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MATERNAL NEWBORN HEALTH AND CHILD SURVIVAL RETREAT

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MATERNAL NEWBORN HEALTH AND CHILD SURVIVAL RETREAT Powered By Docstoc
					MATERNAL, NEWBORN HEALTH,
CHILD SURVIVAL AND DEVELOPMENT
RETREAT
WORKSHOP REPORT

Bontana Hotel, Nakuru
15-17 March 2010
ACRONYMS
ACT       Artemisinin Combination Therapy
AOP       Annual Operative Plan
AMREF     African Medical Research Foundation
BCC       Behaviour Change Communication
DCAH      Division of Child and Adolescent Health
DFID      Department for International Development
DHP       Division of Health Promotion
EHS       Essential Health Services DFID Technical Assistance Project
FCI       Family Care International
FHI       Family Health International
FTP       File Transfer Protocol
GTZ       German Technical Cooperation Agency
HENNET    Health NGO Network
HII       High Impact Interventions
HMIS      Health Management Information System
IEC       Information Education and Communication
IMR       Infant Mortality Rate
IPT       Intermittent Presumptive Treatment
JHPIEGO   Johns Hopkins Program for International Education in Gynecology and Obstetrics
JICA      Japan International Cooperation Agency
KDHS      Kenya Demographic and Health Survey
KEMRI     Kenya Medical Research Institute
LLITN     Long Lasting Insecticide Treated Net
MCHIP     Maternal and Child Health Integrated Program
MDG       Millennium Development Goal
MgSO4     Magnesium Sulphate
MNH       Maternal and Neonatal Health
MNCH      Maternal Neonatal and Child Health
MOH       Ministry of Health
MOPHS     Ministry of Public Health and Sanitation
MTEF      Medium Term Expenditure Framework
NASCOP    National AIDS Control Program
NGO       Non Government Organization
NMR       Neonatal Mortality Rate
ORT       Oral Rehydration Therapy
PATH      Program for Appropriate Technology in Health
PMTCT     Prevention of Mother to Child Transmission
PPH       Post partum haemorrhage
PPP       Public Private Partnership
SOPO      Hand Washing Campaign
TT        Tetanus Toxoid
U5MR      Under Five Mortality Rate
UN        United Nations
UNICEF    United Nations Children’s Fund
USAID     United States Agency for International Development
WHO       World Health Organization
                                               2
Background

With only six years left to the Millennium Development Goal (MDG) date, there has been reduction
in infant and under five mortality. However, maternal and newborn health indicators in Kenya have
generally stagnated or show very marginal improvement. The recently released KDHS revealed the
following:
      Reduction in Infant Mortality from 77 to 52/1000
      Reduction in Under Five Mortality from 115 to 74/1000
      Newborn mortality rate has reduced from 33 to 31/1000
      Delivery by a health care professional has increased from 42 to 44%
      Delivery in a health facility increased from 40 to 43% but with some regions reporting only
       17% delivery in a health facility
      FP contraceptive prevalence rate has increased from 39 to 46%
      Maternal mortality ratio has decreased from 414 to 410/ 100 000
      Breastfeeding coverage

These changes are still way below the National as well as the MDG targets. Kenya therefore like
other sub Saharan Africa countries has to put in place strategies to accelerate the reduction in
maternal, newborn and child morbidity and mortality. With NMR contributing over 60% of IMR, we
know that if this is addressed, we will be able to attain MDG 4. However issues of the newborn
cannot be addressed separately as they are intrinsically entwined with pregnancy, labour, delivery
and postpartum care. Hence addressing maternity care automatically translates to improved
newborn health.


Many stakeholders are expressing greater interest in investing in Maternal and Newborn health.
Key policy documents have been developed including the National MNH Road Map which is almost
finalized , the Child Survival and Development Strategy and the Infant and Young Child Feeding
Strategy and the National MNH Road Map. These key policy documents clearly outline the broad
strategies and priority actions necessary to accelerate the reduction in maternal and newborn
morbidity and mortality. The priority interventions therefore need to be adapted by the districts
and included in the Annual Operational Plans.


                                                3
Justification for the Retreat:
The need for this workshop was muted out of the concerns emanating from the results of the KDHS
2008/9 and the AOP 4 (2008-2009) review which revealed little progress in attaining MDG 1
(nutrition), 4 & 5. At the same time it was clear that there was a need to integrate the maternal,
neonatal and child Health (MNCH) - Cohort 1 &2 for better progress in MNCH in Kenya.


The main Objectives of the retreat were:
   1. To bring together MNH stakeholders for updating on the status of MNH in Kenya and what
       different partners are doing to date
   2. To identify key priority actions to be incorporated into the AOP6 for the purpose of
       accelerating the attainment of MDGs 4& 5
   3. To obtain stakeholder buy in and resource mobilisation for implementation of identified
       priority actions

Expected Outcomes of the meeting were as follows:

   1. The situation of maternal, newborn, child survival and nutrition Kenya is reviewed
   2. The activities to expedite progress in acceleration of the implementation of the MNH Road
      map, Child Survival and Development Strategy and nutrition strategies are identified.
   3. The actions and commitments to implement the identified activities and strategies are
      clearly spelled out with timeline.
The format of the meeting comprised targeted presentations in plenary followed by group
discussions.


Participants
The workshop brought together stakeholders in Maternal, Newborn and Child health from policy,
Implementation and Partners levels. They included: the Director of Public Health and Sanitation,
Provincial heads, representatives from the development partners (DFID, GTZ, JICA, USAID), the UN
agencies (WHO, UNICEF), NGOs (Save the Children, AMREF, HENNET, FHI, JHPIEGO, FCI, PATH,
Capacity project, Clinton Foundation, MCHIP, World Vision, Micronutrient Initiative, PSI),heads and
programme managers of technical divisions of the MOPHS (DRH, DCAH, HMIS, Nutrition, Health
promotion, NASCOP, Community Strategy), EHS, The White Ribbon Alliance, Training Institutions
                                                 4
(Moi Teaching and referral hospital, University of Nairobi, Aga Khan University hospital), CHAK,
Catholic Health Commission, KEMRI Wellcomme, CIFF, and The Nairobi City Council Health
services, among others. The complete list of participants is attached.

