15 Nov 2011Regional CH Meeting, Kathmandu1 Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011 Progress in Implementation of Child Health Programme Thailand

15 Nov 2011Regional CH Meeting, Kathmandu2 Epidemiology / burden of childhood diseases: Under five mortality and trends since 1990 Figures Under five mortality Rate (WHO)32 (1990)13 (2010) Infant Mortality Rate (WHO)27 (1990)11 (2010) Neonatal Mortality Rate (WHO) 8 (2010) Nutrition Status Low Birth Weight (MoPH)9.4 (1990)8.1 (2010) Underweight (MoPH)7.4 (2010) Stunting (MoPH)9.1 (2010)

15 Nov 2011Regional CH Meeting, Kathmandu3 Epidemiology / burden of childhood diseases: Main causes of Neonatal Mortality: - Prematurity 30 % - Severe infections 27 % - Birth asphyxia 23 % - Congenital anomalies 6 % - Others 14 % Source: WHO. Mortality Country Fact Sheet 2006.

15 Nov 2011Regional CH Meeting, Kathmandu4 Epidemiology / burden of childhood diseases: Main causes of Child Mortality: - Neonatal causes 48% - Pneumonia 11% - Injuries 6% - Diarrheal diseases 3% - HIV/AIDS 1% - Other causes 31% Source: WHO. Mortality Country Fact Sheet 2008.

Management of childhood illness MCH strategy was implemented in Thailand before Integrated program such as Safe Motherhood hospital, Baby Friendly hospital, Health System Development, Primary Health Care Program, HRD, etc.

Management of childhood illness Professional training on pediatric are done by medical and nursing schools. Number of Medical Schools teaching MCI20 Number of Nursing Schools teaching MCI83

15 Nov 2011Regional CH Meeting, Kathmandu7 Management of childhood illness Key factors that helped scaling up 1. Enable policy at all level. 2. Cooperation. 3. Good guideline and training. Key challenges to scaling up: 1. Data and surveillance system. 2.Computerize support system for education and report. 3.Accreditation of hospitals.

15 Nov 2011Regional CH Meeting, Kathmandu8 Newborn Health Thailand started Safe Motherhood Program and BF promotion using ENC since 1997 Training courses on newborn and neonatal care are done in every province. Volunteers are trained by health personnel.

Antenatal Care early ANC (12 wks gestation or less) Thalassemia screening VCT HIV Parental School Nutrition Iron supplement Dental Care Mother club in community Well Child Clinics Standard WCC Parental School Child Development check up Nutrition Story telling, Toys Dental Care Mother club in community Intrapartum and Postpartum Care Safe motherhood hospitals Baby Friendly Hospitals Initiatives Parental School Lactation Clinics Congenital Hypothyroid and PKU Screening Mother club in community Quality System in Family Love Bonding Hospitals Mother clubs in communities for breastfeeding promotions / Child rearing practices Results Birth Asphyxia less than 30 per 1,000 LBs Low Birth Weight less than 7% Exclusive Breastfeeding for 6 months more than 30% Normal Child Development more than 90%

10 Safe motherhood Hospital Baby Friendly Hospital Initiative + community involvement Birth asphyxia Low Birth Weight Exclusive Breastfeeding at 6 months Child (0-5 Years) Development Royal family Photos Safe motherhood Hospital Baby Friendly Hospital Initiative + community involvement Safe motherhood Hospital Baby Friendly Hospital Initiative enrollment bronze silver gold Family Love Bonding Hospitals Regional CH Meeting, Kathmandu 15 Nov 2011

Regional CH Meeting, Kathmandu11 In-Patient (Hospital) care of sick newborns and children Training courses for Hospital care done: Yes Number of Healthcare providers trained: –all pediatricians –all nurse in pediatric ward and community hospital Proportion of hospitals providing pediatric care having oxygen: 67 regional/provincial hospitals and 746 community hopitals.

