Joint Programme Strategy to Improve Maternal and Neonatal Health

1. Joint Programme Strategy to Improve Maternal and Neonatal Health Rapid reduction of maternal and neonatal mortality in selected areas of the Philippines by 2015 UNFPA-UNICEF-WHO-DOH-LGU-DONORS 22 July 2009 Ateneo Medical School

2. Outline of presentation: Background The Three Delays The Joint Programming Approach What We Hope to Achieve Local Experiences

3. International commitments related to MDGs 4 and 5: 1946: Universal Declaration of Human Rights 1976: International Covenant on Social, Economic and Cultural Rights (ICSCER) 1979: Conventions on the Elimination of All Forms of Discrimination Against Women(CEDAW) 1989: Convention for the Rights of Children (CRC) 1994: International Conference on Population and Development (ICPD) 2000 and 2005: Millennium Development Goals (MDG) and the Millennium Summit 2005 and 2008: Paris Declaration on AID effectiveness and the Accra Agenda for Action (AAA)

4. United Nations 2005 World Summit Heads of State and Government pledged to reduce maternal mortality and achieve universal access to reproductive health by 2015. – Summit Declaration

5. The revised MDG monitoring indicators Goal 4: Target 4:Reduce by 2/3 the under-5 MR Improve child health • Under-five and infant mortality rate (MR) • Measles immunization

6. Maternal mortality ratio-MMR reduction by regions (1990 – 2005) To achieve MDG 5, MMR must decline by 5.5 percent/year • Since 1990, annual decline is less than 1 percent (Sub-Saharan Africa and S. Asia = 0.1%) Source: Maternal Mortality 2005 estimates

7. Mothers and newborns (0-28 days) dying every year… Global 560,000 4,000,000 Philippines 4,600 33,620 • Main causes of maternal deaths: • Hypertensive disorderof pregnancy • Post-partum hemorrhage • Pregnancy with abortive outcomes • Main causes of neonatal deaths: • Pre-term • Infection • Asphyxia

8. The Problem: On Target 5A, MMR is statistically “off-track” to meet MDG 5A by 2015 Figure 1. The progress made on MMR, according to surveys Sources: 1993 NDS, 1998 NDHS, 2006 FPS

9. No. newborn deaths Day of Life Newborns 0-1 day 2-7 days 8-14 days 15-21 days 22-30 days 31-42 days Day of maternal deaths after delivery Source: X. F. Li et al., International Joumal of Gynecology & Obstetrics 54 (1996): 1-10 2003 NDHS, Special tabulations Percent of maternal and newborn deaths after delivery 50% of neonates die in the first 2 days of life

10. Comparison of key maternal and neonatal health indicators

11. Utilization of CEmOC:Caesarian Section Rate (2003) Source: 2003 NDHS

12. Pregnancy status in the country: 3.1 to 3.6 Million pregnancies per annum Half (around 1.4 M to 1.9 M) are unintended or unplanned pregnancies 1/3 of which (473,000 to 570,000)end in abortion • Sources: 2006 and 2008 Guttmacher

13. Young mothers…more likely to have complications during labour, higher morbidity and mortality for them/their children. • Teenage Pregnancies are high: • Less educated • Poor household • Regions IV-B, XII, XIII, ARMM Sources: 2003 NDHS, 2002 YAFS

14. How do we prevent mothers from dying? Planned Families Deliveries by: Skilled Health Personnel (MD, nurse, midwife) Easy access to: Emergency Obstetric and Newborn Care (w/ post-partum/ post-natal services)

15. Higher contraceptive use lowers maternal deaths by 25-40 percent Percent of women using contraception Maternal mortality ratio Sources: 2006 Lancet; Prafa N. Sheernivas, et. al

16. Higher deliveries by Skilled Birth Attendants (SBAa) reduce maternal deaths In East and South-East Asian Region:

17. Greater access to EmONC reduces maternal deaths by 40 percent 5:

18. In three decades, Thailand and Malaysia significantly reduced their MMR

19. Source: www.unfpa.org/mothers/obstetrics.htm

20. Why are they dying? What can we do? • Ensure all women access to continuum of care by doctors, nurses, midwives • From pre-pregnancy-family planning/RH • antenatal care, delivery to postpartum and neonatal care • Set-up referral system 1st Delayin recognizing danger signs and in seeking care;

21. Why are they dying? • What can we do? • Available EmONC in strategic sites (consider waiting homes) • Set-up family and community support system thru... • communication system • transport support system • community-basedfinancing (w/ CCT/DSF) 2nd Delay in reaching health facilities

