Transcript Countdown to 2015: Nepal 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:
Nepal
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 Nepal 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. Nepal 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
Nepal 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)= 40 deaths per 1000 live births
Infant mortality rate (IMR) = 32 deaths per 1000 live births
Neonatal mortality rate (NMR) = 23 deaths per 1000 live births
Why do South Asian
mothers die?
ICS
ive deaths, 2012
Leading direct causes:
Globally nearly
half of child
2%
deaths
are
Haemorrhage
–
30%
Preterm 25%
attributable to
Sepsis –14% undernutrition
Hypertension
– 10%
Neonatal
death: 55%
Abortion – Asphyxia*
6% 11%
Embolism –Other
2%5%
Causes of maternal deaths, 2013
Sepsis 14%
Regional estimates
for Southern Asia,
2013
Embolism 2%
Abortion 6%
M
(X
M
M
Indirect 29%
Po
aft
Hypertension
10%
Source: WHO 2014
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Understanding the cause of death distribution is
ND NEWBORN HEALTH
important for program development and monitoring
years attended at least once by a
La
to
or
Le
Haemorrhage
30%
Other direct
8%
Congenital 4%
Sepsis** 9%
P
Demand for family planning satisfied (%)
73
Ka
bir
An
ma
(2008)
In
Nep al
Why do Nepali children die?
DEMOGRAPHICS
Cau
Causes of under-five deaths, 2012
Pneumonia
Leading causes:
Neonatal – 52%
Pneumonia – 12%
Measles – 9%
Diarrhoea – 6%
Injuries – 6%
Preterm 16%
Globally nearly
half of child
deaths are
attributable to
undernutrition
2%
12%
Other 15%
Neonatal
death: 52%
HIV/AIDS 0%
Asphyxia* 12%
Other 5%
Malaria 0%
Injuries 6%
Congenital 6%
Measles 9%
Sepsis** 10%
6%
Diarrhoea
* Intrapartum-related events
0%
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
MATERNAL AND NEWBORN HEALTH
Undernutrition is a major underlying cause of child
Antenatal care
deaths
Percent women aged 15-49 years attended at least once by a
Dema
Anten
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
birth
Other maternal and newborn health indicatorsAnte
EALTH
man
Demand for family planning satisfied (%)
64
(2011)
Antenatal care (4 or more visits, %)
50
(2011)
-
-
5, 15, 4
(2011)
Low
man
Neonatal tetanus vaccine
82
(2012)
Postnatal visit for baby
30
(2011)
SY
Malaria during pregnancy - intermittent preventive
treatment (%)
C-section rate (total, urban, rural; %)
58
(Minimum target is 5% and maximum target is 15%)
(within 2 days for home births, %)
Postnatal visit for mother
45
(2011)
20
(2011)
(within 2 days for home births, %)
011
HS
Women with low body mass index
(<18.5 kg/m2, %)
Countdown to 2015 Report. 2014.
Inter
Brea
Com
with
Cost
plan(
child
Life S
Rep
Ma
Child health
Child health
Child health
Child health
Child health
Child health
DHS
DHS
DHS
DHS
Water
and
sanitation
WATER AND SANITATION
Improved drinking water coverage
Improve
Percent of population by type of drinking water source, 1990-2012
Piped on premises
Other improved
Surface water
Unimproved
Percent of pop
Improved
Unimprove
Percent
80
3
9
27
8
3
9
7
80
41
67
72
61
60
46
20
49
6
2012
Total
Source: WHO/UNICEF JMP 2014
1990
0
2012 1990
Urban
40
16
2
1990
60 86
20
21
0
100
30
51
60
40
2
1
2
Percent
100 7
2012
5
3
6
1990
Rural
Source: WHO/U
expenditure
DHS
Reproductiv
and child he
Improved sanitation coverage
1990-2012
Rural
Out of pocke
expenditure
Water and sanitation
3
9
Percent of population by type of sanitation facility, 1990-2012
Improved facilities
Shared facilities
Open defecation
Unimproved facilities
100
72
Percent
80
60 86
6
16
0
8
37
Out-of-po
Other
47
91
25
6
17
40
20
2012
40
33
9
3
External s
General g
13
51
5
3
37
34
6
1990
2012
Total
Source: WHO/UNICEF JMP 2014
34
5
1
3
1990
2012
Urban
1990
2012
Rural
ODA to child
ODA to mate
per live birth
Note: See annex
MNCH policies
• NO - Maternity protection in accordance with Convention 183
• NO - Specific notifications of maternal deaths
• -- - 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: Partial (2013)
• Density of doctors, nurses and midwives (per 10,000 population):
6.7 (2004)
• National availability of EmOC services: 46% (2007)
(% of recommended minimum)
• Per capita total expenditure on health (Int$): $80 (2012)
• Government spending on health: 10% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 49% (2012)
(as % of total health spending)
• Official development assistance to child health per child (US$):
$13 (2011)
• Official development assistance to maternal and newborn health
per live birth (US$): $31 (2011)
Who is left behind?
Nepal
The wide bars for many
indicators show important
inequalities in coverage.
Inequality is greatest for
skilled birth attendant and
antenatal care.
Vitamin , and ORT show
much smaller gaps in
coverage.
Thank you!
Optional additional slides
Equity profiles
Nepal
Coverage levels in poorest and richest
quintiles
Coverage levels in the 5 wealth
quintiles
Co-coverage of health interventions
Composite coverage and coverage gap