MNCWH & Nutrition Strategic Plan

MCH Indaba

July 2012

Background

Reducing maternal and child mortality is a key priority for the health sector.

Good coverage with many key interventions, but outcomes remain poor

Many interventions and initiatives are in place, but a single overall strategic framework and plan are lacking

Context

Findings from three Ministerial Mortality committees

PHC restructuring District clinical specialist teams PHC outreach teams Integrated School Health programme

NSDA and Health Data Advisory and Coordination Committee

Baseline and targets

IndicatorBaseline

(2009)Target (2014)

Target(2016)

MDG Target 2015

Maternal Mortality Ratio (per 100 000 live births) 310 270 - 38

Under 5 mortality rate (per 1 000 live births) 56 50 40 21

Infant mortality rate (per 1 000 live births) 40 36 32 -

Neonatal mortality rate (per 1 000 live births) 14 12 11 -

Contents of the Strategy Introduction

Priority Health Interventions for reducing maternal and child mortality

Current MCWH service delivery Priority interventions for:

Maternal Health Newborn Health Child Health Women’s Health Community-based MCH services

Strategic Plan Monitoring and evaluation framework Critical success factors

Priority interventions: The service package

Maternal health – BANC, HIV testing and PMTCT, access to care in labour, intrapartum care, post-natal care

Newborn care – Exclusive breastfeeding, PMTCT follow-up, resuscitation of newborns, care of ill/small newborns (incl. KMC), post-natal visits

Child Health – IYCF, Preventive services (EPI, Growth monitoring, Vitamin A), IMCI, early identification and management of HIV-infection, hospital care, School Health Services, Long term health conditions

Women’s Health – contraception, SRH services for adolescents, cervical cancer screening, sexual assault care

Community interventions – PHC outreach teams, multi-sectoral action, MCWH communication strategy

Vision and Mission

VisionAccessible, caring, high quality health and nutrition services for women, mothers, newborns and children

MissionTo reduce mortality and to improve the health and nutritional status of women, newborns and children through promotion of healthy lifestyles and provision of integrated, high quality health and nutrition services

Guiding principles

Sustained political commitment and supportive leadership Commitment to realizing the human rights of women,

newborns and children. Working with all sectors to improve the lives of women,

newborns and children Provision of an integrated service using a lifecycle

approach Effective communication Empowerment of communities and families, including men Protecting and respecting children Ensuring linkages between the levels of care –

community, primary health care and hospital levels

Overall goals

To reduce the maternal mortality ratio and neonatal, infant and child mortality rates by at least 10% by 2016

To empower women, and to ensure universal access to reproductive health services

To improve the nutritional status of all mothers and children

Eight Key Strategies Addressing inequity and the social determinants of health Development of a comprehensive and co-ordinated framework for

provision of MNCWH & Nutrition services Strengthening community-based MNCWH & Nutrition interventions Scaling-up provision of key MNCWH & Nutrition Interventions at

PHC level Scaling-up provision of key MNCWH & Nutrition Interventions at

district hospital level Strengthening the capacity of the health systems to support the

provision of MNCWH & Nutrition services Strengthening human resource capacity for delivery of MNCWH &

Nutrition services Strengthening systems for monitoring and evaluation of MNCWH

& Nutrition interventions and outcomes

Addressing inequity and social determinants of health

Work with other sectors Mobilize and empower women and children and men to

participate in efforts to improve their health at individual, household and community levels.

Work with the education sector to promote comprehensive health education and promotion in schools which address a range of issues including psychosocial well-being, mental health and violence prevention.

Ensure that under-served districts and sub-districts are prioritized in efforts to scale-up and improve the quality of priority MNCWH & Nutrition interventions

Review the framework for MNCWH and Nutrition Service delivery

Review the framework for delivery of MNCWH & Nutrition services -

Review and update which MNCWH & Nutrition services should be delivered at community, PHC, and district and regional hospital levels

Review and update norms and standards for delivery of these services

Estimate and cost the gap between ideal and current levels of service delivery

Provinces should develop and implement comprehensive plans to address the gap

Strengthen the health system to support MNCWH & Nutrition services

Ensure that adequate equipment for delivery of MNCWH & Nutrition services is available.

Ensure that essential supplies and drugs are available at PHC and district hospital levels

Work with EMS to ensure that adequate transport is available (maternity ambulances)

Strengthen referral systems

Strengthen routine health information systems

Strengthen community-based MNCWH & Nutrition services

Provision of a package of evidenced-based community MCWH services by generalist CHWs who are part of PHC outreach teams.

Provision of services through community-based campaigns such as HCT, EPI Vitamin A and mass deworming campaigns.

Strengthening specific intersectoral actions – in particular programmes and interventions that address access to clean water and sanitation.

Development of an MCWH communication strategy

Scale-up provision of key MNCWH & Nutrition interventions at PHC level

Ensure high coverage with pneumococcal and rotavirus vaccines as part of the routine EPI schedule

Ensure that HIV & AIDS services, including provision of ART, are provided at all PHC facilities, and are integrated with maternal and child health services.

Strengthen School Health Services through provision of a comprehensive and integrated school health programme.

Scale-up new or existing inventions with low coverage. This includes: ANC (using BANC approach), post-natal care and breastfeeding and infant feeding support, IMCI (including EPI and growth monitoring and promotion) and Youth-friendly services.

Strengthen supportive supervision of MNCWH & Nutrition services and ensure that all PHC facilities receive regular supervisory visits.

Scale-up key MNCWH & Nutrition interventions at district hospital level

Scale-up new or existing interventions with low coverage e.g. post-natal care, high risk ANC care, PMTCT, KMC, neonatal resuscitation, management of common childhood illnesses using standardized protocols, post-rape care

Train health care workers in key MNCWH & Nutrition interventions.

Improve the quality of hospital care through provision of protocols and strengthening supportive supervision through development of outreach teams at provincial level.

Ensure that all facilities use of mortality reviews or audits to identify and address deficiencies in the quality of care provided.

Strengthening human resource capacity

Appoint district clinical specialist teams who will play a key role in ensuring provision of high quality comprehensive MCWH services to mothers and children in the catchment population.

Ensure that PHC outreach teams are adequately trained to provide MCWH services.

Develop norms which define the staff which are required for delivery of MNCWH & Nutrition services

Develop estimates of the number of health workers with MNCWH & Nutrition skills who are required

Update curricula of health professionals to ensure adequate pre-service training in MNCWH & Nutrition

Work with Regional Training Centres to co-ordinate and strengthen in-service training in MNCWH & Nutrition

Strengthen systems for monitoring and evaluation

Develop consensus on key MNCWH & Nutrition outcome indicators, and review progress on an annual basis

Strengthen mechanisms for reporting and recording of maternal, perinatal and child deaths

Expand the use of mortality reviews and audits at facility level.

Strengthen the existing health information systems such as the DHIS - ensure that the systems provide information that can and is used for planning and monitoring of MNCWH & Nutrition services.

Strengthen the capacity of MNCWH & Nutrition, district and facility managers to analyse and use data.

Monitoring and evaluation framework

Detailed plan contains indicators and targets which will be used to monitor implementation of the plan (routinely collected data).

19 outcome and impact indicators will be monitored on an annual basis (mostly collected through a variety of surveys)

Critical Success Factors

Social determinants of health are addressed

Support from key stake-holders

Resource mobilization

Strengthening of supportive supervision of MNCWH & Nutrition services at PHC level

Strengthening supportive supervision at district hospital level (district clinical specialist teams)

Thank you