Head , Division of Family health Overview and trends of Reproductive, Maternal , Newborn , Adolescent and Child health Program in Kenya ‘Investing in woman and child health …..… Dr. Mohamed .A. Sheikh Head , Division of Family health Ministry of Health .

INTRODUCTION . The health status of mothers and children is an important indicator of the overall heath system status , economic of nation and well-being of a country. Thus, The government recognizes that good health of WOMEN and CHILDREN is a prerequisite to socioeconomic development. The government of Kenya emphasizes the health of its citizens and the improvement of health service delivery is a key priority. Children represent the future and ensuring their healthy growth and development ought to be a prime concern for all society. Newborns are particularly vulnerable to infectious diseases and malnutrition.

INTRODUCTION Maternal health is inextricably linked with the survival of newborns. For every woman who dies, another 30 suffer long-lasting injuries and illnesses such as obstetric fistula (UNDP, WHO, UNFPA, and World Bank, 2006). Provision of a continuum of care during pregnancy, labour and delivery, and the postnatal period results in reduced maternal and neonatal morbidity and mortality Early childhood development is consider to be the most important phase in life which determines the quality of health . Globally , Every year nearly 6 Million children die due to preventable and treatable causes Kenya has made significant progress in reducing child mortality

Vision A Kenya where there are no preventable deaths of women, new-borns or children and; no preventable still-births, where every pregnancy is wanted, every birth celebrated and accounted for; and where women, babies, children and adolescents are free of HIV/AIDS, survive, thrive and reach their full social and economic potential

Key Priority Indicators Maternal Mortality Ratio – 362 per 100,000 live births Neonatal Mortality rate – 22 per 1000 live births Skilled Birth Attendance – 62% Antenatal care coverage – 96% Under five mortality Rates – 52 per 1000 live births Infant mortality Rate – 39 per 1000 live births Neonatal Mortality Rate – 22 per 1000 live births Focused Antenatal care coverage (using 4th ANC visit) Postnatal Care coverage Targeted Postnatal Care coverage (48h and 6 weeks) Stunting , wasting and underweight cases

Government Initiatives FREE MATERNITY SERVICES Campaign by Her Excellency, Margaret Kenyatta, First Lady of the Republic of Kenya FREE PRIMARY HEALTH SERVICES UHC DEVOLUTION

Ministry of Health Government of Kenya January 31, 2016

KEY ACHIEVEMENTS. Kenya is making progress in reducing child mortality and improving maternal health services

Key Achievements: Maternal Health Utilization of Skilled Deliveries Maternal Mortality Ratio

Key Achievements: Child Health “Things are looking up!” Trends in Childhood Mortality Deaths per 1,000 live births for the five-year period before the survey

Key Achievements: HIV Control PMTCT HIV Prevalence Declined from 13% (2000) to 6.0 % (2014) Care and Treatment ~1M PLHIV on ART New Treatment Regimens

Performance of the Immunization program; administrative reports Reported Immunization Coverage Trends (2013-2018) Unimmunized Children & Penta 3 Coverage 2013 - 2018 Number of unimmunized children is lowest since devolution.; general improvement leading to better coverage numbers.

Key Achievements: Nutritional Status of Children Percent of children under 5

Trends of Stunting, Wasting and Underweight

Contraceptive use increasing and fertility declining

Progress in Key RMNCAH Indicators   Key Indicators KDHS 2008/09 KDHS 2014 SSA region Neonatal mortality rate (per 1,000 Live births) 31 22 31.1* Infant mortality rate (per 1,000 Live births) 52 39 61.1* Under-five mortality rate (per 1,000 Live births) 74 92.4* Maternal mortality ratio (per 100,000 live births) 488 360 510* Total fertility rate (per women) 4.6 3.9 5.0* Teen pregnancy (%) 18 - Children under-five stunted (%) 35 26 Deliveries attended by a skilled provider (%) 43 62 48.6** Pregnant women received any antenatal care (%) 92 96 77** Children received all basic vaccines (%) 65 71 Children under 6 months exclusively breastfed (%) 32 61 37.7** Contraceptive prevalence rate (any method) among currently married women (%) 46 58 23.6** Unmet need for family planning (%) 25 24.4** * Source- World Bank 2013, **2011, NA – Not available, KDHS – Kenya Demographic and Health Survey, SSA – Sub Sahara Africa

KEY ISSUES AND CHALLENGES

CURRENT STATUS: Women & children die from preventable illnesses 108,0000 Kenyan children die before their 5th birthday ≈ 40% die within the 1st month after birth 13,000 new HIV infections per year Over 6,000 -8,000 Kenyan women die every year due to pregnancy related causes

