The  10th  Interna,onal  Conference  on  Maternal  and  Child  Health  Handbook    Panel  session

How  to  make  MCH  Handbooks  “Standard  Tool  to  support  mothers  and  children  globally”

23th  November,  2016  U  Thant  Interna6onal  Conference  Hall,  United  Na6ons  University,  Tokyo  

Prevalence  of  MCH  handbook

Year Region

Africa Europe Middle  East

Asia Americas Total

Before  1980s

4 1 2 7

1990s 2 2

2000s 1 3 4

2010s 7 4 1 12

Total 11 1 1 11 1 25

Table  Number  of  countries  having  the  na,onal  standard  MCH  handbook  by  regions  and  year

Source:  non-­‐systemaCc  data  collecCon  as  of  Feb.  2016  Countries  having  the  naConal  standard  MCH  Handbook  does  not  include:  (i)  Countries  adopted  separate  HBRs  (i.e.  UK,  Netherlands,  Morocco  and  Ghana;  (ii)  UNRWA  covering  counCres,  if  the  host  country  have  not  adopted  for  their  naCons;  and  (iii)  State  governments  in  the  United  States  of  America.

Monitoring  Tool  +  Referral  Tool  

Health  Educa,on  Tool  +  Communica,on  Tool  

Recording  Tool    

Capacity of provider side

Capacity of client side

Used for monitoring and referral by staff

at different facilities

Used for Health

Education by staff

Used for Recording by

staff

Kept at home

Read at home

Brought to different facilities at different

occasions

Demand

Supply

Source:  Modified  from  “MCHHB  for  beZer  MCH  services    (2012)”

Life  style  Tool

#2 Roles of MNCH HBRs

Roles  of  MCHHB  and  required  capaci,es

Project  for  Improving  Maternal  and  Child  Health/ReproducCve  Health  in  PalesCne  (Phase  2)  Source  :  MCHHB  use  situaCon  analysis  in  West  Bank  of  PalesCne,  2010  

Health  CommunicaCon  tool  

ü  93%  of  pregnant  women/mothers  have  read  the  MCHHB  (and  some  of  them  have  changed  behaviors)

Home  reference   (PalesCne)

ü  71%  of  pregnant  women/mothers  have  received  explanaCon  on  MCHHB.

ü  65%  of  pregnant  women/mothers  have  showed  the  MCHHB  to  their  family  members  .  

Roles  of  HBRs  and  required  capaci,es

Mothers'  class  :  A  set  of  group  learning  sessions  to  facilitate  counseling  and  communicaCon  between  health  personnel  and  mothers.

Health  CommunicaCon  tool　(Indonesia)

Source:  “Impact  of  Pregnancy  Classes  to  knowledge,  adtude  and  behavior  of  pregnant  women  in  preparaCon    of  delivery,  childbirth  and  post-­‐birth  period  in  Central  Lombok  (2008)  

48

Role of Mothers’ Class (MC) Predisposing factors

Reinforcing factors

Enabling factors

KAP change MC

Peer network (sharing and stimulating)

Communication between

midwives and pregnant women

-Access to health personnel- Support from husband - Support from communities

Project  on  Ensuring  Maternal  and  Child  Health  Service  with  MCH  Handbook  Phase  2

Bali,  2014

Roles  of  HBRs  and  required  capaci,es

Jan  2016    PMAC  

       

(Bangkok)

May  2016  Women  Deliver  

         

(Copenhagen)

Nov  2016  Health  Systems  

Research        

(Vancouver)  

 Nov  2016      

Int’l  Symposium  MCHHB  

       

(Tokyo)  

 Sep  2015      

Int’l  Symposium    MCHHB  

       

(Tokyo)  

Opera,on

 

efficiency  

Road  to  Tokyo  2016

Moderator:    JICA  (HQ)   Comments:    WHO  (Thailand) WHO  SEARO  TAG  member  (Thailand)   UNFPA  (Asia  &  the  Pacific)    UNICEF  (East  Asia  and  Pacific)  absent   ü  MCH  Handbook  was  defined  as  a  locally  adapted  tool.  ü  Values:  Outcome＋ Process  (Empower,  EducaCon,  Accountability,  Demand  creaCon),  No  one  leA  

behind,  EmoConal  effect  to  make  mothers  happy）  ü  RaConale  is  clear,  Barriers  needs  to  be  addressed    ü  Minimum  contents  and  effecCve  operaCon  is  needed.  

Best  Buy!!  Mother  and  Child  Health  Handbook  toward  UHC  and  Women’s  Empowerment    

Round  Table  Discussion  

Country  Reports 27th  January,  2016,  Bangkok    

Value

Empowerment of women/

family

UHC

CoC

Effec,veness  of  MCH  Handbooks Value  of  MCH  Handbooks  lies  in  effecCveness/efficacy  in  health  service  coverage/healthy  behavior  in  the  context  of  conCnuum  of  care  (CoC),  universal  health  coverage  (UHC)  and  empowerment  of  women/family. Services

Financing

Equity Preparedness

Governance

Value

UHC

Kenya Philippines

Ghana

CoC

Services

Financing

Equity Preparedness

Governance

People-­‐Centered  Services,  Quality  and  Mul,sectoral  Ac,on  

More  and  Be`er  Spending  and  Effec,ve  Financial  Protec,on  

Targe,ng  the  Poor  and  Marginalized,  Leave  No  One  Behind

Empowerment  of  Women  for  Resilience  through  Life  Course

Promote  Coordina,on,  Integra,on  with  Health  Systems

MCH  handbook  for  “UHC  in  Africa”-­‐  5  pillars  

Indonesia

Burundi

Philippines

Kenya

Speakers  PalesCnian  MOH  UNRWA  (HQ)  Vietnamese  MOH  Ghanaian  MOH  

Empowerment through Maternal and Child Health Handbook

Commentators  PMNCH  (ExecuCve  Director,  HQ)  PalesCnian  FP  &  ProtecCon  AssociaCon  (ExecuCve  Director,  HQ)  UNFPA  (RH  Program  Analyst,  Myanmar)  UNICEF  (Deputy  Director  Health,  HQ)  WHO  (Director,  Dept.  MNCA  Health,  HQ)  

