Transcript Countdown to 2015: Vietnam 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:
Vietnam
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 Vietnam 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. Vietnam 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
Vietnam 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)= 24 deaths per 1000 live births
Infant mortality rate (IMR) = 19 deaths per 1000 live births
Neonatal mortality rate (NMR) = 13 deaths per 1000 live births
Why do SE Asian
Causemothers
of deathdie?
Leading direct causes:
Haemorrhage – 30%
Hypertension –15%
Embolism – 12%
Abortion – 7%
Sepsis – 6%
Understanding the cause of death distribution is
important for program development and monitoring
Vi et Nam
Why do Vietnamese children die?
DEMOGRAPHICS
Cau
Causes of under-five deaths, 2012
Pneumonia
Leading causes:
Neonatal – 54%
Pneumonia – 9%
Diarrhoea – 7%
Injuries – 4%
Measles – 2%
HIV/AIDS – 1%
9%
4%
Preterm 20%
Other 24%
Neonatal
death: 54%
HIV/AIDS 1%
Globally nearly
half of child
deaths are
attributable to
undernutrition
Asphyxia* 7%
Other 6%
Malaria 0%
Injuries 4%
Sepsis** 5%
Measles 2%
7%
Diarrhoea
* Intrapartum-related events
Congenital
13%
0%
Source: WHO/CHERG 2014
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
MATERNAL AND NEWBORN HEALTH
Undernutrition is Antenatal
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
Dema
Anten
Demographics
Countdown to 2015 Report. 2014.
Variable coverage along the continuum of care
Maternal and newborn health
Maternal and newborn health
Diarrhoea
* 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
100
Percent
80
86
71
91
94
Malaria du
treatment
C-section r
68
(Minimum ta
60
Neonatal t
40
Postnatal v
(within 2 day
20
Postnatal v
(within 2 day
0
1997
DHS
2000
MICS
2002
DHS
2006
MICS
2011
MICS
Women wi
(<18.5 kg/m2
alitis
birthw
Other maternal and newborn health indicators
EALTH
Anten
mana
Demand for family planning satisfied (%)
95
(2011)
Antenatal care (4 or more visits, %)
60
(2011)
1
(2006)
20, 31, 16
(2011)
Low o
mana
91
(2012)
-
-
SYS
Malaria during pregnancy - intermittent preventive
treatment (%)
4
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
-
-
-
-
(within 2 days for home births, %)
11
CS
Women with low body mass index
(<18.5 kg/m2, %)
Countdown to 2015 Report. 2014.
Intern
Breas
Comm
with a
Coste
plan(s
child h
Life Sa
Repr
Mate
Child health
Child health
DHS
MICS
DHS
MICS
MICS
(<18.5 kg/m
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 re
Perce
100
80
60
40
20
0
65
40
57
40
47
26
24
11
1997
DHS
2000
MICS
2002
DHS
2006
MICS
WATER AND SANITATION
2011
MICS
Percent
Mala
Percent
Diarrhoeal disease treatment
100
80
60
40
20
0
MICS
Reprod
Matern
(<18.5 kg/m2, %)
Child health
Newbor
Child he
Malaria prevention and treatment
Percent children receiving first line treatment among
those receiving any antimalarial
Percent children < 5 years sleeping under ITNs
42 (2011)
Density o
midwives
National
Obstetric
57
47
2011
MICS
Percent
(% of recom
100
80
60
40
20
0
FINA
16
2000
MICS
13
2005
Other NS
9
2011
MICS
Per capit
health (In
General
on healt
expendit
Out of po
expendit
Child health
Child health
DHS
MICS
DHS
MICS
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 f
Unimprove
1
4
100
16
18
22
47
80 39
28
69
85
53
61
9
9
0
2012
Total
Source: WHO/UNICEF JMP 2014
22
40 2
20 37
26
1990
60
54
43
20
0
100
37
60
40
2
4
Percent
Percent
80
20
6
4
1990
2012 1990
Urban
2012
0
1990
Rural
Source: WHO/UN
MICS
MICS
MICS
Out of pocke
expenditure
Water and sanitation
Reproductiv
and child he
Improved sanitation coverage
990-2012
Rural
Other NS
2
4
Percent of population by type of sanitation facility, 1990-2012
Improved facilities
Shared facilities
Open defecation
Unimproved facilities
100
2
19
85
Percent
80 39
60
2012
4
93
75
26
43
8
4
Out-of-po
3
5
22
40 2
20
9
4
24
0 2
External s
General g
24
37
67
31
0
1990
2012
Total
Source: WHO/UNICEF JMP 2014
1990
2012
Urban
ODA to child
ODA to mate
per live birth
Note: See annex
2
64
Other
1990
2012
Rural
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
• NO - 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): 23.0 (2011)
• National availability of EmOC services: - (% of recommended minimum)
• Per capita total expenditure on health (Int$): $233 (2012)
• Government spending on health: 9% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 49% (2012)
(as % of total health spending)
• Official development assistance to child health per child (US$):
$9 (2011)
• Official development assistance to maternal and newborn
health per live birth (US$): $33 (2011)
Who is left behind?
Vietnam
The wide bars for many
indicators show important
inequalities in coverage.
Inequality is greatest for
skilled birth attendant,
antenatal care and DTP3.
ORT, careseeking for
pneumonia, and vitamin A
show much smaller gaps in
coverage.
Thank you!
Optional additional slides
Equity profiles
Vietnam
Coverage levels in poorest and richest
quintiles
Coverage levels in the 5 wealth
quintiles
Co-coverage of health interventions
Composite coverage and coverage gap