Review and Mapping of initiatives in Maternal and Newborn Health

Report
Zambia
Accelerating progress in
saving women, newborns and
children
Dr. Joy Lawn MB BS MRCP (Paeds) MPH PhD
Director Global Evidence and Policy
Saving Newborn Lives/Save the Children
DFID Senior Research Fellow, Newborn Health
Countdown Country Working group Co Chair
On behalf of the Countdown Coordinating Committee
#CD2015
Country progress in reducing
maternal mortality (MDG5)
Number of Countdown Countries
(n=73)
40
30
20
10
Bangladesh
Bolivia
Cambodia
China
Egypt
Eritrea
Lao People’s Rep
Nepal
Vietnam
40
18 are African
countries
Mostly African
countries
17
9
All are African
countries
9
0
On Track
Making
progress
Insufficient
progress
Countdown to 2015 report 2012, Figure 1,progress as of 2010
No progress
Number of Countdown Countries (n=74)
Country progress in reducing
under-five mortality (MDG4)
40
37
30
28 are African
countries
20
10
24
All are African
countries
African Countries
Eritrea
Liberia
Madagascar
Malawi
18
0
On Track
Insufficient
progress
No progress
Countdown to 2015, report June 2012, Figure 3, progress as of 2010
Pregnancy and Postnatal Home Visits
Evidence base
Increasing, mainly from Asia, Cochrane review
2009 Joint Statement
by WHO and UNICEF,
co-signatories of Save
the Children and USAID
Policy change
More countries have a policy for mother and
newborn home visits
Still gap in coverage on continuum of
care, and also a data gap
And many implementation research questions
especially in Africa
Lancet paper of the year 2009
Who is Countdown?
A global movement since 2005 of
1. Individuals: Scientists & academics, policymakers, public
health workers, communications experts, teachers…
2. Governments: RMNCH policymakers, Parliamentarians…
3. Organizations:
NGOs, UN agencies,
HCPAs, donors,
medical journals…
And from countries
Linked to Global strategy for Women and Children
and Commission on Information and Accountability
Zambia’s Countdown profile
2012
Mortality and MDG progress
Countdown to 2015 Report. 2012.
Cause of neonatal and child deaths
Leading causes:
Neonatal – 29%
Malaria – 13%
HIV/AIDS – 10%
Pneumonia – 13%
Diarrhoea – 9%
Undernutrition is an underlying cause of child deaths
(note this estimate is country specific for Zambia)
Countdown to 2015 Report. 2012.
Causes of maternal death
Leading causes:
Haemorrhage – 34%
Hypertension – 19%
Understanding the cause of death distribution is
important for program development and monitoring
(note this estimate is for Africa, not country specific)
Countdown to 2015 Report. 2012.
Variable coverage along the continuum of care
BUT only measles immunisation at high coverage
Countdown to 2015 Report. 2012.
Maternal and newborn health
Limited progress for scale up of skilled care at birth
– especially compared with neighbours
Countdown to 2015 Report. 2012.
Maternal and newborn health
High coverage of ANC 1 – but what about ANC 4
and coverage of effective interventions in ANC?
Countdown to 2015 Report. 2012.
Other maternal and newborn
health indicators
Countdown to 2015 Report. 2012.
Review and Mapping of initiatives in
Maternal and Newborn Health in
Zambia
Background
Maternal Mortality in Zambia
Progress & trends towards reducing the
Maternal Mortality Ratio [MMR] to attain the
MDG target of 162 by 2015 in Zambia
ality ratio (Zambia)
Proportion of women (%) attended to by
skilled health workers during birth in Zambia
52%
Maternal dealths/ 100,000 live births
800
729
700
50%
649
600
48%
591
500
46%
400
44%
300
42%
200
40%
200
162
100
38%
1992
0
1992
1996
2001
2007
Source: Zambia DHS data sets
2015
1996
1999
2001
Source: Zambia DHS data sets
2007
slow progress in trends for births with skilled health personnel
(1995 to 2008 with projections to 2015)
100%
CEE/CIS
90%
East Asia and Pacific
80%
Latin America and Caribbean
Middle East and North Africa
70%
Developing countries
60%
Sub-Saharan Africa
50%
South Asia
40%
30%
20%
10%
By 2008 only 13 of 68 Countdown countries had increased skilled
Around 1995
Around 2005
2015 projection
attendance by >10% in the last 20 years
0%
Rapid change now in many countries
Data: UNICEF 2007 (www.childinfo.org) based on a subset of 80 countries with trend data
Ref: Lawn JE et al IJGO 2009
Equity
The narrow bars show
Zambia’s relatively
equitable coverage
found for many
coverage indicators
with exception of
skilled birth attendant,
where almost all the
richest women have
access but only 1 in 5
of the poorest women
Countdown to 2015 Report. 2012.
Continuum of Care
Variable coverage along the continuum of care
BUT only measles immunisation at high coverage
Countdown to 2015 Report. 2012.
Cause of neonatal and child deaths
Leading causes:
Neonatal – 29%
Malaria – 13%
HIV/AIDS – 10%
Pneumonia – 13%
Diarrhoea – 9%
Undernutrition is an underlying cause of child deaths
(note this estimate is country specific for Zambia)
Countdown to 2015 Report. 2012.
Survey results
•116 completed surveys
•Across all districts
Vacancy rates
Use of Best Practice
Source of best practice
Partnerships
INGOs
NGOs/CBOs
Number of survey respondents
Donor Sources
OTHER
Other: 27% smaller; 18% of projects from larger INGO such as Plan, Save the
Children World Vision or ZISSP;
10% GRZ: MOH or MCDMCH ; 4% by JICA ;3% CDC and 3% PEPFAR; 2% each from
UNICEF, EU and ZNAN.
B&M Gates foundation; CORDAID; DANIDA; Irish Aid; NZAID.
4 communities and 4 private partners.
Monitoring and Evaluation
M&E plan in place
Baseline conducted
Types of interventions based on the continuum of care
Focus of training programs
Project surveyed continuing after 2012
Not all countries are the same
Malawi is on track for MDG 4
Under-five mortality rate (UN)
250
Under-five mortality rate (IHME)
Mortality per 1000 live births
Under -five mortality rate (DHS/MICS)
200
Neonatal mortality rate (UN)
Neonatal mortality rate (IHME)
Neonatal mortality rate (DHS/MICS)
150
113
100
104
73
MDG 4 target
50
31
30
0
1990
1995
2000
2005
2010
2015
Year
NMR reducing at 2% per year, double the regional average
Only 5 national paediatricians!
Source:
Zimba
al Malawi:Policy
a decade Planning
of change, HPP journal
in press
More
inE etHealth
supplement Decade of Change for Newborn Survival
Data U5MR from UNICEF www.childmortality.org and Lozano et al Lancet 20101 NMR from Oestergaard et al 2011 PLoS , Malawi DHS 1999, 2000, 2004, 2010 and
and intoIERG
report
panel
and in from
Countdown
MICS 2006. MDG 4 target from Countdown
2015, decade
report
-- 2/3 reduction
1990 U5MR June 2012 report
Changes in skilled birth attendance
for Malawi, 1990-2010
100
90
80
73
Coverage (%)
70
60
55
50
40
30
20
10
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
Increased by 16% over the last 5 years
Multiple approaches both supply and demand
> 30% increase in numbers of nurse/midwives
Source: Malawi DHS 1992, 2000, 2004, preliminary 2010. Malawi MICS 2006
2008
2010

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