Figure 1: Section of participants to MNCH retreat




Session 1 and 2: Situation analysis
The first 2 sessions reviewed the global, regional and national situation analysis on MNCH and
nutrition. These were presented by the following;
   Global and Regional Situational Analysis:
        o Maternal Health: Dr. Joyce Lavussa WHO
        o Neonatal and Child Health: Dr. Sanjiv Kumar UNICEF
   Situational Analysis Kenya:
        o Maternal Health: Dr. Isaack Bashir
        o Neonatal and Child Health: Dr. Annah Wamae
        o Nutrition in Achieving MNC Survival Goals: Ms. Grace Gichohi


Key points from these presentations were that:
       Sub-Saharan countries are lagging behind other regions in progress towards MDG 1, 4 and 5
        targets.


                                                    5
      Worldwide, 536 000 women loose their life during pregnancy and childbirth every year. The
       world map below indicates the magnitude of the maternal mortality ratio. Maternal
       mortality ratio is by far the highest in Sub-Saharan Africa, where 1 in 23 women faces life
       time risk of dying, when compared to 1 in 2300 in Europe"
      Children living in Africa have a much higher chance of dying before the age of five, and
       among those, it are the children of the poorest families who will suffer most. Of these 1 in 4
       deaths occur during the neonatal period
    There is no sub-Saharan country among the 63 on track for attainment of MDG 1, with 54%
       of childhood mortality being associated with under nutrition.


Results of the 2008 Kenya Demographic and Health Survey (KDHS) indicate that:
      All maternal health indicators remain poor. Kenya is 14th in the list of the worst 20 countries
       that contribute the highest numbers of maternal deaths
      Child Survival has improved but is being pulled back by the high newborn deaths. (In 2008
       DHS, neonatal mortality has increase to 60% of the IMR, up from 45% in 2003).
      Nutritional indicators have also largely remained unchanged over the last decade.


Available strategies were reviewed and outlined by;
      The Maternal and Newborn Health as outlined in the National Roadmap which is adapted
       from the African Union Road Map: Dr. Shiphrah Kuria, DRH
      The Child survival and Development Strategy: Dr. Annah Wamae DCAH
      The Nutrition and Infant and Young Child Feeding strategy: Ms. Grace Gichohi, DN
      The Community Strategy: Dr. James Mwitari, Division of Community Health Services.


Discussion following the presentations focused on the need to rally other players from different
sectors e.g. Ministry of Education, Gender, Agriculture, Social services, Youth, Roads, Transport
and Communication, Finance, Office of the president etc, since reduction of MNC morbidity and
mortality goes beyond the health sector.
The operations research component and health financing issues need to be highlighted strongly in
all the MNCH and nutrition strategies.


                                                  6
The use of local best practices that are cost effective in reducing maternal, newborn, and child
morbidity and mortality needs to be scaled up.

Figure 2: A Group work session




Session 3: Group work
Participants in 5 groups identified the problems /bottlenecks slowing Kenya’s progress towards
attaining the MNCH and nutrition targets.
The groups looked at: 1) commodities; 2) Monitoring of data flow/ HMIS, 3) Communication for
behavior change, 4) Human resources, 5) Referral and quality assurance


Session 4: Highlights from Group Discussions
Group 1: Commodities for MNCH
      Challenges were identified as inadequate financial allocations and delays in disbursement of
       procurement funds, Inadequate capacity of human resources for logistics management,
       Unavailability of reporting tools and poor reporting , Push system is a challenge leading to
       mal-distribution of commodities , Delayed deliveries of commodities
      It was proposed that: concerned departments and divisions to advocate for adequate
       funding allocation in the MTEF process, Capacity strengthening be done at all levels on
       logistic management, and beaurocratic and legal delays be addressed



                                                 7
      There is need for divisions working in MNCH to engage with and participate in the
       commodities and supplies ICC


Group 2: Monitoring of data flow/ HMIS
      Key challenges included: incomplete data in 50 -70% of districts, multiplicity of reporting
       tools, low numbers of records officers/ skilled HMIS personnel, and low capacity for
       utilisation of data
      Suggested interventions included- Capacity building for data management, harmonisation
       of tools, prioritisation of key indicators and supportive supervision.
      It was proposed that the private sector and FBOs be encouraged to submit their data to the
       district, provincial and central level


Group 3: Communication for behaviour change
      Challenges include: poor articulation/ understanding of the community strategy,
       communication strategies not user friendly, low participation of communities in design ,
       development and dissemination of messages, demand created when services are not yet
       available.
      To address this, capacity building for IEC/BCC, Strengthen linkages at all levels, and all
       partners need to work in synergy
      There is need to avoid demand creation without commensurate services being in place


Group 4: Human resources for MNCH
      Challenges noted include: HRH coverage and poor deployment of available staff; this is
       augmented by deficient competencies in MNCH, lack of harmonised guidelines, and
       inadequate facilitative supervision. Poor staff attitudes have also been noted to affect
       quality of service provision
       Short term measures to address these include: Onsite training / mentoring for higher level
       facilities (level 4 and above), Revitalise or strengthen rural health facilities for the lower
       level, rational and equitable distribution of available staff, and integrated MNCH facilitative
       supervision



                                                   8
      The government under the economic stimulus package is set to deploy 20 additional nurses
       per constituency. The USAID is also supporting contract hiring of health workers for hard to
       reach areas.


