koki agarwal, director rebecca levine, program officer maternal and child health integrated program...
TRANSCRIPT
Koki Agarwal, DirectorRebecca Levine, Program Officer
Maternal and Child Health Integrated Program
Lives Saved Tool: Using LiST for Maternal, Newborn, and Child
Health Advocacy
The Maternal and Child Health Integrated Program (MCHIP)
•USAID Bureau for Global Health’s flagship maternal, newborn and child health program
•Working in well over 30 countries worldwide
•MCHIP supports programming and opportunities for integration in:
• Maternal, Newborn and Child Health•Immunization, Family Planning, Malaria, HIV/AIDS•Wat/San, Urban Health, Health Systems Strengthening
Session Outline
•Advocacy Tools for Global Health•Overview of Lives Saved Tool (LiST)•Benefits & Limitations of LiST•How LiST has been used for Global Health Advocacy•How MCHIP has used LiST for Advocacy•Recommendations based on Experience
GLOBAL HEALTH ADVOCACY
TOOLS
What Tools Exist for Global Health Advocacy?• REDUCE
An advocacy model for reducing maternal mortality, morbidity, and disability. Developed by the SARA Project. Safe Motherhood Model
A computer program to examine the impact of maternal health services on the maternal mortality ratio
• ALIVE An advocacy model for saving newborn lives
• Marginal Budgeting for Bottlenecking (MBB) Aims at estimating the potential impact,
resources needs, costs and budgeting implications of country strategies to remove implementation constraints of the health system.
WHAT IS THE LIVES SAVED
TOOL?
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Goal of LiST To promote evidence-based decision making and aid in the planning for expansion of maternal, neonatal and child health interventions
ObjectivesTo estimate potential lives saved when introducing or scaling up key MNCH interventions
The Lives Saved Tool - LiST
The Lives Saved Tool - LiST The Lives Saved Tool
A computer-based software that models multi-causes of mortality
Predicts changes in Under-five and neonatal mortality rates and deaths Maternal mortality ratios and deaths Causes of death
Based on changes in health intervention coverage levels
Using Country specific fertility and HIV information and
trends Country specific health status information Effect sizes of interventions (based on RCT studies) Baseline intervention coverage values (60+)
Which Interventions Are Included? Proximal factors
Not distal (being equal) Work through health programs
Not included: income, education and crowding, etc. Water and sanitation are the exceptions
Feasible in a low income country 68 priority countries with highest MNCH mortality
Cause-specific evidence of effect Research studies or systematic reviews Delphi method if research is impossible (i.e. CEmOC) Updated as new evidence is published Several published International Journal of Epidemiology
(Apr 2010)
Intervention Types Maternal, neonatal, child
ex. AMTSL, Neonatal Resuscitation, Rotavirus vaccine
Periconceptional, antenatal, birth, immediate postnatal, childex. Folic acid supplementation, IPTp malaria, delivery care, routine postnatal care, antimalarials
Preventive, curativeex. Vitamin A, Pneumonia case management
Immediate, time-laggedex. ORS, breastfeeding
What’s NOT Calculated in LiST? Education Motivation Gender issues Economic status Emergencies (i.e. famine, flooding) Delivery mechanism Quality of care
What Information Can LiST Provide?
