1. Family Health Division Presentation

2. Dr. Kiran Regmi Director, Family Health Division Feb 2011 regmikiran@gmail.com

3. 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

4. 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

5. Under 5 mortality rate 158118.39161505538 Infant mortality rate10678.56448414432 Neonatal mortality rate 49.94333203016 MDG Impact indicator AchievementTarget 19911996200 1 200 6 200 9 201 0-11 2015

6. MDG Impact indicatorAchievementTarget 199119962001200620092010 -11 2015 Maternal mortality ratio 539 415281229134 Total fertility ratio5.34.64.13.12.93.02.5 Adolescent fertility rate(15-19 years) 1271109870 CPR (Modern method) 2426354445.14867 Millennium Development targets and achievements of Nepal Target Set by Nepal and Achievements Goal 5A

7. MDG Impact indicator AchievementTarget 199920042006200820092010 -11 2015 No of women delivering in health facility 2114.1263060 Childbirth by SBA4.841.3 C/S rate2.818 Target Set by Nepal and Achievements Goal 5B

8. FY2007/082008/092009/10Target 2012 CEOC* 51 in 33 district76 in 35 district 94 in 45 district ** 47 district BEOC hosp 314547 BEOC PHC 37 45 22% 5860% of PHCC BEOC total 6890105 24 hr del in PHC 168 78% 167 79% 148 71% 406 60% 24 hr del at HP 219 301 45% 406 60% 30% of HP 24 hr del at SHP 35 64 2% 137 4% Total birth center 422532695 Total CAC sites 39 86 Target Set by Nepal and Achievements Goal 5B

9. Key interventions 1. Ama Surachha program 2. Family Planning

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

11. 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

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

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

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

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

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

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

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

20. Key Intervention II: Family Planning

21. 57 Gap

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

23. New Acceptors Current Users

24. New Acceptors Current Users

26. Continue reduction of MNMR Sustainability of Ama program Quality of care

27. Coverage of unreached and underserved population Bringing childbirth institution at home

28. 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

29. Develop a strong Reporting, Monitoring and Evaluation mechanism

30. Thank You