16 nov 2011regional ch meeting, kathmandu 1 meeting of south-east asia regional programme managers...
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16 Nov 2011 Regional CH Meeting, Kathmandu1
Meeting of South-East Asia Regional Programme Managers on Child Health,
Kathmandu, 15 – 18 Nov 2011
Progress in Implementation of Child Health Programme
Country: BANGLADESH
16 Nov 2011 Regional CH Meeting, Kathmandu 2
Epidemiology / burden of childhood diseases:
Under five mortality
Figures Year
Under five mortality Rate 54 (SVRS 2008) 2008
Infant Mortality Rate 41 (SVRS 2008) 2008
Neonatal Mortality Rate 37 (BDHS 2007) 2007
Nutrition Status
Low Birth Weight 22 % (UNICEF) 2009
Underweight 41 % (BDHS) 2007
Stunting 43% (BDHS) 2007
3
0
20
40
60
80
100
120
140
160
Dea
ths
per
1,0
00 li
ve-b
irth
s
12-59 months
1-11 months
0-28 days
Declining U5 mortality
-9.3% per year
-6.0% per year
-2.6% per year
1989-93 1992-6 1995-9 1999-2003 2002-6
Source: BDHS 1993-2007
Age groups:
4
Dea
ths
per
1,0
00 li
ve-b
irth
s
12-59 months old children
1-11 months old infants
Neonates (0-28 days)
Declining under-5 child mortality in Bangladesh…..But, proportion of neonatal mortality increasing……
1989-93 1992-6 1995-9 1999-2003 2002-6
39%
57%42%
45% 47%
Source: Bangladesh Demographic and Health Surveys
5
Cause of death distribution of neonatal deaths in Bangladesh: 1994-2003
Source: Bangladesh Demographic and Health Survey 2004
IMCI ImplementationIMCI implementation started (If yes, year) 2002
Newborn Added (If yes, year) 2000 (From day 1)2009 (From 0 day)
Number and Proportion of districts implementing IMCI 54 (84%)
Number and proportion of MOs trained 2,866
Number and proportion of Nurses/other workers trained
7,924
Proportion of districts (out of IMCI districts) with 60 % or more health providers trained
na
IMCI supervisory checklists introduced 2004
Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month
during previous year
na
Proportion of districts (out of IMCI districts) covered
with Follow-up IMCI training na
IMCI implementation
IMCI implementation review conducted (If yes, year; National or sub-national)
2003Sub-national
IMCI Health Facility Survey conducted (If yes, year; National or sub-national)
2008
Sub-National
Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI
>90% (approx)
Pre-Service IMCI teaching/training:
Number and proportion of Medical Schools teaching IMCI
48 (88%)
2010
Number and proportion of Nursing Schools teaching IMCI
nil
ICATT introduced (If yes, year and scale) No
INDIA
INDIA
INDIA
Bay of Bengal
MYANMAR
INDIA
*
*
*
RANGAMATI
SYLHET
TANGAIL
BOGRA
BANDARBAN
KHULNA
PABNA
COMILLA
DINAJPUR
NAOGAON
MYMENSINGH
SUNAMGANJ
CHITTAGONG
JESSORE
SATKHIRA
HABIGANJRAJSHAHI
RANGPUR
NETRAKONA
NATORESIRAJGANJ
DHAKA
BAGERHAT
KURIGRAM
BHOLA
FARIDPUR
NOAKHALI
FENI
KUSHTIA
JAMALPUR
MAULVIBAZAR
GAZIPUR
GAIBANDHA
KISHOREGANJ
JHENAIDAH
KHAGRACHHARI
COX'S BAZAR
CHANDPUR
NILPHAMARI
NAWABGANJ
SHERPUR
NARAIL
RAJBARI
THAKURGAON
GOPALGANJ
MAGURA
MANIKGANJ
BARISAL
BRAHAMANBARIANARSINGDI
PANCHAGARH
SHARIATPURMADARIPUR
LAKSHMIPUR
CHUADANGA
LALMONIRHAT
JOYPURHAT
MUNSHIGANJ
PATUAKHALI
MEHERPUR
PIROJPUR
BARGUNA
NARAYANGANJ
JHALOKATI
2002
2003
2004
2005
2006
2007
Expansion of IMCI guided by evidence of need
Bangladesh Maternal Mortality Survey, 2001: Provided District Under-5 Mortality Estimates
FIMCI CIMCI
2009
20082009
2010
2010
• All 159 upazillas of 20 districts in the “red” (high mortality) areas covered by 2007
• As of now, IMCI is in facilities in:• 54 districts• 400upazilas • IMCI in the community is in 71
