The MNCH Roadmap

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					The MNCH Roadmap

By Dr Caroline Phiri Chibawe
      Ag Director MCH
What is this MNCH Roadmap?
•    A strategic document identified
    that highlights the need to address
    the problems of high maternal,
    neonatal, infant and under-5
    mortality rates in Zambia over the
    next 10 years.

• Accelerated reduction of maternal,
  newborn and childhood morbidity and
  mortality to attain set targets by 2015.

• (Thereafter focus on attaining universal coverage goals
  from 2016 to 2019 and aim to attain universal coverage
  (80% and above – nationally and within each district)
   Objectives in MNCH Strategic
• To reduce maternal mortality from 591 to
  162 per 100,000 live births
• To reduce neonatal mortality from 34 to 20
  per 1,000 live births
• To reduce Under-5 mortality rate from 119
  to 64 per 1000 live births

(based on ZDHS 2007)
         Specific Objective
• Provide skilled attendance during pregnancy,
  childbirth, and the postnatal period, at all
  levels of the health care delivery system
• Strengthen the capacities of individuals,
  families, communities, line Ministries, and
  the private sector to share responsibility and
  play their role in efforts to significantly
  improve MNCH outcomes for universal
  coverage to attain the set MDGs.
Situational Analysis
             Maternal and newborn
            health situation in Zambia

• Maternal mortality ratio – 591/100,000 live births
• Neonatal mortality rate – 34/1000 live births
• Infant mortality Rate     – 70/1000 live births
• Under five mortality rate – 119/1000 live births
• Fertility rate   6.8
• HIV prevalence – 14 %
      Men          – 12 %
      Women        – 16 %
                          Comparison of MMR versus SBA
al mortality ratio (Zambia)                                                  Progress & trends towards reducing the                              Proportion of women (%) attended to by
                                                                            Maternal Mortality Ratio [MMR] to attain the
                                                                               MDG target of 162 by 2015 in Zambia
                                                                                                                                               skilled health workers during birth in Zambia
                                                                      800                                                                52%
                                                                      700                                                                50%
                              Maternal dealths/ 100,000 live births

                                                                      600                                               591

                                                                      500                                                                46%

                                                                      400                                                                44%


                                                                      200         200

                                                                        0                                                                         1992 1996 1999 2001 2007
                                                                              1992      1996        2001           2007         2015
                                                                                                                                                             Source: Zambia DHS data sets
                                                                                                 Source: Zambia DHS data sets
  Issues around the high MMR and NMR in
• TBA to train or not to train
• Three delay model
• Inadequate equipment Indirect effect of HIV,
  malaria and TB.
• reduced funding affected out reach services
• Reduced Human resources
 Rural versus Urban disparities
• Long distances to health facilities & high cost
  of care
• Uneducated, poor and living in rural areas.
• Less likely to attend 4 FANC visits, rarely seek
  ANC services in 1st trimester
• ANC services tend to be poor quality with
• inadequate drugs, laboratory services
• more likely to be seen by an unskilled health
  worker and rarely by a physician.
 Rural versus Urban disparities
• Poor, rural, uneducated and multigravida women
  tend to deliver at home by unskilled TBA or relatives.
• No access to FP, postnatal and new born care
• No outreach services for Immunisation and GMP
• Schools have few teachers, high illiteracy rate,
  poverty, (access to social welfare ??)
• Early age marriages leading
• Obstetric complications, malnutrition,
   Key Strategies to be implemented
1. The continuum of care approach recognizes
   five critical phases in the life cycle of women
   and children which are:
  – Adolescence and pre-pregnancy
  – pregnancy,
  – childbirth and the postnatal period,
  – newborn and
  – childhood
         Key Strategies to be
2. Using a three dimensional approach in
   coming up with strategies and
  – ensuring engagement and synergy between
    the health system, communities, other line
    ministries and the private sector
3. Strengthening partnerships with the donor
  community and the private sector for
  sustainable long-term predictable financing
  to achieve universal coverage.
Advocacy and Resource Mobilization

• Advocacy efforts will :

  – Increasing the budget allocation for MNCH
    interventions from both internal and external
  – Revision of laws, policies that hinder effective
    provision of maternal, newborn and childcare
  – Improving the production, employment,
    deployment and retention of a skilled health
    work force at all levels
  – Institutionalize the Maternal Death Reviews
    and make maternal deaths to be made
    notifiable events
    Adolescence and pre-pregnancy

