kc_maternal mortality reduction in nepal

8/2/2019 KC_Maternal Mortality Reduction in Nepal

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Reducing Maternal

Mortality in Nepal

Photocredit:StephjanieSuhowatsky

Photocredit:DanielAntonaccio

Dr Naresh Pratap K.C.

Ministry of Health and Population, Nepal


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Health and Development in Nepal

Population: 30 million, diverse ethnicgroups

Post-conflict, transitional democracy

Diverse topography

Large-scale out-migration With 80% of the Nepals population

living in rural areas amid challengingtopography

Equity, access and social inclusion keypolitical and development issues

Photocredit:Saveth

eChildren,Nepal


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153

11891

6154 54

102

79 64

48 4634

46 50 39

33 33 15

1991 1996 2001 2006 2011 2015

0

20

40

60

80

100

120

140

160

180Under five mortality rate

Infant mortality rate

Neonatal mortality rate

Source: NDHS

Improving Maternal & Child Health in

Nepal

Dramatic declines inchild mortality

Improvements in

maternal health TFR dropped to 2.6

MMR from 539 to 281

(DHS 1996,2006)

Most women in Nepal

still deliver at home

(64%) and without askilled provider (65%)

NMR remains unchanged: Estimated 32,000 newborn

deaths/year during their first monthmost in first week


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AntepartumHemorrhage

, 5%

PostpartumHemorrhage

, 46%

Eclampsia,14%

Abortion,5%

ObstructedLabor, 18%

Infection,12%

AntepartumHemorrhage,

7%

PostpartumHemorrhage,

17%

Eclampsia,21%

Abortion, 7%Heart

Disease, 7%

ObstructedLabor, 6%

Anemia, 4%

Gastroenteritis, 4%

PuerperalSepsis, 5%

Other direct ,6%

Otherindirect, 16%

Maternal Health in Nepal

Maternal causes leading cause (21%, 1998) of all deaths of

women of reproductive age; suicide now leading cause(16%, 2009)

Causes of maternal deaths have shifted: PPH dropped from 46% to 17%

Eclampsia now leading cause (21%)

4Source: Maternal Mortality and Morbidity Survey, 1998, 2009

1998

2009


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Health System in Nepal 75 districts

Each divided intoVillage Development

Committees (VDCs)

Each VDC has a health

facility

Health services incities/towns are

managed by

municipalities

8 health worker cadres Almost 50,000 female

community health

volunteers mobilized

Source: Department of Health Services Annual Report 2066/2067 (2009/2010)


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75 districtsin Nepal

District is

divided into

VDCs

12

3

5

7

4

96

8

Each VDC has nine wards &

1 health facility Mothers group

FCHV

Settlement

Each ward has:

80-100 households

1 Female Community Health Volunteer

(FCHV) who provides maternal and

child care services in the community.

A mother group coordinated by FCHV

for community mobilization

Settlement

SettlementCommunity

Health

System


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Interventions to Reduce Maternal

Mortality Continued successful family planning services program

Developed Birth Preparedness Package (2001)

Legalized abortion (2002)

Addressed anemia: iron intensification, deworming (2003-2004)

Developed SBA Policy (2005)

Distributed Misoprostol for home births (2006)

Launched SBA inservice training initiative (2006-7)

IntroducedAAMA Programme:

Safe delivery incentive (2005)

Free maternity care (2009)

Introduced ANC and PNC incentive (2010)

Expanded CEOC and birthing centers (2007-2008)

Piloted community-based newborn care package (2008)

Expanded adolescent-friendly RH services in 35 districts (2008-2011)

1996

2006


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Measurements of Maternal Mortality

539

281

865

471

343240

1500

830740

830

229

0

200

400

600

800

1000

1200

1400

1600

1980 1985 1990 1995 1996 2000 2005 2006 2009

DHS Hogan Model UN Model FHD/SSMP

Source: Oona Campbell presentation, 2010


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Methodology

STUDY Frequency Method Coverage

DHS 10 years Sisterhood National

MaternalMortality

and

Morbidity

Study

10 years Prospectivecommunity

verbal

autopsies

8 districts

Photocredit:G

eetaSharma


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Improving Equity and Access: Study in 6

Districts

Source: Early Evaluation of the Aama Programme presentation, 2010


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Contributors to MMR Reduction

Reductions in fertility (reducedlifetime risk of maternal death)

Reduced anemia rates

Development improvements:education, wealth, HDI

Gender empowerment

Increased met need for EmOC Safe abortion services

Source: Investigating Recent Improvements in Maternal Health in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey, 2008;Hussein et al. An Appraisal of the Maternal Mortality Decline in Nepal, 2011


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MoHP Results

4.6

4.1

3.12.6

0

0.5

1

1.5

2

2.53

3.5

4

4.5

5

1996 2001 2006 2011

Total Fertility Rate (TFR)


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Implications for the National

Maternal Health Strategy

Eclampsia top direct cause of maternal

mortality

41% of maternal deaths occurring in facilities

2 of 3 births still occurring at home

No reduction in NMR

Declining TFR, stagnating CPR

High unmet needs among under-served,

excluded groups and the poor


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Remaining Challenges

Reaching remote areas, under-served populations, excluded

groups

Human resource shortages,especially in remote areas

Motivating and sustaining a

large volunteer network Health sector reform

Photocredit:GeetaSharma


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Thank You

Photocredit:Step

hjanieSuhowatsky

kc_maternal mortality reduction in nepal

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