dir. catibog-maternal and child health
TRANSCRIPT
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Maternal and Child Health
Dr. Honorata L. Catibog
Family Health Office - NCDPC
NSM Presentation
September 7, 2006
Pryce Hotel, Cagayan de Oro City
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Overall Health Issues
slow progress in achieving MDGs
IMR / UFMR reduction on track
Under nutrition reduction is slow
MMR reduction is very slow
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Health IndicatorsSelected Asian Countries
Japan So. Korea Malaysia Thailand Philippines
Life
expectancy
81 75 73 70 70
IMR 3 5 8 24 29Underfive
Mortality
5 5 8 28 40
MMR 8 20 41 44 172
Populationgrowth
0.3 0.8 2.2 1.4 2.1
HOWEVER, WE LAG BEHIND OUR ASIAN NEIGHBORS IN TERMS OF
MORTALITY RATES
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Infant Mortality Rate
0
10
20
30
40
50
60
1990 1995 1998 2003 2015
49
35
29
19
57
Source: NDHS,2003
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NDHS, 2003
Infant Mortality by Region
4441
393838
3635
3029
282828
2727
2525
2414
MIMAROPA
Western Visayas
Davao
Caraga
Ilocos
Bicol
Zamboanga Pen.
CALABARZON
National Capital Region
Number of infant deaths per 1000 live birthsNumber of infant deaths per 1000 live births
Cordillera Admin
Central Luzon
SOCCSKSARGEN
Central Visayas
Cagayan Valley
Cordillera Admin
Ilocos
Northern Mindanao
ARMM
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Underfive Mortality
0
10
20
30
40
50
60
70
80
1990 1995 1998 2003 2015
48
80
67
40
27
Source: NDHS,2003
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Under 5 Mortality Rate by Region
NDHS 1993-2003
0
10
20
30
40
50
60
70
80
CAR N
CR 1 2 3 4A 4B5 6 7 8 9 10 11 12
CRG
ARM
Regions
In Thousands
Legend:
higher than national rate 40
Lower than national rateSource: NDHS,2003
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Maternal Mortality Ratio
0
50
100
150
200
250
1990 1995 1998 2015
209
180 172
52
Source: NDHS,2003
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Assistance at Delivery
8886
7574
68
6060
53484847
4341
3736
3129
22
National Capital Region
CALABARZON
Central Visayas
Cordillera Admin. Region
Bicol
Western Visayas
Northern Mindanao
Eastern Visayas
MIMAROPA
Percent distribution of live births assisted by a doctor, nurse ormidwife
ARMM
Zamboanga
Eastern Visayas
Caraga
Davao
Cagayan Valley
PHILIPPINES
Ilocos
Central Luzon
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Problems in accessing health carewealth index quintile
Reasons lowest second middle fourth highest
Knowing where to go for
treatment27.4 19.2 13.6 10.7 8.6
Getting permission to go
for treatment22.0 12.7 8.4 7.5 6.8
Getting money for
treatment87.1 80.1 73.0 62.9 45.6
Distance to health facility 59.1 33.8 22.2 18.7 13.6
Having to take transport 57.1 32.5 20.3 17.4 12.0
Not wanting to go alone 44.0 28.8 25.2 25.5 22.0
Concern there might not
be a female provider31.5 20.9 18.0 18.5 17.2
Any of the specified
problems93.5 87.1 80.8 73.6 59.7
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Fully Immunized Child &
Hepatitis B Coverage
Phil, 2002-2005
77
38.5
84
45.2
84
45.6
80
0
10
20
30
40
50
60
70
80
90
100
2002 2003 2004 2005
FIC
HepB3
Percent
YearSource: FHSIS & NCDPC
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Status of Malnutrition
Philippines,0-5 yrs old
32
34
6
0.4
27.630.4
5.5
1.40
510
15
20
25
3035
40
45
50
1998 2003
Prop. Underwt for age Prev Underht for age Prev. thinness Prev. overweightPercent
Year
Source: NNS 2003
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Status of Nutrition
School-Age Children, Phil, 2001 & 2003
33
41
8
26
37
13
0
10
20
30
40
50
2001 2003
Prop. Underwt for age per 100school-age children
Prev Underht for age per 100school-age children
Overwt per 1,000 school-agechildren
Percent
Year
Source: NNS 2003
P l f d f i
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Prevalence of degree of anemia
among different population groups,
2003
67.5
21.3
10.9
0.3
62.7
27.9
9.1
0.3
56.1
2518.6
0.3
57.8
23.9
17
1.30
1020
30
40
50
60
70
80
90
100
6 mo-5y 6-12 y Pregant Lactating
Normal
Mild
Moderate
Severe
Percent
Population Groups
Source: FNRI-DOST
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(Place of Delivery)
38
61
54 46
22
77
Philippines Urban Rural
Health Facility
Home
Percent
distributionof live births
in the 5
years before
the survey
Maternal Care
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Maternal Care
(Place of delivery) 38% of live births were delivered in a
health facility and 61% were born at home.