• investment in
  – Information – to prevent sexually transmitted
    diseases, HIV, and unwanted pregnancies
  – Education
  – Availability and easier access to contraceptive
    services and supplies.
• The underlying thinking is that a good
  outcome of pregnancy starts before
• The thrust in interventions is ensuring
  provision of skilled care during pregnancy.
• provide quality FANC
  – promote birth plan
  – helping the family prepare for good
  Childbirth and the postnatal period
• Focus on skilled, professional care during childbirth
   – providing access to professional skilled care before,
     during and after childbirth;
   – Train Health workers to provide quality Emergency
     obstetric and newborn care
   – Skilled and professional care should also be available
     to the mother during the postnatal period
         Newborn (neonatal):
• bridging the postnatal and postpartum gap,
  ensuring no interruption in the continuum of
  care, and
  – establish mechanisms for communication and
    handover between maternal and child
  – mix of approaches, from the improved care of
    newborns within the home, through home visits
    by health workers, better uptake of services in
    case of problems and referral when needed.
•    The Expanded programme on Immunisation
•    “Integrated Management of Childhood Illness”
•     Management of the newborn,
•    nutrition promotion,
•     the strengthening of school health
•     shifting focus from health centres alone to a
    continuum of care that implicates families and
    communities, health centres, and referral-level
  Health System Strengthening and Capacity

• Health system strengthening for MNCH will comprise
  of improving service delivery by strengthening:
   – The health workforce,
   – Adopting Results Based Management (RBM) approaches,
   – The health management information system (HMIS),
   – The logistics management of medical products, vaccines
     and technologies,
   – Increased financing to comply with Abuja target of 15%,
   – Improving the infrastructure for service delivery, and
   – Strengthened planning, leadership and governance
              Referral System

• Improve referral system through:
  • appropriate transportation and improving
    linkages between community and referral
  • Communications equipment (e.g., radio calls
    and mobile phones).
  • Community structures for handling MNCH
  • Mothers’ waiting shelters
       Community Mobilization
– Educating and sensitising communities on
  community-based MNCH interventions
– Mobilizing resources at the village level for
  MNCH including emergency referral as well
  as building and strengthening health
– Orienting the facility governing committees
  to the MNCH Strategic Plan to ensure
– implementation of the plan at the health
  facility and community levels
– Institutionalizing ‘village health days’
Behaviour Change Communication (BCC)

• Use of BCC approaches for quality MNCH
  including nutrition and adolescent sexual
  reproductive health.
• Target community-based initiatives
• Use of targeted mass campaigns
      Fostering Partnerships and

• Effective implementation of this MNCH Strategic
  Plan will require
  • stimulating and establishing strategic partnerships
  • improve coordination and collaboration between
    communities, partners
  • galvanizing political will and mobilizing resources
    for long-term sustainable MNCH interventions.
  • Coordinate regular planning, implementation,
    monitoring and evaluation of MNCH interventions
    to assess progress towards attainment of the
  Monitoring and Evaluation Framweork

• One agreed indicator of maternal, newborn
  and child health interventions will be evaluated
• 33 operational targets developed
• Include nutrition, water and sanitation and
  systems strengthening
• Quantitative indicators
• Qualitative indicators obtained through
  periodic and commissioned studies.
• Sources of data will include both the routine
  and non-routine health information systems
• The indicators will be updated from time to
  time as need arises
                    Operational targets
Indicator                                      Current status   Target
Unmet need for Contraceptives                  27%              14%
Modern Contraceptive rate for women of         33%              58%
Reproductive age
Teenage Pregnancy                              28%              18%
% of women accessing ANC in first Trimester    19%              58%
% of women accessing 4 or more ANC visits      60%              80%
% of women on IPT 2 or more                    66%              80%
% of women accessing PMTCT
Proportion of women delivered by skilled HW    47%              75%
Proportion of women accessing postnatal care   39%              55%
within 2 days weeks
            Operational targets
Indicator                                       Current   Target
% of women initiating early and exclusive       63%       90%
% of districts with 50% HF implementing         %         80%
kangaroo care
% of children receiving correct treatment for   38%       80%
% Vitamin A supplementation                     60%       80%
% of households women accessing improved        24%       80%
drinking water
% of households accessing improved              42%       80%
% of districts conducting maternal death        50%       100%
 Implementation Arrangements

• Involvement of a multisector approach to
  increase access to health services
  • MCDMCH and Ministry of Health
  • Other Ministries such as Finance, Information,
    chiefs and traditional affairs, Local
    Government, Agriculture, Work and supply,
    Education, gender, DMMU
  • Cooperating partners- NGO and private sectors
• The strategies are packages of interventions
  for each phase of life cycle and at each level
  of intervention within each selected
• The interventions have been costed
• Implementation of the MNCH plan should
  not be done in silos but comprehensively.
For a healthy nation,
invest in us now!

A prosperous,
middle income Zambia
requires healthy mothers
and healthy newborns.

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