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Zambia Accelerating progress in saving women, newborns and children. Dr. Joy Lawn MB BS MRCP ( Paeds ) MPH PhD Director Global Evidence and Policy Saving Newborn Lives/Save the Children DFID Senior Research Fellow, Newborn Health Countdown Country Working group Co Chair - PowerPoint PPT Presentation
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ZambiaAccelerating progress in saving women, newborns and children
Dr. Joy Lawn MB BS MRCP (Paeds) MPH PhD
Director Global Evidence and PolicySaving Newborn Lives/Save the Children
DFID Senior Research Fellow, Newborn Health
Countdown Country Working group Co Chair On behalf of the Countdown Coordinating Committee
#CD2015
Country progress in reducing maternal mortality (MDG5)
On Track Making progress
Insufficient progress
No progress0
10
20
30
40
9
40
17
9
Num
ber o
f Cou
ntdo
wn
Coun
trie
s (n
=73)
18 are African countries
Mostly African countries
Countdown to 2015 report 2012, Figure 1,progress as of 2010
BangladeshBoliviaCambodiaChinaEgyptEritreaLao People’s RepNepalVietnam
All are African countries
Country progress in reducing under-five mortality (MDG4)
On Track Insufficient progress
No progress0
10
20
30
40
24
37
18
Num
ber o
f Cou
ntdo
wn
Coun
trie
s (n=
74)
African CountriesEritreaLiberiaMadagascarMalawi
Countdown to 2015, report June 2012, Figure 3, progress as of 2010
All are African countries
28 are African countries
Evidence base Increasing, mainly from Asia, Cochrane review
Policy change More countries have a policy for mother and newborn home visits
Still gap in coverage on continuum of care, and also a data gapAnd many implementation research questions especially in Africa
Pregnancy and Postnatal Home Visits
Lancet paper of the year 2009
2009 Joint Statement by WHO and UNICEF, co-signatories of Save the Children and USAID
Who is Countdown?A global movement since 2005 of1. Individuals: Scientists & academics, policymakers, public
health workers, communications experts, teachers…
2. Governments: RMNCH policymakers, Parliamentarians…
3. Organizations: NGOs, UN agencies, HCPAs, donors, medical journals…
Linked to Global strategy for Women and Children and Commission on Information and Accountability
And from countries
Zambia’s Countdown profile 2012
Mortality and MDG progress
Countdown to 2015 Report. 2012.
Leading causes:Neonatal – 29%Malaria – 13%HIV/AIDS – 10%Pneumonia – 13%Diarrhoea – 9%
Undernutrition is an underlying cause of child deaths(note this estimate is country specific for Zambia)
Cause of neonatal and child deaths
Countdown to 2015 Report. 2012.
Leading causes:Haemorrhage – 34%Hypertension – 19%
Understanding the cause of death distribution is important for program development and monitoring(note this estimate is for Africa, not country specific)
Causes of maternal death
Countdown to 2015 Report. 2012.
Variable coverage along the continuum of care
BUT only measles immunisation at high coverage Countdown to 2015 Report. 2012.
Maternal and newborn health
Limited progress for scale up of skilled care at birth – especially compared with neighbours
Countdown to 2015 Report. 2012.
Maternal and newborn health
High coverage of ANC 1 – but what about ANC 4 and coverage of effective interventions in ANC?
Countdown to 2015 Report. 2012.
Countdown to 2015 Report. 2012.
Other maternal and newborn health indicators
Review and Mapping of initiatives in Maternal and Newborn Health in Zambia
BackgroundMaternal Mortality in Zambia
Martenal mortality ratio (Zambia)
200
649
729
591
162
0
100
200
300
400
500
600
700
800
1992 1996 2001 2007 2015
Mat
erna
l dea
lths/
100
,000
live
birt
hs
Source: Zambia DHS data sets
Progress & trends towards reducing the Maternal Mortality Ratio [MMR] to attain the
MDG target of 162 by 2015 in Zambia
38%
40%
42%
44%
46%
48%
50%
52%
1992 1996 1999 2001 2007Source: Zambia DHS data sets
Proportion of women (%) attended to by skilled health workers during birth in Zambia
Around 1995 Around 2005 2015 projection0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CEE/CIS
East Asia and Pacific
Latin America and Caribbean
Middle East and North Africa
Developing countries
Sub-Saharan Africa
South Asia
Data: UNICEF 2007 (www.childinfo.org) based on a subset of 80 countries with trend dataRef: Lawn JE et al IJGO 2009
slow progress in trends for births with skilled health personnel (1995 to 2008 with projections to 2015)
By 2008 only 13 of 68 Countdown countries had increased skilled attendance by >10% in the last 20 years
Rapid change now in many countries
Equity
The narrow bars show Zambia’s relatively equitable coverage found for many coverage indicators with exception of skilled birth attendant, where almost all the richest women have access but only 1 in 5 of the poorest women
Countdown to 2015 Report. 2012.
Continuum of Care
Variable coverage along the continuum of care
BUT only measles immunisation at high coverage Countdown to 2015 Report. 2012.
Leading causes:Neonatal – 29%Malaria – 13%HIV/AIDS – 10%Pneumonia – 13%Diarrhoea – 9%
Undernutrition is an underlying cause of child deaths(note this estimate is country specific for Zambia)
Cause of neonatal and child deaths
Countdown to 2015 Report. 2012.
Survey results
•116 completed surveys•Across all districts
Vacancy rates
Use of Best Practice
Source of best practice
Partnerships
NGOs/CBOs
Number of survey respondents
INGOs
Donor Sources
OTHER
Other: 27% smaller; 18% of projects from larger INGO such as Plan, Save the Children World Vision or ZISSP; 10% GRZ: MOH or MCDMCH ; 4% by JICA ;3% CDC and 3% PEPFAR; 2% each from UNICEF, EU and ZNAN. B&M Gates foundation; CORDAID; DANIDA; Irish Aid; NZAID. 4 communities and 4 private partners.
Monitoring and Evaluation
M&E plan in place Baseline conducted
Types of interventions based on the continuum of care
Focus of training programs
Project surveyed continuing after 2012
Not all countries are the sameMalawi is on track for MDG 4
Source: Zimba E et al Malawi: a decade of change, HPP in pressData U5MR from UNICEF www.childmortality.org and Lozano et al Lancet 20101 NMR from Oestergaard et al 2011 PLoS , Malawi DHS 1999, 2000, 2004, 2010 and MICS 2006. MDG 4 target from Countdown to 2015, decade report -- 2/3 reduction from 1990 U5MR
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
0
50
100
150
200
250
104
73
113
3031
Under-five mortality rate (UN)Under-five mortality rate (IHME)Under -five mortality rate (DHS/MICS)Neonatal mortality rate (UN)Neonatal mortality rate (IHME)Neonatal mortality rate (DHS/MICS)
Year
Mor
talit
y pe
r 100
0 liv
e bi
rths
MDG 4 target
NMR reducing at 2% per year, double the regional averageOnly 5 national paediatricians!
More in Health Policy Planning journal supplement Decade of Change for Newborn Survival and in IERG report panel and in Countdown June 2012 report
Changes in skilled birth attendance for Malawi, 1990-2010
Source: Malawi DHS 1992, 2000, 2004, preliminary 2010. Malawi MICS 2006
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
10
20
30
40
50
60
70
80
90
100
55
73
Cov
erag
e (%
)
Increased by 16% over the last 5 years Multiple approaches both supply and demand> 30% increase in numbers of nurse/midwives