Group 5: Other health systems challenge s (Referrals, Q/A)
      Challenges included: lack of collaboration with other key ministries (transport, roads,
       security, etc); lack of community based referral systems, deficient communication and
       feedback mechanisms, deficient competencies in management of referral systems
      Suggested measures to address this included: Strengthening community referral systems,
       review GOK referral management system and strengthen linkages with other sectors
      With regard to quality of care there is no standardised quality improvement system or tools
       in place. Short term measures to address this include revitalisation of Quality Management
       committees, audits, and COPE (client-oriented, provider-efficient services).


Figure 3: Thank God its break time




                                                 9
Day 2:


Session 5: Learning from Global and Regional Good Practices

In this session, the good practices from global experience and some countries that have made a
good progress in maternal, newborn and child survival were highlighted and discussed.


Accelerating Child Survival and Development- Malawi Mr. Humphreys Nsona, National IMCI/ACSD
Coordinator, MOH Malawi
Malawi has been able to accelerate child survival and development (and overshoot their MDG
targets) by investing in simple cost effective interventions. Malawi’s package of services
emphasized community participation, selected outreach / facility based interventions, as well as
individual oriented curative services. The country has an established community structure that
supports a cadre of staff that is able to provide simple and safe basic promotive and curative care
for the most important causes of child morbidity, such as acute malnutrition, malaria, pneumonia
and diarrhoea to save lives in the interim, while referring more complicated cases of pneumonia,
sepsis.


Operationalising of the Child Survival and Development Strategy Dr. Vincent Orinda, UNICEF
Evidence based High Impact Interventions (HII) to operationalise child survival and developments
as outlined in the Lancet series were disseminated. These include both preventive and treatment as
summarized below:

          Preventive                                      Treatment
         Breastfeeding                                  Oral rehydration therapy
         Insecticide-treated materials                  Antibiotics for pneumonia
         Complementary feeding                          Antimalarials
         Water, sanitation, hygiene                     Antibiotics for sepsis
         Hib vaccine                                    Newborn resuscitation
         Zinc                                           Antibiotics for dysentery
         Vitamin A                                      Zinc
         Antenatal steroids                             Vitamin A
         Newborn temperature management
         Tetanus toxoid
         Nevirapine and replacement feeding
         Antibiotics for premature rupture of
          membranes
         Clean delivery
         Measles vaccine
         Antimalarial intermittent preventive
          treatment in pregnancy                 10
To operationalise this, the country needs to prioritise their interventions and to ensure that the
government leads the process.


Overview of Best Practices in preventing maternal mortality – Dr. Nancy Kidula, WHO
Success stories to reduce maternal mortalities in various countries covering Skilled Birth
Attendance, Family Planning, Transport, advocacy, multi-sectoral approach were also shared. These
included simple, cost effective interventions such as: increased numbers and coverage of skilled
birth attendants as in the case of Thailand, Sri Lanka and Malaysia; Increased advocacy for MNH by
White Ribbon Alliance; and strengthening community initiatives as in Eritrea.


Reducing Maternal Mortality by Focusing in PPH Prevention - Dr. Marsden Solomon, KOGS
The KOGS also shared the concept paper for reducing maternal mortality by focusing on prevention
of PPH. There following areas need to be strengthened
      Intensify Advocacy for prevention and reduction of complication rates of PPH
      Strengthen the health systems targeting the delivery of services-both public and private
       sector involved in the prevention of PPH
      Improve the PPP[Public –Private partnerships ]
      Improve the linkages with other line ministries
      Strengthen community based services –including referrals with regards to prevention and
       /or reduce the complications rates of PPH


Session 6: Learning from experiences in Kenya
This session reviewed, discussed and identified the good practices from Kenyan experience that
have the potential to accelerate our progress in maternal, newborn and child survival.


Experiences from Kenya included:
      Child- Mother Health and Nutrition weeks (Malezi Bora) initiative presented by: Mr. Crispine
       Ndeda, DCAH. Malezi Bora has been cited as a success story in the region. This focuses on
       increasing the utilization and improving the delivery of routine evidence based health and
       nutrition services for children, expectant women and lactating mothers and women of


                                                  11
        reproductive age in Kenya. The importance on focussing on a smaller package of high
        impact interventions during outreaches was highlighted
       AMREF BUSIA Child survival project presented by Angela Nguku, AMREF. This project
        utilizes community structures, innovative BCC approaches, advocacy and capacity building
        to increase access to and utilization of maternal and newborn services, reduce malaria
        incidence in pregnant women and under 5s, and reduce neonatal HIV infections
       The Family Care International (FCI) project in Yatta presented by: Angela Mutunga, FCI. This
        project aims at Increasing Community Participation in Health Systems Strengthening for
        Improved Maternal health by increasing community participation in maternal health service
        delivery, engaging community leaders in increasing service utilisation, and strengthening
        health facility management for improved maternal health.


In summary, the role of advocacy at all levels for improvement of MNCH was highlighted. Key
elements of success included:        strong leadership, good coordination across sectors, strong
emphasis on community involvement, adequate resources, monitoring and evaluation including
facilitative supervision.