Maternal and Neonatal deaths in Kenya Maternal & Newborn situation 2014 KDHS  Maternal mortality ratio (MMR) at 362/100,000 live births New-born mortality rate as 22/1000 livebirths 15 out of the 47 counties contribute to 98% of all maternal deaths in Kenya   One maternal death = 30 maternal morbidities Counties with High Maternal Deaths For every maternal death, there are nearly 30 women who survive with severe complications such as obstetric fistula Late or inconsistent ANC attendance, variable quality of antenatal care, and poor access to skilled care during pregnancy, delivery and the postpartum period contribute to adverse outcomes for women and newborns.

Direct Causes of Maternal Mortality Meghna D, Penelope A et al (2013). An Analysis of Pregnancy-Related Mortality in Health and Demographic Surveillance Sytestem in Western Kenya. PLOS One July 2013 | Volume 8 | Issue 7 | e68733

Causes of Neonatal mortality in Kenya

SELECTED INDICATORS COUNTIES PERFORMANCE

Counties with increased skilled attendance coverage: Makueni,Mandera,Nandi,Nyandarua,Laikipia,Muranga,Marsabit,Nyeri,Kirinyaga,Kiambu

SBA Trend,2014-2018

SBA Coverage Per County 2018

Kenya’s S-Curve of mCPR % of MWRA 7% 8% 16% 64% 5% 1%

Counties with the highest burden of teenage pregnancy and motherhood (Above National average of 18%)

QUALITY OF CARE OF MATERNAL AND CHILD HEALTH SERVICES

Period of death- when are our mothers dying? Most deaths occurred outside working hours Week day working hours: Monday-Friday 8am-5pm Week day out of hours: Monday-Friday 5pm to 8am

Trends in Maternal Deaths and Audits

Comparison of 4th ANC and at least ANC visit coverage Antenatal care (ANC) from a skilled provider is important to monitor pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery.

Postnatal care visits The postpartum period is particularly important for women, since during this period they may develop serious, life-threatening complications. Evidence has shown that a large proportion of deaths occur during the postpartum period, with postpartum haemorrhage being a major cause . A postnatal care visit is a time to educate a new mother on how to care for herself and her newborn. Newborn care is essential to reduce neonatal health problems and death. To identify, manage, and prevent newborn health complications, the government of Kenya recommends at least three postnatal checkups for the newborn within the seven days after delivery, which is considered a critical time period. 1WK, 7-14 after birth, 4-6 wk after birth.

Moving forward , key issues to address Quality of care of Maternal and Child health services along the continuum of Care ,ANC, Deliveries, postnatal care, first 1000days Apply High impact interventions Strengthen MPDRS Address high Teenage Pregnancy Malnutrition Introduction of new vaccines HPV Vaccine, Yellow Fever vaccine expansion, Menegococcal Vaccine

Opportunities Improving coverage for RMNCAH indicators is a priority for the government of Kenya.as reflected Constitution of Kenya Vision 2030 Health sector strategic and investment plan Free maternity and linda Mama Beyond zero campaign etc.

UHC DAY AND UHC LAUNCH IN KISUMU KENYA DECEMBER 2018

UNIVERSAL HEALTH COVERAGE PROGRESS-PILOT COUNTIES Attainment of 100% Universal Affordable Health Coverage 2nd October 2018 His Excellency, the President of the Republic of Kenya, has prioritized Universal Health Coverage (UHC) in His Big4 agenda over the next 5 years. Maternal, child and adolescent health is critical to achieving UHC. Immunization is a key pillar of Maternal, Child and Adolescent Health and UHC. It is also a basic right as defined by the Constitution of Kenya and in the Children’s Act.

UHC Aspirations For Kenya By 2022, in Kenya Each person can access a health benefit package that addresses their health needs Essential health interventions are provided to all areas of the country including hard-to-reach areas All Kenyans are protected from potential financial catastrophe arising from use of health services. Special focus is given to the poor and vulnerable Ensuring adequacy of Health resources /Ensure that resource base is appropriate for delivery of health services .

WAYFORWARD

WE NEED TO MOVE AWAY FROM THE FRAGMENTED APPROACH TO MATERNAL AND CHILD HEALTH MOVE TOWARDS TAKING A HOLISTIC VIEW OF THE HEALTH OF WOMEN AND CHILDDREN FOCU ON TH E CONTIMUUM OF CARE , PREGNANCY , PREGNANCY , DELIVERY , POSTNATAL , CHILD HEALTH AND ADOLESCENT

THANK YOU