Transcript The United Nations’ MDG Strategy
Agenda
Motivation and Overview
example) (using Education as an
Discussion by Selected Intervention Area
Energy Services Hunger (multi-sector) Gender
Health www.unmillenniumproject.org
Key Assumptions for Health Needs Assessment
Interventions:
Comprehensive set of interventions to comprise minimum package of health services
Targets:
Coverage targets should aim at meeting MDGs for entire population
Synergies:
Benefits of prevention and non-health interventions should be factored into needs assessment
Investment model:
Service delivery models should reflect local needs and health system structure; unit costs should reflect costs for reaching hard-to-reach populations.
Financing:
package.
User fees should be eliminated for basic health
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Summary of Health Interventions
Health System Child and Maternal Health Infectious Disease
• New infrastructure and O&M of existing infrastructure • Health personnel salaries • Pre- and in- Service training • Community demand interventions • Management and monitoring & evaluation • Research and development • IMCI package • Immunization • Neonatal package • Antenatal care • Skilled attendance and clean delivery • Emergency obstetric care (EmOC) • Abortions and care of complications of abortion • Antiretroviral therapy • UNAIDS prevention and care package • ACT for malaria • Insecticide treated nets • DOTS
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Child Health and Maternal Health Interventions
Category
Child health
Intervention Package
Neonatal integrated package Immunization Integrated Management of Childhood Ilnness (IMCI)
Description
Clean delivery, newborn resuscitation, prevention of hypothermia, kangaroo care (skin-to skin contact to promote parent/infant bonding especially for premature babies), antibiotics for infection, tetanus toxoid, breastfeeding education, hygiene education Vaccines for polio, diptheria, pertussis, tetanus, measles, hepatitis B, Hib and yellow fever Integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and Maternal health Antenatal care Skilled attendance and clean delivery Emergency Obstetric Coverage (EmOc) Reproductive health Contraception and family planning services Safe abortions Visits with skilled personnel during pregnancy to check that all is well with mother and baby. It includes being offered a range of tests and should be implemented in accordance with the new WHO antenatal care model Presence of trained and registered midwives, nurses, nurse/midwives or doctors at birth Treatment for ecclampsia, haemorrhage, obstructed labor and sepsis. Universal access to family planning counselling and all forms of contraception. Provision of safe abortions and counseling as well as post-abortion care.
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HIV/AIDS Interventions
Category
HIV/AIDS
Intervention Package
Prevention: Behavior change programs STD Control Blood safety interventions (e.g., HIV antibody screening, exlcuding high risk donors) Care and Treatment: Antiretroviral therapy
Description
Programs to encourage safer sexual behavor including condom social marketing, peer-based education, mass media campaigns and school based AIDS education. Routine screening and effective treatment of sexually transmitted diseases (e.g., syphilis, gonorrhea, vaginitis) Voluntary Counseling and Testing (VCT) Harm reduction for injecting drug users VCT includes both pre and post test counseling and is available to people testing positive or negative Actions to prevent transmission of HIV and other infections that occurs through sharing of non-sterile injection equipment and drug preparations. Specific programs include provision Child Transmission of sterile syringes and needles and drug substitution treatment.
Prevention of Mother to Prevention of transmission of the HIV virus from infected women to their infants during pregnancy, labour and delivery, as well as during breastfeeding. Includes short-term antiretroviral prophylactic treatment, infant feeding counselling and support, and Measures to reduce the risk of receiving infected blood through a transfusion. Includes HIV antibody screening, avoiding unnecessary blood transfusions and excluding high risk donors.
Treatment of opportunistic infections Orphan support Combination of protease inhibitors taken with reverse transcriptase inhibitors used in treating AIDS and HIV.
Treatment of any infection caused by a microorganism that would not normally cause disease in individual but occurs in persons with abnormally functioning immune systems (as in AIDS patients) Provision of support to orphans to minimize the impact of AIDS on their lives. Includes school fee support, provision of orphanages and community support.