Session 7: Group work
Participants were divided into 6 groups to identify the priority High Impact interventions required
to accelerate progress towards attainment of MNCH and nutrition targets both at community and
facility level. The results of these discussions are highlighted below:




                                                   12
Community- L1                       Facility level- L2, L3, L4
   Demand creation for early          Four timely focused ANC visits with a focus on:
    initiation of ANC                      o Individualised Birth Plan and Emergency Preparedness
   Individualised birth plan and          o Prevention and management of pregnancy complications
    Emergency preparedness                      ( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients)

   Community actions to               Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics,
    promote skilled care                Magnesium sulphate, Manual removal of placenta, removal of
                                        retained POCs, Assisted delivery, Blood transfusion, and caesarean
                                        section
                                       Active management of third stage labour
                                       Monitoring labour using partograph

   BCC for FP, PNC, Newborn           Skilled attendance within first 24-48 hours after delivery
    and child care practices           PNC
   BCC to promote skilled             Long acting and permanent FP methods
    attendance with first 24-48        Conduct maternal and perinatal death reviews
    hours after delivery
   Hygienic cord care
   Newborn temperature                Hand washing with soap by caregiver
    management                         Temperature management
   Hand washing with soap by          Antibiotics for neonatal infections
    caregiver                          Newborn resuscitation
                                       ARV prophylaxis
   Early initiation and EBF           Early initiation and EBF
   Complementary feeding              Complementary feeding
   Vitamin A                          Vitamin A

   Immunization                       Immunization
   LLITN                              LLITN
   ORT and Zinc                       ORT and Zinc
   Safe drinking water                ACT
                                       Antibiotics for childhood pneumonia
                                       Early Infant Diagnosis of HIV
                                       ART


Summary – The discussions highlighted that the existing challenges are already known and a
paradigm shift in addressing them is required. The discussions highlighted the lack of scaling up of
recommendations from pilot studies that have shown positive results.                  Possible approaches
include: establishing structures to ensure that allocated funds reach the lower levels, improving the
quality of care provided at all levels (including, addressing the attitude of the workers, privacy, and
sensitivity to gender-cultural issues to include ensuring the availability of female attendants in
cultural sensitive regions), and devising innovative and cost effective approaches of implementing
key strategies.

                                                     13
The role of Communication in achieving MNCH goals – Dr. Salim Hussein, DHP, MOPHS
These were defined as follows:
   1. Educate families through social mobilization to adopt and sustain desirable behavior
   2. Create demand, provide supplies and educate and motivate families to use these
   3. Create demand to avail services, provision of quality services and educate families, social
       mobilization to avail services
   4. Families identify danger signs early and know where to go.
Malezi Bora and Hand washing (SOPO) are among the MNCH initiatives that have had an intensive
health promotion component.


The role of HMIS in achieving Maternal, Neonatal, Child health and Nutrition goals – Mr. Pepela
Wanjala, HMIS MOPHS
HMIS is focusing on harmonising and standardising health sector indicators, supplying harmonised
summary tools to the facilities, and training service providers on use of these tools. The file transfer
protocol (FTP) system has been set up at AFYA house which collates all data from districts and
provinces, and can be used for analysis and generation of graphs etc Data generated can be easily
retrieved and utilized for planning and resource allocation.


It was reported that HMIS is in the process of finalizing and adoption of the Community Health
Information systems tools for national roll out.
Challenges with HMIS include inadequate human resources, and limited financial allocation.


Session 10: Group Work
The last group work session reviewed key action points needed to accelerate high impact
interventions for maternal, neonatal and child survival and development (MNCSD) and how they
would be monitored. The groups included;


Partnership, coordination and leadership and advocacy for accelerated MNCSD
It was noted that there was lack of leadership and coordination by MOPHS and MOMS was an
issue, hence the need for strong leadership and advocacy, to ensure that the acceleration of
MNCSD is put high on the government’s agenda. Partners were also not willing to move away from

                                                   14
their own agenda which would sometimes not be in line with the government agenda. One of the
ways this could be done is by establishing a “working group” of MNCH and child survival that would
feed to the various ICCs. This working group would also coordinate the inputs of various Ministries
that have a stake in the MNCSD agenda. Provinces and districts also need to be empowered to
better coordinate and/or reactivate the stakeholder coordinating groups to strengthen
programming. The roles of the NGOs and partners need to be clearly defined. Mapping of who is
doing what and where they are located in the provinces and districts was noted as a priority for
resource planning and mobilisation.


Resource allocation
       The government and partners should honour their commitments to resource allocations to
enable programming to continue. There should also be transparency and disclosure by
stakeholders so that the resource envelop is known. This is one of the key SWAP objectives.


Synergy among partners
       All Partners need to be oriented on the HII so that they include them in their planning
processes. Joint planning, monitoring and evaluation would be strengthened. The district
stakeholders’ forum can be an avenue for this


Acceleration at the community level
       Acceleration of MNCH at community level can be done through strengthening Community
involvement and participation as well as outreach activities. Efforts should be made to scale up the
community maternal and newborn guidelines.


Commodities and supplies
       The government needs to take the lead in coordinating a streamlined procurement and
distribution system and also put in more resources for procuring MNCSD supplies and
commodities. The roll-out of the pull distribution system needs to be countrywide. Stock
monitoring needs to be strengthened


Monitoring and evaluation

                                                 15
One of the key steps to strengthen the M&E would be to establish an M&E working group with
clear terms of reference. Quality Assurance Teams would also be established and institutionalized
with clear guidelines on standard operating procedures, DQA and evidence of use. There was also
need to review and revise the current MNCSD supervisory tools. Reporting should be based on
District denominators obtained from Central Bureau of Statistics at the national level. This would
provide a standardized figure and hence a better picture of progress being made.


CONCLUSIONS:
In his concluding remarks, the DPHS outlined the components of the Economic Stimulus Package
which aims at upgrading the infrastructure of health facilities, increasing the number of human
resources by 20 health workers per constituency, and yearly procurement of drugs amounting to
KSH one billion with the higher proportion of about KSH 700 million allocated to drugs and the
balance to vaccines.
       He outlined the establishment and operationalisation of the HSSF (as performance based
financing) to facilitate disbursement of funds especially to level 2 and 3 facilities.
Calling on the stakeholders’ to make a deliberate and concerted effort to ensure that the
interventions identified during the meeting are implemented, the DPHS reaffirmed the
commitment of his office and the Minister’s in improving the MNCH indicators. As a follow-up step,
he called for a meeting in September 2010 to assess the progress being made to accelerating
progress towards MDG 1, 4, 5 and 6.

