Critical appraisal of child health policies, programs, guidelines and their implementation strategies and review the current status of national context
- 1. Critical Appraisal of Child Health Policies, Programs, Guidelines and Their Implementation Strategies and Review the Current Status of National Context Prepared By: Mohammad Aslam Shaiekh MPH-3rd Batch School of Health and Allied Sciences (SHAS) Pokhara University (P.U)
- 2. Introduction Childhood mortality in general and infant mortality in particular is often used as broad indicators of social development or as specific indicators of health status. Childhood mortality therefore contribute to a better understanding of a country’s changing socioeconomic situation and quality of life.
- 3. Childhood mortality indicators 1. Perinatal mortality rate 2. Neonatal mortality rate 3. Postnatal mortality rate 4. Infant mortality rate 5. Childhood mortality rate 6. Under 5 year mortality
- 4. Determinants of Child Health
- 5. Source: WHO SEAR,MDG progress report 2014
- 6. Child Mortality rate in Nepal Source: NDHS 2016
- 7. NEONATAL MORTALITY IN SOUTH EAST ASIA 2012 INFANT MORTALITY RATE IN SOUTH EAST ASIAN REGION 2012 Source: WHO SEAR,MDG progress report 2014
- 8. Under 5 mortality rate Source: WHO SEAR,MDG progress report 2014
- 10. Major causes of Child Morbidity Malnutrition Infection- diarrhea, diphtheria, tetanus, whooping cough, measles, eye and skin problems Parasitic infestation Accidents cause disability
- 11. Development in Child health policies, plans and programs in Nepal
- 12. Child Health Programs of Nepal Immunization Nutrition Community Based Integrated Management of Newborn and Childhood Illness (CBIMNCI)
- 13. National Immunization Program The National Immunization Programme (NIP) is a high priority program (P1) of Government of Nepal. Immunization is considered as one of the most cost-effective health interventions. At present, National immunization Program provides vaccine against 12 diseases. National Immunization Program is guided by Comprehensive multi year plan of action (CMYP 2017-21)
- 14. Goal, Objectives and Strategies of CMYP2012-16 Goals: To reduce child, mortality, morbidity and disability associated with vaccine preventable diseases OBJECTIVES AND STRATEGIES: Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at national and district level by 2016 Key strategies: •Increase access and utilization to vaccination by implementing RED strategies in every district •Enhance human resources capacity for immunization management Strengthen immunization monitoring system at all level •Strengthen communication, social mobilization, and advocacy activities Strengthen immunization services in the municipalities.
- 15. Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management Key strategies: Strengthen the vaccine management system at all levels Objective 3: Achieve and maintain polio free status Key strategies: •Achieve and maintain high immunity levels against Polio by strengthening routine immunization and conducting high quality national polio immunization campaigns. •Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine •Achieve and maintain certification standard AFP surveillance
- 16. Objective 4: Maintain maternal and neonatal tetanus elimination status Key strategies: •Achieve and maintain at least >80% TT2+ coverage for pregnant women in every districts •Conduct Td follow up campaigns in high risk districts Expand school based immunization program •Continue surveillance of NT
- 17. Objective 5: Initiate measles elimination Key strategies: •Achieve and sustain high population immunity to reduce measles incidence to elimination level •Investigate all suspected measles like outbreaks with program response Use platform of measles elimination for Rubella / CRS control •Continue case-based measles surveillance Objective 6: Accelerate control of vaccine-preventable diseases through introduction of new and underused vaccines Key strategies: Introduction of new and under-used vaccines (rubella, pneumococcal, typhoid, rota) based on disease burden and financial sustainability
- 18. Objective 7: Strengthen and expand VPD surveillance Key strategies: • Expand VPD surveillance to include vaccine preventable diseases of public health concern. •Strengthen and expand laboratory support for surveillance. Objective 8: Continue to expand immunization beyond infancy Key strategies: Consider for booster dose of currently used antigen based on evidence and protection of adult from potential VPDs.
