Maternal and Child Health

NSM Presentation

September 7, 2006
Pryce Hotel, Cagayan de Oro City Dr. Honorata L. Catibog Family Health Office - NCDPC

Overall Health Issues

slow progress in achieving MDGs IMR / UFMR reduction on track Under nutrition reduction is slow MMR reduction is very slow

Health Indicators Selected Asian Countries

Japan So. Korea Malaysia Thailand Philippines

Life expectancy
IMR Underfive Mortality MMR Population growth

81
3 5 8 0.3

75
5 5 20 0.8

73
8 8 41 2.2

70
24 28 44 1.4

70
29 40 172 2.1

HOWEVER, WE LAG BEHIND OUR ASIAN NEIGHBORS IN TERMS OF MORTALITY RATES

Infant Mortality Rate

60 50 40 30 20 10 0 1990
Source: NDHS,2003

57 49 35 29 19

1995

1998

2003

2015

Infant Mortality by Region

Cordillera Admin National Capital Region Central Luzon CALABARZON SOCCSKSARGEN Zamboanga Pen. Central Visayas Bicol Cagayan Valley Ilocos Ilocos Caraga Cordillera Admin Davao Northern Mindanao Western Visayas ARMM MIMAROPA
NDHS, 2003

14 24 25 25 27 27 28 28 28 29 30 35 36 38 38 39 41 44
Number of infant deaths per 1000 live births Number of infant deaths per 1000 live births

Underfive Mortality
80 70 60 50 40 30 20 10 0 1990
Source: NDHS,2003

80 67 48 40 27

1995

1998

2003

2015

Under 5 Mortality Rate by Region NDHS 1993-2003

In Thousands 80
70 60 50 40 30 20 10 0
R 4B AR G 1 2 3 5 6 7 8 9 10 11 4A C 12 R AR N M

Regions
Source: NDHS,2003

Legend: higher than national rate 40 Lower than national rate

Maternal Mortality Ratio

250 200
209

150 100 50 0 1990

Source: NDHS,2003

180

172

52

1995

1998

2015

Assistance at Delivery
ARMM

22 29 31 36 37 41 43 47 48 48 53 60 60 68 74 75 86 88
Percent distribution of live births assisted by a doctor, nurse or midwife

MIMAROPA
Zamboanga

Eastern Visayas
Eastern Visayas

Northern Mindanao
Caraga

Western Visayas
Davao

Bicol
Cagayan Valley

Cordillera Admin. Region

PHILIPPINES

Central Visayas
Ilocos

CALABARZON
Central Luzon

National Capital Region

Problems in accessing health care wealth index quintile

Reasons
Knowing where to go for treatment Getting permission to go for treatment

lowest

second middle

fourth

highest

27.4 22.0

19.2 12.7

13.6 8.4

10.7 7.5

8.6 6.8

Getting money for treatment

Distance to health facility Having to take transport

87.1
59.1 57.1

80.1
33.8 32.5

73.0
22.2 20.3

62.9
18.7 17.4

45.6
13.6 12.0

Not wanting to go alone

Concern there might not be a female provider Any of the specified problems

44.0 31.5
93.5

28.8 20.9
87.1

25.2 18.0
80.8

25.5 18.5
73.6

22.0 17.2
59.7

Fully Immunized Child & Hepatitis B Coverage Phil, 2002-2005

100

Percent

90 80 70 60 50 40 30 20 10 0 2002

84 77

84

80

45.2 38.5

45.6

FIC HepB3

2003

2004

2005

Source: FHSIS & NCDPC

Year

Status of Malnutrition Philippines,0-5 yrs old

Percent
Prop. Underwt for age Prev Underht for age Prev. thinness Prev. overweight

50 45 40 35 30 25 20 15 10 5 0

34 32 30.4 27.6

6 0.4 1998

5.5 1.4 2003

Year
Source: NNS 2003

Breastfeeding rates are decreasing

54% of infants started breastfeeding within 1 hour of birth Children of mothers whose delivery were assisted by health professionals are less likely to be breastfed than those delivered by TBAs ( 83 vs 93%) Children delivered at the health facility are less likely to be breastfed than those born at home (81 vs 90% ) Median duration of exclusive breastfeeding is less than one month

Status of Nutrition School-Age Children, Phil, 2001 & 2003

Prop. Underwt for age per 100 school-age children Prev Underht for age per 100 school-age children Overwt per 1,000 school-age children

