MNCHN in RNHeals

(With Brief GP & FP Description)

Eduardo C. Janairo, MD, MPH

Director IV

National Center for Disease Prevention and Control

PHILIPPINES HEALTH SITUATION AND STRATEGIES TO ACHIEVE THE MILLENNIUM DEVELOPMENT GOALS (FOCUS ON MDGS 4 & 5)
Dir. Eduardo C. Janairo, MD, MPH Director IV National Center for Disease Prevention and Control, Dept. of Health

Philippine Progress Report on MDG 5:

Improve maternal health

On reducing the MMR by 75 percent:

Remains a difficult challenge

On universal access to RH services: CPR-modern method= 34 percent (married women) and 22 percent (all women of reproductive age)

Philippine Progress Report on MDG 4: Reduce child mortality

Philippines has been doing well in reducing under-five mortality and infant mortality rates but needs to address neonatal mortality rates.

A Minute-by-Minute Assessment of Newborn Care within the First Hour of Life in Philippines Hospitals (2009) Intervention Percentage and Median Time WHO Standard

Cord Clamp
Drying

12 sec 99% in < 1 min

97% at 1 min

Until pulsations stop (1-3 mins)

100% Immediately

Immediate Skin-to-skin contact

Put on cold surface Not dried Head not dried Wash Temp taken before

9.6% at 5 min
12% 2.5% 6.2% 84% at 8 min 17%

>90% (except those needing resuscitation)

None None None >6 hours All
Sobel, Silvestre, Mantaring, Oliveros, 2009

RATIONALE FOR THE NEW DESIGN OF GP PROGRAM

GLOBAL STRATEGY Integrated delivery of health services LANCET EVIDENCE Improved integration of child survival & reproductive health services

PNOY CHALLENGE Public & private partnerships Alignment with 4Ps

DOH REFORM Continuum of care All year round 6-14 as neglected population Public & private partnerships Inter-agency collaboration

G P

STRATEGIC CREATIVE DESIGN OF THE NEW GP PROGRAM

GARANTISADONG PAMBATA
a child health communication & service delivery program

Different age groups 0-5 6-14

Different service delivery modes

Different partners

Different
communicati on

channels

Different services

Different behaviors

Work together consolidating efforts for childs rights.

Situationer
good and satisfying statistics devoid of realities A call for healthy behaviors devoid of support Common negative behavior and values becoming positive Still program based approach Limitations created by guidelines and policies Lost initiatives and forever searching

Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality
Eduardo C. Janairo, MD, MPH Director IV National Center for Disease Prevention and Control

Assessment
Very slow decline of MMR in past 20 years Maternal deaths account for 14% of deaths among women of reproductive age Maternal death triggers other adverse consequences in families: orphans, loss of family care provider 17 infants die per 1,000 live births within first 28 days of life
Mostly within first week after birth Half die during the 1st 2 days

Policy Objective
Reduce maternal and neonatal mortality rates faster from 2007 to 2015 in order to meet MDG targets However, we need to understand features and characteristics of maternal and newborn deaths to focus our interventions.

MNCHN Strategy
Every pregnancy is wanted, planned and supported Every pregnancy is adequately managed

Intermediate Goals
Every delivery is facilitybased and managed by skilled health professional
Every mother and newborn pair secures proper postpartum and postnatal care with smooth transitions to the womens health care package for the mother and child survival package for the newborn.

Lifes Events
Programs: EPI, Anti-smoking FP, NBS etc

Conception

Birth

Five years after Or Under Five

Pregnancy Pre-union: Premarital sex Premarital counselling

Delivery

3-yr & 3 years after

Repositioning Family Planning as a Program & Family Planning Commodities

EDUARDO C. JANAIRO, MD, MPH Director IV, National Center for Disease Prevention and Control

From ...
Birth control Population control Limiting family numbers Liquidating a race Contraceptives Birth spacing tools

 Rights based: know, informed, choose, use Health concerns: maintenance and sustenance; prevention and control of diseases Economic reasons/family financial stability Continuum of service: MNCHN context Inclusion of fertility problems Inclusion of other modern methods available

To ...

Lifes Events and Continuum of Service

Conception

Birth

Pregnancy Pre-union: Premarital sex Premarital counselling

INDIVIDUAL HOME

Delivery

3-yr & 3 years after

COMMUNITY

FACILITIES

EFFECTIVE ACCESSIBLE

EFFICIENT

EQUITABLE SUSTAINABLE

EMPOWERING
AFFORDABLE

APPROPRIATE

RESPONSIVE

Approaches...
Decentralized (social prep.; things not to expect) Rights based (from the womb) Life cycle Lifes events

sense of urgency, focus, consolidated efforts and recognition on the MATERNAL, NEONATAL & CHILD HEALTH AND NUTRITION (MNCHN) and its INTEGRATED strategies

Pregnancies and Deliveries ...

As emergencies whether for the so-called rich or poor Maternal and infant deaths as reportable cases Blood as a public good Continuum of services from premarital/union Pregnant Patient Rights Facility modification Imposed/Purposive messages fbd or fbc shp or sba 6mos. EB vs. LAM 3yrs spacing

TBAs ...
Incentives to refer deliveries Join a Barangay Health Team or the Womens Health Team Qualified TBAs provided educational assistance to become midwives

Components ...
BEmONCs CEmONCs WBCs 3Tiered and 4Tiered Services WHT/CHT Training Centers PhilHealth accredited MCP Plus (Unbundling) Database Tracking and Monitoring (TCL, Deaths daily) Networks and birth plans including Blood Centers

BUNTIS Connection
Facilities Professionals Blood Transportation services Communication services Follow-up services GET CONNECTED!!!

Where are we now...

PRC Boards CHED Academic Professional Organizations Policy consolidation and review Speakers Bureau BEmONC Certification & Accraditation BEmONC Teams and Midwives Trainings Promotional Strategies and Products Social Prep Info dissemination Network development and functional referral system and facility rationalization

Thank you !!!