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Why invest in maternal, new bornand child health in Nepal?

Presented by:

Samjhana Shrestha(31)Seema Giri (32)

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INTRODUCTION

Investing in maternal new born and childhealth is not only a political and socialimperative for Finance and Health

Ministers, Heads of State and otherpolicymakers, but it is also cost-effective.

Healthy mothers lead to healthy familiesand societies, strong health systems, andhealthy economies.

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,Health: Helps Achieve Health andDevelopment GoalsWomens and childrens health is

valuable in itself 2 of 8 MDGs focus on health of women and children

Saving a pregnant womans life often means saving her newbornbab .

Complement

Interact

Other MDGsNutritionWater andsanitation

TBHIV and AIDSEmpowerme

nt of women

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Investing in Maternal, Newborn and ChildHealth:

There are proven and affordable ways of savingthe lives of women and children

Could prevent about two-thirds of child deaths,

half to two-thirds of newborn deaths and manymaternal deaths.

At least six million children, including two million

babies, and many of the half a million motherswho currently die could be saved globally eachyear .

Ensuring that every pregnancy is wanted bringscost savin s and concrete benefits to maternal

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Investing in Maternal, Newborn and ChildHealth: makes economic sense

.Investing in MNCH:

Saves money reduced health care costs on Preventingillness can save up to US$ 700 million globally per year forchild survival alone

Every dollar spent on family planning saves four or moredollars of spending on complications of unplanned

pregnancies

Generates economic returns: health > cognitivedevelopment > increased productivity

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Investing in Maternal, Newborn and Child Health:has political benefits, including social stability andhuman security

.Investing in MNCH:

Healthy mothers and children contribute to andbenefit from peace and social stability

Minister of Health in Nepal, 2008: visibleimprovement in MNCH directly strengthens peaceprocess

State Failure Task Report 2000: infant mortality ratewas one of three indicators that most directlycorrelated with state crisis and conflict

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Investing in Maternal, Newborn and Child Health:Social and cultural significance

.Investing in MNCH:

A womans poor health pushes her family into furtherpoverty

Mothers survival is linked to the survival of her newbornor her children below five years

Mothers survival is essential for :

o Instilling social and cultural values

o Ensuring education of young girls who otherwise wouldtake on responsibility of the family

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Investing in Maternal, Newborn and Child Health:makes the health system work better

.

Investment in MNCH along continuum of carefrom pre-pregnancy to infancy and beyondstrengthens health system

MNCH access and outcome indicators aresensitive measures of the health system

If a country can provide 24-hour emergency careof good quality for complications during delivery:sign that necessary physical and humanresources are in place.

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Need for investing in Maternal ,

Newborn and Child birth inNepal

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Current status of maternal, new born andchild health in Nepal

Neonatal mortality ;remains a majorconcern 61% of U5 mortality is neonatal61% of U5 mortality is neonatal

72% of72% of deliveries occur at home (NDHS 2011)occur at home (NDHS 2011)

CBNCP and Health facility based newborn care being promotedCBNCP and Health facility based newborn care being promoted

Nutritional status of children in Nepal 41percent of children born are stunted (which needs to be decreased to 29

percent)

Maternal health in Nepal Number of births attended by SBAs remains a challenge .

Currently country has around 2,400 SBAs, it needs toincrease the number to around 6,500. However, the

government lacks a strong commitment on this issue. Trend of using contraceptives in 2011 is 43.2 percenta

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Coverage of Key Maternal, Newborn andChild Survival Intervention (Nepal

Demographic Health Survey 2011)

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6067

PNC: 23% in NDHS 2006 ,recent data notavailable in NDHS 2011

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Current status of maternal, new born andchild health in Nepal

NDHS: 2011DOHS 2066/67

Nutrition

Stunting: 41%Under weight:29%Anemia:78%(6-8mnths)

34.8%(women)46.2%(Children)

Pneumonia

Casefatalityrate :0.1%

DiarrhoeaDeaths dueto diarrhoea:

206

MMR:229per 100000live birthsNMR: 33per 1000live births

IMR:46 per1000 livebirths

U5MR: 54per 1000live births

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What causes maternal and childmortality and morbidity in Nepal?

Coverage of many key interventionsare low

Only 36% of mothers in Nepal have

access to a skilled attendant at birth andaccess to emergency care is inadequate

Many common childhood diseases go

untreated in rural areas. Lack of equity in access to health care.

Lack of trained health workers in rural

areas. 13

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Response to MNCH and Challenges in Nepal

CB-NCP Pilot program

reduction on NMR

CB-IMCI Integrated approach Address five killer

disease

Safe motherhoodprogram

Incentives to Women Incentive to Health

Facility as Institutional

Cost

Incentives to HealthWorkersMMR:229/100000LB,

NMR:33/1000LB,

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Response to MNCH Challenges

Cost

Quality of training Follow up.

Frequent transferred of HF staffand drop FCHVs.

Supportive supervision monitoringat all level

Equity gap

Quality gapANC not full package of services syphilisscreening, prevention of mother to childtransmission etcFP : poor quality with continuing high unmetneeds leading to unwanted pregnancies,unsafe abortions, complications contributing

to Maternal Deaths, frequent stock outs,

Lack of skilled health workersFCHVs drop out

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WAY FORWARD

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Th d

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Three pronged strategy to savelives

Social, cultural, political,

economic factors

Family

planning

Emergency

obstetric care

(EmOC)

Skilled birth

attendants

(SBA) Health systems

Family and

community

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Reproductive, maternal, newborn andchild health continuum of care

H

ouse

hold

Healthfacilities

Communityandoutreach

Adolescenceand beforepregnancy

pregnancy BirthPostnanata

l

Postnatal(Neonatal)

Infancy

Newborn

Motherhood

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Cont

Money alone will not solve the problem, butthree key approaches can have a dramaticpositive impact on the health of women inNepal:

health systems interventions: health

workers efficient financing mechanisms

political partnerships

Investing in maternal health is urgent: not onlybecause giving life should not result in death,but also because women are important

economic drivers and their health is critical to18

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References

NDHS 2011

INVESTING IN MATERNAL, NEWBORN AND CHILD HEALTH

,2009 Maternal Health in South Asia ,UNFPA 2012

Annual report FY 2066/67

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Women are not dying because of thediseases we cannot treat, they are dyingbecause societies have yet to make the

decision that their lives are worth saving.