Percent

50 40 30 20 10 0 33

41 26 8

37

13

2001
Source: NNS 2003

2003

Year

Prevalence of degree of anemia among different population groups, 2003 Percent

100 90 80 70 60 50 40 30 20 10 0 27.9 21.3 10.9 0.3 6 mo-5y
Source: FNRI-DOST

67.5

62.7

56.1

57.8

25 18.6 0.3 Pregant

23.9 17 1.3 Lactating

Normal Mild Moderate Severe

9.1 0.3 6-12 y

Population Groups

Maternal Care (Place of Delivery)

Health Facility Home
Percent distribution of live births in the 5 years before the survey

77 61 54 46 38 22

Philippines

Urban

Rural

Maternal Care (Place of delivery)

38% of live births were delivered in a health facility and 61% were born at home. (NDHS 2003) Increase compared to 34% in 1998 (NDHS) & a decline in the home deliveries (66% NDHS 1998)

Assistance at Delivery
37
Percent distribution of live births in the 5 years preceding the survey

34 25

2
Hilot Doctor Midwife Relative/ Friend/ Other

1
Nurse

1
No one/ missing

Delivery Assistance
60% of deliveries assisted by health professionals (2003 NDHS) : 34% deliveries assisted by doctors 25% by midwives 1% by nurses Increased from 56% (1998) but still low vis a vis the 80% target in 2004

Essential Health and Nutrition Services for Mothers & Unborn

Antenatal, natal and post natal care Tetanus toxoid immunization Nutrition (including vitamin A, iron, folate supplementation) Treatment of existing conditions or diseases Recognition, early detection and management of complications before, during and after pregnancy Clean and safe delivery/postpartum care Promotion and support to breastfeeding and management of breast complications Information services for birth spacing / newborn screening / psychosocial stimulation STD/HIV prevention and management Oral health care emergency obstetric care family planning

Essential Health and Nutrition Services for Newborns and Infants (0 11 months)
Resuscitation Routine eye prophylaxis Prevention and management of hypothermia Newborn screening/congenital defects Immediate and exclusive breastfeeding Complementary feeding at six months Prevention and management of infection Birth registration Birth weight and growth monitoring and promotion Full immunization Micronutrient supplementation Oral care Development milestone screening Advice on psychosocial stimulation

Essential Health and Nutrition Services for Early Childhood (1- 5 years)
Growth monitoring and promotion Nutritional screening Micronutrient supplementation Developmental milestone screening Disability detection Integrated management of childhood illness Oral Care Counseling on accident prevention and use of safe toys and psychological stimulation First Aid

Essential Health and Nutrition Services for Middle Childhood (6 - 9 years)

Management of Childhood Illness Regular medical/dental check-up Injury prevention Counseling on personal hygiene/ healthy lifestyle/life skills Deworming Nutrition and diet counseling Counseling on fertility awareness Growth monitoring (BMI) Healthy lifestyle Audiovisual screening/disability detection

Essential Health and Nutrition Services for Adolescents and Youth

Management of illness

Counseling on substance abuse, sexuality and reproductive tract infections Nutrition and diet counseling Mental Health and coping mechanisms Fertility awareness and responsible sexual behavior Injury prevention Regular medical and dental check-up Tetanus Toxoid immunization (females) Iron/folate supplementation (females)

Essential health and nutrition service for the Pre-pregnant Woman

Iron /folate supplementation Tetanus toxoid immunization Deworming, oral health Counseling on fertility awareness, responsible parenthood, birth spacing, informed choice, consequences of abortion Counseling on nutrition and healthy lifestyle Diagnostics: Hgb, urinalysis, TB screen, pregnancy test Therapeutic services

Family / Community Behavior

Handwashing use of safe water Use of sanitary toilet Use of iodized salt / fortified foods Timely care seeking Regular check-ups Effective parenting/child rearing Life skills Family nutrition Home management of diseases Prevention of domestic violence

Cross Cutting Issues

Insufficient funding LGU cost recovery schemes : are they hurting health services LGU transparency / accountability / ownership Sustainability Human resources / out-migration Link/reconcile MCH package with PhilHealth accreditation

Cross Cutting Issues

Data Management collection, analysis,
validation, feedback Sensitive MCH indicators NGOs, organization partners in the real Sense, not in conflict with DOH policies and MCH

messages
communication issues effective message, approaches, target groups, quality service delivery increasing access, improving quality & increasing utilization community involvement & support