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TB, Malaria, Access to Medicines, and Health Systems Interventions
Category
TB Malaria Access to Essential Medicines Health Systems
Intervention Package
BCG vaccine Directly Observed Treatment Short Course (DOTS) Insecticide treated nets Artemisinin combination therapy Interventions to ensure availability, affordabilty, and appropriate use Interventions to strengthen health system
Description
Bacillus of Calmette and Guérin vaccine for TB in high prevalence settings. Internationally-recommended TB control strategy combining five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems, and use of highly efficacious regimes with direct observation of treatment. Mosquito nets that are treated with insecticide, which can provide a physical and chemical barrier to mosquitos. The chemical halo that extends beyond the mosquito net itself also shortens the mosquito's life span.
Combination of drugs used to treat multi-drug resistant falciparum malaria, which is now widespread in Africa.
Provision of procurement and distribution facilities, adequate transportation, monitoring systems to assure drug quality; elimination of user fees for essential medicines; programs to improve the way drugs are prescribed, dispensed, and used, including development and implementation of national essential medicines lists and clinical treatment guidelines, public media campaigns and education of providers.
Includes, human resources , improving management capacity, enhancing monitoring and evaluation, increasing capacity for R&D, enhancing community demand, and improving infrastructure
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Proposed Health Coverage Targets 1/2
Maternal Health Coverage Current 2015
% of women receiving antenatal care 17% 99% % of women with access to EmOC 3% 90% % skilled attendance contraceptive prevalence rate (CPR) 6% 99% 5% 41%
Child Health Coverage Current 2015
percent of sick children receiving care 15% 99% percent of sick infants receiving care 16% 99%
TB Coverage Current 2015
case detection 26% 70% cure rates 61% 85%
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Proposed Health Coverage Targets 2/2
HIV/AIDS coverage Current 2015
antiretroviral therapy 1.5% 100% condom distribution PMTCT N/A N/A 100% 90% voluntary counseling & testing N/A 100%
Malaria coverage Current 2015 .
ITNs/IRS 0% 80% effective therapy within 24h 1.4% 80%
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Estimating Costs for Direct Service Provision
Country epidemiological data Country demographic data Target coverage rates Intervention components and quantities Unit costs of components • Drugs • Hospital bed and food • Laboratory costs • Other supplies
NO. OF CASES COST PER CASE TOTAL COSTS www.unmillenniumproject.org
Assessing Need for Infrastructure
Based on scale-up plan of Federal Ministry of Health (2004). “Draft Proposal for an Accelerated Expansion of Primary Health Care Facilities in Ethiopia (2004-2008)”
Scale-up of health centres and health posts from Draft Proposal until 2008 Scale-up of hospitals based on targets outlined in the Draft Proposal • 1 zonal hospital per one million people, 1 district hospital per 250,000 Include costs of construction, upgrading, operations, and maintenance
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Estimating Needed Health Workers
Target staffing ratios can be obtained from Federal Ministry of Health (2004). “Draft Proposal for an Accelerated Expansion of Primary Health Care Facilities in Ethiopia (2004-2008)” Consider appropriate physician and nurse ratios for health centers and hospitals Include training costs associated with increasing health workers; consider need for revision of training curricula Consider increase in health worker salaries (by how much?) to improve recruitment and retention, particularly in rural areas
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Investing in Health Systems
In addition to disease specific activities, human resources, and infrastructure, need to invest in strengthening health systems. This includes:
Enhancing community demand (community education, awareness raising) Improving management (planning, supervision, supply management, accounting, financial management at the Ministry of Health and district health center levels) Enhancing monitoring and evaluation (data gathering, vital registries, epidemiological surveillance, regulation of service delivery, formulation of policy guidelines, and implementation of quality-assurance schemes) Building R&D capability (clinical and operational research)
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Adding Up the Components
Direct costs of all interventions + Infrastructure and HRH costs + Costs of health system strengthening
Total health costs
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Way Forward
It is important to agree on key assumptions for three health needs assessment scenarios: • ambitious scenario (maximum coverage targets, full intervention package) • middle scenario (lower coverage targets, key low-cost interventions) • business-as-usual scenario (incremental increases over current service provision) Work with existing data and models to understand range of health inputs required to meet the MDGs
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