15-18 Nov 2011Regional CH PM Meeting, KTM1 Child health programmes: What do we need to measure?...

15-18 Nov 2011 Regional CH PM Meeting, KTM 1

Child health programmes:What do we need to measure?

CAH-SEARO


Uses of Data

• Determine public health priorities• Data informed planning• Effective implementation:

– Scale– Quality– Equity

• Monitoring progress of implementation• Evaluation


Programmatic pathway for improving child health

IMPLEMENTATION OF ACTIVITIES

Advocacy for Child health

Human, material and financial resource

mobilization

Human resource capacity

development

Communication with adolescents, families

& communities

Health system supports

strengthened

Progress tracked

IMPROVED

Availability and access to health

care

Quality of care

Demand for care

Knowledge of adolescents, families and communities

INCREASED POPULATION-

BASED COVERAGE

of key effective interventions

IMPROVED SURVIVAL

AND HEALTH

Social determinants


Health system

Inputs Outputs Outcomes

(programme efforts) (coverage/ behaviours)

Policies Information to families Proportion of targetHuman resources Availability of services population who Financing Access to services received interventions;Logistics/supplies Quality of services

Determinants of Health

Socioeconomic and demographic factorsEnvironmental and behavioural risk factors

Health status

("impact")

Mortality

Morbidity -disability

Growth

Development

Well-being

Source: Health Metrics Network

Framework for measurement


Health Status Indicators(Source: Vital Registration, DHS surveys)

• Mortality– U5MR– IMR– NMR– Cause specific mortality

• Nutrition status– LBW– Wasting– Stunting


Mortality in SEAR

Infant Mortality Rates (IGME 2011)

Under-five Mortality Rates (IGME 2011)

4856

3363

3515

6650

1713

55

0 20 40 60 80

BangladeshBhutan

DPR KoreaIndia

IndonesiaMaldives

MyanmarNepal

Sri LankaThailand

Timor Leste

Percent


Neonatal Mortality Rate (UN IGME 2011)

27

26

18

32

17

9

32

28

10

8

24

0 5 10 15 20 25 30 35

Bangladesh

Bhutan

DPR Korea

India

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

Thailand

Timor Leste

Percent


DisparitiesUnder Five Mortality Rate by Sex

7670

56

8580

85

7279

46

6978 75

0102030405060708090

BAN IND INO MMR NEP TLS

Mor

tality

/100

0 live

birth

s

Male

Female

Under Five Mortality Rate by Wealth Quintile

86

101

77

98

4334 32

47

0

20

40

60

80

100

120

BAN IND INO NEP

Mor

talit

y/10

00 liv

e bi

rths

Poorest

Richest

Source: Bangladesh DHS 2007; Bhutan National Nutrition and Young Child Feeding Survey 2009; DPRK National Nutrition Survey 2004; India NFHS-2005-06; Indonesia DHS 2007; Maldives DHS 2009; Myanmar FRHS 2007; Nepal DHS 2006; Sri Lanka DHS 2006-07; Thailand MICS 2005-06; Timor Leste DHS 2003 (for ARI data) and 2009-10


Deaths among children under-five Neonatal deaths

Major causes of death in children under-five neonatesin the South-east Asia Region 2008 (revised )

Source: WHO. The World Health Statistics 2011

Pneumonia (postneonatal)

12%

Neonatal deaths52%

Other 12%

Measles 4%

Noncommunicable diseases (postneonatal)

4%

Injuries (postneonatal)4%

Diarrhoeal diseases (postneonatal)

12%

Malaria 1%

Neonatal infections28%

Prematurity and lowbirth w eight

26%

Birth asphyxia andbirth trauma

20%

Neonatal tetanus 1% Diarrhoeal diseases 3%

Congenital anomalies 4%

Other 17%


Child NutritionUnderweight children Stunting in children



Low birth weight in SEA Region

Source: State of the World’s Children 2008, UNICEF

15

30

97

22

15

21 22

9

12

22

0

5

10

15

20

25

30

35


Health system



Policies Information to families Proportion of targetHuman resources Availability of services population who Financing Access to services received interventions;Logistics/supplies Quality of services



Health status

("impact")

Mortality


Growth

Development

Well-being

Scope


Framework for measurement of health information


Outcome indicators(Source: Coverage surveys including DHS/MICS surveys)


Newborn Interventions• Proportion of deliveries

assisted by SBAs• Neonates protected against

tetanus at birth

18

71

97

47

79

98

64

19

99

97

30

0 20 40 60 80 100 120

Bangladesh

Bhutan

DPR Korea

India

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

Thailand

Timor Leste

Percent


Management of sick children Children 0-59 months with

diarrhoea past two weeks given ORS

Children 0-59 months with suspected pneumonia taken to health care provider and received antibiotics (red bars)



Health system



Policies Information to families Proportion of targetHuman resources Availability of services population who Financing Access to services received interventions;Logistics/supplies



Health status

("impact")

Mortality


Growth

Development

Well-being


Quality of Service



Output indicators(Source: HFS, Hospital Assessment, MNCAH surveys)

OOUUTTPPUUTT IINNDDIICCAATTOORRSS

1. Proportion of first–level facilities with at least 60% of health workers who care for children trained in IMCI

2. Proportion of first-level health facilities with at least 1 trained midwife available

3. Proportion of hospitals or maternity facilities accredited as baby friendly in the previous two years

4. Availability of emergency obstetric care services

5. Proportion of villages with a trained CHW

6. Proportion of first level health facilities with all essential medicines for IMCI

7. Proportion of facilities that manage severely ill children with oxygen and paediatric delivery systems available in the paediatric ward

8. Proportion of sick children 0-59 months needing an antibiotic and/or an antimalarial who are prescribed the drug correctly

9. Proportion of caretakers of children 0-59 months who know at least two danger signs for seeking care immediately


Health system



Policies Information to families Proportion of targetHuman resources Availability of services population who Financing Access to services received interventions;Logistics/supplies



Health status

("impact")

Mortality


Growth

Development

Well-being




Input indicators(Source: Programme Reviews, Administrative records)

IINNPPUUTT IINNDDIICCAATTOORRSS

1. CRC reporting mechanism established and working

2. Maternity Protection Convention 183 ratified

3. Mechanism for monitoring the International Code for Marketing of Breastmilk substitutes established and working

4. Costed national plan for ensuring universal access to maternal, newborn and child survival interventions available

5. National maternal, newborn and child health coordinating committee established and meeting regularly

6. Proportion of medical, nursing and other health professional training schools giving pre-service IMCI training

7. Proportion of key service delivery policies and guidelines adopted

8. Proportion of districts implementing IMCI

9. Proportion of districts with a training plan for facility and community-based MNCH health workers


Way forward

Collaborate for developing a Regional framework in alignment with Global framework including UN Information and Accountability Framework

15-18 Nov 2011Regional CH PM Meeting, KTM1 Child health programmes: What do we need to measure?...

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