Framework for Strategic Planning

Goals/ultimate outcomes Proximate outcome: High coverage/utilization of quality services Demand side: - information - non-monetary costs - subsidies - preferences Supply side: - availability of essential and specialized services - high quality of services - expanded network of service outlets - commodity security

Financing Regulation

National and Local Governance

Broadstroke Strategies and Activities

Based on Fourmula One

Broad strokes: MCH Strategic Directions

Based on MDGs

Goals By 2015,
Reduction of Underfive Mortality by 2/3 Reduction of Maternal Mortality by 3/4 Reduction of Underweight Children by 1/2

Proximate Outcomes
Increased in proportion of facility-based deliveries Increased proportion of births attended by health professionals (MDs, RHs, MWs) Increased early initiation of breastfeeding within one hour Increased exclusive breastfeeding up to 6 months Increased proportion of infants receiving appropriate complementary foods at 6 months while continuing breastfeeding Increased proportion of fully immunized children

Proximate Outcomes
Increased proportion of sick children underfive yrs old receiving integrated management of illness Increased care seeking Increased proportion of children receiving vitamin A supplements

Broad Strokes: Strategies and activities Governance

Improving technical leadership and management capability
Devt. of new policies & guidelines (i.e. adoption of Mother & Child Book, Male Involvement in RH, Facility Based Delivery) Institutionalzing MDR Updating existing policies, i.e. EPI, SM New policies on perinatal health, disabilities, congenital birth defects Dissemination and translation into actions Improving procurement and financing systems, e.g. Vit.A Strengthening multisectoral partnerships Strengthening monitoring, evaluation, research Develop tracking system for progress and accountabilities of LGU Improve information management Develop MCH advocacy package for LGUs

Service delivery
Improving quality and efficiency
Upgrading facilities for specialized services and as training units,e.g. Emergency Obstetric care (EmOC) Instituting standard Clinical Practice Guide (CPGs) for FP, SM, etc. Improving human resource capabilities Link health facilities with the community Strengthen public health interventions in hospitals Intensify disease prevention and control Provision of essential MCH drugs and commodities

Service Delivery
Improving accessibility and availability of basic / essential / specialized services
available service delivery points, e.g. adolescents, Developing special approaches/package of services for: Indigenous People (IPs), displaced children and mothers, emergency situations Tracking system and case holding, follow up dropouts/defaulters Systematic outreach services

Service Delivery
Engaging and empowering families and communities
Community-based interventions, i.e health and nutrition posts, Botika Sa Barangay (BSBs) Communication for behavioral and social change Creating an educated demand for services

Regulation
Assuring access to quality and affordable health products and services
Harmonizing Sentrong Sigla standards with Philhealth accreditation Strict enforcement of laws. i.e. Milk Code, ASIN Law, Food Fortification Law, Newborn Screening Law Harmonizing and streamlining licensing, certification and accreditation, e.g. MBFHI, NBS Assure low priced commodities and drugs Seal of approval system, e.g. Sangkap Pinoy. Diamond Seal

Financing
Ensuring health care financing support for children with bias to the poor
Multiyear planning and budgeting for priority program, e.g. EPI Enrolment in Philhealth/ indigency program Expand private sector participation Explore other financing mechanisms, user fees, voucher system Maternal and child survival should be made part of poverty reduction strategies, socioeconomic development plans, sector-wide approaches

Investments for Maternal, Child & Adolescent Health for 5 years: (2006-2010)
I. Maternal Health :
GOP TBI WORLD BANK UNFPA LGU

P 17,166,959,750.00
649,811,700.00 509,420,000.00 802,367,300.00 20,000,000.00 15,185,360,750.00

Investments for Maternal, Child & Adolescent Health for 5 years: (2006-2010)
II. Child Health : P2,772,763,327.00

GOP A to Z UNICEF TBI LGU

2,572,504,454.00 3,750,000.00 250,000.00 884,556.00 195,374,317.00

Investments for Maternal, Child & Adolescent Health for 5 years: (2006-2010)
III. Adolescent Health : P 13,768,000.00

GOP UNICEF UNFPA TBI

300,000.00 150,000.00 5,000,000.00 8,318,000.00

TOTAL :

P19,953,491,077.00