Maternal and Child Health

1
Maternal and Child Health
NSM Presentation September 7, 2006 Pryce Hotel,
Cagayan de Oro City

• Dr. Honorata L. Catibog
• Family Health Office - NCDPC

2
Overall Health Issues

• slow progress in achieving MDGs
• IMR / UFMR reduction on track
• Under nutrition reduction is slow
• MMR reduction is very slow

3
Health Indicators Selected Asian Countries
HOWEVER, WE LAG BEHIND OUR ASIAN NEIGHBORS IN
TERMS OF MORTALITY RATES
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Infant Mortality Rate
57
49
35
29
19
Source NDHS,2003
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Infant Mortality by Region
Cordillera Admin
Central Luzon
SOCCSKSARGEN
Central Visayas
Cagayan Valley
Ilocos
Cordillera Admin
Northern Mindanao
ARMM
Number of infant deaths per 1000 live births
Number of infant deaths per 1000 live births
NDHS, 2003
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Underfive Mortality
Source NDHS,2003
7
Under 5 Mortality Rate by Region NDHS 1993-2003
In Thousands
Legend higher than national rate 40 Lower than
national rate
Regions
Source NDHS,2003
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Maternal Mortality Ratio
209
180
172
52
Source NDHS,2003
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(No Transcript)
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Assistance at Delivery
ARMM
Zamboanga
Eastern Visayas
Caraga
Davao
Cagayan Valley
PHILIPPINES
Ilocos
Central Luzon
Percent distribution of live births assisted by a
doctor, nurse or midwife
11
Problems in accessing health carewealth index
quintile
12
Fully Immunized Child Hepatitis B
CoveragePhil, 2002-2005
Percent
Year
Source FHSIS NCDPC
13
Status of MalnutritionPhilippines,0-5 yrs old
Percent
Year
Source NNS 2003
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Breastfeeding rates are decreasing

• 54 of infants started breastfeeding within 1
  hour of birth
• Children of mothers whose delivery were
  assisted by health professionals are less likely
  to be breastfed than those delivered by TBAs
• ( 83 vs 93)
• Children delivered at the health facility are
  less likely to be breastfed than those born at
  home
• (81 vs 90 )
• Median duration of exclusive breastfeeding is
  less than one month

15
Status of NutritionSchool-Age Children, Phil,
2001 2003
Percent
Year
Source NNS 2003
16
Prevalence of degree of anemia among different
population groups, 2003
Percent
Population Groups
Source FNRI-DOST
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(Place of Delivery)
Maternal Care
Percent distribution of live births in the 5
years before the survey
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Maternal Care (Place of delivery)

• 38 of live births were delivered in a health
  facility and 61 were born at home.
• (NDHS 2003)
• Increase compared to 34 in 1998 (NDHS) a
  decline in the home deliveries (66 NDHS 1998)

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Assistance at Delivery
Percent distribution of live births in the 5
years preceding the survey
20
Delivery Assistance

• 60 of deliveries assisted by health
  professionals (2003 NDHS)
• 34 deliveries assisted by doctors
• 25 by midwives
• 1 by nurses
• Increased from 56 (1998) but still low vis a vis
  the 80 target in 2004

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Essential Health and Nutrition Services
for Mothers Unborn

• Antenatal, natal and post natal care
• Tetanus toxoid immunization
• Nutrition (including vitamin A, iron, folate
  supplementation)
• Treatment of existing conditions or diseases
• Recognition, early detection and management of
  complications
• before, during and after pregnancy
• Clean and safe delivery/postpartum care
• Promotion and support to breastfeeding and
  management of
• breast complications
• Information services for birth spacing / newborn
  screening /
• psychosocial stimulation
• STD/HIV prevention and management
• Oral health care
• emergency obstetric care
• family planning

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Essential Health and Nutrition Services
for Newborns and Infants (0 11 months)

• Resuscitation
• Routine eye prophylaxis
• Prevention and management of hypothermia
• Newborn screening/congenital defects
• Immediate and exclusive breastfeeding
• Complementary feeding at six months
• Prevention and management of infection
• Birth registration
• Birth weight and growth monitoring and promotion
• Full immunization
• Micronutrient supplementation
• Oral care
• Development milestone screening
• Advice on psychosocial stimulation

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Essential Health and Nutrition Services for Early
Childhood (1- 5 years)

• Growth monitoring and promotion
• Nutritional screening
• Micronutrient supplementation
• Developmental milestone screening
• Disability detection
• Integrated management of childhood illness
• Oral Care
• Counseling on accident prevention and use of
  safe toys
• and psychological stimulation
• First Aid

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Essential Health and Nutrition Services
for Middle Childhood (6 - 9 years)

• Management of Childhood Illness
• Regular medical/dental check-up
• Injury prevention
• Counseling on personal hygiene/
• healthy lifestyle/life skills
• Deworming
• Nutrition and diet counseling
• Counseling on fertility awareness
• Growth monitoring (BMI)
• Healthy lifestyle
• Audiovisual screening/disability
• detection

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Essential Health and Nutrition Services
for Adolescents and Youth

• Management of illness
• Counseling on substance abuse, sexuality
• and reproductive tract infections
• Nutrition and diet counseling
• Mental Health and coping mechanisms
• Fertility awareness and responsible sexual
• behavior
• Injury prevention
• Regular medical and dental check-up
• Tetanus Toxoid immunization (females)
• Iron/folate supplementation (females)

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Essential health and nutrition service for the
Pre-pregnant Woman

