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BuildingbridgesAJointUnitedNationsProgramme tosupport
RMNCAHinVanuatu
ApIsai Tokon, National Coordinator RMNCAH programme
12th PSRH Conference Port Vila
13-19 July, 2017
VanuatuArchipelago
83islands6provinces
“Somanycallit
paradise-
Wecallit
home”
Countryoverview- Vanuatu
…istheworld'smostat-riskcountryfornaturalhazards,withhighestvulnerabilityranking(WorldRiskIndexReports2014/2015)
…stillisinthelistofleastdevelopedcountries(UNDepartmentofEconomicandSocialAffairs,2016)
butinthevisiontobeupgradedtoMICstatusin2020
…
Countryoverview(TheStateoftheWorldChildrenReport2016)
• Totalpopulation:265,000• GNIpercapita- 3160(US$)• Lifeexpectancyatbirth,years– 72;• Annualnumberofbirths– 7000• Totaladultliteracyrate- 84%
• Lowbirthweightrate- 10%(2009-2013);• EarlyinitiationofBF– 85%• Exclusivebreastfeeding<6months- 73%• Introductionofsolid,semi-solidorsoftfoods(6-8m)-72%• Breastfeedingatage2- 49%
Countryoverview(TheStateoftheWorldChildrenReport2016)
• U5MR36(1990)– 28(2015)• IMR- 29(1990)23(2015)• NMR- 12(2015)
• Stunting- 29%• Underweight- 11%• Wasting4%• Overweight- 5%
Countryoverview- Keypoints
• Halfofpopulationisunderageof24;threequarterslivinginruralareas;
• Populationgrowthrateof2.2percent,fertilityrateis3.35birthperwoman(2014);
• 29%ofpregnanciesarereportedlyunplanned(17%mistimedand12%unwanted).
• oneofthehighestadolescentbirthratesinthePacificregion;womenaged15–19reportedthehighestproportionofunplannedbirthsat40%;
• Prevalenceofsexualabuseagainstyounggirlsisalsohigh;• Lowdensityoffrontlinehealthworkerstopopulationat1.7per
1,000population– wellbelowtheWHO’scurrentrecommendedrateof2.1;
• CountrymetMDG6relatedtargetonHIV/AIDS,malariaandotherdiseases,whilefailedtoprogressonMDG4(toreducechildmortality)andMDG5(toimprovematernalhealth).Similartoothercountriesintheregion,facesa“doubleburdenofdisease”situation
• 2.5-yearprogrammetoimprovereproductive,maternal,newborn,childandadolescenthealth(RMNCAH)systemsandoutcomes,withcorefundingprovidedbyAustralianDFAT;
• InVanuatu,theUNJPforRMNCAHwaslaunchedin2015;
• StartoftheprogrammecoincidedwithTCPamandpeakofpoliticalinstabilityandrelatedturmoilinseniorleadershippositionsinthecountry.
• Thoseconditionsdelayedrealonsetofimplementationprocesstillearly2016.
• FullimplementationofallthreecomponentsoftheUNJPstartedin2016.
UNJPonRMNCAH
UNJPonRMNCAHinVanuatu
Alignedwithglobalstrategiesandinitiatives
UNJPONRMNCAHSupportsnationalpriorities
Organizationalre-structuring:
•DelegationofplanningandmanagementofhealthservicestotheProvinciallevel(decentralisation)
• Strengthenedfinancialmanagementandhealthfinancing,transparencyandaccountabilityatalllevels.
Bettercoordinationwithpartners
Strengtheningofinternational,regionalandsub-regional partnerships
Developmentofoperationalandstrategicplanningprocesses
UNJPONRMNCAHThreeProgrammecomponents:
Component1:ImproveselectedRMNCAHservicesandoutcomes• supporttoaddresscriticalgapsinservicesbasedonneeds andgaps
analysisComponent2:HealthSystemsStrengtheningthroughRMNCAH
• Improvingpolicy,planning,budgetingandmonitoringsystemsbothatnationalanddecentralisedlevel
Component3:DevelopinganimprovedUNbusinessmodel•increaseefficiencyandeffectivenessofUNsupport;•IntegrateUN-supportedplansintogovernmentplansandbudgets
ComponentOne:ImproveselectedRMNCAHservicesandoutcomes
– Focusonaddressingcriticalgapsinservicesbasedonneedsandbottleneckanalysisconductedin4pilotprovinces,andnationwide.