Value

Empowerment of women/

family

UHC

CoC

Effec,veness  of  MCH  Handbooks Value  of  MCH  Handbooks  lies  in  effecCveness/efficacy  in  health  service  coverage/healthy  behavior  in  the  context  of  conCnnum  of  care  (CoC),  universal  health  coverage  (UHC)  and  empowerment  of  women/family.

“A symbol of care, acknowledgement of mother and child by society” Value

Empowerment “A tool for increasing awareness regarding their rights and confidence to decide for future. It is for human security and dignity.”

Palestine UNRWA

Vietnam Ghana

Value   OperaCon  

#4 Assessment of MNCH HBRs

Two  key  perspecCves  from  which  MCHHBs  are  assessed:  (i)  effecCveness/efficacy  in  health  service  coverage/healthy  behavior/awareness  and  knowledge;  and  (ii)  efficiencies  in  health  system  operaCon.

Value

Efficacy  and  Efficiency  of  MCHHBs

Opera,on

Empowerment

UHC

CoC

15:00-­‐17:00,  15  November  2016,    Mee=ng  Room  13,    

The  Vancouver  Conven=on  Centre,  Vancouver,  Canada

 

Too many cards and handbooks: Fragmentation and integration of

MNCH home-based records

4th Global symposium on Health System Research 2016  

Satellite Session #37:

Operation

efficiency

#4 Assessment of MNCH HBRs

MCH  handbook  

   

Child  vaccina,on  card  

   

Child  growth  chart  

   Typology  of  

HBRs Maternal  care Child  care

Antenatal  care  

Delivery Postpartum  care

Family  planning  

Postnatal  care

ImmunizaCon

Breast  feeding

Growth  monitoring

Child  develop.

IMCI

Maternal  record

Immuniza,on  record  (M)

Immuniza,on  record  (C)

Growth  monitoring

Child  record  xxx

MCH  handbook

Availability  of  evidence  on  MNCH  HBRs  

Figure  2.  Computed  percent  difference  in  reported  number  of  home-­‐based  records  printed  for  2013  and  the  esCmated  number  of  births  from  the  United  NaCons  PopulaCon  Division.  

Prevalence  of  HBRs  for  MCH  

[Source]  Young  S,  Gacic-­‐Dobo  M,  and  Brown  D  (2015)  Results  from  a  survey  of  naConal  immunizaCon  programmes  on  home-­‐based  vaccinaCon  record  pracCces  in  2013          

Figure.  Latest  naConal  esCmated  prevalence  of  home-­‐based  vaccinaCon  cards  based  on  MICS  or  DHS  survey  results  for  the  period  2000-­‐2015  

Prevalence  of  HBRs  for  MCH  

[Source]  Home-based Record Ownership Prevalence      (hZps://sites.google.com/site/vaccinaConcardprevalence/  accessed  in  Nov  2016)  

       

Do  we  discuss  on  a  strategy  to  color  countries  with  PINK?            

No,  but………….    

     we  are  going  to  discuss  how  to  decrease  opportunity  cost  for  the  countries,  which  would  like  to  introduce  it,  use  it  effec,vely,  and  sustain  it  efficiently  by  fiing  it  into  their  na,onal  health  systems.  

What  we  discuss  in  this  session  

Bui l t -­‐ in  h e a l t h    system  

2004    

Pilot  

Na,onal  version    

N a , o n w i d e  implementa,on  Implementa,on  

of  na,onal  version  in  na,on-­‐

wide    

Na,onal   version  is  developed    

2003  

Constant  procurement  &  

periodical  revision  

2008  Xx/xx  prov.    

2010  Xx/xx  prov.  

2016  

Pilot  implementa,on  in  limited  geographical  area  

A B

C

A

B

C

2015    

2016  

Maturity  of  opera,on  

Coordina,on  of  stakeholders  

Effec,ve  use  by  health  personnel  supported  by  health  system  input    

Challenges  in  opera,on  of  MCHHBs  

Effec,ve  use  by  women  and  family  

2010  Xx/xx  prov.  

What  we  would  learn  from  partners  

UNICEF:    Experiences  in  child  records  (EPI  +  Growth  Monitoring  and  MCHHB  operaCons)  UNFPA:  Experiences  in  women  records  and  MCHHB  operaCons  WHO:    Experiences  in  normaCve  operaCon  guidelines  of  home-­‐based  records  IPPF:    Experiences  in  MCHHB  operaCon  from  NGO  perspecCves

Who  need  to  be  changed?   •  Mother  and  child?  •  Family?  •  Community?  •  Health  personnel?  •  Programs?  •  Policy?  •  Government?  •  Development  

partners?  Opera,on

The  6th  Symposium,  2008  + The  10th  Symposium,  2016

What  need  to  be  changed?  

               

Partners/Global  iniCaCves

           

Health  Policy

     

 Health  

Programmes

   

Health  Personnel

Mothers

Thank  you  for  you’re  a`en,on!   For  the  details,  please  contact:    Keiko  Oskai  Email:  osaki.keiko@jica.go.jp  Phone:+81-­‐3-­‐5226-­‐9348  Fax:  +81-­‐3-­‐5226-­‐6389