• Iron /folate supplementation
• Tetanus toxoid immunization
• Deworming, oral health
• Counseling on fertility awareness, responsible
  parenthood, birth spacing, informed choice,
  consequences of abortion
• Counseling on nutrition and healthy lifestyle
• Diagnostics Hgb, urinalysis, TB screen,
  pregnancy test
• Therapeutic services

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Family / Community Behavior

• Handwashing
• use of safe water
• Use of sanitary toilet
• Use of iodized salt / fortified foods
• Timely care seeking
• Regular check-ups
• Effective parenting/child rearing
• Life skills
• Family nutrition
• Home management of diseases
• Prevention of domestic violence

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Cross Cutting Issues

• Insufficient funding
• LGU cost recovery schemes are they
• hurting health services
• LGU transparency / accountability / ownership
• Sustainability
• Human resources / out-migration
• Link/reconcile MCH package with PhilHealth
  accreditation

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Cross Cutting Issues

• Data Management collection, analysis,
• validation, feedback
• Sensitive MCH indicators
• NGOs, organization partners in the real
• Sense, not in conflict with DOH policies and MCH
  messages
• communication issues effective message,
• approaches, target groups, quality
• service delivery increasing access,
  improving quality increasing utilization
• community involvement support

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Framework for Strategic Planning
Goals/ultimate outcomes
Proximate outcome High coverage/utilization of
quality services

• Demand side
• information
• non-monetary costs
• subsidies
• preferences

• Supply side
• - availability of essential and specialized
  services
• high quality of services
• expanded network of service outlets
• commodity security

Financing Regulation
National and Local Governance
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Broadstroke Strategies and Activities

• Based on Fourmula One

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Broad strokes MCH Strategic Directions
Based on MDGs

• Goals
• By 2015,
• Reduction of Underfive Mortality by 2/3
• Reduction of Maternal Mortality by 3/4
• Reduction of Underweight Children by 1/2

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Proximate Outcomes

• Increased in proportion of facility-based
  deliveries
• Increased proportion of births attended by health
  professionals (MDs, RHs, MWs)
• Increased early initiation of breastfeeding
  within one hour
• Increased exclusive breastfeeding up to 6 months
• Increased proportion of infants receiving
  appropriate complementary foods at 6 months while
  continuing breastfeeding
• Increased proportion of fully immunized children

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Proximate Outcomes

• Increased proportion of sick children underfive
  yrs old receiving integrated management of
  illness
• Increased care seeking
• Increased proportion of children receiving
  vitamin A supplements

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Broad Strokes Strategies and activitiesGovernanc
e

• Devt. of new policies guidelines (i.e.
  adoption of Mother Child Book, Male Involvement
  in RH, Facility Based Delivery)
• Institutionalzing MDR
• Updating existing policies, i.e. EPI, SM
• New policies on perinatal health, disabilities,
  congenital birth defects
• Dissemination and translation into actions
• Improving procurement and financing systems, e.g.
  Vit.A
• Strengthening multisectoral partnerships
• Strengthening monitoring, evaluation, research
• Develop tracking system for progress and
  accountabilities of LGU
• Improve information management
• Develop MCH advocacy package for LGUs

• Improving technical leadership and management
  capability

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Service delivery

• Improving quality and efficiency

• Upgrading facilities for specialized services and
  as training units,e.g. Emergency Obstetric care
  (EmOC)
• Instituting standard Clinical Practice Guide
  (CPGs) for FP, SM, etc.
• Improving human resource capabilities
• Link health facilities with the community
• Strengthen public health interventions in
  hospitals
• Intensify disease prevention and control
• Provision of essential MCH drugs and commodities

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Service Delivery

• Improving accessibility and availability of basic
  / essential / specialized services

• available service delivery points, e.g.
  adolescents,
• Developing special approaches/package of
  services for Indigenous People (IPs), displaced
  children and mothers, emergency situations
• Tracking system and case holding, follow up
  dropouts/defaulters
• Systematic outreach services

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Service Delivery

• Engaging and empowering families and communities

• Community-based interventions, i.e health and
  nutrition posts, Botika Sa Barangay (BSBs)
• Communication for behavioral and social change
• Creating an educated demand for services

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Regulation

• Assuring access to quality and affordable health
  products and services

• Harmonizing Sentrong Sigla standards with
  Philhealth accreditation
• Strict enforcement of laws. i.e. Milk Code, ASIN
  Law, Food Fortification Law, Newborn Screening
  Law
• Harmonizing and streamlining licensing,
  certification and accreditation, e.g. MBFHI, NBS
• Assure low priced commodities and drugs
• Seal of approval system, e.g. Sangkap Pinoy.
  Diamond Seal

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Financing

• Ensuring health care financing support for
  children with bias to the poor

• Multiyear planning and budgeting for priority
  program, e.g. EPI
• Enrolment in Philhealth/ indigency program
• Expand private sector participation
• Explore other financing mechanisms, user fees,
  voucher system
• Maternal and child survival should be made part
  of poverty reduction strategies, socio-economic
  development plans, sector-wide approaches

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Investments for Maternal, Child Adolescent
Health for 5 years (2006-2010)
I. Maternal Health P 17,166,959,750.00
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Investments for Maternal, Child Adolescent
Health for 5 years (2006-2010)
II. Child Health P2,772,763,327.00
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Investments for Maternal, Child Adolescent
Health for 5 years (2006-2010)
III. Adolescent Health P 13,768,000.00
TOTAL P19,953,491,077.00
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Thank you