SM2015 - Reproductive Health Supplies Coalition

Transcript SM2015 - Reproductive Health Supplies Coalition

SM2015 - BELIZE

SM2015 Initiative

Innovative Approaches May 2012

Content — Health profile — Health System SM2015 — Objective — Components — Methodology

Demographic transition

— A reduction in the fertility rate (3.3 to 2.7) and increase in life expectancy (73 years) have resulted in population aging — More than half of the population is below 25 years – 55.6%

Epidemiological transition

— Double burden – increasing non-communicable and degenerative diseases related to lifestyle, behaviors and a longer life-span, combined with the continued occurrence of communicable diseases related to poverty, sanitation, environmental conditions, malnutrition and sexual risk behaviors — NCD’s are among the main causes of morbidity and mortality

Maternal Mortality Ratio 1991-2011

147 101 161 113 82 139 100 134 05 Protocols Training 134 42 82 58 111 64 42 40 04-05 Surveillance system 09 Quality improvement MNC 85 10 Protocols Training 53.9

53.7

43 0 Source: MOH, Health Statistical abstracts — Maternal and infant mortality are low compared to other countries of the region and appear to be declining

Skilled birth attendance is high (96%)

Source: MICS, 2006

Quality improvement of maternal and neonatal care since 2009 Process

— Planning and resource mobilization — Standards and indicators — Training — Policy — Framework — Monitoring tools

Demonstration phase in 2 hospitals

— 70% reduction in neonatal death — 65% reduction in birth asphyxia

Spread to rest of hospitals in 2011

Adapted from

University Research Company LLC

., maternal and neonatal care package [Nicaragua Office]

Monthly monitoring Quality of process of care in all hospitals

Revisited monitoring tool - Post reminders In-service training and practical sessions -Staff sensitization -peer coaching Partograph modified Refresher training at SRH New partograph form Audit sessions with midwives Median =90

‘High season’ Midwife: patient

Strategy sample: random selection and convenience, Source: medical records

Source: MoH, Belize, May 2011

Under-5 mortality rate

Source: MoH, Belize, May 2011

Analysis of protected cohorts against Measles/Rubella by year of birth and Vaccination Strategies 1962-2010 100 90 80 70 60 Rubella Mass campaign (females) (1998) MMR vaccine 5-35 yrs 50 Rubella Mass Campaign (males) (2004) MMR vaccine 5-35 yrs Coverage 97% Measles "Big Bang" (1991) MMR vaccine 9mths-14 yrs Coverage 82% 100 90 80 70 60 50 40 30 40 30 20 10 0 20 10 0 6 9 1 2 6 9 1 4 9 1 6 6 9 1 8 6 9 1 0 7 9 1 2 7 9 1 4 7 9 1 6 7 9 1 8 7 9 1 0 8 9 1 2 8 9 1 4 8 9 1 6 8 9 1 8 8 Year of Birth 9 1 0 9 9 1 2 9 9 1 4 9 9 1 6 9 9 1 8 9 0 2 0 0 0 2 2 0 0 2 4 0 0 0 2 6 0 2 8 0 0 2 0 1 Routine MMR1 coverage 2nd dose MMR 2000 (1-4yrs)95% Measles F/U 1995 (1-4yrs) 85% MMR2 coverage Measles vaccine 1986 (9mths-3yrs) 91% Source: MOH reports to EPI-CAREC

Under nutrition (low height for

age) is persistent among certain populations – MICS2006 Poorest/richest– three fold Indigenous / Maya 12-23 months of age

Stunting in < 5 year old

LSMS 2001 – 17.9

MICS 2006 – 17.6

Stunting Standard I Class

1996 – 13.7

2009 - 12.2

Unmet need for reproductive health

services, and teenage pregnancy is a priority concern

Contraceptive use

prevalence rate MICS2006: 1999 – 56% 2006 – 34

% Adolescent birth rate

/ 1,000 females 15-19 1995 - 99 2010 - 73

Adolescent Health

• • • • • • There were 1,356 live births to mothers in the 15-19 year age group, which represents 18.1% of the total live births. There was an average of 24 live births to mothers under 15 years.

From 2001-2005, there were 145 (41 males and 104 females) new HIV Infections in adolescents 10-19 years 6.9% of total new HIV Infections (16 ) occurred in the 10-14 age group; Early initiation of sexual activity and the prevalence of STIs are public health concerns in this age group. Fourteen suicides and self-inflicted injuries were reported in the 10-19 age group during 2001-2005.

Belize Health Agenda, 2007-2011

Objective

The SM2015 Operation in Belize seeks to:

Increase the coverage of quality reproductive, maternal, neonatal and child health care in the poorest geographic areas and increase the use of information in decision making to reduce neonatal death and increase the use of family planning among adolescents

Where?

National Poverty Assessment, 2009 • Living Standards Measurements Survey • % of poor and indigent households per rural/urban districts

Districts with highest increase in poverty rates

[2001/2009] — Corozal — Orange Walk — Cayo

Component 1: Strengthening use of data to improve MCH service quality

• • • • Expansion of the Collaborative Improvement Model to reduce maternal and child mortality Expansion and Utilization of the Belize Health Information System in decision making at the local level System of facility based-incentives at the MoH Clinics in the Northern and Western Regions for expanding coverage and quality Cross-country exchange and training to improve quality of care

Component 2: Improving Community Based Care

• • • Monitoring and Evaluation of Community Health Workers (CHW) • Currently rolling out community based nutrition initiatives that include breast-feeding promotion, growth-monitoring, and waiting for results to decide about rolling out sprinkles Incentives for Community Health Workers who reach targets • Currently receive $50 US, exploring incentives that would improve working conditions such as Basic supplies and equipment for CHW and developing a recognition system Improved coordination and training of CHW (recognition of high-risk cases)

