1. MNCWH & Nutrition Strategic Plan MCH Indaba July 2012

2. Background Reducing maternal and child mortality is a key priority for the health sector. Good coverage with many key interventions, but outcomes remain poor Many interventions and initiatives are in place, but a single overall strategic framework and plan are lacking

3. Context Findings from three Ministerial Mortality committees PHC restructuring District clinical specialist teams PHC outreach teams Integrated School Health programme NSDA and Health Data Advisory and Coordination Committee

4. Baseline and targets Indicator Baseline (2009) Target (2014) Target (2016) MDG Target 2015 Maternal Mortality Ratio (per 100 000 live births) 310270-38 Under 5 mortality rate (per 1 000 live births) 56504021 Infant mortality rate (per 1 000 live births) 403632- Neonatal mortality rate (per 1 000 live births) 141211-

5. Contents of the Strategy Introduction Priority Health Interventions for reducing maternal and child mortality Current MCWH service delivery Priority interventions for: Maternal Health Newborn Health Child Health Women’s Health Community-based MCH services Strategic Plan Monitoring and evaluation framework Critical success factors

6. Priority interventions: The service package Maternal health – BANC, HIV testing and PMTCT, access to care in labour, intrapartum care, post-natal care Newborn care – Exclusive breastfeeding, PMTCT follow-up, resuscitation of newborns, care of ill/small newborns (incl. KMC), post-natal visits Child Health – IYCF, Preventive services (EPI, Growth monitoring, Vitamin A), IMCI, early identification and management of HIV- infection, hospital care, School Health Services, Long term health conditions Women’s Health – contraception, SRH services for adolescents, cervical cancer screening, sexual assault care Community interventions – PHC outreach teams, multi-sectoral action, MCWH communication strategy

7. Vision and Mission Vision Accessible, caring, high quality health and nutrition services for women, mothers, newborns and children Mission To reduce mortality and to improve the health and nutritional status of women, newborns and children through promotion of healthy lifestyles and provision of integrated, high quality health and nutrition services

8. Guiding principles Sustained political commitment and supportive leadership Commitment to realizing the human rights of women, newborns and children. Working with all sectors to improve the lives of women, newborns and children Provision of an integrated service using a lifecycle approach Effective communication Empowerment of communities and families, including men Protecting and respecting children Ensuring linkages between the levels of care – community, primary health care and hospital levels

9. Overall goals To reduce the maternal mortality ratio and neonatal, infant and child mortality rates by at least 10% by 2016 To empower women, and to ensure universal access to reproductive health services To improve the nutritional status of all mothers and children

10. Eight Key Strategies Addressing inequity and the social determinants of health Development of a comprehensive and co-ordinated framework for provision of MNCWH & Nutrition services Strengthening community-based MNCWH & Nutrition interventions Scaling-up provision of key MNCWH & Nutrition Interventions at PHC level Scaling-up provision of key MNCWH & Nutrition Interventions at district hospital level Strengthening the capacity of the health systems to support the provision of MNCWH & Nutrition services Strengthening human resource capacity for delivery of MNCWH & Nutrition services Strengthening systems for monitoring and evaluation of MNCWH & Nutrition interventions and outcomes

11. Addressing inequity and social determinants of health Work with other sectors Mobilize and empower women and children and men to participate in efforts to improve their health at individual, household and community levels. Work with the education sector to promote comprehensive health education and promotion in schools which address a range of issues including psychosocial well-being, mental health and violence prevention. Ensure that under-served districts and sub-districts are prioritized in efforts to scale-up and improve the quality of priority MNCWH & Nutrition interventions

12. Review the framework for MNCWH and Nutrition Service delivery Review the framework for delivery of MNCWH & Nutrition services - Review and update which MNCWH & Nutrition services should be delivered at community, PHC, and district and regional hospital levels Review and update norms and standards for delivery of these services Estimate and cost the gap between ideal and current levels of service delivery Provinces should develop and implement comprehensive plans to address the gap

13. Strengthen the health system to support MNCWH & Nutrition services Ensure that adequate equipment for delivery of MNCWH & Nutrition services is available. Ensure that essential supplies and drugs are available at PHC and district hospital levels Work with EMS to ensure that adequate transport is available (maternity ambulances) Strengthen referral systems Strengthen routine health information systems

14. Strengthen community-based MNCWH & Nutrition services Provision of a package of evidenced-based community MCWH services by generalist CHWs who are part of PHC outreach teams. Provision of services through community-based campaigns such as HCT, EPI Vitamin A and mass deworming campaigns. Strengthening specific intersectoral actions – in particular programmes and interventions that address access to clean water and sanitation. Development of an MCWH communication strategy

15. Scale-up provision of key MNCWH & Nutrition interventions at PHC level Ensure high coverage with pneumococcal and rotavirus vaccines as part of the routine EPI schedule Ensure that HIV & AIDS services, including provision of ART, are provided at all PHC facilities, and are integrated with maternal and child health services. Strengthen School Health Services through provision of a comprehensive and integrated school health programme. Scale-up new or existing inventions with low coverage. This includes: ANC (using BANC approach), post-natal care and breastfeeding and infant feeding support, IMCI (including EPI and growth monitoring and promotion) and Youth-friendly services. Strengthen supportive supervision of MNCWH & Nutrition services and ensure that all PHC facilities receive regular supervisory visits.

16. Scale-up key MNCWH & Nutrition interventions at district hospital level Scale-up new or existing interventions with low coverage e.g. post-natal care, high risk ANC care, PMTCT, KMC, neonatal resuscitation, management of common childhood illnesses using standardized protocols, post-rape care Train health care workers in key MNCWH & Nutrition interventions. Improve the quality of hospital care through provision of protocols and strengthening supportive supervision through development of outreach teams at provincial level. Ensure that all facilities use of mortality reviews or audits to identify and address deficiencies in the quality of care provided.

17. Strengthening human resource capacity Appoint district clinical specialist teams who will play a key role in ensuring provision of high quality comprehensive MCWH services to mothers and children in the catchment population. Ensure that PHC outreach teams are adequately trained to provide MCWH services. Develop norms which define the staff which are required for delivery of MNCWH & Nutrition services Develop estimates of the number of health workers with MNCWH & Nutrition skills who are required Update curricula of health professionals to ensure adequate pre-service training in MNCWH & Nutrition Work with Regional Training Centres to co-ordinate and strengthen in-service training in MNCWH & Nutrition

18. Strengthen systems for monitoring and evaluation Develop consensus on key MNCWH & Nutrition outcome indicators, and review progress on an annual basis Strengthen mechanisms for reporting and recording of maternal, perinatal and child deaths Expand the use of mortality reviews and audits at facility level. Strengthen the existing health information systems such as the DHIS - ensure that the systems provide information that can and is used for planning and monitoring of MNCWH & Nutrition services. Strengthen the capacity of MNCWH & Nutrition, district and facility managers to analyse and use data.

19. Monitoring and evaluation framework Detailed plan contains indicators and targets which will be used to monitor implementation of the plan (routinely collected data). 19 outcome and impact indicators will be monitored on an annual basis (mostly collected through a variety of surveys)

20. Critical Success Factors Social determinants of health are addressed Support from key stake-holders Resource mobilization Strengthening of supportive supervision of MNCWH & Nutrition services at PHC level Strengthening supportive supervision at district hospital level (district clinical specialist teams)

21. Thank you