15-18 nov 2011regional ch pm meeting, nepal1 improving neonatal & child health and development...

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

Improving Neonatal & Child Health and Development along

the continuum of care in South-East Asia Region:

A Strategic Framework (Draft)

UNICEF WHO


Need of the Strategic Framework

• SEAR is unlikely to achieve the MDG4 target despite good progress

• The coverage of well-known life saving interventions remains low in member countries

• There are large disparities signifying health inequity for child health in the Region

• Rapid scale-up while maintaining quality and equality is essential to accelerate progress in achieving MDG4


The Framework presents:• Analysis of coverage levels of the existing

interventions and identify opportunities to strengthen health system

• Analysis of the broader determinants such as safe drinking water, sanitation and hygiene, education, gender etc

• Set of parameters that characterize the health systems that would be useful for member states to decide their national and sub-national priorities and revise national and sub-national plans accordingly

• Importance of strong information system and ongoing research


Member States• Bangladesh: UNICEF ROSA• Bhutan: UNICEF ROSA• DPR Korea: UNICEF EAPRO• India: UNICEF ROSA• Indonesia: UNICEF EAPRO• Nepal: UNICEF ROSA• Maldives: UNICEF ROSA• Myanmar: UNICEF EAPRO• Sri Lanka: UNICEF ROSA• Thailand: UNICEF EAPRO• Timor Leste: UNICEF EAPRO


Target audience

• Primarily, governments of member countries • Policy makers at national and sub-national level• International agencies and • NGOs

Intended to be the basis for subsequent joint WHO-UNICEF country support for the member states in the WHO SEAR for newborn and child health and development


Main Sections of the Document• Executive Summary (2 pages) • Introduction (2 pages) • Situation analysis ( 12 pages)• Improving Neonatal & Child Health and

Development along the continuum of care in South-East Asia Region: A Strategic framework (24 pages)

• Roles and responsibilities (2 pages) • Conclusions • References • Annexes


Section 2Situation Analysis in South-

East Asia Region


Section 2 2.1 MDG 4 – overview in the region

2.2. Newborn Health

2.3. Child Health and Development

2.4 Maternal Health

2.5 Underlying factors affecting newborn and child health

2.6 Health service provision along the continuum of care:Identifying gaps and opportunities

2.7 Issues of Health System: Funding, financing and health workforce

2.8 Multidimensional inequities in newborn and child health


Section 3Improving Neonatal & Child Health and Development along the continuum of

care in South-East Asia Region: A Strategic framework


Section 3 3.1 Objectives, vision and guiding principles 3.2 Strategic Directions for improving newborn and child health 3.2.1 Strategic Direction 1: Action to improve service delivery-universal

coverage: Strengthening Implementation along the continuum of care 3.2.2 Strategic Direction 2: Action to strengthen the Health System to

ensure delivery of equitable and quality health services 3.2.3 Strategic Direction 3: Achieving Equity 3.2.4 Strategic Direction 4: Improving and maintaining quality of services 3.2.5 Strategic Direction 5: Private Sector Participation 3.2.6 Strategic Direction 6: Action within and beyond the health system

to address determinants of maternal, newborn, child health and development

3.3 From strategic directions to national plans and sub-national plans 3.4 Strengthening programme management capacity 3. 5 Operational research


Goal of the Strategic Framework

• The overarching goal of the Strategic Framework is to guide and assist member countries to, within overall national health plans, develop or strengthen their national strategies and plans to improve newborn and child survival, reduce the burden of child morbidity and disability and promote child health and development.


Objectives of the Strategic Framework • Implement and scale up evidence-based cost-

effective interventions through effective service delivery strategies throughout the continuum of care.

• Establish effective health systems to ensure equitable access of all mothers, newborns and children to good quality health care services, with particular attention to the poorest and discriminated population groups.

• Promote development and application of multi-sector approaches to address the determinants of maternal, newborn and child health.


Objectives of the Strategic Framework

• Incorporate a child development perspective into policies and actions within and beyond the health system, and use all contact opportunities with families and communities to promote early childhood development.

• Mainstream child health and development into national development agendas and recognize the responsibility to ensure a healthy start to the children as part of the commitment to child’s rights and as a pillar of their social and economic development policies.