Component 3: Increasing the Coverage of Reproductive Health Services

• • • Increased access to 5 modern family planning methods Capacity-building in counseling for Patient/Users Differentiated services designed and used by adolescents

Interventions

Making pregnancy safer : Prenatal, postnatal care, skilled birth attendance, managing complicated pregnancy, childbirth and patients in postnatal period, managing complications Immediate and routine newborn care, Managing Complicated neonates Multiple micronutrient supplementation: females 15-49, children Fortified food: pregnant women and children Growth promotion and development: community, facilities 5/7 hospitals certified as baby Friendly Contraceptive methods: public sector and NGO Supplies procured thru UN Agencies [UNFPA, UNICEF] and IDA Foundation.

Prevention mother to child transmission: HIV & syphilis…….

Technical assistance in Maternal and child health including reproductive health services

Quality improvement of services utilizing collaborative model — Updating of protocols, standards and indicators, framework and tools for the

monitoring of process of care

in all areas under the project Integrated RH services for adolescents Management of RH supplies Data management [Belize Health Information System] Community based care

Health System Structure

• • • •

Ministry of Health

Operates in six districts: Belize, Corozal, Orange Walk , Cayo Stann Creek and Toledo Employs Service Level Agreements with District Level Limited planning function, financing of health supply Interest in introducing incentives • • • •

National Health Insurance

Started in 2001 and operates in three areas: Toledo, Stann Creek and South Side Belize Utilizes P4P through contracts with PCP in private and public health centers Provides free services to all eligible (poorest) populations Focuses on pre-natal and postnatal care and deliveries, and primary care for chronic illnesses such as diabetes, hypertension, and asthma .

Health System Network

1 National Referral Hospital 3 Regional Hospitals Stann Creek, Beloman, Orange Walk 3 Community Hospitals Toledo, Corazol, y San Ignacio Poly-Clinic 2 Poly-Clinic 1 (primary care) Mobile Units Health Posts-no permanent staff Community Health Workers

NHI Details (1)

• • The NHI pays the clinics a monthly member capitation payment • Clinics have an incentive to register as many people as they can Each month, the NHI pays clinics 70 percent of the member capitation payment upfront.

• • The remaining 30 percent of the payment depends on how the clinic performs on groups of indicators that lead to scores for efficiency • • • 70 percent of the withheld amount quality (20 percent of the withheld amount) and administrative processes (10 percent of the withheld amount) If an indicator is not fully achieved, then the proportional weight is deducted from the clinic’s total potential payment for that month

Source: Michelle Vanzie, Natasha Hsi, Alix Beith, and Rena Eichler (2010): Using Supply-side Pay for Performance to Strengthen Health Prevention Activities and Improve Efficiency: The Case of Belize. USAID Health Systems 2020, P$P Case Studies.

NHI Details (2)

NHI Details (3)

Goals 18 months

Indicador

Health facilities that have the necessary inputs for providing emergency obstetric and neonatal care according to the norms Health facilities that have the necessary inputs for providing pre- and post natal care according to the norms Health facilities that have submitted a Quality Improvement Fund (QIF) proposal to the national quality audit team Health facilities that have the necessary inputs to provide child health care according to the norms Health facilities that have implemented Quality of Care job aid tools for reproductive health Health facilities that can submit and receive data from the Belize Health Information System (BHIS) Health facilities that have permanent availability of all 5 types of modern family planning methods (injectable, barrier, oral, IUD, permanent) according to the norms Health facilities that have sexual and reproductive health (SRH) educational materials specifically targeted at adolescents Norms for improving the quality of reproductive and child health and nutrition services and for the establishment of a community platform of services adopted Community health workers (CHW) trained in the community platform District HECOPAB Officers that are currently monitoring the CHWs Health facilities with a mechanism in place for carrying out patient satisfaction surveys

Target

75% 85% 75% 85% 85% 85% 85% 85% Yes 85% 85% 85%

Source of verification

Health Facility Survey Health Facility Survey Health Facility Survey Health Facility Survey Health Facility Survey Health Facility Survey Health Facility Survey Health Facility Survey Norm Approved Health Facility Survey Health Facility Survey Health Facility Survey

Goals 36/54 months

Indicator

Institutional deliveries for which oxytocin was administered immediately following birth as part of Active Management of the Third Stage of Labor (AMTSL) in the last two years for the most recent delivery Pregnancies for which the woman attended at least one antenatal care visit during the first trimester that was carried out according to the norms for the most recent pregnancy in the last two years Institutional deliveries for which immediate neonatal care (within 24 hours) was provided to the infant according to the norms in the last two years for the most recent pregnancy Neonatal complications (prematurity, low birth weight, asphyxia and sepsis) handled according to norms in the last two years Obstetric complications (sepsis, hemorrhage, severe pre-eclampsia and eclampsia) handled according to the norms in the last two years C-sections as a proportion of childbirths in the last two years Female health facility patients of reproductive age that are given family planning counseling according to the norms in the last two years Women of reproductive age (15-49 years) who were not using/unable to obtain contraception during last year Infants 0–5 months of age who were fed exclusively with breast milk the previous day Mothers with a child 0-23 months that that can recognize 3 out of 5 signs of danger Percentage of children aged 6-23 months that consumed 60 sachets of micronutrients in the last 6 months Mothers who gave their children (0-5 9 months) ORS and zinc supplements during the last episode of diarrhea in the two weeks

Baseline

80% 26% 50% 15% 20% 30% 25% 31% 23% 20% 0 0

Target PP change