The MNCH Roadmap

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The MNCH Roadmap

• By Dr Caroline Phiri Chibawe
• Ag Director MCH
• MCDMCH

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(No Transcript)
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What is this MNCH Roadmap?

• A strategic document identified that highlights
  the need to address the problems of high
  maternal, neonatal, infant and under-5 mortality
  rates in Zambia over the next 10 years.

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Goal

•  Accelerated reduction of maternal, newborn and
  childhood morbidity and mortality to attain set
  targets by 2015.
• (Thereafter focus on attaining universal coverage
  goals from 2016 to 2019 and aim to attain
  universal coverage (80 and above nationally
  and within each district)
•  

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Objectives in MNCH Strategic plan

•  To reduce maternal mortality from 591 to 162 per
  100,000 live births
• To reduce neonatal mortality from 34 to 20 per
  1,000 live births
• To reduce Under-5 mortality rate from 119 to 64
  per 1000 live births
• (based on ZDHS 2007)

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Specific Objective

• Provide skilled attendance during pregnancy,
  childbirth, and the postnatal period, at all
  levels of the health care delivery system
• Strengthen the capacities of individuals,
  families, communities, line Ministries, and the
  private sector to share responsibility and play
  their role in efforts to significantly improve
  MNCH outcomes for universal coverage to attain
  the set MDGs.

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Situational Analysis
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Maternal and newborn health situation in Zambia

• Maternal mortality ratio 591/100,000 live
  births
• Neonatal mortality rate 34/1000 live births
• Infant mortality Rate 70/1000 live births
• Under five mortality rate 119/1000 live births
• Fertility rate 6.8
• HIV prevalence 14
• Men 12
• Women 16

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Comparison of MMR versus SBA
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Issues around the high MMR and NMR in Zambia

• TBA to train or not to train
• Three delay model
• Inadequate equipment Indirect effect of HIV,
  malaria and TB.
•   reduced funding affected out reach services
• Reduced Human resources

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Rural versus Urban disparities

• Long distances to health facilities high cost
  of care
• Uneducated, poor and living in rural areas.
• Less likely to attend 4 FANC visits, rarely seek
  ANC services in 1st trimester
• ANC services tend to be poor quality with
• inadequate drugs, laboratory services
• more likely to be seen by an unskilled health
  worker and rarely by a physician.

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Rural versus Urban disparities

• Poor, rural, uneducated and multigravida women
  tend to deliver at home by unskilled TBA or
  relatives.
• No access to FP, postnatal and new born care
• No outreach services for Immunisation and GMP
• Schools have few teachers, high illiteracy rate,
  poverty, (access to social welfare ??)
• Early age marriages leading
• Obstetric complications, malnutrition,

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Key Strategies to be implemented

• The continuum of care approach recognizes five
  critical phases in the life cycle of women and
  children which are
• Adolescence and pre-pregnancy
• pregnancy,
• childbirth and the postnatal period,
• newborn and
• childhood

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Key Strategies to be implemented

• 2. Using a three dimensional approach in coming
  up with strategies and interventions
• ensuring engagement and synergy between the
  health system, communities, other line ministries
  and the private sector
• 3. Strengthening partnerships with the donor
  community and the private sector for sustainable
  long-term predictable financing to achieve
  universal coverage.

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Advocacy and Resource Mobilization

• Advocacy efforts will
• Increasing the budget allocation for MNCH
  interventions from both internal and external
  resources
• Revision of laws, policies that hinder effective
  provision of maternal, newborn and childcare
  services
• Improving the production, employment, deployment
  and retention of a skilled health work force at
  all levels
• Institutionalize the Maternal Death Reviews and
  make maternal deaths to be made notifiable events

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Adolescence and pre-pregnancy

• investment in
• Information to prevent sexually transmitted
  diseases, HIV, and unwanted pregnancies
• Education
• Availability and easier access to contraceptive
  services and supplies.
• The underlying thinking is that a good outcome of
  pregnancy starts before conception.

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Pregnancy

• The thrust in interventions is ensuring provision
  of skilled care during pregnancy.
• provide quality FANC
• promote birth plan
• helping the family prepare for good parenting.