Figure 4: Dr Shariff- DPHS makes his remarks




                                                   16
The WAY FORWARD
This is outlined in the attached communiqué.



               ACCELERATION OF MATERNAL, NEWBORN AND CHILD SURVIVAL IN KENYA

                                   Setting a national agenda-March 2010


Background
           Kenya has recently registered encouraging improvements in child survival indicators over
the period 2003-2008/9. On the other hand, we hardly made any progress with maternal neonatal
health and nutrition indicators over the same period. The preliminary Kenya Demographic Health
Survey (KDHS) 2008/9 showed reductions in Infant Mortality Rate (IMR) from 77 per 1000 live
births in 2003 (KDHS 2003) to 52 per 1000 live births in 2008/9. The Under Five Mortality Rate
reduced from 115 to 74 per 1000 live births over the same period of time. It is thought that the
improvements seen in child survival during that period could be explained by the scale up of high
impact evidence based interventions such as Insecticide Treated Nets (ITNs), Artemisinin
Combination Therapy (ACTs) and Vitamin A supplementation
           The neonatal mortality rate only reduced marginally from 33 to 31 per 1000 live births
between 2003 and 2008/9. Only 43 percent of women were delivering in health facilities by 2008/9
(KDHS, 2008/09). Over the same period exclusive breastfeeding rates, 0-5 months, increased from
13% to 32% and at 6 months from 3% to 13%. However this was noted to be still way below the
target. Nutrition related indicators continue to show significant regional disparities with the arid
and semi arid areas showing high levels of stunting. The national average distances to domestic
water points have increased to 25-30 km against the normal of 7 kms. This has had a corresponding
effect on the quantity of water available for domestic use with the average down to less than 5
litres per day compared to the recommended 5-10 litres per day (KFSSG 2009). Only 42 percent of
the population has access to a safe drinking water supply and 46 percent has safe sanitation in
20071 while handwashing is very low despite their importance in the prevention of diarrhoea and
neonatal sepsis.




1
    2007 WHO UNICEF Joint Monitoring Program
                                                   17
Setting the Agenda for Accelerating Maternal, Newborn and Child survival
        A national stakeholder’s workshop on acceleration of maternal, newborn and child survival
was convened by the Ministry of Public Health and Sanitation in March 2010. The workshop
achieved consensus on the following outcomes:
    1. Prioritization of selected high impact interventions for maternal, newborn and child survival
        and,
    2. Identification of cardinal actions, commitments and timelines which stakeholders will
        implement towards the acceleration of maternal, newborn and child survival.

Table 1: Priority High Impact Interventions by Level of Care, Cohort and Intervention Area
Community- L1                       Facility level- L2, L3, L4
   Demand creation for early          Four timely focused ANC visits with a focus on:
    initiation of ANC                      o Individualised Birth Plan and Emergency Preparedness
   Individualised birth plan and          o Prevention and management of pregnancy complications
    Emergency preparedness                      ( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients)

   Community actions to               Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics,
    promote skilled care                Magnesium sulphate, Manual removal of placenta, removal of
                                        retained POCs, Assisted delivery, Blood transfusion, and caesarean
                                        section
                                       Active management of third stage labour
                                       Monitoring labour using partograph

   BCC for FP, PNC, Newborn           Skilled attendance within first 24-48 hours after delivery
    and child care practices           PNC
   BCC to promote skilled             Long acting and permanent FP methods
    attendance with first 24-48        Conduct maternal and perinatal death reviews
    hours after delivery
   Hygienic cord care
   Newborn temperature                Hand washing with soap by caregiver
    management                         Temperature management
   Hand washing with soap by          Antibiotics for neonatal infections
    caregiver                          Newborn resuscitation
                                       ARV prophylaxis
   Early initiation and EBF           Early initiation and EBF
   Complementary feeding              Complementary feeding
   Vitamin A                          Vitamin A

   Immunization                       Immunization
   LLITN                              LLITN
   ORT and Zinc                       ORT and Zinc
   Safe drinking water                ACT
                                       Antibiotics for childhood pneumonia
                                       Early Infant Diagnosis of HIV

                                                     18
                                     ART



Cardinal Actions, Commitments and Timelines for the Acceleration of Maternal, Newborn
and Child Survival

National level
   1. The Director PHS will issue a twice yearly bulletin to all stakeholders on new developments
       in the health sector such as the Community Strategy, HSSF, HRH, and Infrastructure
       Development e.t.c.
   2. The Director PHS will convene national annual forum to review progress in accelerating
       MNC survival just before commencement of AOP process.
   3. The Director PHS will issue a bulletin outlining the cardinal actions, commitments and
       timelines for acceleration of Maternal, Newborn and Child survival to all stakeholders in the
       health sector as well as in other sectors 1 week after the national annual review forum for
       accelerating MNC survival.
   4. Programme managers in the Ministry of PHS and partners will include high priority MNC
       Child survival in all quarterly Interagency Coordinating Committee meeting agendas
       including Commodity and Supplies ICC.
   5. The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation will
       conduct partner mapping for MNCH for resource identification and targeting.
   6. The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation will
       finalize the MNC survival Road Map using multi-sectoral engagement to clarify roles and
       responsibilities.
   7. The Director PHS will develop RRI schedule based on high impact interventions for MNC
       survival by end of May 2010. The director will build leadership and management capacity
       for MNCH (RRI) at national, provincial and district levels.
   8. The head of HMIS will review AOP monitoring indicators to include priority high impact
       interventions (HII).

Provincial level
   1. The Provincial Directors will convene quarterly Provincial Health Stakeholder forum focusing
       on acceleration of MNC survival.

                                                  19
   2. The Provincial Directors will prioritise selected high impact interventions outlined above in
       the AOP 6 process before end of April 2010.
   3. The Provincial Directors will conduct partner mapping for MNCH for resource identification
       and targeting.
   4. The Provincial Directors will initiate onsite supportive supervision in the provincial hospital
       and provincial management level.
   5. PHMTs will participate in supportive supervision and monitoring of district and other lower
       levels.

