16 Nov 2011 Regional CH Meeting, Kathmandu1

Meeting of South-East Asia Regional Programme Managers on Child Health,

Kathmandu, 15 – 18 Nov 2011

Progress in Implementation of Child Health Programme

Country: BANGLADESH

16 Nov 2011 Regional CH Meeting, Kathmandu 2

Epidemiology / burden of childhood diseases:

Under five mortality

Figures Year

Under five mortality Rate 54 (SVRS 2008) 2008

Infant Mortality Rate 41 (SVRS 2008) 2008

Neonatal Mortality Rate 37 (BDHS 2007) 2007

Nutrition Status

Low Birth Weight 22 % (UNICEF) 2009

Underweight 41 % (BDHS) 2007

Stunting 43% (BDHS) 2007

3

0

20

40

60

80

100

120

140

160

Dea

ths

per

1,0

00 li

ve-b

irth

s

12-59 months

1-11 months

0-28 days

Declining U5 mortality

-9.3% per year

-6.0% per year

-2.6% per year

1989-93 1992-6 1995-9 1999-2003 2002-6

Source: BDHS 1993-2007

Age groups:

4

Dea

ths

per

1,0

00 li

ve-b

irth

s

12-59 months old children

1-11 months old infants

Neonates (0-28 days)

Declining under-5 child mortality in Bangladesh…..But, proportion of neonatal mortality increasing……

1989-93 1992-6 1995-9 1999-2003 2002-6

39%

57%42%

45% 47%

Source: Bangladesh Demographic and Health Surveys

5

Cause of death distribution of neonatal deaths in Bangladesh: 1994-2003

Source: Bangladesh Demographic and Health Survey 2004

6

Causes of U5 deaths

7

Trend in U5 mortality (1990-2008)

151

IMCI ImplementationIMCI implementation started (If yes, year) 2002

Newborn Added (If yes, year) 2000 (From day 1)2009 (From 0 day)

Number and Proportion of districts implementing IMCI 54 (84%)

Number and proportion of MOs trained 2,866

Number and proportion of Nurses/other workers trained

7,924

Proportion of districts (out of IMCI districts) with 60 % or more health providers trained

na

IMCI supervisory checklists introduced 2004

Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month

during previous year

na

Proportion of districts (out of IMCI districts) covered

with Follow-up IMCI training na

IMCI implementation

IMCI implementation review conducted (If yes, year; National or sub-national)

2003Sub-national

IMCI Health Facility Survey conducted (If yes, year; National or sub-national)

2008

Sub-National

Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI

>90% (approx)

Pre-Service IMCI teaching/training:

Number and proportion of Medical Schools teaching IMCI

48 (88%)

2010

Number and proportion of Nursing Schools teaching IMCI

nil

ICATT introduced (If yes, year and scale) No

INDIA

INDIA

INDIA

Bay of Bengal

MYANMAR

INDIA

*

*

*

RANGAMATI

SYLHET

TANGAIL

BOGRA

BANDARBAN

KHULNA

PABNA

COMILLA

DINAJPUR

NAOGAON

MYMENSINGH

SUNAMGANJ

CHITTAGONG

JESSORE

SATKHIRA

HABIGANJRAJSHAHI

RANGPUR

NETRAKONA

NATORESIRAJGANJ

DHAKA

BAGERHAT

KURIGRAM

BHOLA

FARIDPUR

NOAKHALI

FENI

KUSHTIA

JAMALPUR

MAULVIBAZAR

GAZIPUR

GAIBANDHA

KISHOREGANJ

JHENAIDAH

KHAGRACHHARI

COX'S BAZAR

CHANDPUR

NILPHAMARI

NAWABGANJ

SHERPUR

NARAIL

RAJBARI

THAKURGAON

GOPALGANJ

MAGURA

MANIKGANJ

BARISAL

BRAHAMANBARIANARSINGDI

PANCHAGARH

SHARIATPURMADARIPUR

LAKSHMIPUR

CHUADANGA

LALMONIRHAT

JOYPURHAT

MUNSHIGANJ

PATUAKHALI

MEHERPUR

PIROJPUR

BARGUNA

NARAYANGANJ

JHALOKATI

2002

2003

2004

2005

2006

2007

Expansion of IMCI guided by evidence of need

Bangladesh Maternal Mortality Survey, 2001: Provided District Under-5 Mortality Estimates

