Transcript Annual review meeting - Karamoja Health Data Center

HEALTH AND NUTRITION
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Immunization
Maternal health
PMTCT and paediatric HIV
Nutrition
Health systems
Health and nutrition in emergencies
◦ DHOs
◦ NGO partners
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ACF
(Kaabong, Moroto)
AFLI
(Karamoja)
CESVI (Abim, Kaabong)
Concern
(Nakapiripirit)
CUAMM
(Karamoja)
IRC
(Kotido, Moroto, Nakapiripirit)
MSF
URCS
(Moroto, Nakapiripirit)
(Karamoja)
◦ Bridging plan (Jan-Jun 2010)
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Maintain / consolidate
VHTs
Sponsorship
Nutrition coordination / quality care
Data / evidence base
◦ Annual work plan 2010/11
 Maternal and newborn health
 IYCF
 Integration and best practices
Health, nutrition and CAA
• Since 2005/06 when Kaabong
become a district, it became
apparent that access to basic health
care services was a big challenge to
contributing to achieving the 4th, 5th
and 6th MDGs.
• The major gaps were identified in the
maternal and child health and
nutrition and HIV/AIDS
• The intervention activities
implemented during the year under
review therefore, were aimed at
improving access to basic health care
services in these areas.
• These activities were implemented by
the district in partnership with NGOs;
CUAM, CESVI, ACF and MSF
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DPT3 coverage improved from 50% in
2007/08 to 63% against 80% target
ANC 1st visit at 45% and 4th visit reduced
from 33% to 20.4% against 60% target.
Institutional deliveries have improved from
5% during 2007/08 to 6.7% this year against
a national average of 34%.
Pregnant women tested for HIV have
improved from 22% last year to 34%.
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HIV prevalence among pregnant mothers
has reduced from 2.6% last year to 1,6%.
71% of HIV exposed children have been
tested for HIV against a target of 50%.
90.9% of these children have been started
on co-trimoxazole against a target of 10%.
The number of HC IIIs and above providing
PMTCT services have risen from 29% last
year to 60% against a target of 100% (CESVI
& MSF).
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Under nutrition, the district GAM has reduced
from 15% in 2007 to 9.5% to date.
Under infrastructure, CUAM has constructed
three staff houses and fenced two health
facilities.
Staffing for midwives has improved from 5 to
10 with support from CUAM.
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Involvement of VHTs in mobilization
activities.
Ringing of bells at the out post as a
mobilization strategy.
Use of a mobile public address system as a
mobilization strategy during
implementation (use of police vehicles).
Engagement of operational partners (NGOs).
Institutional out reaches for Albendazole
and TT in schools
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Inadequate human resource.
Lack of infrastructure and equipment
leading to poor access.
Poor data capture and management.
Unrealistic population estimates.
Poor quality of available health services.
Insecurity
Poor referral system
Increase access to quality health care
through;
 Task shifting.
 Recruitment and training of health workers.
 Establish and equip service centers.
 Improve mobilization strategies.
 Establish a strong monitoring and
evaluation framework.
Health, nutrition and CAA
Kotido district
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HSD-District with 17 health units
 Total district population of 188,100
 38,561 under fives.
 9,405 pregnant women
 38,000 WCBA.
 8,088 infants
Health, nutrition and CAA
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HSD-District with 17 health units
 Total district population of 188,100
 38,561 under fives.
 9,405 pregnant women
 38,000 WCBA.
 8,088 infants
 EPI
 Mass polio activities.
 Support to routine outreaches.
 Sunday TTV non pregnant WCBA.
 Build capacity of health units to plan for catchment pop.
 Maternal health
 Integrated PMTCT/ANC outreaches.
 Build capacity for commodity management to ensure no
stock-outs of commodities for ANC in all HC 3 and 4's
 C.A.A
 Support establishment of ART clinic and monthly Paediatric
ART outreaches .
 Procure supplies and logistics for PMTCT and pediatric care
services.
 PMTCT outreaches
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Nutrition
 Opening of TFC in Kotido H.C.4
 Provision of supplies to the TFC and OTP.
 Trained 3 H/W’s from Kotido H.C.4 on mgt of acute
malnutrition.
 Child days plus activities
Strengthening community based systems
 Rollout of the VHT system in the district
 Production of monthly reports.
Strengthening facility based health systems
 Promotion of the retention and usage of all LLITNs in the
district
 Community Education/ campaign about ITN
DPT 3 5,278 (65.3%)
 TTV 2 non pregnant 12,473 (32.8%)
 TTV 2 Pregnant 5,509 (58.6%)
 TTV 2 Non Pregnant 5,509 (43.6%)
 ANC 4th visit 2,193 (23.3%)
 IPT 2 2,783 (29.8%)
 Deliveries 1,034 (11.3%)
 PMTCT 4,737 (50.4%)
 VHT ,330(100%) Coverage
 Vit A(1st round- 111% , 2rd round -106%)
 Deworming(1st round- 75% , 2rd round -66%)
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 Use
of VHT’s in mobilize of the
population(mass polio & measles campaigns.
