Transcript Countdown to 2015: Nigeria Add presenter name Date Event/location Notes for the presenter on adapting this presentation • Personalise with photos, charts • Data presented are based.

Countdown to 2015:
Nigeria
Add presenter name
Date
Event/location
Notes for the presenter on
adapting this presentation
• Personalise with photos, charts
• Data presented are based on best available data up
to mid-2014. When presenting, mention more recent
studies or data. (2013 mortality on slide #18 added)
• Select which slides are appropriate for the audience.
For example: Slides are provided for each figure presented
in the country profile; select from these (choosing all or a few
depending on needs)
• Sub-national data can be substituted as appropriate
and available
• Review the Speaker Notes, adapt according to your
audience and purpose
Purpose of this presentation
• To stimulate discussion about Nigeria country data,
especially about progress, where we lag behind, and
where there are opportunities to scale up
• To provide some background about Countdown to
2015 for MNCH, the indicators, and data sources in the
country profiles
• To showcase the country profile as a tool for
monitoring progress, sharing information and
improving accountability
Outline
1. Countdown to 2015: Background
2. Nigeria Countdown profile
Part I
Countdown to 2015:
Background
What is Countdown?
A global movement initiated in 2003 that tracks
progress in maternal, newborn & child health in
the 75 highest burden countries to promote action
and accountability
Countdown aims
•
To disseminate the best and most recent
information on country-level progress
•
To take stock of progress and propose new
actions
•
To hold governments, partners and donors
accountable wherever progress is lacking
What does Countdown do?
•
Analyze country-level coverage and trends for
interventions proven to reduce maternal, newborn and
child mortality
•
Track indicators for determinants of coverage (policies and
health system strength; financial flows; equity)
•
Identify knowledge and data gaps across the RMNCH
continuum of care
•
Conduct research and analysis
•
Support country-level Countdowns
•
Produce materials, organize global conferences and
develop web site to share findings
9
75 countries that together account for > 95% of maternal
and child deaths worldwide
Who is Countdown?
• Individuals:
scientists/academics,
policymakers, public health
workers, communications
experts, teachers…
• Governments:
RMNCH policymakers,
members of Parliament…
• Organizations:
NGOs, UN agencies,
health care professional
associations, donors,
medical journals…
12
Countdown moving forward
Four streams of work to promote accountability,
2011-2015
• Responsive to global accountability frameworks
-Annual reporting on 11 indicators for the Commission on
Information and Accountability for Women’s and Children’s
Health (COIA)
-Contribute to follow-up of A Promise Renewed/Call to
Action
• Production of country profiles/report and global
event(s)
• Cross-cutting analyses
• Country-level engagement
Part 2
Nigeria Countdown
country profile
Main findings
data on the profile
WhatRange
doesofCountdown
monitor?
• Progress in coverage for critical interventions across
reproductive, maternal, newborn & child health
continuum of care
• Health Systems and Policies – important context for
assessing coverage gains
• Financial flows to reproductive, maternal, newborn
and child health
• Equity in intervention coverage
Sources of data
The national-level profile uses data from global databases:
• Population-based household surveys
• UNICEF-supported MICS
• USAID-supported DHS
• Other national-level household surveys (MIS, RHS and
others)
• Provide disaggregated data - by household wealth, urbanrural residence, gender, educational attainment and
geographic location
•
Interagency adjusted estimates
U5MR, MMR, immunization, water/sanitation
•
Other data sources (e.g. administrative data, country reports
on policy and systems indicators, country health accounts, and
global reporting on external resource flows etc.)
National progress towards
MDGs 4 & 5
Mortality data through 2012:
2013 child mortality data was released in late 2014:
Under-five mortality rate (U5MR)= 117 deaths per 1000 live births
Infant mortality rate (IMR) = 74 deaths per 1000 live births
Neonatal mortality rate (NMR) = 37 deaths per 1000 live births
Why do sub-Saharan African
mothers die?
Leading direct causes:
Haemorrhage – 25%
Hypertension – 16%
Unsafe abortion – 10%
Sepsis – 10%
Understanding the cause of death distribution is
important for program development and monitoring
Ni
ger
i
a
Why do Nigerian children die?
DEMOGRAPHICS
Causes of under-five deaths, 2012
Pneumonia
Leading causes:
Neonatal – 32%
Malaria – 20%
Pneumonia – 14%
Diarrhoea – 9%
Injuries – 4%
HIV/AIDS – 3%
Measles – 1%
14%
Other 17%
2%
Preterm 10%
Neonatal
death: 32%
Ca
Globally nearly
half of child
deaths are
attributable to
undernutrition
Asphyxia* 10%
Other 2%
Congenital 1%
HIV/AIDS 3%
Sepsis** 6%
0%
9%
Malaria 20%
Diarrhoea
Injuries 4%
* Intrapartum-related events
Measles 1%
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
AND NEWBORN
HEALTH
Undernutrition isMATERNAL
a major underlying
cause of child
Dema
Antenatal care
deaths
Percent women aged 15-49 years attended at least once by a
Demographics
Countdown to 2015 Report. 2014.
