Transcript Welcome [kesehatanibu.depkes.go.id]

GLOBAL ISSUES AND STRATEGY ON
MATERNAL, NEWBORN AND CHILD HEALTH
Launching of the “National Actions Plan for Accelerating
Reduction of Maternal Mortality in Indonesia; “Scaling-Up
PMTCT in Indonesia”; and “Maternal Health Pocket Book”
Thursday, 26 September 2013
Dr Long Chhun
Key messages
• Maternal mortality trends and determinants in the
Western World from 1880 to 1980 and Implications to
Global efforts
• Global Initiatives to improving Maternal, Newborn and
Child Health
• Discussion and recommendations on the current Global
Maternal, Newborn and Child Health Issues and Strategy
Historical trend in maternal mortality rates in the
Western World
• USA had the highest MMR
• Differences classification
of deaths or methods of
data collection
Why did maternal mortality rates remain on a high plateau from
the 1850s to the mid-1930s in the Western World?
Unnecessary
interference
Puerperal
fever
Home
deliveries
social class
What caused the abrupt change in the maternal mortality
rate in the mid-1930s with the subsequent steep decline?
Sulfonamides
• Ergometrine
• Blood transfusions
• Penicillin
Better organization of
obstetric services
Better
Anesthesia &
training
less interference in
normal labour
Lessons from the past history of the Western World
and the needs for data for Developing World
• Causes of high rates of maternal mortality in Developing
Countries today are reasonably similar to those in Western
World in the 1870s
.
• Profound decline in maternal mortality rates in Western World
dependent on accurate data and system of continuous audit
• During 1970s and 1980s, advances in statistical techniques
and availability of data resulted in increasing availability and
reliability of data on infant mortality, but
• no equivalent breakthroughs for measurement of maternal mortality
• During 1985, first community studies on levels of maternal
mortality in developing countries provided an estimation
Safe Motherhood and Child Survival
• 1987:
First
international
Motherhood (SM) Conference
Safe
• Sound estimates based on new data for
foundation of understanding and concern
• First international SM Conference in
Nairobi
• 1989: World Summit for Children in New
York
• Maternal
mortality viewed within the
context of ensuring the survival and health
of children, largely by product of child
survival efforts
• Reduction in maternal mortality as one of
the goals to be monitored along with
increases in antenatal care attendance
• 1997: 10th Anniversary SM Meeting in
Sri Lanka
• Every pregnancy faces risks
• Ensure skilled attendants at delivery
• Improve quality and access of maternal
care
Critical actions for increasing Child Survival
• Skilled care during pregnancy and birth
• Safe and clean delivery at birth
• Care of the newborn at birth
• Appropriate feeding in sickness and health
• Exclusive breastfeeding for the first six months of life
• Starting at six months of age, appropriate complementary feeding with continued
breastfeeding up to 2 years of age and beyond
• Micronutrient supplementation (at least vitamin A)
• Prevention of illness
• Vaccination
• Insecticide-treated materials
• Water, sanitation and hygiene
• Prevention of mother-to-child transmission of HIV
• Antiretrovirals
• Safer infant feeding practices
• Treatment of illness
• Oral rehydration therapy to prevent and treat dehydration resulting from diarrhoea
• Zinc to reduce the duration and severity of diarrhoea
• Antibiotics for sepsis, pneumonia and dysentery
• Antimalarials
Millennium Development Goals in 2000 and
Subsequent Global Efforts
• The Millennium Development Goals established in 2000, include
MDGs 4 and 5:
• MDG 4: Reduce child mortality
• Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
• Millennium Development Goal 5: Improve maternal health
• Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality
ratio
• Target 5.B: Achieve, by 2015, universal access to reproductive health
• Partnership for “Safe Motherhood and Newborn Health” merges with
“Child Survival Partnership” and “Healthy Newborn Partnership”
• Women Deliver Conference held in London, 2007- 20th anniversary
of Safe Motherhood Initiatives
• Countdown to 2015- Maternal, Newborn and Child Survival, 2008
• UN Leaders’ Summit for MDGs, 2010- Global strategy for Women’s
and Children’s Health
Global strategy for Women’s and Children’s
Health from the UN Summit 2010
Status of MDG4
Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
• Globally, significant progress has been made in reducing
mortality in children under five years of age.
• In 2011, 6.9 million children under five died, compared with 12
million in 1990- 41% decline, from 87 deaths per 1000 live births to
51
• estimated number of measles deaths decreased by 74%, accounting for
about one fifth of the overall decline in child mortality
• Decline accelerated from 1.8% per year during 1990–2000 to 3.2%
during 2000–2011
• Despite improvement, the world is unlikely to achieve the MDG4
target
• In 2011, global measles immunization coverage was 84%
among children aged 12–23 months
Status of MDG5
Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Target 5.B. Achieve, by 2015, universal access to reproductive health
• Significant reduction in the number of maternal deaths:
• from an estimated 543,000 in 1990 to 287,000 in 2010
• the rate of decline is just over half that needed to achieve the MDG
target
• In 2008, 63% of women aged 15-49 years who were married or
in a consensual union were using some forms of contraception
• 11% who wanted to stop or postpone childbearing were not using
contraception
• Proportion of women receiving ANC at least once during
pregnancy was about 81% for the period 2005–2011
• for
the recommended minimum
corresponding figure is around 55%
of
four
visits
or
more
the
• Proportion of births attended by skilled personnel remains less
than 50% in WHO African Region
Discussion on opportunity and weakness
• Need to reduce maternal and newborn deaths
• Progress towards the health MDGs is being made, but is unequal and fragile
• Reductions attributable to:
• technical requirements- data systems, professional expertise and access
to technologies
• political enabling conditions- awareness of the problem and commitment to
act
• Opportunities in place today in the developing world
• Technologies available and cost-effective
• Political will exists
• Health care professionals and women advocate for safe motherhood and
MDGs
• Missing elements- health sector readiness:
• Combination of financial, human and organizational resources needed to
provide required services
• Both recipient countries and donors need to invest
• Evidence of local operational constraints and best practices
Recommendations to improving the health of mothers
and children and achieving MDGs 4 & 5
• Effective interventions that are safe and evidence-based
• Operations research
• Health systems to deliver the interventions
• Community support systems to facilitate access to the
interventions
• Monitoring and evaluation systems to assess, monitor and
evaluate progress, impact and accountability
• Policies and strategies that set out how the resources
needed to deliver results
• Increased investment in the health of mothers and
children, to align financial and technical support to the
national health policy and strategy
Thank you very much for your attention!