15-18 Nov 2011Child Health Programme Managers' Meeting 1 Meeting of South-East Asia Regional...

15-18 Nov 2011 Child Health Programme Managers' Meeting

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Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18

Nov 2011

Progress in Implementation of Child Health Programme

Country: MYANMAR


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• Total population-59.13 million (2009-2010, CSO)

• 11.7%- under five population

• DOH, MOH is mainly taking the responsibilities for promotive, preventive, curative and rehabilitative health care services for the people.

• WCHD is the main section for child health development.

• Child health related projects and program


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EPIDEMIOLOGY / BURDEN OF CHILDHOOD DISEASES:


4

130

82.477.77

66.1

46.1 43.355.4 55.1

49.737.5

32.7

98

0

20

40

60

80

100

120

140

1990 1995 1999 2003 2010 2015

Series1 Series2U5MR IMR

MDG

TRENDS IN CHILD MORTALITY RELATED TO MDG 4, MYANMAR

DOH DOH CSO DOH MICS

Dea

ths

per

1,0

00 L

B


5

38.641.6

8.29.4

32.2

8.6

35.1

7.9 8.6

35.3 33.931.8

22.6

0

5

10

15

20

25

30

35

40

45

1 2 3 4

Under weight Stunting Wasting LBW

Per

cen

tag

eNUTRITION STATUS

1997 2000 2003 2010


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Diarrhoea (18%)

Brain Infection (17%)

Malaria (8%)

Beri Beri (7%)

Pneumonia (27%)

Others( 14%)

Malnutrition(1%) Measles

(1%)DHF( 1%)

Septicaemia (6%)

MAIN CAUSES OF UNDER-FIVE DEATHS

(Source: Cause specific under five mortality survey, DOH/UNICEF, 2003)


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MAIN CAUSES OF NEONATAL MORTALITY

Brain infection (4%) Unknown

(13%)

Asphyxia (24%)

Congenital anomaly (3%)

Prematurity, (31%)

Sepsis (25%)

(Source: Cause specific under five mortality survey, DOH/UNICEF, 2003)


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IMCI IMPLEMENTATION


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National adaptation of IMCI Training Package

1998

IMMCI Implementation started in the country

1998-2001

WCHD/IMMNCI Implementation started in the country

2001 upto now

IMCI implementation started (If yes, year)

2004-2005Upto now

Newborn included in WCHD (0-1 month)

2001

Newborn Added to IMCI 2011

Number and Proportion of districts implementing WCHD

200

Number and Proportion of districts implementing IMCI

18


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Number and proportion of MOs trained for IMCI 80

Number and proportion of Nurses/other workers trained for IMCI

810

Proportion of districts (out of IMCI districts) with 60 % or more health providers trained

18/18

IMCI supervisory checklists introduced 2004-2005

Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during previous year

7 tsp47 RHC

& SubRHC

Proportion of districts (out of IMCI districts) covered with Follow-up IMCI training

18/18

IMCI Implementation 2004 - 2011


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IMCI implementation review conducted (If yes, year; National and sub-national)

2009

IMCI Health Facility Survey conducted (If yes, year; National or sub-national)

2008

Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI

18

Pre-Service IMCI teaching/training:

Number and proportion of Medical Schools teaching IMCI

4 out 4

Number and proportion of Nursing Schools teaching IMCI

23

Number and proportion of Midwifery Schools teaching IMCI

20/22

ICATT introduced (If yes, year and scale) Not yet


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Key factors that helped scaling up:1. Political and community commitment2. Priority issue in National Health Plan3. Existence of Child Health Development

Strategic Plan and implementation plan4. Strong

coordination/cooperation/collaboration with UN agencies, NGOs, related departments and ministries and projects and program

Key challenges to scaling up:1. Policy shift2. Funding gaps3. HR gaps


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NEWBORN HEALTH


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• ENC Course adapted: Year 2006• Other training courses: IMCI, PCPNC,

WCHD, Management of Critically ill children

• Healthcare providers trained: in 30 Tsps out of 330 tsps

Healthcare providers

Total no.