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Childbirth and the postnatal period

• Focus on skilled, professional care during
  childbirth
• providing access to professional skilled care
  before, during and after childbirth
• Train Health workers to provide quality Emergency
  obstetric and newborn care
• Skilled and professional care should also be
  available to the mother during the postnatal
  period

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Newborn (neonatal)

• bridging the postnatal and postpartum gap,
  ensuring no interruption in the continuum of
  care, and
• establish mechanisms for communication and
  handover between maternal and child programmes
• mix of approaches, from the improved care of
  newborns within the home, through home visits by
  health workers, better uptake of services in case
  of problems and referral when needed.

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Childhood

• The Expanded programme on Immunisation
• Integrated Management of Childhood Illness
  (IMCI)
• Management of the newborn,
• nutrition promotion,
• the strengthening of school health programmes,
• shifting focus from health centres alone to a
  continuum of care that implicates families and
  communities, health centres, and referral-level
  hospitals
•  

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Health System Strengthening and Capacity
Development

• Health system strengthening for MNCH will
  comprise of improving service delivery by
  strengthening
• The health workforce,
• Adopting Results Based Management (RBM)
  approaches,
• The health management information system (HMIS),
• The logistics management of medical products,
  vaccines and technologies,
• Increased financing to comply with Abuja target
  of 15,
• Improving the infrastructure for service
  delivery, and
• Strengthened planning, leadership and governance

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Referral System

• Improve referral system through
• appropriate transportation and improving linkages
  between community and referral facilities
• Communications equipment (e.g., radio calls and
  mobile phones).
• Community structures for handling MNCH
  emergencies
• Mothers waiting shelters

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Community Mobilization

• Educating and sensitising communities on
  community-based MNCH interventions
• Mobilizing resources at the village level for
  MNCH including emergency referral as well as
  building and strengthening health facilities.
• Orienting the facility governing committees to
  the MNCH Strategic Plan to ensure effective
• implementation of the plan at the health facility
  and community levels
• Institutionalizing village health days

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Behaviour Change Communication (BCC)

• Use of BCC approaches for quality MNCH including
  nutrition and adolescent sexual reproductive
  health.
• Target community-based initiatives
• Use of targeted mass campaigns

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Fostering Partnerships and Accountability

• Effective implementation of this MNCH Strategic
  Plan will require
• stimulating and establishing strategic
  partnerships
• improve coordination and collaboration between
  communities, partners
• galvanizing political will and mobilizing
  resources for long-term sustainable MNCH
  interventions.
• Coordinate regular planning, implementation,
  monitoring and evaluation of MNCH interventions
  to assess progress towards attainment of the
  MDGs.

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Monitoring and Evaluation Framweork

• One agreed indicator of maternal, newborn and
  child health interventions will be evaluated
• 33 operational targets developed
• Include nutrition, water and sanitation and
  systems strengthening
• Quantitative indicators
• Qualitative indicators obtained through periodic
  and commissioned studies.
• Sources of data will include both the routine and
  non-routine health information systems
• The indicators will be updated from time to time
  as need arises

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Operational targets
Indicator Current status Target
Unmet need for Contraceptives 27 14
Modern Contraceptive rate for women of Reproductive age 33 58
Teenage Pregnancy 28 18
of women accessing ANC in first Trimester 19 58
of women accessing 4 or more ANC visits 60 80
of women on IPT 2 or more 66 80
of women accessing PMTCT
Proportion of women delivered by skilled HW 47 75
Proportion of women accessing postnatal care within 2 days weeks 39 55
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Operational targets
Indicator Current status Target
of women initiating early and exclusive breastfeeding 63 90
of districts with 50 HF implementing kangaroo care 80
of children receiving correct treatment for fever 38 80
Vitamin A supplementation 60 80
of households women accessing improved drinking water 24 80
of households accessing improved sanitation 42 80
of districts conducting maternal death reviews 50 100
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Implementation Arrangements 

• Involvement of a multisector approach to increase
  access to health services
• MCDMCH and Ministry of Health
• Other Ministries such as Finance, Information,
  chiefs and traditional affairs, Local Government,
  Agriculture, Work and supply, Education, gender,
  DMMU
• Cooperating partners- NGO and private sectors

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Conclusion

• The strategies are packages of interventions for
  each phase of life cycle and at each level of
  intervention within each selected intervention.
• The interventions have been costed
• Implementation of the MNCH plan should not be
  done in silos but comprehensively.

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For a healthy nation, invest in us now! A
prosperous, middle income Zambia requires
healthy mothers and healthy newborns.