District Level
   1. The DMOs will convene quarterly District Health Stakeholder forum focusing on
       acceleration of MNC survival.
   2. The DMOs will prioritise selected high impact interventions outlined above in the AOP 6
       process before end of April 2010.
   3. The DMOs will conduct partner mapping for MNCH for resource identification and targeting.
   4. The DMOs will initiate onsite support supervision in the District hospital and District
       management level.
   5. DHMTs will participate in supportive supervision and monitoring of health centres,
       dispensaries and community while specifically focussing on completeness of HMIS at all
       levels.
   6. DHMT, District Accountant and District Internal Auditor will monitor the implementation of
       HSSF at level 1, 2, and 3.
   7. Strengthen FTP HMIS

Level 2, 3, 4 – Health Facilities
   1. The facility I/C will initiate onsite supportive supervision in their respective facilities.
   2. I/C to coordinate Planning and implementation of selected priority high impact
       interventions for the level of care as shown in table 1 above.
   3. I/C will oversee HSSF implementation at Level 2 and 3
   4. I/C will maintain up to date HMIS and up load to central server through file transfer
       protocols.



                                                   20
Level 1-Community
  1. The CHEW will coordinate planning and implementation of priority high interventions at the
     community as shown in table 1 above.
  2. CHEWs to initiate onsite supportive supervision at the community level.




                                              21
          List of participants

                          Ministry/
                                                                                                    Email
            Name          Organization     Title/Department            Telephone
                                           Director, Medical
1    Dr. S K Sharif       MOPHS            Services                    0733 813449      sksharif@africaonline.co.ke

2    Absalom Ingabo       MOPHS            PCO Western                 0722 865183      ingaboabsalom@yahoo.com
                                                                                        wangainjiru@yahoo.com
3    Angela Njiru         MOPHS            Health                      0722 605 687     pmonairobi@yahoo.com

4    Annie Gituto         MOPHS            Prog Manager                0722 370 122     wangmaina78@yahoo.com

5    Dr. Bashir M Issak   MOPHS            Head DRH                    0722 - 318 084   drbashiri@yahoo.com
     Carolyn C
6    Kenduiwa             MOPHS            Nutritionist - PGH Nakuru   0724 - 754 682   chepck@yahoo.ocm

7    Crispin Ndedda       MOPHS            DCAH                        0722 645 384     ndedda@yahoo.com

8    Dr. Annah Wamae      MOPHS            Head, DCAH                  0722 674 681     dchildhealth@swiftkenya.com

9    Dr. Wago D Ejersa    MOPHS            PDCHS - Rift Valley         0720 846127      pmorvp@yahoo.com

10   Grace Gichohi        MOPHS            Div of Nutrition            0721 971 572     gichohigrace@yahoo.com

11   Grace Wasike         MOPHS            Prog Officer - DCAH         0720 55 4171     grewasike@gmail.com
                                           Dept of Health              0723 586 832 /
12   Judith Karia         MOPHS            Promotion                   020 2721507      newnessnew@yahoo.com

13   Dr. Osman Warfa      MOPHS            PDPHS                       0726 - 846809    owarfa@yahoo.com

14   Rachel Randu         MOPHS            District Clinical Officer   0734 242215      randurachel@yahoo.com

15   Raphael K Njue       MOPHS            PCO Eastern Province        0722 459 414     njueraphael@yahoo.com
                                           Head, Division of Health
16   Dr. Salim Hussein    MOPHS            Promotion                                    saalhu@yahoo.com

17   Sellina Cherutich    MOPHS            DRH - Prog Officer          0721 884338      siematur@yahoo.com
     Dr. Shiphrah N
18   Kuria                MOPHS - DRH      Prog Manager                0722 300279      shiphonk@yahoo.com

19   Esther Oloo          MOPHS - Nakuru   DNO                         0722 327 937     swaknku@yahoo.com
                                                                       0722 922
                                                                       466/0733 709
                                                                       388/057 2023
20   Charles Ngwalla      MOPHS - Nyanza   PCO/Rep PDPHS Nyanza        176              ngwallacharles@yahoo.com
     Dr. Jennifer
21   Othigo               MOPHS & MOMS     RH Coordinator              0722 411 545     mj_othigo@yahoo.com.au


                                                              22
22   Dr. Alfred Owiti     MOMS              Prov Dentist - Nairobi     0722 797266      aowiti@yahoo.com
     Lydia Njuki                                                       0722 28 47 22/
23   Mwangi               MOMS              SACCO PGH Nakuru           0734-284722      ladimwa@yahoo.com
     Evangeline K                                                                       evangelinemugoh@yahoo.co
24   Mugo                 MOMS              Nursing Council of Kenya   0723 703 137     m

25   Patrick O Kamo       MOMS - Nyanza     Rep PDMS - Nyanza          0721 546 843     plokamo2007@yahoo.com
                                                                       0733
                                                                       627077/36620
26   William Macharia     AKU               Prog Officer               40               william.macharia@aku-edu.