(NDHS 2003)
Increase compared to 34% in 1998
(NDHS) & a decline in the home deliveries
(66% NDHS 1998)
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Assistance at Delivery
3734
25
2 1 1
Hilot Doctor Midwife Relative/
Friend/
Other
Nurse No one/
missing
Percent
distribution oflive births in
the 5 years
preceding the
survey
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Delivery Assistance
60% of deliveries assisted by health
professionals (2003 NDHS) :
34% deliveries assisted by doctors
25% by midwives
1% by nurses
Increased from 56% (1998) but still low vis avis the 80% target in 2004
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Antenatal, natal and post natal care
Tetanus toxoid immunization Nutrition (including vitamin A, iron, folate supplementation) Treatment of existing conditions or diseases Recognition, early detection and management of complications
before, during and after pregnancy Clean and safe delivery/postpartum care Promotion and support to breastfeeding and management of
breast complications Information services for birth spacing / newborn screening /
psychosocial stimulation
STD/HIV prevention and management Oral health care emergency obstetric care family planning
Essential Health and Nutrition Services forMothers & Unborn
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Resuscitation Routine eye prophylaxis Prevention and management of hypothermia Newborn screening/congenital defects Immediate and exclusive breastfeeding Complementary feeding at six months Prevention and management of infection Birth registration Birth weight and growth monitoring and promotion Full immunization
Micronutrient supplementation Oral care Development milestone screening Advice on psychosocial stimulation
Essential Health and Nutrition Services forNewborns and Infants (0 11 months)
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Growth monitoring and promotion Nutritional screening
Micronutrient supplementation
Developmental milestone screening
Disability detection
Integrated management of childhood illness
Oral Care
Counseling on accident prevention and use of safe toysand psychological stimulation
First Aid
Essential Health and Nutrition Services forEarly Childhood (1- 5 years)
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Management of Childhood Illness Regular medical/dental check-up Injury prevention Counseling on personal hygiene/
healthy lifestyle/life skills Deworming Nutrition and diet counseling Counseling on fertility awareness
Growth monitoring (BMI) Healthy lifestyle Audiovisual screening/disability
detection
Essential Health and Nutrition Services forMiddle Childhood (6 - 9 years)
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Management of illness Counseling on substance abuse, sexuality
and reproductive tract infections Nutrition and diet counseling
Mental Health and coping mechanisms Fertility awareness and responsible sexual
behavior Injury prevention
Regular medical and dental check-up Tetanus Toxoid immunization (females) Iron/folate supplementation (females)
Essential Health and Nutrition Services forAdolescents and Youth
E ti l h lth d t iti i f
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Essential health and nutrition service for
the Pre-pregnant Woman
Iron /folate supplementation
Tetanus toxoid immunization
Deworming, oral health
Counseling on fertility awareness, responsibleparenthood, birth spacing, informed choice,consequences of abortion
Counseling on nutrition and healthy lifestyle
Diagnostics: Hgb, urinalysis, TB screen, pregnancytest
Therapeutic services
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Family / Community Behavior
Handwashing
use of safe water
Use of sanitary toilet
Use of iodized salt / fortified foods
Timely care seeking Regular check-ups
Effective parenting/child rearing
Life skills
Family nutrition Home management of diseases
Prevention of domestic violence
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Cross Cutting Issues
Insufficient funding LGU cost recovery schemes : are they
hurting health services
LGU transparency / accountability /
ownership
Sustainability
Human resources / out-migration
Link/reconcile MCH package with
PhilHealth accreditation
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Cross Cutting Issues Data Management collection, analysis,
validation, feedback Sensitive MCH indicators
NGOs, organization partners in the real
Sense, not in conflict with DOH policies and MCHmessages
communication issues effective message,
approaches, target groups, quality service delivery increasing access, improving
quality & increasing utilization
community involvement & support
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Goals/ultimate outcomes
Proximate outcome:High coverage/utilizationof quality services
Demand side:
- information- non-monetary costs
- subsidies
- preferences
Supply side:
- availability ofessentialand specializedservices
- high quality of services
