Afghan Women Health Status Helsinki

10 November 2010

Presented by : Dr Wamta Shams

1

Afghan Women Health statusHelsinki , 10th November 2010 Prepared by: Dr Wamta Shams

Out line of presentation

Health status, indicators Achievements Barriers ,challenges Response & strategies ( suggestion/recommendation)

Mortality 2002

Maternal mortality ratio (per 100,000 live births)

1,600

Under-five mortality rate (per 1000 live births)

257

Infant mortality rate (per 1000 live births)

165

Life Expectancy 46

The Bottom Line…

** National nutritional Survey 2004 ** Afghanistan Household Survey 2006

Nutritional Status 2004

Under weight prevalence U5 35**

Complementary feeding (6-9 months) 20**

Exclusive breastfeeding 30**

Continue

4

Health services 2002

#of assisted delivery (SBA) 9%

Delivery at home 88.5%

Contraceptive Prevalence rate 13

Total Fertility rate 6.6

Unmet demand 32%

MMR in the World/ Afghanistan

6500

1600900

390 190 36 110

1000

2000

3000

4000

5000

6000

7000

Badakhshan Afghansitan Africa Asia Latin America Europe North America

5

Causes of Maternal Mortality (Globally)

20%

8%

13%7%13%

14%

25%Other indirect causes Other direct causes Unsafe abortion

Obstracted LabourHypertensive Disordders Sepsis

6

Causes of maternal death in Afghanistan

2%2%

6%9%

4%

5%

10%

25%

37%

Haemorrhage

Obstructed labour

Pre/eclampsia

Sepsis

Other direct

TB

Malaria

Tetanus

Unclear

7

• Estimated 26,000 women dying from pregnancy related causes per year

• 1 woman dying every 27 minutes

• 78% of deaths are preventable

When Do Maternal Deaths Occur?

20%

25%

50%

5%

Between weeks 2and 6 after delivery

Between days 2 and7 after delivery

During pregnancy

In the first 24 hoursafter delivery

0

1000

2000

3000

4000

5000

6000

7000

Urban Semi-rural Rural Remote

6500

2200

800400

Afghanistan M

MR

/100

,000

#9

Where we are ?(achievement )

Health& Nutrition strategy Commitment of Afghan government & MoPH RH strategy & policy Basic package of Health services (BPHS)& Essential package of

Health Services (EPHS) Substantial progress has been made in provision of health care

services in rural Afghanistan Competent Training guideline & curricula for community MWs Establish community Based Health Care (CBHC)

Where we are?

•

Coverage of Health facilities 89%

# of HF 1241(2003) to 1586(2008)

Family Planning service availability 82.3

<5 mortality 191

Infant mortality rate 129

ANC coverage 80.3

% of deliveries by SBA 18.2%

CPR 36%

# of Community Health worker 20.000

# of Midwives 467 to 1919

Millennium Development Goals (MDGs)– Reduce by 50%, between 2003 and 2015, the under-five mortality rate,

and further reduce it to one third of the 2003 level by 2020– Reduce by 50%, between 2002 and 2015, the maternal mortality ratio,

and further reduce it to 25% of the 2002 level by 2020– Have halted by 2020 and begun the reverse the spread of HIV/AIDS– Have halted by 2020 and begun to reverse the incidence of malaria and

other major diseasesICPD Bench marks • 60% of Primary Health Care centers should provide RH services by 2005• 80% by 2010 and • 100% by 2015Afghanistan Compact Benchmark

By end 2010, in line with Afghanistan’s MDGs, the Basic Package of Health Services will be extended to cover at least 90% of the population; maternal mortality will be reduced by 15%; and full immunization coverage for infants under 5 for vaccine preventable diseases will be achieved and their mortality rates reduced by 20%

Health and Nutrition Sector ,Goals:

12

Desired Results, New Health secretor Strategy

• MMR to be reduced by 21% - from an estimated 1600 deaths per 100,000 live births.

• Under 5 Mortality Rate (U5MR) to be reduced by 35% - from 257 deaths per 1000 live births

• Infant Mortality Rate (IMR) to be reduced by 30% - from 165 deaths per 1000 live births

• the ratio of Caesarian Sections per 100 deliveries carried out in district, provincial and regional hospitals– the HIV sero-prevalence rate in the general population will be

maintained at less than 0.1%

14

Remaining challenges

15

• Insecurity • Coverage VS accessibility and utilization • Sustainability – BPHS is a donor driven program• Least budget allocation on RH activities • Aligning strategies of BPHS NGOs toward

achieving the MDGs.• Geographical dispersal of population &

remoteness.

