Transcript Countdown to 2015: Kenya 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:
Kenya
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 Kenya 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. Kenya 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
Kenya 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)= 71 deaths per 1000 live births
Infant mortality rate (IMR) = 48 deaths per 1000 live births
Neonatal mortality rate (NMR) = 26 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
K en ya
Why do Kenyan children die?
DEMOGRAPHICS
Ca
Causes of under-five deaths, 2012
Pneumonia
Leading causes:
Neonatal – 37%
Pneumonia – 15%
Diarrhoea – 10%
Injuries – 6%
HIV/AIDS – 4%
Malaria – 4%
15%
Other 22%
Preterm 10%
2%
Neonatal
death: 37%
Globally nearly
half of child
deaths are
attributable to
undernutrition
Asphyxia* 12%
Other 2%
Congenital 3%
HIV/AIDS 4%
Sepsis** 7%
Malaria 4%
Injuries 6%
Measles 0%
* Intrapartum-related events
0%
10%
Diarrhoea
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
MATERNAL AND NEWBORN HEALTH
Undernutrition isAntenatal
a major underlying
cause of child
care
Percent women aged 15-49 years attended at least once by a
deaths
skilled health provider during pregnancy
Dem
Ante
Demographics
Countdown to 2015 Report. 2014.
Variable coverage along the continuum of care
Maternal and newborn health
Maternal and newborn health
Maternal and newborn health
phalitis
birthw
Other maternal and newborn health indicatorsAnten
EALTH
mana
92
Demand for family planning satisfied (%)
64
(2008-2009)
Antenatal care (4 or more visits, %)
47
(2008-2009)
Malaria during pregnancy - intermittent preventive
treatment (%)
15
(2008-2009)
6, 11, 5
(2008-2009)
73
(2012)
-
-
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
42
(2008-2009)
-
-
(within 2 days for home births, %)
08-2009
DHS
Women with low body mass index
(<18.5 kg/m2, %)
Countdown to 2015 Report. 2014.
Intern
Breas
Comm
with a
Low o
mana
SYS
Coste
plan(s
child
Life S
Rep
Mat
Child health
Child health
Child health
Child health
Child health
Child health
1993
DHS
1998
DHS
2000
MICS
2003
DHS
2008-2009
DHS
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 popu
Improved fac
Unimproved
23
80 41
4
4
36
Percent
29
38
16
16
18
42
40
19
42
25
56
20
44
20
18
2012
Total
Source: WHO/UNICEF JMP 2014
23
1990
13
2012 1990
Urban
36
60
40 20
20
10
0
1990
80
49
15
60
100
5
13
Percent
100
2012
Rural
25
0
1990
To
Source: WHO/UNI
3
2008-2009
DHS
MICS
DHS
expenditure (%)
DHS
Water and sanitation
ge
Out of pocket e
expenditure on
Reproductive, m
and child health
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
19
29
80
9
8
42
23
3
31
18
13
0
2012
Rural
17
31
35
38
60
48
40
40 20
Out-of-pock
Other
19
16
30
25
26
31
29
24
0
1990
2012
Total
Source: WHO/UNICEF JMP 2014
ODA to materna
per live birth (US
Note: See annexes fo
26
20
10
22
General gov
ODA to child he
36
Percent
16
13
3
External sou
1990
2012
Urban
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
• NO - Community treatment of pneumonia with antibiotics
• YES - Low osmolarity ORS and zinc for diarrhoea management
• - Rotavirus vaccine
• YES - Pneumococcal vaccine
* Policy information not available
Systems and financing for MNCH
• Costed national implementation plans for MNCH: -• Density of doctors, nurses and midwives (per 10,000
population): 9.7 (2011)
• National availability of EmOC services: - (% of recommended minimum)
• Per capita total expenditure on health (Int$): $84 (2012)
• Government spending on health: 6% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 48% (2012)
(as % of total health spending)
• Official development assistance to child health per child
(US$): $23 (2011)
• Official development assistance to maternal and newborn
health per live birth (US$): $27 (2011)
Who is left
behind?
Kenya
The wide bars for many
indicators show important
inequalities in coverage.
Inequality is greatest for
skilled birth attendant,
family planning and
antenatal care (4+).
Breastfeeding, vitamin A,
and pneumonia care show
much smaller gaps in
coverage.
Thank you!
Optional additional slides
Equity profiles
Kenya
Coverage levels in poorest and richest
quintiles
Coverage levels in the 5 wealth
quintiles
Co-coverage of health interventions
Composite coverage and coverage gap