CHW approach for care of sick newborns and children 900,000 CHW 7,400 Health care Centers. refer to curative system at Primary Care Unit : Health Care Center, Community Hospital via health insurance system (universal coverage system) 15 Nov 2011Regional CH Meeting, Kathmandu12

1315 Nov 2011 Regional CH Meeting, Kathmandu

Growth monitoring Regional CH Meeting, Kathmandu 15 Nov

15 Parental School Antenatal Period First Trimester until 28 wks of gestation 32 weeks of gestation or more Early Post partum period (1-3 days) At Well child clinic 2 months old 6 months until 1 ½ year 2 – 3 years old Husband Participation Regional CH Meeting, Kathmandu 15 Nov 2011

Regional CH Meeting, Kathmandu16 Programme Review and Management CH Short Programme Review introduced: MCH Board Meeting. Accredit Family Love Bonding Hospitals.

15 Nov 2011Regional CH Meeting, Kathmandu17 Health Management Information Systems Key indicators for newborn and child health in 2011: - Pregnant women attend ANC before 12 weeks of gestation (50%) - Rate of HIV/AIDS transmission from mother to child (3.5%) - Newborn baby weight under 2,500 grams (<7%) - Rate of Birth Asphysia 30/1,000 LBs - Rate of exclusive BF for 6 month increase 2.5%/year - 95% of Children under 5 have proper growth & development - Family Love Bonding Hospitals are accredited at goal level at least 100 hospital

15 Nov 2011Regional CH Meeting, Kathmandu18 Health Management Information Systems Key indicators for newborn and child health in 2011: - 95% of day care centers arrange tooth brushing activity after lunch using fluoride toothpaste for children daily. The data was used by hospital, MCH board, local health administration, Provincial Health Office and the DoH.

15 Nov 2011Regional CH Meeting, Kathmandu19 Future Plans Strengthening and scale-up plans MCI: HRD for MCH network and volunteer, KM and evaluation. ICT use: Website for health personnel to use and download for their knowledge, training, public relation, etc. - Improve computerize information system.

15 Nov 2011Regional CH Meeting, Kathmandu20 Future Plans Strengthening and scale-up plans CHW Packages: –Manuals on Maternal and Child booklet, Preparation of parental hood and caring for children under-five-years, Exclusive BF promotion and practice, vaccination. –Home visit for all newborns, etc.

15 Nov 2011Regional CH Meeting, Kathmandu21 Future Plans Strengthening and scale-up plans CHW Packages: –Manual for training BF experts. –Manual for assessment of Family Love Bonding Hospitals. –Home Based NB Care package & Sick child package. –Manuals for Health Volunteer on MCH.

15 Nov 2011Regional CH Meeting, Kathmandu22 Future Plans Strengthening and scale-up plans –Healthy Child package: Manauls on Child growth and development assessment, BF Sub-district Model, Development of Care Giver in Day Care Center. –Folk tales for children. –Research.

21/05/58N Voramongkol23 Story telling book, Aesop’s fables Childbirth 6 month old 1 year old

15 Nov 2011Regional CH Meeting, Kathmandu24 Future Plans Strengthening and scale-up plans Referral (Hospital) Care: Sub-district Health Center District hospital Provincial hospital. - In case of emergency/disaster: Coordinate through Emergency Medical Institute.(Helicopter or boat transfer)

15 Nov 2011Regional CH Meeting, Kathmandu25 Future Plans Strengthening and scale-up plans Programme Review and Management: –CH Short Programme Review: 6, 9 and 12 months Report and meetings. –Programme Managers Course: ● Family Love Bonding Hospitals management and assessment, ● National Breast Feeding Meeting, ● KM and acknowledgement of Sub-district BF. ● IQ Development. ● Surveillance system and evaluation.

15 Nov 2011Regional CH Meeting, Kathmandu26 Future Plans Maternal and Child Nutrition –Breast Feeding Promotion –Nutrition surveillance –Control of Iodine Deficiency Program –Nutrition Education. –Food security –Food safety