EgyptMinistry of Health & Population

MDG 4 and Beyond

“Lessons Learnt”“Lessons Learnt”

Emad Ezzat, MDHead of PHC Sector

EMRO high-level meeting, Dubai, Jan 2013

Trends of Under 5, Infant and

Neonatal Mortality (1990 – 2008)

Under 5

Egyptian DHS

Infant

Neonatal

� Ten years ago, the United Nations General Assembly passed the landmark resolution on A

World Fit for Children, and in doing so, helped save and enhance the lives of millions of

children. Today, we renew this promise to the world’s children.

� Therefore, we the undersigned heads of State and Government and representatives of States,

reaffirm our commitment to children. Consistent with the Secretary-General’s Every Woman

Every Child initiative, we pledge our support for the global movement to end

preventable child deaths.

� The world has made tremendous strides in reducing child mortality. Over the past 40 years,

Signed June

2012,

Washington DC

� The world has made tremendous strides in reducing child mortality. Over the past 40 years,

new vaccines, improved health care practices, investments in education, and the dedication

of governments, civil society and other partners have contributed to reducing the number of

child deaths by more than 50%. The momentum generated by this unprecedented progress,

and the scientific and social advances that underpin it, present an historic opportunity for

dramatic declines in preventable child deaths – in high, middle and low-income countries

alike.

� Through national action and international cooperation, we pledge to take action to

accelerate progress on newborn, child and maternal survival. We hold ourselves

accountable for our collective progress towards this goal. And on behalf of all children

everywhere, we recommit the efforts of our respective governments to give every child the

best possible start in life.3

How did Egypt address the issue of under-five mortality?

Reduction of child mortality, where the 2015 target of

MDG4 has been achieved in 2008. (Average Annual Rate

of Reduction 1990 – 2011 is 6.7%) , in 2011, Egypt has

gone beyond MDG4, a 75% reduction in under-five

mortality between 1990 and 2011 through:mortality between 1990 and 2011 through:

• Full (or almost full) coverage of children by child care

programs (e.g. IMCI including EPI, CDD, ARI, growth

monitoring,, Micronutrient supplementation)

• Neonatal care units in all general and 10% of district

hospitals (total of 242 hospitals)

• National neonatal screening for congenital

hypothyroidism

4

EPI program

5

80

82

84

86

88

90

92

94

96

98

100

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Cov

erag

e %

Coverage of DPT3 vaccine

90

95

100

Co

ve

rag

e %

6

75

80

85

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١٩٩٩

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Co

ve

rag

e %

• Early introduction of Zinc preparation and Low-

osmolarity ORS for diarrhea treatment since 2007

How did Egypt address the issue of under-five mortality?

osmolarity ORS for diarrhea treatment since 2007

• Starting perinatal and nutritional health care program

• Landscaping Analysis study for assessment of

willingness and readiness for scaling up of nutritional

interventions

• Conducting Perinatal Surveillance System

• Establishing Nutritional Surveillance System7

• Ante-natal care program (73% coverage for any

ANC visit and 66% for 4 ANC visits)

• Strong family planning program: 58% use of

How did Egypt address the issue of under-five mortality?

8

• Strong family planning program: 58% use of

modern contraceptive methods.

• Midwifery training to ensure equity to access to

safe deliveries to poor women that improved

delivery outcomes.

IMCI Program

• Includes cost effective package of interventions to

address main causes of U-5 mortality at PHC

level:

– Pre-referral management of severe conditions.

– Case management of:

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– Case management of:

• Sick newborn

• Pneumonia

• Diarrhea

• Malnutrition.

– Breastfeeding and complementary feeding counseling.

– Checking vaccination and vitamin A supplementation status.

– Improving care-seeking.

• Introducing Health insurance for under 5 years children

• Inclusion of IMCI programs in the medical education

How did Egypt address the issue of under-five mortality?

• Inclusion of IMCI programs in the medical education

curriculum at universities since year 2000

• Scaling-up implementation of IMCI in a relatively short

time by adopting a systematic approach (started 1999 and

nearly full coverage 2012)

10

A systematic approach for IMCI scaling up

enabled reaching high coverage (94% PHC

facilities)

2301

2992

3524

40244211

44784645

4731

3000

3500

4000

4500

5000

Health f

acili

ties im

ple

menting I

MC

I

11 11

28150

569

1114

1652

2301

0

500

1000

1500

2000

2500

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Health f

acili

ties im

ple

menting I

MC

I

Health facilities implementing IMCI Cumulative total

Improved quality of services as proven by the survey and follow up reports.

However, Egypt is facing

challenges

• High turnover of trained staff: overburden on in-service

training.

Inequities• Inequities in coverage of interventions (geographic and

socio-economic), and distribution of human resources.

• Multiple planning processes for child health with different

partners.

• A lot of investments are required to scale up the

community based interventions.

12

However, Egypt is facing

challenges (cont.)

• Private sector is expanding, not necessarily complying

with the technical protocols of the public sector with the technical protocols of the public sector

(regulations).

• Inadequate budget allocation for MCH.

• Inadequate Government health expenditure and High out-

of-pocket expenditures.

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• Political commitment and strong leadership

• High accessibility to a wide and well staffed PHC network

• High coverage with child health interventions.

Key drivers of success

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• High coverage with child health interventions.

• Utilize cost effective interventions and adopting

standardized protocols within the BBP

• Institutionalized EPI, CDD and ARI Programs (IMCI)

• prioritized under-privileged areas and high risk groups

• Adoption of community based initiatives (Raedat

Refeyat) to increased demand and coverage with health

services

• Surveillance Systems (Maternal and Child mortality)

Key drivers of success

• Surveillance Systems (Maternal and Child mortality)

• Capacity building at all levels (to ensure quality care)

• Efficient partnership:

– Private sector

– Academia

– Civil society and community

– Partners for development15

Way Forward

• Renewal of commitment to child survival (Call to Action)

• Sustain our gains (e.g. IMCI and Perinatal Care Program)

• Mobilizing enough resources to achieve this target.

• Addressing inequities as a major approach to further

reduce mortality.

• Providing emphasis on the neonatal mortality while

sustaining the attention to the post-neonatal period.

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Way Forward (cont)

• Emphasize efficient partnership with private Sector,

academia, civil society and donors (getting everyone on

board)

• Expand community based interventions• Expand community based interventions

• workforce capacity building and motivation (medical

students, pre-service and in-service) with fair distribution

• Innovation (mobile technology, telemedicine and

introduction of new vaccines)

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Way Forward (cont)

• Scaling up the “Family Health Model”.

• Strengthening the MOHP regulatory role over the private

sector practices.

• Shifting the multiple planning processes into one

integrated national planning process to which all partners

contribute.

• Making more efforts in pre-service education to ensure

sustainability and reduction of the overburden of in-service

training.

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Thank You

19

Thank You