 Use of religious leaders to help boost TTV
non pregnant.
 Setup of a coordination mechanism at the
district health office to regulate the use of the
village health teams by the different partners.
 Frequent
campaigns interfered with routine
activities.
 Difficulty in data capture as indicators are
not present in HMIS(PMTCT & Nutrition).
 VHT's not adequately involved in routine
mobilisation and monitoring especially EPI.
 The VHT reporting format requires serious
review.
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Train VHT’s in the different modules.
Training members of the VHT's on use of child health card as
a monitoring tool for assessing EPI coverage in villages.
continue the Sunday TTV non pregnant initiative and expand
to schools & institutions.
Continue with integrated outreach activities
Train 30 health workers in mgt of malnutrition at TFC and
OTP level.
Organize a strategy to target the 6-14 year olds, especially
those to be found in the grazing areas(leave albendazole with
the VHT's overnight for 3 days to continue administering the
drugs)
Health, nutrition and CAA
Moroto District
20thNov 2009
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Population:
276,000
WCBA:
63,480
Preg. Women:
14,352
Children <5 Yrs:
56,580
Children <1 Yr:
11,868
3 HSDs with 2 Hospitals, 9 HC IIIs, 9 HC IIs and 2
Mobile Clinics
EPI
 Micro-planning for Outreaches
 Routine Outreaches
 Outreaches to the Hard to Reach Areas
 5 rounds of Mass polio Immunisation campaigns.
 One round of Mass Measles Immunisation
 Child Days Plus activities in July
Maternal Health
 Training of Health Workers on ANC +.
 Support to the Supply Chain Management.
 Support to integrated Community Outreaches.
VHTs
 Involved in the community mobilisation in support
for the Mass Polio Immunisation campaigns.
CAA
 Support for Early Infant Diagnosis through DBS.
 Support for Integrated Outreaches.
 Support Supervision and Monitoring of the PMTCT
and Paediatric HIV AIDS programmes.
Variables
Numbers
Percentage
DPT3
7441
62.7
TT2 Non Preg Women
9866
15.54
TT2 Preg Women
6368
44.3
ANC 4thVisit
6670
46.47
IPT 2
3615
25.19
Deliveries in HUs
1510
12.7
PMTCT Mothers HIV Tests
5396
97.3
VHTs Trained
481
38.4
VHTs Active
110
22.8
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Involvement of Stakeholders in Routine Activities and
campaigns
Involvement of VHTs in Community Health service
delivery
Coordination of Health, Nutrition and HIV/AIDS SGs
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The Numerous Polio Campaigns.
Not all indicators are Captured in the HMIS, incomplete
and late reporting
Low VHT coverage and the drop out rate is high for the
trained.
Late release of funds Vs work plans.
Excessive bureaucracy and paper work in requests and
reporting.
Little or no involvement of LGs in partners proposal
reviews.
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There is need to harmonise the selected indicators with the
available data tools
HMIS strengthening at the District and the LLUs including
appropriate HRs, Trainings, Support Supervision and
Mentoring are very essential.
VHTs; An appropriate selection, Training, supply of tools,
Motivation as well as support for the routine running costs
should be catered for.
Timely release of funds!
The bureaucracy; can the hassle be reduced?!
It is important that the LGs are involved in reviewing the
Project Proposals of the District implementing partners
ALAKARA
NOOI
Health, nutrition and CAA
ABIM DISTRICT
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1 HSD-District with 18 HUs and a district
hospital
Staffing position at 60.4% & technical at 44.6%
Doctor patient ratio, 1 to 30,328 people
Midwives, 1 to 348 pregnant mothers
Health system strengthening on track; district
league standing from 52 to 49 to 29 in the
past three FYs
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5 rounds of mass polio-March to October
Child days-April & October
Trainings-HMIS, TT, full ANC package
Setting up ORT corners in all the HUs
Routine EPI outreach support to all HUs
Radio messages on malaria, diarrhea and
pneumonia
◦ Training of pediatric core team/TOTs
◦ PMTCT outreaches + CESVI
◦ HSD/DHT/Integrated monitoring of CSD&CAA
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INDICATORS
TARGET
ACHIEVEMENT
DPT3
100%
104%
Measles
100%
100%
TT2 Pregnant
70%
81%
Vitamin A
100%
96%
1st Visits
100%
94%
4th Visit
50%
38%
IPT2
60%
34%
HU deliveries
50%
30%
EPI (Infant)
ANC
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INDICATORS
TARGET ACHIEVEMENT
TFC death
<10%
19%
% of exposed children tested for HIV
50%
100%
% of exposed children on CTX prophylaxis
10%
93.4%
Functionality of H/C3 and HOSP
100%
100%
% of pregnancies tested for HIV
80%
90.1%
% of HIV+ women given ARVs for PMTCT
50%
69%
% Villages with functional VHTs
100%
30%
% of VHTs reporting monthly
100%
32%
% VHTs trained; mal, diarrhea & pneumonia 100%
0%
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Involvement of VHTs, Red Cross Volunteers,
LCs, Parish chiefs & teachers
Through & through involvement of stakeholders
& development partners
Strong supervision from HSD& DHT
Mentoring/training on data management, human
resource for health
Use of ICT for reminders on key issues
Coordination meetings for CAA and CSD
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Data management incapacities
Human resource inadequacy
Medical supply management problems cf
gas/vaccines, medicines.
