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EXPERIENCE IN DEVELOPING ONE COUNTRY MNCH PLAN - NIGERIA

HEALTH CARE PROFESSIONAL ASSOCIATIONS WORKSHOP 11TH – 15TH NOVEMBER 2007, Blantyre, Malawi.

Dr Nkeiru Onuekwusi, FMOH Nigeria.

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Out line of Presentation

• Demographic Indicators• Justification• IMNCH strategy• Priority Areas• IMNCH Targets• Cost and impact• Strategic Objectives• Steps for Rolling out• Partnership• Opportunities• Challenges

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Demographic Indicators• 36 states & FCT (774 LGA & 6 Area Council)

• Population -140million (census 2006)– 23% Women of child bearing age– 20% children under five years

• MMR – 800/100,000 live births (NE 1549 & SE 165,)

• U5MR – 201/1000 live births (NW 269 & SE

103)

• NMR – 48/1000 live births (NDHS 2003)

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Justification

• High MMR, NMR & U5MR - weak health system & low coverage of MNCH interventions

• Mother, newborn and child are inseparable Triad

• > 61% of newborn deaths between day 0 and 1: Key role of skilled delivery in maternal and newborn mortality reduction

• Maternal deaths, still births and newborn deaths strongly linked in time, place of death & delay in access to care.

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Trends in U5M rates

230

77

176

195

0

50

100

150

200

250

1990 2000 2004 2006 2009 2012 2015

U5M

rate

s

Current trend MDG target

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Nigeria Trend in Maternal Mortality

250

800

540

0

250

500

750

1000

1990 2000 2004 2006 2009 2012 2015

Mat

erna

l Mor

talit

y R

atio

Current trend MDG target

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The Integrated Maternal, Newborn and Child Health Strategy

• Goal – To reduce maternal, neonatal and child

morbidity and mortality in line with MDG 4 & 5 • Targets

– Reduce maternal mortality by three-quarter from 1000/100,000 LB 1990 base to 250 in 2015

– Reduce U5MR from 230/1000 in 1990 to 77/1000 in 2015

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Guiding principles

• Continuum of care• Integration• Women’s and Child rights (CEDAW, CRC)• Equity• Multi-sectoral collaboration• Partnerships

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Strategic Approaches

• Advocacy• Strengthening of the health system• Empowering families and communities • Organizing operational partnerships• Mobilization of resources

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Selection of key Interventions

• Evidence shows the effectiveness of interventions in reducing maternal, newborn (72%) and child (62%) deaths in developing countries ( lancet series).

•Sixty one (61) interventions out 74 available were selected based on their impact and cost effectiveness to include in the IMNCH strategy

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Priority Areas For Action

• Focused Antenatal Care• Intra-partum Care• Emergency Obstetric and Newborn Care• Routine Postnatal Care• Newborn care• Infant and Young Child Feeding (IYCF)

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Priority areas for action

• Prevention of malaria using ITNs and IPT

• Immunization Plus

• PMTCT

• Management of common childhood illnesses and care of HIV exposed or infected children

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Phasing of implementation• Phase I : 2007-2009

– Immediate removal of major bottlenecks• Phase II: 2010-2012

– implementation will be reinforced at all service delivery modes

• Phase III: 2013-2015– 80% effective coverage of clinical

interventions at basic health care, and– 70% at first and secondary referral care

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IMNCH targets: Family/ community

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IMNCH targets: Population oriented

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IMNCH targets: Clinical care

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Cost and impact per phase

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Strategic Objectives• Improve access to good quality health

services

• Ensure adequate provision of medical supplies, drugs etc.

• Strengthen family and community capacity to take necessary MNCH actions

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Strategic Objectives- Contd

• Improve capacity for organisation and management of MNCH services

• Establish financing mechanism that ensures adequate funding & efficient use of funds

• Strengthen monitoring and evaluation systems

• Establish and sustain partnerships to support implementation of IMNCH strategy

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Steps for Rolling Out IMNCH

• Formation of Core Technical Committee• Institutionalization of the Nigerian PMNCH • Targeted Advocacy for IMNCH – Niger state• State/LGA specific situation analysis & needs

assessment – (2 States)• Development of Operational Guidelines to

support Roll Out of IMNCH by State/LGA• Establish State/LGA level MNCH Partnership

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Steps for Rolling Out IMNCH

• Development of States/LGAs IMNCH Plans• Communication & Social mobilization• IMNCH enhancing capacity building for

paradigm shift• Supervision, monitoring & evaluation Plan• Technical Support to States and LGAs for

IMNCH initiation

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Partnership

• Federal – already established• State• LGA and Ward levels• Development partners to buy in at the

level appropriate to their mandate

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PartnershipMembers:• Govts at the 3 tiers• Line Ministries• Agencies, parastatals and “bodies” such as NACA,

MDG.• Medical Institutions• Professional associations• Organized Private Sectors• Relevant NGOs and CBOs at all levels• Donors and International Development Partners • All relevant stakeholders (religious & traditional leaders)

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Partnership

• Ensure coordination for joint programming among stakeholders

• Maximise resources• Promote synergy• Avoid duplication• Achieve success

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Structure of MNCH Partnership for Nigeria

ICC

Core Technical Committee

Advocacy &ResourceMobilisation

Monitoring & Evaluation

State Support& Roll-Out

Technical MembersFrom Constituents

Agencies and ExpertsChaired by Head/FH, FMOH

Heads of Constituents

Agencies

Technical Working Groups

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Opportunities• ICSD & Nigerian Road Map• Leadership of FMOH• Personal commitment – Partners, PAN, others • Health Sector Reform in the context of NEEDS• Debt Relief Grant• National Health Insurance Scheme• Consensus among major stakeholders• Overwhelming evidence from the Lancet series• National Health Bill• Current HMH• GPMNCH visit & advocacy

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Challenges• Government structure (three tiers, FMOH, NPC)• Political commitment at state & LGA levels• Accessing Government Funding (How do we convince the Minister of

Finance to fund Health Interventions as Capital Budget)

• Integration with vertical programmes eg HIV/AIDs and Malaria.

• Coordination• 2008 critical• Human Resource – skills & numbers (CHEWS, NYSC

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Human Resources AvailableDoctors• In the public sector 10% • In residency programmes

9.1%• In private hospitals 55%• Abroad 18%• Outside the profession

7.9%

Increase from new graduates

• Doctors – 16.5%• Nurses – 1.14%• CHOs/CHEWs – 3.25%Attrition rate• Doctors – 2.34%• Nurses – 1.43%• CHOs/CHEWs – 1.44%

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INNOVATIONS• HMH (awesome)

• Creation of Family Health Division in HMH office. (FH as entry point)

• Core Technical Committee

• NYSC for midwives

• IMNCH included in the WMHCP

• National Health Investment Plan

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Let us join hands…

Thank you