DIR. CATIBOG-Maternal and Child Health

7/31/2019 DIR. CATIBOG-Maternal and Child Health

1/44

Maternal and Child Health

Dr. Honorata L. Catibog

Family Health Office - NCDPC

NSM Presentation

September 7, 2006

Pryce Hotel, Cagayan de Oro City


2/44

Overall Health Issues

slow progress in achieving MDGs

IMR / UFMR reduction on track

Under nutrition reduction is slow

MMR reduction is very slow


3/44

Health IndicatorsSelected Asian Countries

Japan So. Korea Malaysia Thailand Philippines

Life

expectancy

81 75 73 70 70

IMR 3 5 8 24 29Underfive

Mortality

5 5 8 28 40

MMR 8 20 41 44 172

Populationgrowth

0.3 0.8 2.2 1.4 2.1

HOWEVER, WE LAG BEHIND OUR ASIAN NEIGHBORS IN TERMS OF

MORTALITY RATES


4/44

Infant Mortality Rate

0

10

20

30

40

50

60

1990 1995 1998 2003 2015

49

35

29

19

57

Source: NDHS,2003


5/44

NDHS, 2003

Infant Mortality by Region

4441

393838

3635

3029

282828

2727

2525

2414

MIMAROPA

Western Visayas

Davao

Caraga

Ilocos

Bicol

Zamboanga Pen.

CALABARZON

National Capital Region

Number of infant deaths per 1000 live birthsNumber of infant deaths per 1000 live births

Cordillera Admin

Central Luzon

SOCCSKSARGEN

Central Visayas

Cagayan Valley

Cordillera Admin

Ilocos

Northern Mindanao

ARMM


6/44

Underfive Mortality

0

10

20

30

40

50

60

70

80

1990 1995 1998 2003 2015

48

80

67

40

27

Source: NDHS,2003


7/44

Under 5 Mortality Rate by Region

NDHS 1993-2003

0

10

20

30

40

50

60

70

80

CAR N

CR 1 2 3 4A 4B5 6 7 8 9 10 11 12

CRG

ARM

Regions

In Thousands

Legend:

higher than national rate 40

Lower than national rateSource: NDHS,2003


8/44

Maternal Mortality Ratio

0

50

100

150

200

250

1990 1995 1998 2015

209

180 172

52

Source: NDHS,2003


9/44


10/44

Assistance at Delivery

8886

7574

68

6060

53484847

4341

3736

3129

22

National Capital Region

CALABARZON

Central Visayas

Cordillera Admin. Region

Bicol

Western Visayas

Northern Mindanao

Eastern Visayas

MIMAROPA

Percent distribution of live births assisted by a doctor, nurse ormidwife

ARMM

Zamboanga

Eastern Visayas

Caraga

Davao

Cagayan Valley

PHILIPPINES

Ilocos

Central Luzon


11/44

Problems in accessing health carewealth index quintile

Reasons lowest second middle fourth highest

Knowing where to go for

treatment27.4 19.2 13.6 10.7 8.6

Getting permission to go

for treatment22.0 12.7 8.4 7.5 6.8

Getting money for

treatment87.1 80.1 73.0 62.9 45.6

Distance to health facility 59.1 33.8 22.2 18.7 13.6

Having to take transport 57.1 32.5 20.3 17.4 12.0

Not wanting to go alone 44.0 28.8 25.2 25.5 22.0

Concern there might not

be a female provider31.5 20.9 18.0 18.5 17.2

Any of the specified

problems93.5 87.1 80.8 73.6 59.7


12/44

Fully Immunized Child &

Hepatitis B Coverage

Phil, 2002-2005

77

38.5

84

45.2

84

45.6

80

0

10

20

30

40

50

60

70

80

90

100

2002 2003 2004 2005

FIC

HepB3

Percent

YearSource: FHSIS & NCDPC


13/44

Status of Malnutrition

Philippines,0-5 yrs old

32

34

6

0.4

27.630.4

5.5

1.40

510

15

20

25

3035

40

45

50

1998 2003

Prop. Underwt for age Prev Underht for age Prev. thinness Prev. overweightPercent

Year

Source: NNS 2003


14/44


15/44

Status of Nutrition

School-Age Children, Phil, 2001 & 2003

33

41

8

26

37

13

0

10

20

30

40

50

2001 2003

Prop. Underwt for age per 100school-age children

Prev Underht for age per 100school-age children

Overwt per 1,000 school-agechildren

Percent

Year

Source: NNS 2003

P l f d f i


16/44

Prevalence of degree of anemia

among different population groups,

2003

67.5

21.3

10.9

0.3

62.7

27.9

9.1

0.3

56.1

2518.6

0.3

57.8

23.9

17

1.30

1020

30

40

50

60

70

80

90

100

6 mo-5y 6-12 y Pregant Lactating

Normal

Mild

Moderate

Severe

Percent

Population Groups

Source: FNRI-DOST


17/44

(Place of Delivery)

38

61

54 46

22

77

Philippines Urban Rural

Health Facility

Home

Percent

distributionof live births

in the 5

years before

the survey

Maternal Care


18/44

Maternal Care

(Place of delivery) 38% of live births were delivered in a

health facility and 61% were born at home.

