The Role of KNH/UON in Accelerating the Achievement of MDGs 5 and 4

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MNCH Symposium

10 January 2013

Dr. Gathari Ndirangu

Reproductive Health

MDG 5 in Kenya

• MDG 5 is off target – MMR target: 147/100,000 live births by 2015– Universal access to RH – Current MMR: 488/100,000 live births*, up from 414 in 2003**

• Newborn part of MDG 4 has stagnated– Neonatal mortality rate 31/1000 live births*– 60% of IMR

• Commendable progress in the other MDGs (especially 1, 2, 3)

*KDHS 2008-09**KDHS 2003

Socioeconomic Determinants of Maternal Mortality

• Illiteracy, poverty and poor women empowerment

• Pregnancy too soon, too frequent, too many

• Inadequate access to RH/MNH/FP services

• Delivery under unskilled care

• Limited accountability at all levels

Policy Environment

KNH’s Strengths to Accelerate Achievement of MDG5

• Strategic objectives to fulfil national mandate, vision and mission– To improve quality specialized reproductive healthcare

– To reduce maternal and perinatal morbidity and mortality

– To enhance training and research

– To contribute to national RH planning and policy formulation

– To strengthen institutional linkages and collaboration

– To contribute to corporate social responsibility and improve on hospital image

MNH Strategic Objectives

• Reduce maternal and perinatal morbidity/mortality– Service provision from primary to tertiary care– PMTCT program

• Training and research– Graduate and undergraduate levels, paramedical– Vibrant and respected research community– Translation of research into policy and practice

• Contribute to national RH planning and policy formulation• Institutional linkages and collaboration, including PPP

Challenges

• Heavy client load (outstrips capacity)– Non-booked ANC clients (~60%)

– Late referrals

• High MMR– 1223/100,000 LB (Jan-Nov 2012)

• High NMR 116/1000 LB (Jan-Dec 2012)– Prematurity

– NN Sepsis

– Term RDS

– Birth asphyxia

KNH’s Opportunities for Improving MNH Indicators

• Highly trained workforce• Favorable policy environment

– National referral hospital

– Devolved governance

– Strengthen lower tier health care facilities

– Effective knowledge and skill transfer

– Mentorship

– Timely and supportive feedback to referring HCFs

– Satellite health care facilities

– Modern technology

KNH’s Opportunities for Improving MNH Indicators

• Proactively creating modalities to realize full potential in MNH services– Advocacy– Participation in national RH planning including MPDSR – Training– Research– Collaboration including PPP

• Provision of full range of FP services (LAPM)

• Timely reporting to the national HMIS for national planning

Threats

• Political interference and uncertainty

• Poverty

• Inadequate financial resources

• Commodity insecurity/inadequate equipment

• Increased litigation

• Industrial strife

• Inadequate health workforce

National Vision 2030 MNH target

• MMR- 113/100,000 LB (77% reduction)– From 1223 to 281/100,000 LB

• NMR- 13/1000 LB (59% reduction)– From 116 to 47/1000 LB

• Together, we are up to the task!