- 22. Fully Immunized Districts Declaration
- 23. Immunization : Proportion of children age 12-23 months who received all basic vaccinations at any time
- 24. Problems/Constraints Inadequate HRH especially in Metro/Sub – Metropolitan, MCH / Institutional clinics and ill-defined JD of AHW & ANM (for vaccinations) Poor quality immunization data: Under and over reporting Poor Inventory keeping and distribution system Unplanned immunization month celebration Low achievement of FID as per National target Poor Cold Chain and Vaccine management Inadequate CC Equipment and inadequate repair, maintenance and replacement, lack of technician Inadequate Vaccine Store Capacity specially central level
- 25. Nutrition Program Nutrition section under Child Health Division is responsible for national nutrition program for improving the nutritional status of children, pregnant women and adolescents. Goals: Achieve nutritional well-being of all people to maintain a healthy life to contribute in the socio-economic development of the country, through improved nutrition program implementation in collaboration with relevant sectors.
- 27. NutritionalstatusofChildrenin Nepal Source: NDHS 2016 Stunting in children by Province
- 28. Source: WHO SEAR,MDG progress report 2014
- 29. Assessing Severity of Malnutrition by Prevalence among U5 Children Indicator Severity of malnutrition by Prevalence Rates (%) Low Medium High Very high Stunting <20 20-29 30-39 >=40* Underweight <10 10-19 20-29* >=30 Wasting <5 5-9 10-14* >=15 *Nepal Source: http://www.who.int/nutgrowthdb/about/introduction/en/index5.html
- 30. Prevalence ofAnemia in U5 Children and Women Source: NDHS 2016
- 31. InfantYoung and Child Feeding (IYCF) Practice in Nepal - Breastfeeding * Predominant breastfeeding includes exclusive breastfeeding, breastfeeding plus water, and breastfeeding plus non-milk liquids/juice. **Age appropriate breastfeeding = Children age 0-5 months who are exclusively breastfed + children age 6-23 months who receive breast milk and complementary foods. Source: NDHS 2016
- 32. InfantYoung and Child Feeding (IYCF) Practice in Nepal – Complementary feeding . Source: NDHS 2016
- 33. Infant andYoung Child Nutrition Proportion of infants less than age 12 months with breastfeeding initiated within one hour of birth Source: WHO SEAR,MDG progress report 2014
- 34. Nutrition Program Implemented by CHD’s Nutrition Section (1993 – 2016) Nationwide programmes: • Growth monitoring and counselling • Prevention and control of iron deficiency anaemia (IDA) • Prevention, control and treatment of vitamin A deficiency (VAD) • Prevention of iodine deficiency disorders (IDD) • Control of parasitic infestation by deworming • Mandatory flour fortification Scale-up programmes: • Maternal, Infant, and Young Children Nutrition (MIYCN) programme • Integrated Management of Acute Malnutrition (IMAM) • Micronutrient Powder (MNP) distribution linked with infant and young child feeding(IYCF) • School Health and Nutrition Programme • Vitamin A supplementation to address the low coverage in 6–11 month olds • Multi-sector Nutrition Plan (MSNP)
- 35. Objectives and Strategies of National Nutrition Program The overall objective is to enhance nutritional well-being, reduce child and maternal mortality and contribute to equitable human development. Specific Objectives: To reduce protein-energy malnutrition in children under 5 years of age and women of reproductive age To improve maternal nutrition To reduce the prevalence of anemia among adolescent girls, women and children To eliminate iodine deficiency disorders and vitamin A deficiency and sustain elimination To reduce the infestation of intestinal worms among children and pregnant women To reduce the prevalence of low birth weight To improve household food security to ensure that all people can have adequate access, availability and use of food needed for a healthy life
- 36. Objectives and Strategies of National Nutrition Program To promote the practice of good dietary habits to improve the nutritional status of all people To prevent and control infectious diseases to improve nutritional status and reduce child mortality To control lifestyle related diseases including coronary disease, hypertension, tobacco related diseases, cancer and diabetes To improve the health and nutritional status of schoolchildren To reduce the critical risk of malnutrition and life during very difficult circumstances To strengthen the system for analyzing, monitoring and evaluating the nutrition situation Behavior change communication and nutrition education at community levels To align health sector programes on nutrition with the Multi-Sectoral Nutrition Initiative.
