15 Nov 2011 Regional CH Meeting, Kathmandu 1

Meeting of South-East Asia Regional Programme Managers on Child Health,

Kathmandu, 15 – 18 Nov 2011

Progress in Implementation of Child Health Programme

Thailand

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Epidemiology / burden of childhood diseases:

Under five mortality and trends since 1990

Figures Figures

Under five mortality Rate (WHO) 32 (1990) 13 (2010)

Infant Mortality Rate (WHO) 27 (1990) 11 (2010)

Neonatal Mortality Rate (WHO) 8 (2010)

Nutrition Status

Low Birth Weight (MoPH) 9.4 (1990) 8.1 (2010)

Underweight (MoPH) 7.4 (2010)

Stunting (MoPH) 9.1 (2010)

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Epidemiology / burden of childhood diseases:

• Main causes of Neonatal Mortality:

- Prematurity 30 %

- Severe infections 27 %

- Birth asphyxia 23 %

- Congenital anomalies 6 %

- Others 14 %

Source: WHO. Mortality Country Fact Sheet 2006.

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Epidemiology / burden of childhood diseases:

• Main causes of Child Mortality:

- Neonatal causes 48%

- Pneumonia 11%

- Injuries 6%

- Diarrheal diseases 3%

- HIV/AIDS 1%

- Other causes 31%Source: WHO. Mortality Country Fact Sheet 2008.

Management of childhood illness

• MCH strategy was implemented in Thailand before 1990.

• Integrated program such as Safe Motherhood hospital, Baby Friendly hospital, Health System Development, Primary Health Care Program, HRD, etc.

Management of childhood illness

• Professional training on pediatric are done by medical and nursing schools.

Number of Medical Schools teaching MCI 20

Number of Nursing Schools teaching MCI 83

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Management of childhood illnessKey factors that helped scaling up1. Enable policy at all level.2. Cooperation.3. Good guideline and training.

Key challenges to scaling up:1. Data and surveillance system.2. Computerize support system for education

and report.3. Accreditation of hospitals.

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Newborn Health

• Thailand started Safe Motherhood Program and BF promotion using ENC since 1997

• Training courses on newborn and neonatal care are done in every province.

• Volunteers are trained by health personnel.

Antenatal Care• early ANC (12 wks

gestation or less)• Thalassemia screening• VCT HIV • Parental School• Nutrition• Iron supplement• Dental Care• Mother club in

community

Well Child Clinics Standard WCC Parental School Child Development check

up Nutrition Story telling, Toys Dental Care Mother club in

community

Intrapartum and Postpartum Care

Safe motherhood hospitals Baby Friendly Hospitals

Initiatives Parental School Lactation Clinics Congenital Hypothyroid and

PKU Screening Mother club in community

Quality System in Family Love Bonding Hospitals

Mother clubs in communities for breastfeeding promotions / Child rearing practices

Results•Birth Asphyxia less than 30 per 1,000 LBs•Low Birth Weight less than 7%•Exclusive Breastfeeding for 6 months more than 30%•Normal Child Development more than 90%

1010

Safe motherhood HospitalBaby Friendly Hospital Initiative+ community involvement

•Birth asphyxia•Low Birth Weight •Exclusive Breastfeeding at 6 months •Child (0-5 Years) Development

Royal familyPhotos

Safe motherhood HospitalBaby Friendly Hospital Initiative+ community involvement

•Safe motherhood Hospital•Baby Friendly Hospital Initiative

enrollment

bronze

silver

gold

FamilyLove Bonding

Hospitals

Regional CH Meeting, Kathmandu15 Nov 2011

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In-Patient (Hospital) care of sick newborns and children

• Training courses for Hospital care done: Yes• Number of Healthcare providers trained:

– all pediatricians– all nurse in pediatric ward and community hospital

• Proportion of hospitals providing pediatric care having oxygen: 67 regional/provincial hospitals and 746 community hopitals.

CHW approach for care of sick newborns and children

• 900,000 CHW• 7,400 Health care

Centers.

• refer to curative system at Primary Care Unit : Health Care Center, Community Hospital via health insurance system (universal coverage system)

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Growth monitoring

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Parental School Antenatal Period

First Trimester until 28 wks of gestation

32 weeks of gestation or more

Early Post partum period (1-3 days)

At Well child clinic 2 months old6 months until 1 ½ year 2 – 3 years old

Husband Participatio

n

Regional CH Meeting, Kathmandu15 Nov 2011

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Programme Review and Management

• CH Short Programme Review introduced: MCH Board Meeting.

• Accredit Family Love Bonding Hospitals.

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Health Management Information Systems

• Key indicators for newborn and child health in 2011:

- Pregnant women attend ANC before 12 weeks of gestation (50%)

- Rate of HIV/AIDS transmission from mother to child (3.5%)- Newborn baby weight under 2,500 grams (<7%)- Rate of Birth Asphysia 30/1,000 LBs- Rate of exclusive BF for 6 month increase 2.5%/year- 95% of Children under 5 have proper growth & development- Family Love Bonding Hospitals are accredited at goal level at least 100 hospital

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Health Management Information Systems

• Key indicators for newborn and child health in 2011:

- 95% of day care centers arrange tooth brushing activity after lunch using fluoride toothpaste for children daily.

• The data was used by hospital, MCH board, local health administration, Provincial Health Office and the DoH.

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Future PlansStrengthening and scale-up plans

• MCI: HRD for MCH network and volunteer, KM and evaluation.

• ICT use: Website for health personnel to use and download for their knowledge, training, public relation, etc. - Improve computerize information system.

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Future Plans

Strengthening and scale-up plans

• CHW Packages:– Manuals on Maternal and Child booklet,

Preparation of parental hood and caring for children under-five-years, Exclusive BF promotion and practice, vaccination.

– Home visit for all newborns, etc.

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Future Plans

Strengthening and scale-up plans

• CHW Packages:– Manual for training BF experts.– Manual for assessment of Family Love

Bonding Hospitals.– Home Based NB Care package & Sick child

package.– Manuals for Health Volunteer on MCH.

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Future Plans

Strengthening and scale-up plans

– Healthy Child package: Manauls on Child growth and development assessment, BF Sub-district Model, Development of Care Giver in Day Care Center.

– Folk tales for children.– Research.

18/04/23 N Voramongkol 23

Story telling book , Aesop’s fables

•Childbirth•6 month old•1 year old

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Future Plans

Strengthening and scale-up plans

• Referral (Hospital) Care: Sub-district Health Center District hospital Provincial hospital.

- In case of emergency/disaster: Coordinate through Emergency Medical Institute.(Helicopter or boat transfer)

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Future PlansStrengthening and scale-up plans• Programme Review and Management:

– CH Short Programme Review: 6, 9 and 12 months Report and meetings.

– Programme Managers Course: ● Family Love Bonding Hospitals management and

assessment, ● National Breast Feeding Meeting, ● KM and acknowledgement of Sub-district BF. ● IQ Development. ● Surveillance system and evaluation.

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Future Plans

• Maternal and Child Nutrition– Breast Feeding Promotion– Nutrition surveillance– Control of Iodine Deficiency Program– Nutrition Education.– Food security– Food safety