(NDHS 2003)

Increase compared to 34% in 1998

(NDHS) & a decline in the home deliveries

(66% NDHS 1998)


19/44

Assistance at Delivery

3734

25

2 1 1

Hilot Doctor Midwife Relative/

Friend/

Other

Nurse No one/

missing

Percent

distribution oflive births in

the 5 years

preceding the

survey


20/44

Delivery Assistance

60% of deliveries assisted by health

professionals (2003 NDHS) :

34% deliveries assisted by doctors

25% by midwives

1% by nurses

Increased from 56% (1998) but still low vis avis the 80% target in 2004


21/44

Antenatal, natal and post natal care

Tetanus toxoid immunization Nutrition (including vitamin A, iron, folate supplementation) Treatment of existing conditions or diseases Recognition, early detection and management of complications

before, during and after pregnancy Clean and safe delivery/postpartum care Promotion and support to breastfeeding and management of

breast complications Information services for birth spacing / newborn screening /

psychosocial stimulation

STD/HIV prevention and management Oral health care emergency obstetric care family planning

Essential Health and Nutrition Services forMothers & Unborn


22/44

Resuscitation Routine eye prophylaxis Prevention and management of hypothermia Newborn screening/congenital defects Immediate and exclusive breastfeeding Complementary feeding at six months Prevention and management of infection Birth registration Birth weight and growth monitoring and promotion Full immunization

Micronutrient supplementation Oral care Development milestone screening Advice on psychosocial stimulation

Essential Health and Nutrition Services forNewborns and Infants (0 11 months)


23/44

Growth monitoring and promotion Nutritional screening

Micronutrient supplementation

Developmental milestone screening

Disability detection

Integrated management of childhood illness

Oral Care

Counseling on accident prevention and use of safe toysand psychological stimulation

First Aid

Essential Health and Nutrition Services forEarly Childhood (1- 5 years)


24/44

Management of Childhood Illness Regular medical/dental check-up Injury prevention Counseling on personal hygiene/

healthy lifestyle/life skills Deworming Nutrition and diet counseling Counseling on fertility awareness

Growth monitoring (BMI) Healthy lifestyle Audiovisual screening/disability

detection

Essential Health and Nutrition Services forMiddle Childhood (6 - 9 years)


25/44

Management of illness Counseling on substance abuse, sexuality

and reproductive tract infections Nutrition and diet counseling

Mental Health and coping mechanisms Fertility awareness and responsible sexual

behavior Injury prevention

Regular medical and dental check-up Tetanus Toxoid immunization (females) Iron/folate supplementation (females)

Essential Health and Nutrition Services forAdolescents and Youth

E ti l h lth d t iti i f


26/44

Essential health and nutrition service for

the Pre-pregnant Woman

Iron /folate supplementation

Tetanus toxoid immunization

Deworming, oral health

Counseling on fertility awareness, responsibleparenthood, birth spacing, informed choice,consequences of abortion

Counseling on nutrition and healthy lifestyle

Diagnostics: Hgb, urinalysis, TB screen, pregnancytest

Therapeutic services


27/44

Family / Community Behavior

Handwashing

use of safe water

Use of sanitary toilet

Use of iodized salt / fortified foods

Timely care seeking Regular check-ups

Effective parenting/child rearing

Life skills

Family nutrition Home management of diseases

Prevention of domestic violence


28/44

Cross Cutting Issues

Insufficient funding LGU cost recovery schemes : are they

hurting health services

LGU transparency / accountability /

ownership

Sustainability

Human resources / out-migration

Link/reconcile MCH package with

PhilHealth accreditation


29/44

Cross Cutting Issues Data Management collection, analysis,

validation, feedback Sensitive MCH indicators

NGOs, organization partners in the real

Sense, not in conflict with DOH policies and MCHmessages

communication issues effective message,

approaches, target groups, quality service delivery increasing access, improving

quality & increasing utilization

community involvement & support


30/44

Goals/ultimate outcomes

Proximate outcome:High coverage/utilizationof quality services

Demand side:

