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Implementing Health Reforms for Implementing Health Reforms for Rapid Reduction of Maternal & Rapid Reduction of Maternal &
Neonatal MortalityNeonatal MortalityNeonatal MortalityNeonatal Mortality( A.O. No. 2008 ( A.O. No. 2008 –– 0029)0029)
Honorata L. Catibog, MD, MNSA
March 4, 2010
AssessmentAssessment� very slow decline of MMR in the past 20 years
(209/100,000 LB in 1990 to 162/100,00 LB in 2006);
� maternal deaths account for 14% of deaths among women of reproductive age;
� maternal death triggers other adverse consequences in families: orphans, loss of family care provider
� 17 infants die per 1000 LB within first 28 days of life (neonatal mortality rate); mostly within first week after birth; half die during the 1st 2 days
Four Risks Associated with Four Risks Associated with Maternal and Neonatal DeathsMaternal and Neonatal Deaths� Risk of having mistimed, unplanned, unwanted,
unsupported pregnancy
� Risk of not securing adequate care during pregnancypregnancy
� Risk of delivery not attended by skilled birth attendant or access to EmONC services
� Risk of not securing proper postpartum & postnatal care for mother & neonate
STATEMENT OF POLICYSTATEMENT OF POLICY
- An Integrated MNCHN Strategy shall :
• guide development, implementation and evaluation of various programs aimed at women, mothers and children, with the women, mothers and children, with the ultimate goal of rapidly reducing maternal and neonatal mortality in the country.
• Guide in the engagement, assistance and empowerment of LGUs and other partners.
GoalGoal
� Rapidly reduce maternal & neonatal mortality through local implementtion of an integrated MNCHN strategy.integrated MNCHN strategy.
General principlesGeneral principles
� The goal shall be achieved through effective population-wide provision & use of integrated MNCHN services as of integrated MNCHN services as appropriate to any locality in the country
Intermediate resultsIntermediate results
� Every pregnancy is wanted, planned & supported
� Every pregnancy is adequately managed throughout its course
� Every delivery is facility-based & attended by SBA
� Every mother & NB care secures proper postpartum & postnatal care with appropriate package of services
Fourmula 1 in MNCHNFourmula 1 in MNCHN
� Service Delivery - addressing the direct causes ofmortality during childbirth
� Health Regulation- enforcement of regulatory measures and guidelinesmeasures and guidelines
� Health Financing- application of combined financing strategies
� Good Governance for health- political commitment of local stakeholders and accountability for results
Objectives Objectives 1. Develop, adopt, promote, implement & evaluate an
integrated MNCHN strategy2. Engage all province-wide or city-wide health systems to
adopt & implement the integrated MNCHN strategy3. Provide targeted support to areas where maternal &
neonatal deaths is severeneonatal deaths is severe4. Achieve national MNCHN program targets for the ff. key
indicators by 2010a. Increase CPR from 35.9% to 60%b. Increase percentage of pregnant women with 4 antenatal visits
from 70% to 80%c. SBA & facility-based deliveries from 40% to 80%d. And FIC from 70% to 95%
*(2003 NDHS)
General GuidelinesGeneral Guidelines
� Province-wide & city wide health system as the unit for planning, integrating & implementing MNCHN strategy
� Engaging local stakeholders & strengthen public � Engaging local stakeholders & strengthen public & private partnership
� Mobilize the service delivery network for the continuum of services
� Improve the delivery of component services in the maternal and neonatal service package
General guidelinesGeneral guidelines
� Develop & support demand-side interventions
� Monitoring & evaluation systems� Monitoring & evaluation systems
� National support to local planning & development for the MNCHN strategy
SPECIFIC GUIDELINES SPECIFIC GUIDELINES
1.Province-wide and city-wide health system shall be delineated by politico-geographic jurisdictions of its geographic jurisdictions of its components LGUs
2. Three Tiered operations of service delivery
SPECIFIC GUIDELINES SPECIFIC GUIDELINES
3. Province-wide and city-wide health system shall be supported by an adequate communication and adequate communication and transportation system
4. With specifically defined Integrated MNCHN Services
Minimum standard of integrated MNCHNservicesMinimum standard of integrated MNCHNservicesLife Cycle Stage Mother Newborn
Pre-pregnancy Iron and folate acid supplementation
Promotion of HL
IEC/counseling on FP/Responsible Parenting /FP services, especially for the poor; Fertility awareness , identifying population segments with unmet needs
Provision of other services;treatment of Diseases, as indicated; referral
Ante-natal care 8 essential ante-natal care functions
Deworming
Id of early signs and symptoms of risks
Administration of steroids for pre-term babies
Early detection and management of danger
signs and complications of pregnancy
Health caring and seeking behavior, Responsible parenting
Delivery Clean and Safe Delivery: Monitoring progress of labor, & immediate referral to facilities with BEmONC & CEmONC functions ; transport priority for women with birth complications
Minimum Standard of Integrated MNCHN ServicesMinimum Standard of Integrated MNCHN ServicesLife Cycle Stage Mother Newborn
Post partum & Postnatal care
Identification of early signs and symptoms
of postpartum complications
Maternal Nutrition: Iron and folate, Vit A, dewormingtablet, promotion of iodized salt
Family Planning: Latching on; IEC/Counseling on: (i) birth spacing; (ii) return to fertility; (iii) all FP methods especially LAM
Responsible parenting
Exclusive BF up to 6 months/LAM
IEC/Counseling on Healthy Lifestyle
Prevention and Management of Other Diseases
Identification of early signs and symptoms of newborn problems (e.g. respiratory distress, change in color, etc.)
