MDG 4 and Beyond - WHO · 2013. 1. 30. · How did Egypt address the issue of under-five mortality?...
Transcript of MDG 4 and Beyond - WHO · 2013. 1. 30. · How did Egypt address the issue of under-five mortality?...
EgyptMinistry of Health & Population
MDG 4 and Beyond
“Lessons Learnt”“Lessons Learnt”
Emad Ezzat, MDHead of PHC Sector
EMRO high-level meeting, Dubai, Jan 2013
Trends of Under 5, Infant and
Neonatal Mortality (1990 – 2008)
Under 5
Egyptian DHS
Infant
Neonatal
� Ten years ago, the United Nations General Assembly passed the landmark resolution on A
World Fit for Children, and in doing so, helped save and enhance the lives of millions of
children. Today, we renew this promise to the world’s children.
� Therefore, we the undersigned heads of State and Government and representatives of States,
reaffirm our commitment to children. Consistent with the Secretary-General’s Every Woman
Every Child initiative, we pledge our support for the global movement to end
preventable child deaths.
� The world has made tremendous strides in reducing child mortality. Over the past 40 years,
Signed June
2012,
Washington DC
� The world has made tremendous strides in reducing child mortality. Over the past 40 years,
new vaccines, improved health care practices, investments in education, and the dedication
of governments, civil society and other partners have contributed to reducing the number of
child deaths by more than 50%. The momentum generated by this unprecedented progress,
and the scientific and social advances that underpin it, present an historic opportunity for
dramatic declines in preventable child deaths – in high, middle and low-income countries
alike.
� Through national action and international cooperation, we pledge to take action to
accelerate progress on newborn, child and maternal survival. We hold ourselves
accountable for our collective progress towards this goal. And on behalf of all children
everywhere, we recommit the efforts of our respective governments to give every child the
best possible start in life.3
How did Egypt address the issue of under-five mortality?
Reduction of child mortality, where the 2015 target of
MDG4 has been achieved in 2008. (Average Annual Rate
of Reduction 1990 – 2011 is 6.7%) , in 2011, Egypt has
gone beyond MDG4, a 75% reduction in under-five
mortality between 1990 and 2011 through:mortality between 1990 and 2011 through:
• Full (or almost full) coverage of children by child care
programs (e.g. IMCI including EPI, CDD, ARI, growth
monitoring,, Micronutrient supplementation)
• Neonatal care units in all general and 10% of district
hospitals (total of 242 hospitals)
• National neonatal screening for congenital
hypothyroidism
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EPI program
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• Early introduction of Zinc preparation and Low-
osmolarity ORS for diarrhea treatment since 2007
How did Egypt address the issue of under-five mortality?
osmolarity ORS for diarrhea treatment since 2007
• Starting perinatal and nutritional health care program
• Landscaping Analysis study for assessment of
willingness and readiness for scaling up of nutritional
interventions
• Conducting Perinatal Surveillance System
• Establishing Nutritional Surveillance System7
• Ante-natal care program (73% coverage for any
ANC visit and 66% for 4 ANC visits)
• Strong family planning program: 58% use of
How did Egypt address the issue of under-five mortality?
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• Strong family planning program: 58% use of
modern contraceptive methods.
• Midwifery training to ensure equity to access to
safe deliveries to poor women that improved
delivery outcomes.
IMCI Program
• Includes cost effective package of interventions to
address main causes of U-5 mortality at PHC
level:
– Pre-referral management of severe conditions.
– Case management of:
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– Case management of:
• Sick newborn
• Pneumonia
• Diarrhea
• Malnutrition.
– Breastfeeding and complementary feeding counseling.
– Checking vaccination and vitamin A supplementation status.
– Improving care-seeking.
• Introducing Health insurance for under 5 years children
• Inclusion of IMCI programs in the medical education
How did Egypt address the issue of under-five mortality?
• Inclusion of IMCI programs in the medical education
curriculum at universities since year 2000
• Scaling-up implementation of IMCI in a relatively short
time by adopting a systematic approach (started 1999 and
nearly full coverage 2012)
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A systematic approach for IMCI scaling up
enabled reaching high coverage (94% PHC
facilities)
2301
2992
3524
40244211
44784645
4731
3000
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Health f
acili
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MC
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Health f
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MC
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Health facilities implementing IMCI Cumulative total
Improved quality of services as proven by the survey and follow up reports.
However, Egypt is facing
challenges
• High turnover of trained staff: overburden on in-service
training.
Inequities• Inequities in coverage of interventions (geographic and
socio-economic), and distribution of human resources.
• Multiple planning processes for child health with different
partners.
• A lot of investments are required to scale up the
community based interventions.
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However, Egypt is facing
challenges (cont.)
• Private sector is expanding, not necessarily complying
with the technical protocols of the public sector with the technical protocols of the public sector
(regulations).
• Inadequate budget allocation for MCH.
• Inadequate Government health expenditure and High out-
of-pocket expenditures.
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• Political commitment and strong leadership
• High accessibility to a wide and well staffed PHC network
• High coverage with child health interventions.
Key drivers of success
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• High coverage with child health interventions.
• Utilize cost effective interventions and adopting
standardized protocols within the BBP
• Institutionalized EPI, CDD and ARI Programs (IMCI)
• prioritized under-privileged areas and high risk groups
• Adoption of community based initiatives (Raedat
Refeyat) to increased demand and coverage with health
services
• Surveillance Systems (Maternal and Child mortality)
Key drivers of success
• Surveillance Systems (Maternal and Child mortality)
• Capacity building at all levels (to ensure quality care)
• Efficient partnership:
– Private sector
– Academia
– Civil society and community
– Partners for development15
Way Forward
• Renewal of commitment to child survival (Call to Action)
• Sustain our gains (e.g. IMCI and Perinatal Care Program)
• Mobilizing enough resources to achieve this target.
• Addressing inequities as a major approach to further
reduce mortality.
• Providing emphasis on the neonatal mortality while
sustaining the attention to the post-neonatal period.
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Way Forward (cont)
• Emphasize efficient partnership with private Sector,
academia, civil society and donors (getting everyone on
board)
• Expand community based interventions• Expand community based interventions
• workforce capacity building and motivation (medical
students, pre-service and in-service) with fair distribution
• Innovation (mobile technology, telemedicine and
introduction of new vaccines)
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Way Forward (cont)
• Scaling up the “Family Health Model”.
• Strengthening the MOHP regulatory role over the private
sector practices.
• Shifting the multiple planning processes into one
integrated national planning process to which all partners
contribute.
• Making more efforts in pre-service education to ensure
sustainability and reduction of the overburden of in-service
training.
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Thank You
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Thank You