Inadequate transport for referrals, outreaches &
follow up
Numerous new settlements e.g. Kobulin &
Camkok
Insecurity cf mass polio
VHT functionality ????? Ownership and facilitation
Population (54,000-111,400) cf 90,713
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Strengthen community involvement and
participation in health service delivery cf VHTs,
TBAs, LCs, Parish chiefs and Development
partners
Strengthening supervision by DHT/HSD and
HCIIIs
Continuous training/mentoring on data and
health logistics management
Harmonizing coordination of core teams for CAA
and CSD
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Use of ICT for communication/data base set
Human resources; recruitment and training of
new personnel e.g. midwives cf 32
New acceptable population figures Can UBOS
support be tapped?
Facilitate monthly mobile clinics
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BDR
VHTs
Data collection and management
Social mobilization for child survival
School health (deworming, TT)
Disaster risk reduction and emergency
preparedness / response
Human resources
Health & nutrition CAA
by District Health Officer
Nakapiripirit
Overview:
 3 HSDs
 2 HC IV, 1 HOSP, 6 HC III, 7 HC II
 Staffing at least stands at about75%
 Most health facilities are with in 5km from
catchment populations
 Doctor patient ratio is 1:46,000
 8 ANC/PMTCT/Paediatric sites
 Partners:UNICEF, WFP, SAVE THE CHILDREN,
CUAMM, IRC,CONCERN
NUTRITION
 Target
At least 50% of children with severe acute
malnutrition are identified and treated
 2 TFCs and 10 OTCs operational in the
district
 U 5 Screened 58,502 and 740 treated
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ITN coverage >90%
 100% coverage of VHTs; 240 VHTs functional
 DPT3 coverage 60%
 Measles coverage 85%
 TT2 coverage 34%
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Category
Results
Estimated no. of pregnant women (5% of total population)
11,538
No. and % of pregnant women counseled and tested for HIV (Target:
3272(28%)
No. and % of HIV positive pregnant women identified.
48(11%)
No. and % of pregnant women who received ARV prophylaxis
42(9.8%)
No. and % of HIV positive pregnant women accessing cotrimoxazole
prophylaxis (Target: 70% of identified HIV positive pregnant women)
48(11%)
No. partners tested for HIV
811(7%)
80% of all new ANC attendees)
(Target: 50% of HIV positive women identified)
48(15%)
No. and % of children born to HIV positive mothers who are tested
for HIV using PCR. (Target: 50% of children born to HIV positive
mothers)
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No. and % of children born to HIV positive mothers who access ARVs
for PMTCT. (Target: 40% of newborns to HIV positive women
identified)
 Many
mothers have learnt the nutritional program
& can now mobilize others to bring their children
to the program
 Innovative approaches to reach highly
pastoral/mobile communities
 Use of pre-packed Nevirapine increases the ARV
prophylactic uptake among children.
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few mothers still misuse plump nut
 Inconsistence funding
 Poor health seeking behavior of the people
 Occasional stock out of gas
 Hard to reach nature of the district and some
communities leaving in the mountain
 Inadquate space in most of the Hus
 Long distance to be moved by mothers
 Lack
of transport in most of the health
centres
 Inadequate human resource in most health
units
 Strengthen
integrated outreaches to hard to
reach areas
 Intensify routine EPI outreaches
 Avoid gas stock outs
 Support child days planning and activities
 Need for continuous sensitization at parish
level in ITN use
 Need for monthly mobilization of
communities for ANC
 Build
capacity of VHTs to promote early ANC
visits
 Support health centre 2 to hard to reach to
provide ANC services
 Need for refresher training for health unit in
charges and record assistants
 Support sponsorship of students
 Build maternity block and laboratory in Karita
HC III
 Support
monthly meeting btn HU in
charges and VHTs
 Refresher training for VHTs on mgt of
fever , diarrhoea and pneumonia
 Need for quarterly review meetings wit
VHTs
 Strengthen Paediatric care and treatment
strengthen the community follow up and
referral of HIV positive pregnant women
and their children for comprehensive ART
services
THANK YOU
VERY MUCH