FIMCI CIMCI

2009

20082009

2010

2010

• All 159 upazillas of 20 districts in the “red” (high mortality) areas covered by 2007

• As of now, IMCI is in facilities in:• 54 districts• 400upazilas • IMCI in the community is in 71

upazilas and some urban areas

16 Nov 2011 Regional CH Meeting, Kathmandu 11

IMCI ImplementationKey factors that helped scaling up1. Conducive policy environment-HNPSP (206-11), HPNSDP (2011-

16); Lessons from MCE of IMCI2. Continued commitment and support from DPs/GOB

(Financial/Supplies)3. Strong partnership, networking and pro-active role of child

health group (Professional bodies, NWT)

Key challenges to scaling up:1. Lack of supervision and monitoring system2. Utilization of pool fund for scaling up IMCI (Facility/Community)3. Weak health system support to scale up integrated approach

16 Nov 2011 Regional CH Meeting, Kathmandu 12

Newborn Health

• ENC Course adapted: 2009• Other training courses: ETAT and Sick Newborn

Care; BHW package• Healthcare providers trained:

Healthcare providers Total no. No. Trained %

MO 650 222 34%Nurses 1500 247 17%

CHW 80,000 (GoB)

NGO-na

12000 (NGO)

16 Nov 2011 Regional CH Meeting, Kathmandu 13

In-Patient (Hospital) care of sick newborns and children

• WHO Pocket Book introduced: 2009-10• Training courses for Hospital care done: Yes• Details, If yes:(ETAT and Sick Newborn Care part); • Number and proportion of Healthcare providers

trained: Given in previous slide

• Proportion of hospitals providing pediatric care having oxygen: 82%, 483(589)

• Hospital assessment using WHO tools carried out: – Year/s: 2009– How many hospitals covered:6 DH+ 12 UHCs

16 Nov 2011 Regional CH Meeting, Kathmandu 14

CHW approach for care of sick newborns and children

District implementing CHW approach

Total No. of Distt

Implementing Districts

%

Home based newborn care 64 25 39%

Sick child package 64 35 55%

Healthy child package (ECD)

Any review of the experience

Individual project MTR done

16 Nov 2011 Regional CH Meeting, Kathmandu 15

Programme Review and Management

• CH Short Programme Review introduced, if yes : – Year:2010– National or sub-national:National

• Programme Management Course introduced, if yes:– Year:2010– National or sub-national: National

15 Nov 2011 Regional CH Meeting, Kathmandu 16

Health Management Information Systems (HMIS) and DHS/MICS

• List the key indicators for newborn and child health included in HMIS and DHS/MICS?– Thermal care (Wiping/Wrapping/Delayed bathing)-

BDHS– EBF-BDHS, MICS– LBW-BDHS, MICS– Care seeking for suspected pneumonia-BDHS, MICS– ORS and Zinc for diarrhoea-BDHS– IMCI Case management by age and sex-HMIS

16 Nov 2011 Regional CH Meeting, Kathmandu 17

Health Management Information Systems (HMIS) and DHS/MICS

• How and at what level are the data for these key programme indicators analysed and used by the programmes?– desktop based application: Data entry using software

at UHCs– web-based application: Data uploading in the HMIS

server at HQ– Analysis at national level and used by IMCI section– Publication of Newsletter by the HMIS, DGHS

16 Nov 2011 Regional CH Meeting, Kathmandu 18

Future PlansStrengthening and scale-up plans for Next 2

years • IMCI: Full saturation of upazilas/districts with IMCI• ICATT use: Planned in the next Biennium• CHW Packages:

– Home Based NB Care package:35 districts– Sick child package:35 districts– Healthy Child (ECD) package:

• Referral (Hospital) Care: Distribution, Developing training package

• Programme Review and Management:– CH Short Programme Review: 2014– Programme Managers Course: Not yet planned

16 Nov 2011 Regional CH Meeting, Kathmandu 19

Thank You