Immediate Newborn Care: cord care/dressing; warming/skin to skin contact; Initiation of BF; Vitamin K injection; eye prophylaxis; delayed bathing; Hepa-B Immunization
Emergency Newborn Care:
treatment of neonatal sepsis/
infection; oxygen supply; resuscitation and Prevention and Management of Other Diseases
as indicated
Prevention and Management of Abortion
Complications: removal of retained products of conception and treatment of infection as well as correction of anemia, and Anti-tetanusserum (ATS) injection
Diagnostic Test: cervical cancer screening,
(acetic acid wash) for >40 years old women
Follow-up visit and care: all post-partum
women
infection; oxygen supply; resuscitation and stabilization; kangaroo Care
Intensive newborn care for low
birth weight (LBW), preterm,
IUGR, babies born with
congenital anomalies, and sick
newborn
Newborn Screening
Rooming-in or bedding-in/
exclusive BF up to 6 months
BCG Immunization
Birth Registration
Home visit and follow-up
SPECIFIC GUIDELINES SPECIFIC GUIDELINES 5. DOH shall support universal local implementation
of the MNCHN strategy considering the local conditions and capacities
6. Assessment of coordination across the various 6. Assessment of coordination across the various MNCHN-related activities and functions within and outside the health service system shall be in accordance with specific criteria and made part of a local monitoring and evaluation system
The MNCHN Manual of The MNCHN Manual of OperationsOperations
� Contains the following components of the MNCHN strategy:a. Key indicators to measure progress of a. Key indicators to measure progress of
intermediate results
b. Integrated list of MNCHN Services
c. Core list of MNCHN Interventions
d. Budget execution guidelines for the MNCHN grant facility
Key outcome indicatorsKey outcome indicators1. MMR reduced to 52/100,000 Live births
(Baseline: 162/100,000 LB FPS 2006)
2. CPR increased to 65%
(Baseline: 36% FPS 2006)(Baseline: 36% FPS 2006)
3. Newborn mortality reduced to 10/1,000 LB
(Baseline: 13/1,000 LB FPS 2006)
3. Infant mortality rate reduced to 19/1,000 LB
(baseline: 24/1,000 LB FPS 2006)
4. Under 5 mortality reduced to 27/1,000 LB
(Baseline: 32/1,000 LB FPS 2006)
Key result indicatorsKey result indicators� 90% of births are facility-based
� 90% antenatal care coverage
� 80% reduction in unmet need
(baseline: 15.7% FPS 2006)
� 100% of facilities with FP services
� 90% of newborns initiated to breastfeeding “within 1 hour after � 90% of newborns initiated to breastfeeding “within 1 hour after birth”.
� 80% exclusive breastfeeding of infants up to 6 months of age
� 95% of infants are fully immunized
� 95% of children 0-59 months old with diarrhea treated with ORT.
� 90% of children with S/S of ARI & fever treated at health facilities
Critical Activities in support to the local Critical Activities in support to the local MNCHN implementationMNCHN implementation
� Infrastructure upgrading of CEmONC; BEmONC
� Procurement of equipment for BEmONCs/ CEmONCsCEmONCs
� HRTD (human resource training & development) – Establishment of the Training Consortium with
funding support from WHSMP2
– BEmONC Skills Training is on-going in 5 Training Centers
� LGU MOP Orientation by the CHDs
� Organization of Women’s Health Teams and Training
� Organization of BEmONC Teams and Training
� Data recording and reporting
� Advocacy on facility-based delivery.