Challenges

16

Challenges

• Insufficient Reproductive Health commodity security

• Cultural barrier ( knowledge & family prominence )

• Insufficient /lack of SBA

• Insufficient quality of services

• Strengthening monitoring and evaluation to fill missing information

• Poorly motivated CHW

Challenges

Suggestion/recommendation

….1- Focus on equitable coverage for priority interventions .2- Gender & Human

right in MR3- Proper HR planning

4- Strength government support ,monitoring &evaluation on conducted locally driven implementation research

5- Government &Stakeholder Commitment

• Focus on Preventive, Primitive & Curative Services through integrated approach

• Increase accessibility and quality of services

• Promote Community Participation, strength gross root activity .

• Expansion of Services (BPHS & EPHS)• Promote Innovative schemes

• Maternity waiting room• Sufficient commodity security FP method provide 10% reduction in

MMR• Increase Demand for health services

• Performance based incentives• Demand side financing

Suggestion/recommendation

….1- Focus on equitable coverage for priority interventions .2- Gender & Human

right in MR3- Proper HR planning

4- Strength government support ,monitoring &evaluation on conducted locally driven implementation research

5- Government &Stakeholder Commitment

MM reduction is a matter of gender, sexual and reproductive rights, and social justice,

inequity, at the individual level, family level, community level, and institutional level lead to MMR. often, maternal death or disability are the result of gender-based violence.

Promoting gender and RH rights is crucial.

Suggestion/recommendation

….1- Focus on equitable coverage for priority interventions .2- Gender & Human

right in MR3- Proper HR planning

4- Strength government support ,monitoring &evaluation on conducted locally driven implementation research

5- Government &Stakeholder Commitment

The most crucial constraint, or factor is lack of skilled & trained staff.

strenght gross root activity (CMW) .The challenge is also to post (and keep) skilled and committed providers in basic EmOC facilities

Formulate/review national HR policies and stratégies .

To be included in the reform of health system, with multi-partner coordination, not only health.

.

Suggestion/recommendation

….1- Focus on equitable coverage for priority interventions .2- Gender & Human

right in MR3- Proper HR planning

4- Strength government support ,monitoring &evaluation on conducted locally driven implementation research

5- Government &Stakeholder Commitment

• Initiatives must focus on outcomes• Timely and readily available data• Allocate/generate resources for M&E• Action on results • Include on official document ( Misoporstol

& Emergency contraceptive)

Suggestion/recommendation

….1- Focus on equitable coverage for priority interventions .2- Gender & Human

right in MR3- Proper HR planning

4- Strength government support ,monitoring &evaluation on conducted locally driven implementation research

5- Government &Stakeholder Commitment

• Increase Inter-sectoral & ministerial collaborations

• Promoting Private-Public Partnership• Ensure common vision and shared goals• Ensure predictable long-term aid flow• Donor commitment

22

Final Words

• “I am happy with the midwife. Previously there was no midwife in our village and women were suffering bleeding and their children were dying. Now thanks to God, we have got a midwife and since have not seen a pregnancy death.”

• “In the beginning, people thought that I might be a Dayea (traditional birth attendant) and would not be effective. At present, they know me as a women’s specialist and they respect me and say that I solve their women’s problems.”

23

Are Women Getting the Services they Need?

“Before there was no midwife in our health center and we had to travel over one hour to the nearest town. I had all my babies at home before. But now Midwife Hadia is at the health centre and because of this more women are seeing a midwife. I will have my next baby with Hadia in this health center, she is very nice and makes me feel safe”

Woman in Takhar province who was delivered by Midwife Hadia

Effective Interventions

Maternal deaths would fall by 73% if coverage of key interventions rose to 99%

0% 10% 20% 30% 40%

Drugs for preventing malaria

Treatment for iron deficiency

Magnesium sulphate for pre-eclampsia

Active management in third stage oflabor

Improved access to safe abortion services

Improved access to comprehensiveessential obstetric care

deaths averted (as % current total)

Hemorrhage

Puerperal Infection

Eclampsia

Obstructed Labour

Abortion Complications

Malaria

Anemia

Tetanus

Safe pregnancy and childbirth

and a life of dignity

for all women

25

26

Health facility

27

Community Health workers (CHW)

28

SBA( Midwife)

29

Community midwifes