Transcript Saving a Generation: Maternal, Newborn and Child Health

Saving a Generation: Maternal, Newborn and Child
Health (MNCH)
Eastern and Southern Africa
Aga Khan Health Services
Today’s presentation
• Situation of Maternal,
Newborn and Child Health
(MNCH) in Sub-Saharan
Africa, with a particular focus
on Tanzania
• Approaches and impact of
community interventions to
improve mother and child
health outcomes
ESA: maternal mortality amongst the highest in the world
“In 2010, close to
58,000 women [across
Eastern and Southern
Africa] lost their lives
in pregnancy and
childbirth, accounting
for more than 1/5 of
all such deaths in the
world.
That’s close to 10
deaths every hour.”
- UNICEF
Tanzania’s maternal mortality rates are amongst the
worst in an already bad situation
Maternal Mortality Rate
Tanzania
Kenya
Uganda
Burundi
Rwanda
0
300
600
900
Amongst highest maternal mortality rates in the world,
Tanzania ranks 21st globally, tied with Afghanistan.
Child mortality rates are also unconscionably high
Under 5 mortality rate:
81 / 1000 live births
Tanzania
Infant mortality rate:
51 / 1000 live births
Neonatal mortality rate:
26 / 1000 live births
The neonatal mortality rate is the first 28 days after birth, and in
Tanzania accounts for over 30% of all child deaths.
Largely, the problem is no skilled attendant at delivery…
…and most deaths are largely preventable
Direct Cause of Maternal Deaths
Causes of Neonatal Deaths
Others
Other
Obstructed
Labour
Tetnus
Diarrhoea
Unsafe Abortions
Infection
Eclampsia
Preterm
Infections
Congenital
Haemorrahage
Asphyxia
0%
10%
20%
30%
0%
10%
20%
30%
40%
But, there is progress in both maternal mortality rate…
Maternal Mortality Rate in Tanzania – 1996-2010
750
600
450
529
578
454
300
150
0
1996
2004
2010
…and in child mortality rate
160
140
Child mortality in Tanzania
(per 1000 live births)
147
120
112
99
100
81
80
68
58
60
40
91
40
51
2010
20
0
Infant
2005
2008
32 29
Newborn
1999
Under-5
Still, there are large challenges in Tanzania’s health sector
Within health sector:
Community:
Other factors:
.Weak health infrastructure
.Limited human resources
.Poor referral systems
.Inadequate equipment and
supplies
.Inadequate community
involvement and
participation in health
.Education levels
.Economic, social,
& cultural issues
.Gender dynamics
Still, there are large challenges in Tanzania’s health sector
Within health sector:
Community:
Other factors:
.Weak health infrastructure
.Limited human resources
.Poor referral systems
.Inadequate equipment and
supplies
.Inadequate community
involvement and
participation in health
.Education levels
.Economic, social,
& cultural issues
.Gender dynamics
Why do we work in the community?
In Tanzania:
• Out of a population of 40
million, 80% live in rural
areas
• In rural areas, health
infrastructure and services
are limited
• Most people live below
the poverty line and
cannot afford to travel for
health services
Outreach aims to:
• Develop a relationship
with the communities
• Stimulate behavioral
changes that improve
health and prevent
disease
• Improve maternal,
newborn and child health
indicators
And what exactly do we do?
Service delivery
in communities
Community
Meetings and
Interactions
Community
support
Develop links
with referral
health facilities
Health promotion
activities
Develop links with referral health facilities
Government
referral
hospital
Aga Khan
Health Services
PCM
Public Health
Facility
• Links established
through comms
systems
• Ambulance services
• Feedback mechanism
• Follow-up
Teleconsultation Linkage
Service delivery in communities
Community meetings and interactions
Mobile health reach:
• Regular outreach mobile
health visits to underserved rural areas
• Community training and
empowerment
• Support to community
health workers
Health promotion activities – education & entertainment
Community health camps:
• Create demand
• Raise awareness –
prevention, treatment
care, social services
• Change attitudes to
foster behavioral change
Outpatients at public health centres rose 6.5x last year…
Number of Outpatient
(Public Health Facilities)
280,000
243,676
230,000
180,000
130,000
80,000
37,971
30,000
2012
2013
Year
…and deliveries in health facilities rose 11x
Number of Deliveries
(Public and Private Health Facilities)
20,000
17,351
15,000
10,000
5,000
1,539
0
2012
2013
Year