- expanded network of
service outlets
- commodity securityFinancing
Regulation
Framework for Strategic Planning
National and LocalGovernance
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Broadstroke Strategies and
Activities
Based on Fourmula One
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Broad strokes: MCH Strategic
Directions
Goals
By 2015, Reduction of Underfive Mortality by 2/3
Reduction of Maternal Mortality by 3/4
Reduction of Underweight Children by1/2
Based on MDGs
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Proximate Outcomes
Increased in proportion of facility-based deliveries
Increased proportion of births attended by healthprofessionals (MDs, RHs, MWs)
Increased early initiation of breastfeeding withinone hour
Increased exclusive breastfeeding up to 6 months
Increased proportion of infants receiving
appropriate complementary foods at 6 monthswhile continuing breastfeeding
Increased proportion of fully immunized children
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Proximate Outcomes
Increased proportion of sick children
underfive yrs old receiving integrated
management of illness
Increased care seeking
Increased proportion of children receiving
vitamin A supplements
B d St k St t i d ti iti
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Broad Strokes: Strategies and activities
Governance
Improving technicalleadership andmanagement capability
Devt. of new policies & guidelines(i.e. adoption of Mother & Child Book,Male Involvement in RH, FacilityBased Delivery)
Institutionalzing MDR Updating existing policies, i.e. EPI, SM New policies on perinatal health,
disabilities, congenital birth defects Dissemination and translation into
actions Improving procurement and financing
systems, e.g. Vit.A Strengthening multisectoral
partnerships Strengthening monitoring, evaluation,
research Develop tracking system for progress
and accountabilities of LGU Improve information management
Develop MCH advocacy package forLGUs
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Service delivery
Improving qualityand efficiency
Upgrading facilities for
specialized services and astraining units,e.g. EmergencyObstetric care (EmOC)
Instituting standard ClinicalPractice Guide (CPGs) for FP,SM, etc.
Improving human resourcecapabilities
Link health facilities with thecommunity
Strengthen public health
interventions in hospitals Intensify disease prevention and
control
Provision of essential MCHdrugs and commodities
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Service Delivery
Improvingaccessibility andavailability of basic /essential / specialized
services
available servicedelivery points, e.g.adolescents,
Developing specialapproaches/package of
services for:Indigenous People(IPs), displaced childrenand mothers,emergency situations
Tracking system andcase holding, follow updropouts/defaulters
Systematic outreachservices
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Service Delivery
Engaging and
empowering
families and
communities
Community-based
interventions, i.e
health and nutrition
posts, Botika SaBarangay (BSBs)
Communication for
behavioral and social
change
Creating an educated
demand for services
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Regulation
Assuring access toquality and affordablehealth products andservices
Harmonizing Sentrong Siglastandards with Philhealthaccreditation
Strict enforcement of laws. i.e.Milk Code, ASIN Law, Food
Fortification Law, NewbornScreening Law
Harmonizing and streamlininglicensing, certification andaccreditation, e.g. MBFHI, NBS
Assure low priced commoditiesand drugs
Seal of approval system, e.g.Sangkap Pinoy. Diamond Seal
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Financing
Ensuring health carefinancing support forchildren with bias to thepoor
Multiyear planning andbudgeting for priority program,e.g. EPI
Enrolment in Philhealth/indigency program
Expand private sectorparticipation
Explore other financingmechanisms, user fees, vouchersystem
Maternal and child survivalshould be made part of povertyreduction strategies, socio-economic development plans,sector-wide approaches
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Investments for Maternal, Child & Adolescent
Health for 5 years: (2006-2010)
I. Maternal Health : P 17,166,959,750.00
GOP 649,811,700.00
TBI 509,420,000.00WORLD BANK 802,367,300.00
UNFPA 20,000,000.00
LGU 15,185,360,750.00
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Investments for Maternal, Child & Adolescent
Health for 5 years: (2006-2010)
II. Child Health : P2,772,763,327.00
GOP 2,572,504,454.00A to Z 3,750,000.00
UNICEF 250,000.00
TBI 884,556.00LGU 195,374,317.00
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Investments for Maternal, Child & Adolescent
Health for 5 years: (2006-2010)
III. Adolescent Health : P 13,768,000.00
GOP 300,000.00UNICEF 150,000.00
UNFPA 5,000,000.00
TBI 8,318,000.00
TOTAL : P19,953,491,077.00
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