REPBLICA DE MOAMBIQUE MINISTRIO DA SADE GABINETE DO MINISTRO

Scaling-up newborn programming at the national level: agenda setting, policy formulation and implementation Mozambique

GLOBAL NEWBORN HEALTH CONFERENCE April 15-18, 2013 Johannesburg, SA

Dra Nazira Abdula Deputy Minister of Health

PRESENTATION OUTLINE

Mozambique at a glance

Research to Advocacy, Policy, Newborn Survival in Mozambique and Action

The policy framework Gaps and challenges in tackling newborn survival in Mozambique

Key benchmarks for success

MOZAMBIQUE AT A GLANCE
Total Population Population U5 Urban population Population below poverty line (2009) Life expectancy at birth GDP growth (2012) Female literacy (2010) Population using improved water sources Government expenditure on health as % of total (2010) 24.300.000 4.300.000 38% 52% 52 years 7.5% 42.8% 47%

12%

NEWBORN SURVIVAL IN MOZAMBIQUE

More than 950.000 children are born every year in Mozambique.

Of them, more than 28.000 die within the first 28 days of life
Neonatal deaths: approximately 30% of all under five mortality in Mozambique The Neonatal Mortality rate is 33 per 1000 LB

Maternal mortality estimated at 490/100.000

PROGRESS TOWARDS MDGs 4 in MOZAMBIQUE

Trends in Child Mortality in Mozambique 1997 - 2011
Child mortality Infant mortality

200

201

153
150

135 101

141
Newborn Mortality

100

95

97 73

From 2000 to 2011: Under five mortality rate reduction of 4.7% per annum
Further acceleration is needed to achieve MDG 4 objective

54
50

64
37 38 30

1997

2003

2008

2011

2015

Sources: U5MR, IMR, and NMR: DHS1997,2003 and 2011; MICS2008 MDG 4 target from Countdown to 2015, country profiles 2012 -- 2/3 reduction from 1990 U

CAUSES OF UNDER 5 DEATH

Other causes, 16% Meningitis , 2%

Instestinal infectious diseases, 9%

Preterm, 10%

Injuries, 3%

NEWBORN, 30% Acute respiratory infections, 11%

Infection, 8%

Asphyxia, prematurity, and severe infection cause the major proportion of neonatal deaths in country These three conditions alone account for more than 25% of the overall U5 mortality in Mozambique

Birth Asphyxia, 8%

Other , 4% HIV/AIDS, 10%

Malaria , 19%

Source: Countdown to 2015, Report 2010

The policy framework for newborn health in Mozambique

Maternal and Newborn Health POLICIES
National Newborn and Child Health Policy, 2006
Integrated Plan for the Achievement of MDGs 4 and 5 in Mozambique (MISAU, 2008)

POLITICAL PLATFORMS

Road Map to Accelerate Reduction in Maternal and Newborn Mortality in Mozambique (MISAU, 2008)
Maternal and Neonatal Health Needs Assessment in Mozambique, MISAU 2008 (MISAU, 2009) International Code of Marketing and Breast milk Substitutes

Partnership for the promotion of maternal, newborn and child health in Mozambique

Committing to Child Survival: A Promise Renewed

National elimination of MTCT

National Plan for the Revitalization of Community Health Workers in Mozambique (MISAU, 2010)

Intervention packages and delivery strategies

Integrated MNCH service delivery Emergency Obstetric Care Essential Newborn Care, Neonatal Resuscitation, Helping Babies Breathe, Post Natal Care Integrated Management of Childhood Illness Neonatal Component Kangaroo Mother Care Integrated Packages for Continuing Education

Clinical Care

Facility and outreach Services

Ante-natal Care Package (4 visits) Post Natal Care to support healthy practices and early detection and referral of complications EMTCT (B+ option)

Family and Community

Community Integrated Management of Childhood Illness , Neonatal Component (CHWs, CHVs) Traditional Birth Attendants Promotion and distribution of mosquito nets

GAPS AND CHALLENGES :

100

COVERAGE
DHS 2003 DHS2011

90

80
70 60 50 40 30 20 10 0 CPR ANC(any) ANC(4) TT (2+) ITPp 2 d Instittutional PNC w/2days Low birth Excl. BF(<6M) Deliveries babies DTP 3 ARVs*

GAPS AND CHALLENGES :

EQUITY

Barriers to access essential services persist for the poorest and for the least educated citizens of Mozambique. Key interventions such as antenatal care, skilled delivery at birth and immunization are heavily biased by socio-economic status As a results, mothers and children from the most remote and/or least developed areas of the country are more exposed to disease and death.

GAPS AND CHALLENGES :

Quality of Services

National assessment of quality of newborn services conducted at the end of 2012. Preliminary results available by mid 2013.

Implementation of existing newborn health policies at facility level

variable and inconsistent.

Main constraints: Health Infrastructure Human resources

Availability of medicines, supplies and equipment;

Emergency referral mechanisms; Coverage indicators for newborn health

GAPS AND CHALLENGES :

DEMAND

Physical barriers to access services: distance, lack of transport, financial barriers, opportunity costs

Cultural and behavioral barriers in rural areas:

basic knowledge of essential preventive health and hygiene

measures still low;

Role of family, men and of informal leaders in decision making

Addressing gaps and challenges: the way forward

At Policy Level:

Ongoing review of progresses and update the National Plan to Achieve MDGs 4&5 in Mozambique
Accelerate national plan for HR development (pre-service training, continuing education) Develop an action plan to increase quality of essential services based on results of recent national assessments (quality and availability) EMTCT accelerated plan for elimination

Addressing gaps and challenges: the way forward

At service delivery level: Accelerate scale up of existing facility level packages for newborn health, scalling up Model Maternity Initiative Continuing education and supportive supervision

Promote strategies to increase SBMR (new maternities; waiting homes, referral mechanisms, incentives, etc)
Community level: Sustained investment on CHWs and other community based cadres Assess feasibility and effectiveness of community based newborn package Intensify focused social communication and advocacy