Variable coverage along the continuum of care
Maternal and newborn health
Maternal and newborn health
* Intrapartum-related events
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Maternal and newborn health
MATERNAL AND NEWBORN HEALTH
Antenatal care
Demand fo
Percent women aged 15-49 years attended at least once by a
skilled health provider during pregnancy
Antenatal c
Malaria dur
treatment
100
79
Percent
80
57
60
64
58
58
66
C-section ra
(Minimum ta
Neonatal te
40
Postnatal v
(within 2 day
20
Postnatal v
0
(within 2 day
1986
DHS
1990
DHS
1999
DHS
2003
DHS
2008
DHS
2011
MICS
Women wi
(<18.5 kg/m2
halitis
birth
Other maternal and newborn health indicatorsAnte
EALTH
man
66
Demand for family planning satisfied (%)
43
(2011)
Antenatal care (4 or more visits, %)
57
(2011)
Malaria during pregnancy - intermittent preventive
treatment (%)
13
(2010)
5, 9, 3
(2011)
Low
man
60
(2012)
-
-
SY
C-section rate (total, urban, rural; %)
(Minimum target is 5% and maximum target is 15%)
Neonatal tetanus vaccine
Postnatal visit for baby
(within 2 days for home births, %)
Postnatal visit for mother
38
(2008)
-
-
(within 2 days for home births, %)
011
MICS
Women with low body mass index
(<18.5 kg/m2, %)
Countdown to 2015 Report. 2014.
Inte
Brea
Com
with
Cost
plan
child
Life S
Rep
Ma
Child health
Child health
DHS
DHS
DHS
DHS
DHS
MICS
(<18.5 kg/
Child health
CHILD HEALTH
Percent of children <5 years with diarrhoea:
receiving oral rehydration therapy/increased fluids
with continued feeding
treated with ORS
Percent
those r
Perce
100
80
60
40
20
0
34
12
1990
DHS
1999
DHS
28
18
2003
DHS
25 26
28 26
2008
DHS
2011
MICS
WATER AND SANITATION
Percent
Mala
Percent
Diarrhoeal disease treatment
100
80
60
40
20
0
MICS
Women with low body mass index
(<18.5 kg/m2, %)
-
Repro
Mate
Child health
Newb
Child
Malaria prevention and treatment
Percent children receiving first line treatment among
those receiving any antimalarial
Percent children < 5 years sleeping under ITNs
12 (2010)
Density
midwiv
Nationa
Obstet
28 26
2011
MICS
Percent
(% of rec
100
80
60
40
20
0
FIN
29
1
6
2003
DHS
2008
DHS
16
2010
Other NS
2011
MICS
Per cap
health
Genera
on hea
expend
Out of
expend
Child health
Child health
DHS
DHS
DHS
DHS
MICS
Water
and
sanitation
WATER AND SANITATION
Improved drinking water coverage
Improved
Percent of population by type of drinking water source, 1990-2012
Piped on premises
Other improved
Surface water
Unimproved
Percent of pop
Improved
Unimprove
13
Percent
80 34
60
6
16
100
4
17
80 11
49
23
30
45
20
73
40
23
60
32
20
0
6
4
1990
2012
Total
Source: WHO/UNICEF JMP 2014
1990
48
25
33
14
24
21
3
1
2012 1990
Urban
2012
Percent
100
60
28
40
20 37
0
1990
Rural
Source: WHO/U
MICS
DHS
DHS
Other NS
MICS
Out of poc
expenditur
Water and sanitation
Reproduct
and child h
e
Improved sanitation coverage
e, 1990-2012
Percent of population by type of sanitation facility, 1990-2012
Improved facilities
Shared facilities
Open defecation
Unimproved facilities
100
24
21
30
3
48
5
3
1
2012
Rural
Percent
80
60
23
7
11
23
Genera
Out-ofOther
15
14
11
Externa
31
33
12
46
28
32
40
18
40
26
37
28
36
31
37
25
0
1990
2012
Total
Source: WHO/UNICEF JMP 2014
1990
2012
Urban
ODA to ma
per live bir
Note: See ann
12
20
ODA to chi
1990
2012
Rural
MNCH policies
• NO - Maternity protection in accordance with Convention 183
• YES - Specific notifications of maternal deaths
• YES - Midwifery personnel authorized to administer core set
of life saving interventions
• YES - International Code of Marketing of Breastmilk
Substitutes
• YES - Postnatal home visits in first week of life
• YES - Community treatment of pneumonia with antibiotics
• YES - Low osmolarity ORS and zinc for diarrhoea management
• - Rotavirus vaccine
• - Pneumococcal vaccine
Systems and financing for MNCH
• Costed national implementation plans for MNCH: Yes (2013)
• Density of doctors, nurses and midwives (per 10,000
population): 4.1 (2009)
• National availability of EmOC services: - (% of recommended minimum)
• Per capita total expenditure on health (Int$): $161 (2012)
• Government spending on health: 7% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 66% (2012)
(as % of total health spending)
• Official development assistance to child health per child
(US$): $9 (2011)
• Official development assistance to maternal and newborn
health per live birth (US$): $10 (2011)
Who is left behind?
Nigeria
The wide bars show
inequalities in coverage for
almost all indicators.
Inequality is greatest for
skilled birth attendant,
family planning, antenatal
care, and immunizations.
Only early initiation of
breastfeeding and ITN use
show small gaps in
coverage.
Thank you!
Optional additional slides
Equity profiles
Nigeria
Coverage levels in poorest and richest
quintiles
Coverage levels in the 5 wealth
quintiles
Co-coverage of health interventions
Composite coverage and coverage gap