family health division presentation. dr. kiran regmi director, family health division feb 2011...
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Family Health Division Presentation
Dr. Kiran RegmiDirector, Family Health Division
Feb 2011regmikiran@gmail.com
Millennium Development Goals (MDG) 4 & 5Targets set by Nepal and
achievements Key interventions to achieve MDG 4
and 5Direction beyond MDG for Nepal
Goal 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Goal 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Goal 5.B. Achieve, by 2015, universal access to reproductive health
Under 5 mortality rate
158 118.3
91 61 50 55 38
Infant mortality rate
106 78.5 64 48 41 44 32
Neonatal mortality rate
49.9 43 33 20 30 16
MDG Impact indicator
Achievement Target
1991
1996
2001
2006
2009
2010-11
2015
MDG Impact indicator
Achievement Target
1991
1996
2001
2006
2009
2010-11
2015
Maternal mortality ratio
539 539 415 281 229 134
Total fertility ratio
5.3 4.6 4.1 3.1 2.9 3.0 2.5
Adolescent fertility rate(15-19 years)
127 110 98 70
CPR (Modern method)
24 26 35 44 45.1
48 67
Millennium Development targets and achievements of Nepal Target Set by Nepal and AchievementsGoal 5A
MDG Impact indicator
Achievement Target
1999
2004 2006
2008
2009
2010-11
2015
No of women delivering in health facility
2 11 4.1 26 30 60
Childbirth by SBA
4.8 41.3
C/S rate 2.8 18
Target Set by Nepal and AchievementsGoal 5B
FY 2007/08 2008/09 2009/10 Target 2012
CEOC* 51 in 33 district 76 in 35 district 94 in 45 district **
47 district
BEOC hosp 31 45 47
BEOC PHC 37 4522%
58 60% of PHCC
BEOC total 68 90 105
24 hr del in PHC 16878%
16779%
14871%
40660%
24 hr del at HP 219 30145%
40660%
30% of HP
24 hr del at SHP 35 642%
1374%
Total birth center 422 532 695
Total CAC sites 39 39 86
Target Set by Nepal and AchievementsGoal 5B
Key interventions1. Ama Surachha program
2. Family Planning
ANCPromotion of SBA conducted
childbirth Promotion of institutional childbirth
and initiation of delivery incentives PNC
As Ama Surachha program ANC component focused on targeted ANC there is increase in 1st and 4th visits
ANC motivational incentive package Transportation allowance and free childbirth This shows that Ama program is heading
towards in right direction This is a good indication towards meeting MDG
5A There is marked increase in ANC 1st and 4th in
2066 because of initiation of free childbirth policy
73.1
0%
75.3
0%
70.5
0%
71.3
0% 78%
70%
71.8
0%
71.2
0%
66.2
0% 72.8
0% 82.2
0%
75.1
0%
67.9
0%
66.7
0%
62.1
0% 72.5
0%
77.4
0%
68.1
0%
67.5
0%
65.3
0%
68.3
0%
65%
74.2
0%
65.6
0%
87.9
6%
85.9
0%
89.1
1%
80.7
4%
97.9
3%
89.9
0%
0%
20%
40%
60%
80%
100%
120%
Nepal EDR CDR WDR MWDR FWDR
2062/632063/642064/652065/662066/67
Source: HMIS/MD, DOHS
47.7
0%
49.1
0%
47.9
0%
48.8
0%
43% 48
%49.8
0%
50.0
0%
49.2
0% 53.6
0%
45.3
0% 50.4
0%
51.8
0%
53.3
0%
55.4
0%
50.5
0%
44.6
0% 51.7
0%55.9
0%
56.3
0%
59.1
0%
57%
48.1
0% 52.7
0%
50.9
4%
48.5
0%
57.3
6%
49.2
4%
46.5
1%
44.1
2%
0%
10%
20%
30%
40%
50%
60%
70%
Nepal EDR CDR WDR MWDR FWDR
2062/632063/642064/652065/662066/67
Source: HMIS/MD, DOHS
There is increase in SBA conducted delivery indicating achievement of MDG 5B
24.8%
20.7%
22.4%
16.6%
14.7%
13.7%
29.4%
29.4%
31.2%
27.0% 31.8%
24.7%
0%5%10%15%20%25%30%35%
Nepal EDR CDR WDR MWDR FWDR
2065/66 2066/67
44%(Aama average)
44%(Aama average)
16
After the initiation of free childbirth policy there is a marked increase in PNC
Source: HMIS/MD, DOHS
37.8
0%
38.7
0%
35.7
0% 39.4
0%
39%
34%
39.5
0%
41.0
0%
37.2
0% 42.0
0%
43.3
0%
33.5
0%37.8
0%
39.7
0%
37.4
0% 41.1
0%
35.5
0%
31.1
0%37.4
0% 41.1
0%
39.3
0%
35% 36
.00%
30.5
0%
49.7
2%
49.8
5%
50.9
1%
45.8
8% 54.5
7%
46.3
5%
0%
10%
20%
30%
40%
50%
60%
Nepal EDR CDR WDR MWDR FWDR
2062/632063/642064/652065/662066/67
Source: HMIS/MD, DOHS
37.8
0%
38.7
0%
35.7
0% 39.4
0%
39%
34%
39.5
0%
41.0
0%
37.2
0% 42.0
0%
43.3
0%
33.5
0%37.8
0%
39.7
0%
37.4
0% 41.1
0%
35.5
0%
31.1
0%37.4
0% 41.1
0%
39.3
0%
35% 36
.00%
30.5
0%
49.7
2%
49.8
5%
50.9
1%
45.8
8% 54.5
7%
46.3
5%
0%
10%
20%
30%
40%
50%
60%
Nepal EDR CDR WDR MWDR FWDR
2062/632063/642064/652065/662066/67
Key Intervention II: Family Planning
57Gap
New satellite concept introduced to increase access of LTFP IUCD training integrated into SBA
trainingSr. AHW training in implant insertion
New Acceptors
Current Users
New AcceptorsCurrent Users
Continue reduction of MNMRSustainability of Ama programQuality of care
Coverage of unreached and underserved population
Bringing childbirth institution at home
Develop a concept of tertiary referral centers and satellite birthing centers
Finding alternate ways to replace the adhoc human resources and interventions adopted to achieve MDG
Train and involve under used midlevel health worker (HA) in various reproductive health programs
Selective verses universal free childbirth services
Think of the interventions beyond aid
Develop a strong Reporting, Monitoring and Evaluation mechanism
Thank You
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