- information- non-monetary costs

- subsidies

- preferences

Supply side:

- availability ofessentialand specializedservices

- high quality of services

- expanded network of

service outlets

- commodity securityFinancing

Regulation

Framework for Strategic Planning

National and LocalGovernance


31/44

Broadstroke Strategies and

Activities

Based on Fourmula One


32/44

Broad strokes: MCH Strategic

Directions

Goals

By 2015, Reduction of Underfive Mortality by 2/3

Reduction of Maternal Mortality by 3/4

Reduction of Underweight Children by1/2

Based on MDGs


33/44

Proximate Outcomes

Increased in proportion of facility-based deliveries

Increased proportion of births attended by healthprofessionals (MDs, RHs, MWs)

Increased early initiation of breastfeeding withinone hour

Increased exclusive breastfeeding up to 6 months

Increased proportion of infants receiving

appropriate complementary foods at 6 monthswhile continuing breastfeeding

Increased proportion of fully immunized children


34/44

Proximate Outcomes

Increased proportion of sick children

underfive yrs old receiving integrated

management of illness

Increased care seeking

Increased proportion of children receiving

vitamin A supplements

B d St k St t i d ti iti


35/44

Broad Strokes: Strategies and activities

Governance

Improving technicalleadership andmanagement capability

Devt. of new policies & guidelines(i.e. adoption of Mother & Child Book,Male Involvement in RH, FacilityBased Delivery)

Institutionalzing MDR Updating existing policies, i.e. EPI, SM New policies on perinatal health,

disabilities, congenital birth defects Dissemination and translation into

actions Improving procurement and financing

systems, e.g. Vit.A Strengthening multisectoral

partnerships Strengthening monitoring, evaluation,

research Develop tracking system for progress

and accountabilities of LGU Improve information management

Develop MCH advocacy package forLGUs


36/44

Service delivery

Improving qualityand efficiency

Upgrading facilities for

specialized services and astraining units,e.g. EmergencyObstetric care (EmOC)

Instituting standard ClinicalPractice Guide (CPGs) for FP,SM, etc.

Improving human resourcecapabilities

Link health facilities with thecommunity

Strengthen public health

interventions in hospitals Intensify disease prevention and

control

Provision of essential MCHdrugs and commodities


37/44

Service Delivery

Improvingaccessibility andavailability of basic /essential / specialized

services

available servicedelivery points, e.g.adolescents,

Developing specialapproaches/package of

services for:Indigenous People(IPs), displaced childrenand mothers,emergency situations

Tracking system andcase holding, follow updropouts/defaulters

Systematic outreachservices


38/44

Service Delivery

Engaging and

empowering

families and

communities

Community-based

interventions, i.e

health and nutrition

posts, Botika SaBarangay (BSBs)

Communication for

behavioral and social

change

Creating an educated

demand for services


39/44

Regulation

Assuring access toquality and affordablehealth products andservices

Harmonizing Sentrong Siglastandards with Philhealthaccreditation

Strict enforcement of laws. i.e.Milk Code, ASIN Law, Food

Fortification Law, NewbornScreening Law

Harmonizing and streamlininglicensing, certification andaccreditation, e.g. MBFHI, NBS

Assure low priced commoditiesand drugs

Seal of approval system, e.g.Sangkap Pinoy. Diamond Seal


40/44

Financing

Ensuring health carefinancing support forchildren with bias to thepoor

Multiyear planning andbudgeting for priority program,e.g. EPI

Enrolment in Philhealth/indigency program

Expand private sectorparticipation

Explore other financingmechanisms, user fees, vouchersystem

Maternal and child survivalshould be made part of povertyreduction strategies, socio-economic development plans,sector-wide approaches


41/44

Investments for Maternal, Child & Adolescent

Health for 5 years: (2006-2010)

I. Maternal Health : P 17,166,959,750.00

GOP 649,811,700.00

TBI 509,420,000.00WORLD BANK 802,367,300.00

UNFPA 20,000,000.00

LGU 15,185,360,750.00


42/44



II. Child Health : P2,772,763,327.00

GOP 2,572,504,454.00A to Z 3,750,000.00

UNICEF 250,000.00

TBI 884,556.00LGU 195,374,317.00


43/44



III. Adolescent Health : P 13,768,000.00

GOP 300,000.00UNICEF 150,000.00

UNFPA 5,000,000.00

TBI 8,318,000.00

TOTAL : P19,953,491,077.00


44/44

Documents

DIR. CATIBOG-Maternal and Child Health