– Supportprovidedmostlyatthedecentralizedlevel,through channelingDCTtothePHMofficeandusinggovernmentimplementationmodalitiesinlinewithPFMsystem.
– Priorityinterventionareas:ASRH,FP,MNH,Childhealthandnutrition;• ASRH– 5prongedapproach;• FP- TOTonupdatedFPpackageandintroductionoflong-lastingmodernmethods;
• MNC- deathauditsinpriorityprovincesandestablishmentofMCDSRcommitteeatMOH;
• Childhealthandnutrition- EPIandlinkingWASH,health andnutritionprioritiesatthecommunitylevel.
Measuringprogress:ComponentOne
• 2outof4performanceindicatorsexceededannualtargets–onnumberofusersofmodernFPmethodsandonEPI(81%measlescoverage);
• Adolescentfertilityrate-relatedindicatorhasshowngoodprogressin4th quarterofyear,whenactualimpactofUNJPactivities,whichstartedin2016,couldbemeasured(49againstannualtargetof57).
• Theannualtarget onnumberofANCvisitswerenotmet,whiletheconcernwasnotonlythenumbers,butalsoqualityofservicesprovidedduringthosevisitswhichtheUNJP/Governmentcollaborationattemptedtoresolvethroughcomponent2interventions.
Sanma
ComponentTwo:ImprovingRMNCAHpolicy,planning,budgetingandmonitoring
systemsatnationalandprovinciallevels
RMNCAH/healthcoordinationhavebeenstrengthenedatthenationallevelandprovincialcommitteesestablishedinthefourpilotprovinces;
• RMNCAHstrategyfor2017–2020finalizedandapprovedwithwith four-yearimplementationplan,aligningwiththeNationalStrategicDevelopmentPlanforVanuatufor2017–2030andSDGs2030.
• MajorprioritiesoftheRMNCAHstrategyincorporatedintothe2016healthsectorbusinessplan.
• FPnationalguidelinesdevelopedfollowedbydeliveryofnationalToT inpreparationforscale-upin2017.
• nationalYFHSguidelinesdevelopedandToT capacitybuiltinlinewithnewguidelinesatthenationallevelandcoveringallsixprovincesinpartnershipwiththeUNDPMillenniumDevelopmentGoal(MDG)AccelerationFrameworkproject.
• Developmentofcomprehensivenationalmaternalandnewbornhealthguidelines isunderwaythatincorporateANC,intrapartumcare,includingemergencyobstetricandneonatalcare(EmONC), postpartumcare,preventionofmother-to-childtransmission(PMTCT)andmaternalandchildnutrition,aswellasrelatedwaitinghomespolicy.
ComponentTwo(cont’d):ImprovingRMNCAHpolicy,planning,budgetingandmonitoring
systemsatnationalandprovinciallevels
• Nationalmaternalandchilddeathsurveillanceandresponse(MCDSR)committeeestablishedatMoH toimprovesystematicanalysisofandreportingoncausesofmaternal,newbornandchilddeaths.
• Nutritionpolicyfinalizedandapproved;maternalnutritionandIYCFguidelinesdevelopedandvalidated,TOTconductedonthisbasisforfurthercapacitybuildling atprovincial levels;IMAMguidelinesareunderrevisionforprovincialrolloutaswell.
• NationalRMNCAH coordinationcommittee meetsmonthlytodiscuss criticalissuesrelatedtohealthsystembottlenecksandservicequalitywiththeinvolvementofkeygovernmentofficialsfromthePrimeMinisterOffice,DepartmentofStrategicPlanningPolicyandAidCoordinationanddevelopmentpartnersthatincludedUNagenciesandNGOs.Provincialcoordinationcommitteesestablishedinpilotprovinces bridgingcommunityneedswithprovincialandnationalhealthmanagement.