- 37. Objectives and Strategies of National Nutrition Program Strategies: The overall strategies for improving nutrition are: The promotion of a food based-approach Food fortification The supplementation of foods and The promotion of public health measures
- 38. Adopting Multi - Sectoral Nutrition Plan (MSNP) framework
- 39. Community Based Integrated Management of Newborn and Childhood Illness (CBIMNCI) CB-IMNCI is an integration of CB-IMCI and CB-NCP Programs. This integrated package of child-survival intervention addresses the major problems of sick newborn such as birth asphyxia, bacterial infection, jaundice, hypothermia, low birth-weight, counseling of breastfeeding. It also maintains its aim to address major childhood illnesses like Pneumonia, Diarrhea, Malaria, Measles and Malnutrition among under 5 year’s children in a holistic way.
- 40. Goals, targets, objectives, strategies, interventions and activities of CBIMNCI program Goal: Improve newborn and child survival and healthy growth and development. Targets of Nepal Health Sector Strategy (2015-2020): Reduction of Under-five mortality rate (per 1,000 live births) to 28 by 2020 Reduction of Neonatal mortality rate (per 1,000 live births) to 17.5 by 2020 Objectives: To reduce neonatal morbidity and mortality by promoting essential newborn care services To reduce neonatal morbidity and mortality by managing major causes of illness To reduce morbidity and mortality by managing major causes of illness among under 5 years children
- 41. Goals, targets, objectives, strategies, interventions and activities of CBIMNCI program Strategies: Quality of care through system strengthening and referral services for specialized care Ensure universal access to health care services for new born and young infant Capacity building of frontline health workers and volunteers Increase service utilization through demand generation activities Promote decentralized and evidence-based planning and programming
- 42. Interventions of CBIMNCI Newborn Specific Interventions: Promotion of birth preparedness plan Promotion of essential newborn care practice sand postnatal care to mothers and newborns Identification and management of non-breathing babies at birth Identification and management of preterm and low birth weight babies Management of sepsis among young infants (0-59days) including diarrhea Child Specific Interventions Case management of children aged between 2-59 months for 5 major childhood killer diseases. (Pneumonia, Diarrhea, Malnutrition, Measles and Malaria)
- 43. Interventions of CBIMNCI Cross -Cutting Interventions Behaviors change communications for healthy pregnancy, safe delivery and promote personal hygiene and sanitation Improved knowledge related to Immunization and Nutrition and care of sick children Improved interpersonal communication skills of HWs and FCHVs
- 44. Vision 90 by 20
- 45. Classification of cases as per CB-IMNCI protocol by province (FY2073/74)
- 46. Problems in CB-IMNCI No sanctioned position for CB-IMNCI focal persons at district and regional levels Unclarity in roles of staffs (including CBIMNCI focal person) in the new federal context Unable to implement free new-born care guideline since last FY as expected. Frequent stock outs of essential commodities in districts and communities. Poor service data quality Poor quality of care
- 47. Conclusion The program achievements are important to understand progress in child health status. Even though we have achieved tremendous progress in decreasing child mortality. Now, large proportion of babies dies before completing their first month of their life as we can see the number of neonatal death remaining stagnant and poses challenge to the current health system. To understand child health status, it is equally crucial to evaluate the children, who are survived. Their survival should be accompanied by healthy childhood and better future. Thus the aim of child health programme should not be limited to decreasing deaths but the well being of the children and better opportunity in a safe, secure world.
- 48. THANK YOU