upazilas and some urban areas
16 Nov 2011 Regional CH Meeting, Kathmandu 11
IMCI ImplementationKey factors that helped scaling up1. Conducive policy environment-HNPSP (206-11), HPNSDP (2011-
16); Lessons from MCE of IMCI2. Continued commitment and support from DPs/GOB
(Financial/Supplies)3. Strong partnership, networking and pro-active role of child
health group (Professional bodies, NWT)
Key challenges to scaling up:1. Lack of supervision and monitoring system2. Utilization of pool fund for scaling up IMCI (Facility/Community)3. Weak health system support to scale up integrated approach
16 Nov 2011 Regional CH Meeting, Kathmandu 12
Newborn Health
• ENC Course adapted: 2009• Other training courses: ETAT and Sick Newborn
Care; BHW package• Healthcare providers trained:
Healthcare providers Total no. No. Trained %
MO 650 222 34%Nurses 1500 247 17%
CHW 80,000 (GoB)
NGO-na
12000 (NGO)
16 Nov 2011 Regional CH Meeting, Kathmandu 13
In-Patient (Hospital) care of sick newborns and children
• WHO Pocket Book introduced: 2009-10• Training courses for Hospital care done: Yes• Details, If yes:(ETAT and Sick Newborn Care part); • Number and proportion of Healthcare providers
trained: Given in previous slide
• Proportion of hospitals providing pediatric care having oxygen: 82%, 483(589)
• Hospital assessment using WHO tools carried out: – Year/s: 2009– How many hospitals covered:6 DH+ 12 UHCs
16 Nov 2011 Regional CH Meeting, Kathmandu 14
CHW approach for care of sick newborns and children
District implementing CHW approach
Total No. of Distt
Implementing Districts
%
Home based newborn care 64 25 39%
Sick child package 64 35 55%
Healthy child package (ECD)
Any review of the experience
Individual project MTR done
16 Nov 2011 Regional CH Meeting, Kathmandu 15
Programme Review and Management
• CH Short Programme Review introduced, if yes : – Year:2010– National or sub-national:National
• Programme Management Course introduced, if yes:– Year:2010– National or sub-national: National
15 Nov 2011 Regional CH Meeting, Kathmandu 16
Health Management Information Systems (HMIS) and DHS/MICS
• List the key indicators for newborn and child health included in HMIS and DHS/MICS?– Thermal care (Wiping/Wrapping/Delayed bathing)-
BDHS– EBF-BDHS, MICS– LBW-BDHS, MICS– Care seeking for suspected pneumonia-BDHS, MICS– ORS and Zinc for diarrhoea-BDHS– IMCI Case management by age and sex-HMIS
16 Nov 2011 Regional CH Meeting, Kathmandu 17
Health Management Information Systems (HMIS) and DHS/MICS
• How and at what level are the data for these key programme indicators analysed and used by the programmes?– desktop based application: Data entry using software
at UHCs– web-based application: Data uploading in the HMIS
server at HQ– Analysis at national level and used by IMCI section– Publication of Newsletter by the HMIS, DGHS
16 Nov 2011 Regional CH Meeting, Kathmandu 18
Future PlansStrengthening and scale-up plans for Next 2
years • IMCI: Full saturation of upazilas/districts with IMCI• ICATT use: Planned in the next Biennium• CHW Packages:
– Home Based NB Care package:35 districts– Sick child package:35 districts– Healthy Child (ECD) package:
• Referral (Hospital) Care: Distribution, Developing training package
• Programme Review and Management:– CH Short Programme Review: 2014– Programme Managers Course: Not yet planned
16 Nov 2011 Regional CH Meeting, Kathmandu 19
Thank You
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