27   Peter Ofware         AMREF             Prog Manager               0720 337856      peter.ofware@amref.org

28   Angela Nguku         AMREF/WRA         Prog coordinator           0722 365434      angela.nguku@amref.org
     Dr. Gathari
29   Ndirangu             Capacity/DRH      RH Technical Advisor       0720 102 602     gndirangu@intrahealth.org
                          Catholic Health                              0722
                          Commission        Training and Nursing       980431/020-
30   Titus Munene         (KEC)             Services Manager           4443133          tmaeti@catholicchurch.or.ke

31   Joseph Oyongo        CHAK              Training Officer           0722 487 138     jmoyongo@chak.or.ke

32   Henry Kilonzo        CIFF              Monitoring & Evaluation    0721 294 576     henry@ciff.org
                          Clinton           Prog. Manager-                              rkihoto@clintonfoundation.or
33   Rosemary Kihoto      Foundation        Paediatric                 0727 494 715     g

34   Allan Govoga         DCAH/MOPHS        Prog Officer - DCAH        0722 235670      allangovogah@yahoo.com
                                            Reg Maternal Health
35   Tony Daly            DFID              Advisor                    0735 22 6313     a-daly@dfid.gov.uk
     Dr. Margaret
36   Meme                 DRH/MOPHS         Prog Manager - Gender      0722 849835      magmeme2004@yahoo.com
     Dr. Paul
37   Dielemans            EHS               MNHTA                      0723-774963      pdielemans@liverpoolvct.org
                                                                       0724 975 955/
38   Angela Mutunga       FCI Kenya         CD                         443204/3167      amutunga@fcimail.org
     Dr. Marsden                            Reg. Medical Advisor
39   Solomon              FHI               (RH)                       0722 736 813     msolomon@fhi.org

40   Dr. Klaus Hornetz    GDC/GTZ           Director                   0724 260 287     klaus.hornetz@gtz.de

41   Cynthia Macharia     GDC/KFW           Prog officer               0722 279 802     cynthia.macharia@
                                                                       0717
                                                                       491147/272       thorm.maisori@gtz.de /
42   Maisori Thorm        GTZ               Health Sector              5684             thorm.maisori@hotmail.com
                                                                       0721 316 457-
43   Dr. Patricia Odero   GTZ               Component Head             2725684          patricia.odero@gtz.de

44   Allan Oginga         HENNET            Advocacy & Comms           0720 677 577     hennet.advocacy@amref.org

                                                               23
45   Dr. Kazuko Kumon     JICA             PFA                                       kumon.kazuko@jica.jp

46   Yamiko Nakahara      JICA             PFA                                       nakahara.yumiko@jica.go.jp
                          KEMRI-
47   Mike English         WELCOME          Senior Researcher        0722 628700
     Dr. Chris
48   Wanyoike             MI               Country Director         0729 110200      cwanyoike@micronutrient.org
                                                                    +265 999 510
                                                                    272; +265 1759
49   Humphreys Nsona      MOH- Malawi      IMCI/ACSD                563              hnsona@gmail.com
                                           Researcher/Lecturer
50   Peter Gisore         Moi University   Neonatoglogist           0725 619 549     gisore2007@yahoo.com
     Dr. Ambrose
51   Misore               PATH             PD                       0722 810411      amisore@path.org

52   Janet Shauri         PATH             Prog Officer             0713 786382      jshauri@path.org
     Wanjiru
53   Mathenge             PSI - Kenya      CS Programme Manager     0722 968209      wmathenge@psikenya.org
     Catherine
54   Fitzgiblon           SCF-UK           Prog Quality Director    0733 988004      c.fitzgibbon@scuk.or.ke
     Metasebia Gizaw                                                                 m.balcha@savethechildren.or
55   Balcha               SCF-UK           Health                   0737 148793      g.uk

56   Fredrick Donde       UNICEF           WASH                     0722 711940      fdonde@unicef.org
                                           Communication for        0733 731216 /
57   Martin Ocholi        UNICEF           Development              7622171          mochali@unicef.org

58   Ruth Situma          UNICEF           Nutrition Specialist     0722 742865      rsituma@unicef.org

59   Dr. Grace Miheso     UNICEF           Health Specialist        0722 711 466     gmiheso@unicef.org

60   Dr. Sanjiv Kumar     UNICEF           Chief, CSD               0724 255541      ksanjiv@unicef.org
     Dr. Kennedy
61   Ongwae               UNICEF           Health Specialist        0733 554139      kongwae@unicef.org

61   Dr. Vincent Orinda   UNICEF           Consultant               0717 592 887     orinda2006@unicef.org

62   Dr. Juan Ortiz       UNICEF           Dep Representative       0722 52 9714     jortiz@unicef.org
                                                                    0722 448484
63   Doris Kamawera       UNICEF           Program Assistant                         dkamawera@unicef.org
     Dr. Blasio Osogo     University of
64   Omuga                Nairobi          Lecturer                 0722 256080      mitenga@yahoo.com
     Dr. Sheila
65   Macharia             USAID Kenya      Senior Health Advisor    0713 601472      smacharia@usaid.gov
                                           Prog Management          0722 676753 /
66   Lilian Mutea         USAID Kenya      Specialist- MCH/FP/RH    86224 33         lmutea@usaid.org
                                                                    0720 740 977 /
67   Nancy Koskei         USAID MCHIP      Programme Advisor        3751882/84       nkoskei@jhpiego.net

                                                               24
     Dr. Assumpta
68   Muriithi              WHO            CAH/NUT               0723 412 992   muriithia@ke.afro.who.int
                                          Health Promotions
69   Dr. Christine Kisia   WHO            Officer               0721 213969    kisiac@ke.afro.who.int
                                                                0736 416660/
70   Dr. Rex Mpazanje      WHO            Technical Officer     2717902        mpazanjer@ke.afro.who.int

71   Dr. Joyce Lavussa     WHO            NPO/FRH               0722 785 941   lavussaj@ke.afro.who.int
                                                                0722 750
72   Janet Kagai           WHO            Prog Assistant        234/2717902    kagaij@ke.afro.who.int
                                                                0733 614087/
73   Dr. Nancy Kidula      WHO            MPO/MPS               2717902        kidulan@ke.afro.who.int

74   Dr. Kibet Sergon      WHO            EPI                   0722 659 568   sergonk@ke.afro.who.int
                           World Vision                                        mary_kihara@wvi.org /
75   Mary Kihara           Kenya          Health                0722 572 881   mjwkihara@yahoo.com




          Figure 5: Dr Sanjiv (UNICEF and Dr Mpazanje (WHO)




