Family Health Division Presentation

Dr. Kiran Regmi Director, Family Health Division Feb 2011

Millennium Development Goals (MDG) 4 & 5 Targets set by Nepal and achievements Key interventions to achieve MDG 4 and 5 Direction beyond MDG for Nepal

Goal 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Goal 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Goal 5.B. Achieve, by 2015, universal access to reproductive health

Under 5 mortality rate Infant mortality rate Neonatal mortality rate MDG Impact indicator AchievementTarget

MDG Impact indicatorAchievementTarget Maternal mortality ratio Total fertility ratio Adolescent fertility rate(15-19 years) CPR (Modern method) Millennium Development targets and achievements of Nepal Target Set by Nepal and Achievements Goal 5A

MDG Impact indicator AchievementTarget No of women delivering in health facility Childbirth by SBA C/S rate2.818 Target Set by Nepal and Achievements Goal 5B

FY2007/082008/092009/10Target 2012 CEOC* 51 in 33 district76 in 35 district 94 in 45 district ** 47 district BEOC hosp BEOC PHC % 5860% of PHCC BEOC total hr del in PHC % % % % 24 hr del at HP % % 30% of HP 24 hr del at SHP % 137 4% Total birth center Total CAC sites Target Set by Nepal and Achievements Goal 5B

Key interventions 1. Ama Surachha program 2. Family Planning

ANC Promotion of SBA conducted childbirth Promotion of institutional childbirth and initiation of delivery incentives PNC

As Ama Surachha program ANC component focused on targeted ANC there is increase in 1 st and 4 th visits ANC motivational incentive package Transportation allowance and free childbirth This shows that Ama program is heading towards in right direction This is a good indication towards meeting MDG 5A There is marked increase in ANC 1 st and 4 th in 2066 because of initiation of free childbirth policy

ANC 1 st Visits by Region FY 2062/63 to 2066/67 (As % of Expected Pregnancies) Source: HMIS/MD, DOHS

Four Time Antenatal Visits by Region FY 2062/63 to 2066/67 (As % of Expected Pregnancies) Source: HMIS/MD, DOHS

There is increase in SBA conducted delivery indicating achievement of MDG 5B

44% (Aama average) 44% (Aama average) 16

After the initiation of free childbirth policy there is a marked increase in PNC

Postnatal Service Coverage by Region FY 2062/63 to 2066/67 (as a% of Expected Pregnancies) Source: HMIS/MD, DOHS

Postnatal Service Coverage by Region FY 2062/63 to 2066/67 (as a% of Expected Pregnancies) Source: HMIS/MD, DOHS

Key Intervention II: Family Planning

57 Gap

New satellite concept introduced to increase access of LTFP IUCD training integrated into SBA training Sr. AHW training in implant insertion

New Acceptors Current Users

New Acceptors Current Users

Continue reduction of MNMR Sustainability of Ama program Quality of care

Coverage of unreached and underserved population Bringing childbirth institution at home

Develop a concept of tertiary referral centers and satellite birthing centers Finding alternate ways to replace the adhoc human resources and interventions adopted to achieve MDG Train and involve under used midlevel health worker (HA) in various reproductive health programs Selective verses universal free childbirth services Think of the interventions beyond aid

Develop a strong Reporting, Monitoring and Evaluation mechanism

Thank You