22. Why are they dying? What can we do? • Provide easy access to Emergency Obstetric and Newborn & Newborn Care (EmONC) • Personnel • Equipment • Lifesaving drugs (oxytocin, mag sulfate, antibiotics, etc.) • Mobilized funds (PhilHealth and LGU counterpart) 3rd Delay in receiving appropriate care

23. Why TIME is crucial? Source: BEmOC Training Manual Safe Motherhood Learning Course Module5, UNFPA

24. How will we be working together? Sharing a common vision Convergence of efforts, working in the same site SYNERGY Bringing each others strengths and unique expertise Use of an accelerated approach

25. Joint Programme Goal: To contribute to the attainment of the MNCHN strategy, MDG 5 and the neonatal component of MDG 4 by… rapidly reducing maternal and neonatal mortality in selected areas of the Philippines by 2015.

26. The Joint Programme objectives: Objective 1.To improve and consolidate the quality of pre-pregnancy, antenatal, intra-partum, postpartum/postnatal and neonatal care at all levels, and contribute to appropriate management of continuum of care based on national guidelines; Objective 2.To increase equitable access to and utilization of the continuum of RH information, goods and services in programme priority areas with high maternal and neonatal deaths; Objective 3.To enhance the effectiveness of national and sub-national support to local planning, programme development, implementation and monitoring of the MNCHN strategy.

27. How do we do it?

28. Continuum of Care

29. Role of UN Agencies: • The 3 UN agencies will support adolescent sexual • reproductive health (ASRH), monitoring and evaluation (M and E) • and MNH in humanitarian situations. • UNFPA will pilot demand-side financing in cooperation with • UNICEF and WHO • AusAID will provide technical/financial support (M&E development, CQI through missions, South-to-South cooperation, fellowship)

30. Strategic Approaches and Key Activities • Strengthening political and financial commitment at both national and local levels to reduce maternal and newborn mortalities • Evidence-based standards and tools in strengthening supply side interventions • Improved availability of EmONC services and referral system through Standard Treatment Guidelines • Improved competency among SHPs • Functional two-way referral EmONC system

31. Strategic Approaches and Key Activities 3. Empowered women, mothers and young girls generating demand • Improved knowledge among pregnant women • Improved mechanism of support for pregnant women 4.Institutionalizing sustainable mechanisms in a local system • Improved local health administrative, financial and programme management system. • Improved M & E information and logistics management system to achieve MDG 5 and the neonatal component of MDG 4 and the desired quality of care.

32. Strategic Approaches and Key Activities • Improved technical assistance and guidance • Heightened national and sub-national level public-private engagements • Improved technical assistance to LGUs • Strengthened international level (north-to-south and south-to-south) engagements • Division of labor among UN Agencies • Sustaining the gains and institutionalizing • evidence-based practices

33. We hope to achieve… All EmONC health facilities accredited by Philhealth

34. We hope to achieve… Functional and integrated health service delivery network: CEmONC + BEmONC + Community level services

35. We hope to achieve… More couples able to meet their desired family size

36. We hope to achieve… Midwife Nurse Doctor • All mothers assisted by skilled health professional (MDs, nurses and midwives) during • deliveries/post-partum/post-natal from pre-pregnancy/pre-natal period

37. We hope to achieve… More mothers initiate early breastfeeding for their babies

38. We hope to achieve… Less teenage pregnancies

39. We hope to achieve… • LESS or NO mothers and newborn dying • LESS or NO mothers and newborn suffer from severe complications

40. What evidence-based interventions are captured locally?

41. Outcome: Increased demand for/utilization of comprehensive, high-quality RH Services Increased proportion of pregnant women with at least 4 pre-natal visits * Maydolong and Llorente data for validation MT. PROVINCE** MASBATE E.SAMAR * Lagawe data for validation BOHOL OLONGAPO IFUGAO Note: ** With at least 3 visits

42. Outcome:Increased access to comprehensive, high-quality RH services Percentage of facility-based delivery in 6th CP sites (by Mun) MASBATE BOHOL E. SAMAR MT. PROVINCE

43. CPR-modern in the 6th CP sites (by municipalities) Outcome: MASBATE E.SAMAR OLONGAPO BOHOL Mt. PROVINCE

44. Outcome: Percentage of births attended by skilled health professionals (by 6th CP sites) BOHOL MASBATE OLONGAPO E.SAMAR MT. PROVINCE

45. Impact: Number of maternal deaths (by municipalities/city) E.SAMAR BOHOL MT. PROVINCE MASBATE IFUGAO OLONGAPO

47. 2015 Together, we can do it… before 2015

48. Thank you (Maraming salamat po)!