Number of deaths Total, by cause, by age group
Mortality rates/ratios (NMR, U5MR, MMR) Deaths averted (Lives Saved)
Total, by cause, by intervention, by age group
Intermediate outcomes Stunting, breastfeeding
Displays (over a chosen period of time) Tables, graphs, pie charts Single country, multiple scenarios within
one country Multiple countries, single or multiple
scenarios
Some Limitations of LiST Data availability
• If no baseline, can’t evaluate impact accurately
Data quality User Friendliness Sensible scale up targets
• Feasible, acceptable, funds available Interventions included in software Costing/budgeting considerations*
* Links to existing costing tools including MBB and the WHO supported costing tool for child survival are being developed
Using LiST for Advocacy
The Lancet South Africa series –
August 2009 The Lancet, Volume 374, Issue 9692, Pages 835 - 846, 5 September
2009
PMTCT-Dual therapy-Appropriate feeding
NEONATAL -Obstetric care packages-Resuscitation-Kangaroo mother care-Facility case mx of neonatal illness
12,200 lives saved
in 2015
37,000 lives saved
in 2015
Source: Chopra M, Lawn et al Lancet 2009
"We cannot allow a single…neonate to die because of our negligence...it will be criminal for us to allow any of these things to happen. “Minister of Health Dr Aaron Motsoaledi, South Africa
National situation analyses for newborn health in Africa
National as well as sub-national analysise.g. 36 states in Nigeria, 3 regions in Mali, South Sudan
“Science in Action” African Science Academies Development Initiative
http://www.nationalacademies.org/asadi/2009_Conference/PDFs/ScienceInActionFullReport.pdf
Coverage of skilled attendance at birth <30% 31-60% >61% TOTAL
9 example countriesEthiopiaNorthern Nigeria
Ghana, KenyaSenegal, Uganda,Tanzania
CameroonSouth AfricaSouthern Nigeria
Total maternal, neonatal, and child lives saved 903,400 606,000 310,200
1,819,700
Percentage reduction in deaths with 90% coverage 79% 90% 59% 78%
Country specific lives saved and cost for:- Births in facilities – achievable missed opportunities to save lives- Outreach or community interventions – achievable increases (20%)- For Ethiopia, Kenya, Nigeria, Uganda, Tanzania, Senegal, Cameroon, South Africa
MCHIP & LiST
How LiST is being used at MCHIP
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Strategic PlanningStrategic Planning for country workplans Which interventions are necessary to reduce
mortality? (maternal, neonatal, under-5)
Based on feasible targets, what potential reduction in mortality will our program have?
Can counteract current emphasis on one-size-fits-all intervention packages, by suggesting which specific interventions are more likely to have an impact in different contexts
Helping to Reach MDG 4 in Zimbabwe:
Under 5 Mortality Rate
Implementation begins in 2010
Zimbabwe Current Trend Zimbabwe MCHIP Package
Zimbabwe MDG 4 Target
Zimbabwe 90% Maternal Health Coverage
Helping to Reach MDG 5 in Zimbabwe:
Maternal Mortality Ratio
MDG Goal for Maternal MortalityZimbabwe Current Trend Zimbabwe MCHIP Package
Zimbabwe MDG 5 Target
Zimbabwe 90% Maternal Health Coverage
Decreased Child Deaths in Zimbabwe
How LiST is being used at MCHIP con’t
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Advocacy and Planning
InterventionMost Recent
Survey Target Coverage by
2015
Maternal Lives Saved Cumulatively
2010-2015
Newborn Lives Saved Cumulatively 2010-
2015
MATERNAL & NEWBORN
Antenatal Care 47% 67% 0 100
Skilled Birth Attendance 44% 64%70 2,000
Clean Practices & ENC (Home)* 3.9% 24%
Facility-Based Births 40.1% 60%
4,000 24,000
Essential Care for All Women & Newborns** 20.1% 15%
BeMONC** (Essential Care +) 12.0% 9%
CeMONC** (Essential, BeMONC +) 8.0% 36%
Combined Maternal/Newborn Interventions 4,000 24,000
MCHIP Lessons Learned
& Recommendations
What LiST Is, What LiST Isn’t
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Is Multi-cause mortality
model Mathematic model Models coverage
impacts Potential impact
assessment National or sub-
national planning tool
Discussion points Evidence-based Effective advocacy
tool
Isn’t Truth Probabilistic model Natural history
model Detailed costing or
planning tool Bottlenecks,
budgeting Exhaustive
Food for Thought
Maternal Health Intervention Assumptions: Because of the much smaller numbers of
maternal deaths & the continuing work to determine the impact that some interventions have on maternal survival, LiST may not be the best tool to weigh the relative value of different investments in maternal survival
MH interventions included in LiST are packages that are only effective in reducing mortality if all services are provided at quality
Food for Thought
It is often just as important to show the impact of scaling back interventions that already have high coverage levels (ie. Lives LOST due to roll-back in coverage)
Particularly important for mature interventions (i.e. Immunization, Vit A coverage)
We do not want projections to inadvertently make the case for decreasing funding/coverage for these interventions
Thank you!
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