No. Trained

%

MO (public only)

10927 142 Negligible

Nurses 25644535

"

Midwives 19554

CHW 500

Volunteers nil


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IN-PATIENT (HOSPITAL) CARE OF SICK NEBORNS AND

CHILDREN


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• WHO Pocket Book introduced: Year 2008-2009

• Training courses for Hospital care done: Yes • Details: Four days training for doctors

and nurses• Number and proportion of Healthcare

providers trained:– MOs: 864 /10927– Nurses: 865/25644– BHS: 16,172/19556

• Proportion of hospitals providing pediatric care having oxygen: No exact data

• Hospital assessment using WHO tools carried out: not yet– Year/s: planned for 2012-13– How many hospitals covered:


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CHW APPROACH FOR CARE OF SICK NEWBORNS AND

CHILDREN


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District implementing CHW approach

Total No. of

Distt

Implementing

Districts

%

Home based newborn care

330 10

Sick child package

330 1

Healthy child package (ECD)

330 none

Any review of the experience


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PROGRAMME REVIEW AND MANAGEMENT


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• CH Short Programme Review introduced, if yes : – Year: 2009– National or sub-national: both

• Programme Management Course introduced, Not yet. Planned for 2012-13


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HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)

AND DHS/MICS


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Indicators related to ARI/pneumonia

No Key indicators Source of data

1 Morbidity and mortality rates of ARI

HMIS

2 Care seeking for ARI MICS


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1 Percentage of under five diarrhoea with severe dehydration and treated with ORT

HMIS

2 ORT use rate MICS

3 Home management of diarrhoea

MICS

Indicators related to diarrhoea


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Indicators related to nutrition


1 LBW among MW delivery HMIS

2 LBW among AMW delivery HMIS

3 Under three years old under weight (%)

HMISMICS

4 Stunting prevalence MICS

5 Wasting prevalence MICS

6 EBF MICS


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Indicators related to nutrition


7 Continued BF rate MICS

8 Timely complementary feeding rate

MICS

9 Children receiving Vitamin A supplementation

MICS

10 Iodized salt consumption MICS


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Indicators related to WASH


1 Sanitary latrine coverage HMISMICS

2 Use of drinking water MICS


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Indicators related to EPI


1 Immunization coverage (DPT,OPV, Hepatitis B, BCG, Measels)

HMISMICS

2 Morbidity and morality of neonatal tetanus

HMISMICS

3 Morbidity and mortality rates of vaccine preventable diseases

HMIS

4 Children protected against neonatal tetanus

MICS


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Indicators related to vital statistics


1 Early neonatal death rate HMIS

2 NMR (2012) HMIS

3 IMR HMISMICS

4 U5MR HMISMICS

5 Under five referral to the higher center (%)

HMIS


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Other Indicator related to NCH


1 New cases of ophthalmia neonatorum

HMIS

2 SBA HMISMICS

3 AN coverage HMISMICS

4 Post natal visit HMIS


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Data collection and management in HMIS

Data collection • Data Collection System was well established • Cover the whole country• Statistician at state and regional level • Integrated data set• Standing order/clear instruction• Data dictionary to reduce systemic error

Processing and analysis• Manual data editing• Data entry by Epi data program • Data analysis by SPSS program


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Data collection and management in HMIS

Dissemination &Use• Monthly and quarterly report• Annual statistics report• Township health profileQuality Control of HMIS Data• Monitoring and supervision

– Desk monitoring and feedback at each and every level

– Field monitoring and supportive supervision

– Data quality assessment in selected township


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FUTURE PLAN


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Strengthening and scale-up plans for Next 2 years

• IMCI: IMNCI trainings to 2 more townships• ICATT use: not planned yet• CHW Packages:

– Home Based NB Care package:10 townships

– Sick child package: CCM-5 townships– Healthy Child (ECD) package from 2012-

13 biennium• Referral (Hospital) Care: F-IMNCI planned

2012-13• Programme Review and Management:

– CH Short Programme Review: 2013– Programme Managers Course: 2012-13


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• Strengthening of HMIS at all levels e.g. training of HMIS with newly revised data set is urgently needed in 2012.

• Capacity building of information staff at various level is needed for data management.


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THANK YOU

15-18 Nov 2011Child Health Programme Managers' Meeting 1 Meeting of South-East Asia Regional...

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