• RMNCAHUNJPsupportedhumanresourcesgapsassessmentfollowedbythesubmissiontoMOHrecommendationsforshort- andlong-termsolutions.
• Needs- andgaps-basedRMNCAHsupplyinventoryconductedinpartnershipwithbilateralDFATsupporttoMoH.
Penama
Measuringprogress:ComponentTwo
Allthreeindicatorsmetandexceededannualtargets:• Onenationalandfourprovincialplanscomparedwithatargetoftwoprovincialplansweredeveloped,costedandbudgetsreflectedinthehealthsectorbusinessplanfor2016–2017.
• Morethan50percentofgapanalysisactions,comparedwithatargetof30percent,wereprioritizedandactionedinhealthsectorbusinessplan.
• TheRMNCAHcoordinationcommitteechairedbygovernment/MOHmetmorefrequentlythanplanned(10timescomparedwithatargetof4 meetings),tosetthenationalstrategicdirectionforRMNCAH.
ComponentThree:DevelopinganimprovedUNbusinessmodel
• JointworkaroundthesharedRMNCAHagendaamongthethreeUNagencieswasstrengthenedusingjointprogramme funding,planningand implementationandmonitoring;
• “Oneplan,onebudget,onesystem”principleappliedincreasingeffectivenessofMOHworkwithUNpartners;
• Nationalanddecentralizedplanningandmicro-budgetingonRMNCAHimproved;• Regularconsultationsthroughface-to-faceandvirtualmeetingswereheldbetween
UNJPpartnersandRMNCAHcoordinatorsatthenationalandprovinciallevelstoaddresssystembottlenecksandsupporttoprogramme implementation;
• QualityassurancestandardswereestablishedthatalignedwithUNandGoV planning,reportingandfinancingprocedures.
• LinkageswithinMOHandwithrelatedgovernmentinstitutionsstrengthenedaroundRMNCAHagenda.AnnualreviewmeetingonRMNCAHUNJPtodefinestrategicdirections heldinDec2016thewasagoodexampleofthatbeingchairedbyPMOrepresentativesandMoH directors,representedbyprovincialtamsfromallsixprovinces,includingmanagers,RHfocalpoints,hospitalstaffandRMNCAHcoordinators,aswellasnursingschool;NGOs,UNagenciesanddonoragencies.
Shefa
Measuringprogress:ComponentThree
All2016targetsforComponent3aremet:• AllUNJPforRMNCAHactivitiesfor2017wereincorporatedintothehealthsectorbusinessplan;
• Adhocactivitiesnot-reflectedinhealthsectorbusinessplanminimized(onlyonein2016);
• AllTAagreementsrelatedtotheUNJPforRMNCAHwereprocessed asplannedwhile67percentcompletedand33%(long-termassignments)arecurrentlyongoing.
Malampa
SowhatisbeingbridgedbyRMNCAHUNJP?
• ….generations/targetgroups- applyinglifecycleapproachtoprogramming;
• …differentlevelsofhealthsystem- ensuringcontinuumofcare;• ….nationallevelwithprovinces;provinceswithareacouncilsand
communities;• ….UNagencieswithgovernment–bringingtogethercomparative
advantagesofeachtomeetthecountryneeds;• ….UNagenciesamongthemselves- aroundthesharedagenda–
avoidingduplicationsandgapsinsupport;• …DifferentsectorsoftheMOH- RH,Childhealth,EPI,Nutrition,
WASH,NCDs– talkingtoeachothertohavestrongerimpact;• …MOHwithothergovernmentsectorsresponsibleforsocial
determinantsofhealth/RMNCAH(geographicandfinancialaccess,safedrinkingwaterandsanitationfacilities,foodsecurity,communityresiliencetoemergenciesetc)
• …andNGOsreachingthehardtoreachcommunities…
AnnualReviewMeetingRMNCAH2016
ANNUALREVIEWMEETINGRMNCAH2016
ACKNOWLEDGEMENTTOTHERMNCAHTEAMOFVANUATUNATIONALGOVERNMENT/SECTORS/PROVINCES/COMMUNITIES
UNJOINT&PARTNERS
TANKYU
TUMAS