                                                           25
AGENDA
AGENDA


(Day 0):        14 March 2010, Sunday


1730 – 1830          Arrival and Registration




Day 1:          15 March 2010, Monday
                Chair: Dr. Isaack Bashir      Facilitator: Dr. Rex Mpasanje



08:15 – 09:00           Welcome and Introduction: Dr. Isaack Bashir
                           Opening remarks
                           Objectives, agenda of the meeting

09:00 – 10:50          Session 1:
                       Outcome: Participants are updated on and discuss the situation of Maternal,
                       newborn and child survival in Kenya, in East and South Africa region and global and
                       identify areas which need priority attention in Kenya

   Global and Regional Situational Analysis:
        o Maternal Health: Dr. Joyce Lavussa WHO (10 mins)
        o Neonatal and Child Health: Dr. Sanjiv Kumar UNICEF (10 mins)
   Situational Analysis Kenya:
        o Maternal Health: Dr. Isaack Bashir (15 mins)
        o Neonatal and Child Health: Dr. Annah Wamae (15 mins)
   Nutrition in Achieving MNC Survival Goals: Ms. Grace Gichohi (15 mins)
   Role of Communication in achieving MNC goals: Dr. Salim (10 mins)
   HMIS and Reporting on MNCH : Mr. Pepela Wanjala (10 mins)

                       Discussion (20 mins)

10:50 – 11:10         Tea/Coffee

11:10 – 13:00      Session 2: Overview of Strategies in Kenya
                      Outcome: An overview of strategies in Kenya is presented and discussed. The priority
                      interventions for scale up are identified
                      (15 minutes each)
                        Child Survival and Development Strategy: Dr. Annah Wamae
                        Maternal Neonatal Health Roadmap (Draft): Dr. S. Kuria
                        Infant and Young Child Feeding Strategy : Ms. Grace Gichohi
                       Discussion (20 mins)


                                                    26
                            The Role of the Community Strategy in the Attainment of MDG 1, 4 and 5: Dr.
                             Odondi

                         Discussion (30 mins)

13:00 – 14:00            Lunch

14: 00 – 15:30           Session 3: Group Work
                         Outcome: The participants in five groups discuss what can be done to address the
                         problems/bottlenecks preventing us making progress towards the targets in
                         maternal, newborn, child health and nutrition
                         Briefing on Group Work (Annex I)

15:30 – 16:00            Tea/Coffee

16:00 – 17:30            Session 4: Group Presentation and Discussion




Day 2:           March 2010, Tuesday
                 Chair: Dr. Jennifer Othigo     Facilitator: Dr. Vincent Orinda



08:30 – 08:40            Feedback from Day 1

08:40 – 10:30            Session 5: Learning from Global and Regional Good Practices
                         Outcome: The participants review, discuss and identify the good practices from
                         global experience and some countries that have made a good progress in maternal,
                         newborn and child survival.

                            Accelerating Progress Towards MDG 4 and 5: Mr. Humphreys Nsona, National
                             IMCI/ACSD Coordinator, MOH Malawi
                            Overview of the Best Practices in Maternal Health: Dr. Nancy Kidula, WHO
                            Operationalising of the Child Survival and Development Strategy: Dr. Vincent
                             Orinda
                            Reducing Maternal Mortality by Focusing in PPH Prevention: KOGS Dr.
                             Marsden Solomon

                         Discussion

10:30 – 11:00            Tea/Coffee




                                                     27
11:00 – 13:00           Session 6: Learning from Experience in Kenya
                        Outcome: The participants review, discuss and identify the good practices from
                        Kenyan experience that have the potential to accelerate our progress in maternal,
                        newborn and child survival.

                           The Role of the Community Strategy in the Attainment of MDG 1, 4 and 5
                           Malezi Bora: Crispine Ndeda, DCH
                           Systems Strengthening at Community Level: Angela Mutunga Country Director
                            Family Care International
                           Busia Community Maternal Newborn Health Project: John Nduba AMREF
                           Role of Communication in achieving MNC goals: Dr. Salim

                        Discussion

                           Role of HMIS in achieving MNC and nutrition goals

                            Discussion

13:00 – 14:00           Lunch

14:00 – 15:30           Session 7: Group Work
                        Outcome: The groups break into the maternal and child health cohorts and discuss
                        two to three priority interventions needed to accelerate the scale up of MNC and
                        nutrition

15:30 – 16:00           Tea/Coffee

16:00 – 17:30           Session 8: Group Presentation and Discussion




Day 3:          March 2010, Wednesday
                Chair: Dr. SK Sharif             Facilitator: Dr. Vincent Orinda


08:00 – 08:10           Session 9 Remarks from Dr. SK Sharif, Director MOPHS

08:10 – 09:30           Presentation of group work

                        Discussion

09:30 – 09:40           Role of HMIS in achieving MNC and nutrition goals: Pepela Wanjala

09.40 – 09.50           Discussion




                                                     28
09:50 – 12:30   Session 10: Group work 3
                Outcome: Groups to review key action points needed to accelerate high impact
                interventions for Maternal, Neonatal and Child Survival and Development
                (MNCSD)and how they will be monitored

                Groups
                1. Leadership and advocacy for accelerated MNCSD

                2. Partnership and coordinating mechanism for improving MNCSD

                3. Synergy among programs for accelerating HII

                4. Acceleration of MNCS at community level

                5. Commodities and supplies

                6. Monitoring and evaluation
                     a. Identify core indicators based on priority HII
                     b. Include how to provide integrated supportive supervision
                     c. Assessing district performance

                Presentation of group work and discussion

                Tea/Coffee during group work

12:30 – 13:30   Session 10: Way Forward and Concluding

                       Summary of priority interventions
                       Statement of commitment for accelerating MNCH and nutrition
                       Way forward
                       Closing remarks

13:30 – 14:30   Lunch

14:30           Departure for Nairobi




                                           29

				
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