Jamisse: Scaling-Up Newborn Programming at the National Level - Agenda Setting, Policy Formulation and Implementation

7/28/2019 Jamisse: Scaling-Up Newborn Programming at the National Level - Agenda Setting, Policy Formulation and Implementation

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REPBLICA DE MOAMBIQUEMINISTRIO DA SADE

GABINETE DO MINISTRO

Scaling-up newborn programming at thenational level: agenda setting, policy

formulation and implementation

Mozambique

GLOBAL NEWBORN HEALTH CONFERENCE

April 15-18, 2013

Johannesburg, SA

Dra Nazira Abdula

Deputy Minister of Health


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Research to Advocacy, Policy,

and Action

PRESENTATION OUTLINE

Mozambique at a glance

Newborn Survival in Mozambique

The policy framework

Gaps and challenges in tackling newborn survival inMozambique

Key benchmarks for success


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Total Population 24.300.000

Population U5 4.300.000

Urban population 38%

Population below poverty line

(2009)

52%

Life expectancy at birth 52 years

GDP growth (2012) 7.5%

Female literacy (2010) 42.8%

Population using improved watersources

47%

Government expenditure on health

as % of total (2010)

12%

MOZAMBIQUE AT A GLANCE


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More than950.000 children are born everyyear in Mozambique.

Of them, more than 28.000 die within the

first 28 days of life

Neonatal deaths: approximately 30% of all

under five mortality in Mozambique

The Neonatal Mortality rate is 33 per 1000

LB

Maternal mortality estimated at

490/100.000

NEWBORN SURVIVAL IN MOZAMBIQUE


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Sources:U5MR, IMR, and NMR: DHS1997,2003 and 2011; MICS2008

MDG 4 target from Countdown to 2015, country profiles 2012 -- 2/3 reduction from 1990 U

PROGRESS TOWARDS MDGs 4 in MOZAMBIQUE

201

153141

97

73

135

10195

6454

37 38

30

0

50

100

150

200

1997 2003 2008 2011 2015

Trends in Child Mortality in Mozambique

1997 - 2011

Child mortality

Infant mortality

Newborn Mortality

From 2000 to 2011:

Under five mortalityrate reduction of

4.7% per annum

Furtheracceleration is

needed to achieve

MDG 4 objective


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Source: Countdown to 2015, Report 2010

CAUSES OF UNDER 5 DEATH

Asphyxia,prematurity, andsevere infectioncause the majorproportion of

neonatal deaths incountry

These threeconditions aloneaccount for morethan 25% of theoverall U5 mortalityin Mozambique

Malaria , 19%

HIV/AIDS, 10%

Acute respiratory

infections, 11%

Injuries, 3%

Instestinal infectious

diseases, 9%

Meningitis , 2%

Other causes, 16%

Preterm, 10%

Infection, 8%

Birth Asphyxia, 8%

Other , 4%

NEWBORN, 30%


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The policy framework for newborn health in Mozambique

National Newborn and Child Health Policy, 2006

Integrated Plan for the Achievement of MDGs 4and 5 in Mozambique (MISAU, 2008)

Road Map to Accelerate Reduction in Maternaland Newborn Mortality in Mozambique (MISAU,2008)

Maternal and Neonatal Health Needs Assessmentin Mozambique, MISAU 2008 (MISAU, 2009)

International Code of Marketing and Breast milkSubstitutes

National elimination of MTCT

National Plan for the Revitalization of Community

Health Workers in Mozambique (MISAU, 2010)

Partnership for thepromotion of maternal,

newborn and childhealth in Mozambique

Committing to Child

Survival: A PromiseRenewed

Maternal and Newborn Health POLICIES POLITICAL PLATFORMS


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Intervention packages and delivery strategies

Integrated MNCH service delivery

Emergency Obstetric Care

Essential Newborn Care, Neonatal Resuscitation, Helping BabiesBreathe, Post Natal Care

Integrated Management of Childhood Illness Neonatal Component

Kangaroo Mother Care

Integrated Packages for Continuing Education

Clinical Care

Ante-natal Care Package (4 visits)

Post Natal Care to support healthy practices and early detection andreferral of complications

EMTCT (B+ option)

Facility andoutreachServices

Community Integrated Management of Childhood Illness , NeonatalComponent (CHWs, CHVs)

Traditional Birth Attendants

Promotion and distribution of mosquito nets

Family andCommunity


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GAPS AND CHALLENGES : COVERAGE

0

10

20

30

40

50

60

70

80

90

100

CPR ANC(any) ANC(4) TT (2+) ITPp 2 d Instittutional

Deliveries

PNC w/2days Low birth

babies

Excl. BF(


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GAPS AND CHALLENGES : EQUITY

Barriers to access essential services persistfor the poorest and for the least educatedcitizens of Mozambique.

Key interventions such as antenatal care,

skilled delivery at birth and immunizationare heavily biased by socio-economic status

As a results, mothers and children from themost remote and/or least developed areasof the country are more exposed to disease

and death.


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GAPS AND CHALLENGES : Quality of Services

National assessment of quality of newborn services conducted at theend of 2012. Preliminary results available by mid 2013.

Implementation of existing newborn health policies at facility level

variable and inconsistent.

Main constraints:

Health Infrastructure

Human resources

Availability of medicines, supplies and equipment;

Emergency referral mechanisms;

Coverage indicators for newborn health


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GAPS AND CHALLENGES : DEMAND

Physical barriers to access services: distance, lack of transport,

financial barriers, opportunity costs

Cultural and behavioral barriers in rural areas:

basic knowledge of essential preventive health and hygienemeasures still low;

Role of family, men and of informal leaders in decision making


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Addressing gaps and challenges: the way forward

At Policy Level:

Ongoing review of progresses and update the National Plan to Achieve MDGs 4&5in Mozambique

Accelerate national plan for HR development (pre-service training, continuingeducation)

Develop an action plan to increase quality of essential services based on results ofrecent national assessments (quality and availability)

EMTCT accelerated plan for elimination


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At service delivery level:

Accelerate scale up of existing facility level packages for newborn

health, scalling up Model Maternity Initiative

Continuing education and supportive supervision

Promote strategies to increase SBMR (new maternities; waiting

homes, referral mechanisms, incentives, etc)

Community level:

Sustained investment on CHWs and

other community based cadres

Assess feasibility and effectiveness of community

based newborn package

Intensify focused social communication and advocacy

Addressing gaps and challenges: the way forward


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Documents

Jamisse: Scaling-Up Newborn Programming at the National Level - Agenda Setting, Policy Formulation and Implementation