with

funding support from WHSMP2

– BEmONC Skills Training is on-going in 5 Training Centers

� LGU MOP Orientation by the CHDs

� Organization of Women’s Health Teams and Training

� Organization of BEmONC Teams and Training

� Data recording and reporting

� Advocacy on facility-based delivery.