1. 16 Nov 2011Regional CH Meeting, Kathmandu 1 Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011 Progress in Implementation of Child Health Programme Country: BANGLADESH

2. 16 Nov 2011Regional CH Meeting, Kathmandu2 Epidemiology / burden of childhood diseases: Under five mortality FiguresYear Under five mortality Rate54 (SVRS 2008)2008 Infant Mortality Rate41 (SVRS 2008)2008 Neonatal Mortality Rate37 (BDHS 2007)2007 Nutrition Status Low Birth Weight22 % (UNICEF)2009 Underweight41 % (BDHS)2007 Stunting43% (BDHS)2007

3. 3 Deaths per 1,000 live-births 12-59 months 1-11 months 0-28 days Declining U5 mortality -9.3% per year -6.0% per year -2.6% per year 1989-931992-61995-91999-20032002-6 Source: BDHS 1993-2007 Age groups:

4. 4 Deaths per 1,000 live-births 12-59 months old children 1-11 months old infants Neonates (0-28 days) Declining under-5 child mortality in Bangladesh….. But, proportion of neonatal mortality increasing…… 1989-931992-61995-91999-20032002-6 39% 57% 42% 45% 47% Source: Bangladesh Demographic and Health Surveys

5. 5 Cause of death distribution of neonatal deaths in Bangladesh: 1994-2003 Source: Bangladesh Demographic and Health Survey 2004

6. 6 Causes of U5 deaths

7. 7 Trend in U5 mortality (1990-2008) 151

8. IMCI Implementation IMCI implementation started (If yes, year)2002 Newborn Added (If yes, year) 2000 (From day 1) 2009 (From 0 day) Number and Proportion of districts implementing IMCI54 (84%) Number and proportion of MOs trained 2,866 Number and proportion of Nurses/other workers trained 7,924 Proportion of districts (out of IMCI districts) with 60 % or more health providers trained na IMCI supervisory checklists introduced2004 Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during previous year na Proportion of districts (out of IMCI districts) covered with Follow-up IMCI training na

9. IMCI implementation IMCI implementation review conducted (If yes, year; National or sub-national) 2003 Sub-national IMCI Health Facility Survey conducted (If yes, year; National or sub-national) 2008 Sub-National Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI >90% (approx) Pre-Service IMCI teaching/training: Number and proportion of Medical Schools teaching IMCI 48 (88%) 2010 Number and proportion of Nursing Schools teaching IMCI nil ICATT introduced (If yes, year and scale)No

10. INDIA Bay of Bengal MYANMAR INDIA * * * RANGAMATI SYLHET TANGAIL BOGRA BANDARBAN KHULNA PABNA COMILLA DINAJPUR NAOGAON MYMENSINGH SUNAMGANJ CHITTAGONG JESSORE SATKHIRA HABIGANJ RAJSHAHI RANGPUR NETRAKONA NATORE SIRAJGANJ DHAKA BAGERHAT KURIGRAM BHOLA FARIDPUR NOAKHALI FENI KUSHTIA JAMALPUR MAULVIBAZAR GAZIPUR GAIBANDHA KISHOREGANJ JHENAIDAH KHAGRACHHARI COX'S BAZAR CHANDPUR NILPHAMARI NAWABGANJ SHERPUR NARAIL RAJBARI THAKURGAON GOPALGANJ MAGURA MANIKGANJ BARISAL BRAHAMANBARIA NARSINGDI PANCHAGARH SHARIATPUR MADARIPUR LAKSHMIPUR CHUADANGA LALMONIRHAT JOYPURHAT MUNSHIGANJ PATUAKHALI MEHERPUR PIROJPUR BARGUNA NARAYANGANJ JHALOKATI 2002 2003 2004 2005 2006 2007 Expansion of IMCI guided by evidence of need Bangladesh Maternal Mortality Survey, 2001: Provided District Under-5 Mortality Estimates FIMCI CIMCI 2009 2008 2009 2010 All 159 upazillas of 20 districts in the “red” (high mortality) areas covered by 2007 As of now, IMCI is in facilities in: 54 districts 400upazilas IMCI in the community is in 71 upazilas and some urban areas

11. 16 Nov 2011Regional CH Meeting, Kathmandu11 IMCI Implementation Key factors that helped scaling up 1. Conducive policy environment-HNPSP (206-11), HPNSDP (2011- 16); Lessons from MCE of IMCI 2. Continued commitment and support from DPs/GOB (Financial/Supplies) 3. Strong partnership, networking and pro-active role of child health group (Professional bodies, NWT) Key challenges to scaling up: 1. Lack of supervision and monitoring system 2. Utilization of pool fund for scaling up IMCI (Facility/Community) 3. Weak health system support to scale up integrated approach

12. 16 Nov 2011Regional CH Meeting, Kathmandu12 Newborn Health ENC Course adapted: 2009 Other training courses: ETAT and Sick Newborn Care; BHW package Healthcare providers trained: Healthcare providersTotal no.No. Trained% MO 65022234% Nurses 150024717% CHW80,000 (GoB) NGO-na 12000 (NGO)

13. 16 Nov 2011Regional CH Meeting, Kathmandu13 In-Patient (Hospital) care of sick newborns and children WHO Pocket Book introduced: 2009-10 Training courses for Hospital care done: Yes Details, If yes:(ETAT and Sick Newborn Care part); Number and proportion of Healthcare providers trained: Given in previous slide Proportion of hospitals providing pediatric care having oxygen: 82%, 483(589) Hospital assessment using WHO tools carried out: –Year/s: 2009 –How many hospitals covered:6 DH+ 12 UHCs

14. 16 Nov 2011Regional CH Meeting, Kathmandu14 CHW approach for care of sick newborns and children District implementing CHW approach Total No. of Distt Implementing Districts % Home based newborn care642539% Sick child package643555% Healthy child package (ECD) Any review of the experience Individual project MTR done

15. 16 Nov 2011Regional CH Meeting, Kathmandu15 Programme Review and Management CH Short Programme Review introduced, if yes : –Year:2010 –National or sub-national:National Programme Management Course introduced, if yes: –Year:2010 –National or sub-national: National

16. 15 Nov 2011Regional CH Meeting, Kathmandu16 Health Management Information Systems (HMIS) and DHS/MICS List the key indicators for newborn and child health included in HMIS and DHS/MICS? –Thermal care (Wiping/Wrapping/Delayed bathing)- BDHS –EBF-BDHS, MICS –LBW-BDHS, MICS –Care seeking for suspected pneumonia-BDHS, MICS –ORS and Zinc for diarrhoea-BDHS –IMCI Case management by age and sex-HMIS

17. 16 Nov 2011Regional CH Meeting, Kathmandu17 Health Management Information Systems (HMIS) and DHS/MICS How and at what level are the data for these key programme indicators analysed and used by the programmes? –desktop based application: Data entry using software at UHCs –web-based application: Data uploading in the HMIS server at HQ –Analysis at national level and used by IMCI section –Publication of Newsletter by the HMIS, DGHS

18. 16 Nov 2011Regional CH Meeting, Kathmandu18 Future Plans Strengthening and scale-up plans for Next 2 years IMCI: Full saturation of upazilas/districts with IMCI ICATT use: Planned in the next Biennium CHW Packages: –Home Based NB Care package:35 districts –Sick child package:35 districts –Healthy Child (ECD) package: Referral (Hospital) Care: Distribution, Developing training package Programme Review and Management: –CH Short Programme Review: 2014 –Programme Managers Course: Not yet planned

19. 16 Nov 2011Regional CH Meeting, Kathmandu19 Thank You