Guiding Principles• Life-cycle approach • Equity • Child Rights • Health System Approach • Regulation and integration of the private sector • Integration and Convergence among all

components of the health system and between health services

• Multi-sector action and cross- sector collaboration

• Partnerships • Community Ownership and Participation


Actions at 3 levels

1. Action within the health system to implement effective service delivery strategies for the prioritized interventions along the continuum of care

2. Action within the health system to strengthen all health system components

3. Action beyond the health system to address the key determinants of maternal and child health, nutrition and development and address disparities across population groups


Continua of care Life cycle: which includes adolescence, the

preconception period, pregnancy, childbirth, postnatal period and childhood, thereby taking advantage of natural interactions.

Across different levels of health care delivery: Home/community, first level health centre, and referral hospital for functional continuity

• Comprehensive health care: Interventions in health promotion; disease prevention and control, treatment; rehabilitation and reintegration into society


Organization of Services for maternal, newborn and child health

• Family-oriented community based services

• Population-oriented scheduled services• First level individually oriented clinical

services • Referral level clinical services • Strengthen referral systems and

referral linkages


Health System Approach

• Leadership and governance• Financing• Health workforce• Infrastructure and supply system • Health Information System

Health Service Delivery


Strategic Directions

1. Action to improve service delivery - universal coverage: Strengthening Implementation along the continuum of care

2. Action to strengthen the Health System to ensure delivery of equitable and quality health services

3. Achieving equity4. Improving and maintaining quality of services 5. Private sector participation 6. Action beyond Health Sector: Actions to address

determinants of maternal, newborn, child health and development


Strategic directions to national / sub-national plans

1. Establishment of a national technical working group (TWG)

2. National Coordination mechanism 3. Monitoring and Evaluation mechanism 4. Develop and implement a communication

strategy 5. Action to engage families and communities 6. Phased implementation approach: Scenario

based approach for prioritizing policy actions and interventions


Scenario building for phased implementationIndicators Scenario A IntermediateScenarios Scenario B

Enabling policies/health determinants

% girls completing primary school < 50 >90

% children under 5 underweight > 30 <10

% population using an improved sanitation facility < 60 >90

% birth registered < 80 >95

Health system funding, financing and capacity

% exp. on health on total gov’t exp <5 >8

% Out of pocket expenditure out of total health expenditure >60 <40

no. of doctors, nurses and midwives/1000 population <1 >2

% institutional deliveries <60 >90

Coverage of effective interventions

Skilled attendance at delivery <60 >90

BF (exclusive, first 6 months) <30 >60

% receiving antibiotics in pneumonia <50 >80

% receiving ORT in diarrhoea <50 >80

Measles/DPT coverage, 1 year <80 >95

ECD (Family Care Index)

ECD (day care provision, preschool)

Outcome indicators

Neonatal mortality rate > 30 <10

U5MR > 60 <20

Inter-quintile (1st to 5th) ratio for U5MR > 2.0 <1.5


Package of services for different scenarios

Key Interventions by Service Delivery Mode

• E = essential care to be ensured universally;

• S= situational, depending on epidemiological context;

• A = advanced care, based on Health System capacity


Package of services for Different scenariosInterventions Home / Community Based

Services Individual oriented clinical services

Individual oriented clin services

Family Oriented community services

Population oriented schedulable services

First level health facility based services

Referral level services

Infancy and childhood care

Excl breastfeeding for infants up to 6 mo

E E E E

Advise on stimulation and play (CCD)

E E E E

Immunizations basicschedule

E E E E

Immunizations (Newer vaccines)

A A A

HIV early detection and treatment

S E


Section 4. Roles and Responsibilities

• Member Countries– Policy review, development and monitoring – Resource allocation and – Partnership development – Capacity Building – Ensuring communication and social mobilization – Developing a framework for monitoring and

evaluation – Organizing operational research


Section 4. Roles and Responsibilities

• WHO, UNICEF and other international partners – Provide technical support – Support and strengthen institutional capacity – Support country efforts to improve data collection

and analysis – Support the generation of evidence through

operational research – Advocate for mobilization of adequate resources – Improve the targeting of donor funding for equity

focus


ConclusionsGuidance to Member States for accelerating progress

towards MDG4• A comprehensive policy approach with a focus on

equity • Adopting appropriate cross sector policies • Fostering health system developments • Improving service delivery to scale up evidence

based interventions across continuum of care• Strengthening monitoring and evaluation• Extended partnerships within countries, including

with the private sector • Co-operation and support from WHO, UNICEF, and

other UN Agencies and international partners


Your suggestions are indispensible for strengthening

the ‘Framework’

15-18 nov 2011regional ch pm meeting, nepal1 improving neonatal & child health and development...

Documents

regional ch pm meeting

development slide

neonatal child health

mainstream child health

health system analysis

health inequity

health system components

unicef eapro slide