Strategic Directions of the Department of Maternal, Newborn, Child and Adolescent Health ppt

Strategic Directions of the Department of Maternal, Newborn, Child and Adolescent Health For further information and publications please contact: Department of Maternal, Newborn, Child a

Strategic Directions

of the Department of

Maternal, Newborn, Child and Adolescent Health

For further information and publications please contact:

Department of Maternal, Newborn, Child and Adolescent

Health and Development (MNCAH)

World Health Organization

20 Avenue Appia, 1211 Geneva 27, Switzerland

Strategic Directions

of the Department of

Maternal, Newborn, Child and Adolescent Health

Contents iii

Contents

1 Introduction .1

2 Vision, mission, goals, targets and indicators .3

3 Improving health along the continuum of care .6

4 Strategic directions .8

5 Working across the three levels of the Organization 13

6 Working with other depart ments and with partners 14

7 Structure of the Department of Maternal, Newborn, Child and Adolescent Health 16 Annex: Functions of the teams and cross-cutting groups 18

Introduction 1

Introduction

Maternal, newborn, child and adolescent health are central to the agenda of Primary Health Care Healthy mothers can bear and raise healthy children who, when ena-bled to grow into healthy adolescents, are the foundation of future generations Investment in one age group benefits the other, and coordinated investment in all of these groups maximizes the intergenerational benefits Fostering a continuum of care that spans from pre-pregnancy, through pregnancy, childhood and adolescence not only makes programmatic sense, it is also imperative to address emerging health priorities

In pursuit of national and international goals and targets, the World Health Organization (WHO) is committed to contributing to the achievement of universal access to maternal, newborn, child and adolescent health services Much has already been achieved in countries with the support of WHO, and since 1990, significant progress has been made in reducing maternal and child deaths In 2008, the global annual number of maternal deaths was esti-

African Region have seen declines in HIV prevalence, much of it due to reductions in young

Asia and Western Pacific Regions, while for child survival, the greatest progress was made

in countries of the European Region and the Region of the Americas The overall progress

in maternal and child mortality reduction was least in sub-Saharan Africa and the

reach Millennium Development Goals (MDGs) 4 & 5, unless greatly accelerated reductions are seen

Important challenges remain First, median coverage of life-saving interventions remains

not always indicate progress in reaching the poorest and most vulnerable women, children

and adolescents Second, improving quality of care is essential for realizing the benefits of

improved coverage For example, women and children often do not receive the interventions

1 Trends in maternal mortality: 1990 to 2008, Estimates developed by WHO, UNICEF, UNFPA, and the World Bank (http://whqlibdoc who int/publications/2010/9789241500265_eng pdf)

2 World Health Statistics 2010 (http://whqlibdoc who int/publications/2010/9789241563987_eng pdf)

3 The International Group on Analysis of Trends in HIV Prevalence and Behaviours in Young People in Countries most Affected by HIV, “Trends in HIV prevalence and sexual behaviour among young people aged 15–24 years in countries

most affected by HIV”, Sex Transm Infect 2010;86(Suppl 2):ii72eii83 (http://sti bmj com/content/86/Suppl_2/ii72 full pdf)

4 Countdown to 2015 Decade Report: Taking stock of maternal, newborn and child survival (www

countdown2015mnch org/documents/2010report/CountdownReportAndProfiles pdf)

5 EB128/7 “Health-related Millennium Development Goals: Report by the Secretariat”, 30 December 2010 (http://apps who int/gb/ebwha/pdf_files/EB128/B128_7-en pdf)

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2 Introduction

they need when they need them, whether that be access to antenatal care, care during and after childbirth, or services for effectively managing childhood illness There are major gaps

in the continuum of care, in particular in the post-natal period, when the risk of mortality

is high for the mother and her newborn Third, adolescent health needs are still neglected

While many countries have included adolescents in national health policies and strategies, large scale programmatic action is limited Pregnancy in young adolescents is associated with

a higher risk of mortality and morbidity to the mother and her child, yet more than 2 lion girls aged 10–14 years and around 16 million girls aged 15–19 years give birth every year Also, there are currently 5 7 million young people aged 15–24 years living with HIV and an estimated 900,000 more infected with the virus each year

mil-The slow progress in improving reproductive, maternal and newborn health is underpinned

by the many burdens of gender discrimination, poverty and inequity, lack of economic opportunities, lack of education and other forms of exclusion that prevent women in poor countries from exercising their right to health

Five years remain to achieve MDG 4: Reduce the child mortality and MDG 5: Improve

mater-nal health Opportunities exist as never before The UN Secretary General’s Global Strategy for Women’s and Children’s Health provides the platform for joint action Governments and

partners have committed to its implementation

This paper presents the strategic directions through which WHO’s Department of Maternal, Newborn, Child and Adolescent Health (MNCAH) will address the key challenges and take the lead in formulating the Organization’s contributions to attaining MDGs 4 and 5 It high-lights the linkages of MNCAH with other health areas, goals and targets, in particular those

related to: reproductive health goals; MDG 1: Eradicate extreme hunger and poverty; MDG

3 Promote gender equality and empower women; MDG 6: Combat HIV/AIDS, malaria and

other diseases; and the broader agenda for women, children and adolescents beyond 2015

MNCAH will act as the platform for the equitable delivery of quality, integrated health ices for mothers, newborns, children and adolescents

serv- Vision, mission, goals, targets and indicators 3

Vision, mission, goals, targets and indicators

Vision: A world where every pregnant woman, newborn, child and adolescent enjoys the

highest attainable standard of health and development

Mission: The Department of Maternal, Newborn, Child and Adolescent Health will work

closely with other technical units in HQ, WHO Regional and Country Offices and partners to:

new-born, child and adolescent health;

interna-tional human rights standards, including universal access to health care;

• Monitor and measure progress in implementation and the impact of those strategies on

survival, health, growth and development

Goals and targets:

Departmental goals and targets (up to 2015)

In line with the Medium Term Strategic Plan, and recognising the importance of the tary General’s Global Strategy for Women’s and Children’s Health which prioritises action in the 49 highest burden, low-income countries The department has set the following goals and targets:

in place to achieve universal access to high quality health services for MNCAH;

interven-tions among pregnant women, newborns, children and adolescents;

access to effective interventions for maternal, newborn, child and adolescent health;

of skilled care at childbirth to >50%;

6 WHO Packages of interventions for family planning, safe abortion care, maternal, newborn and child health Geneva: World Health Organization, 2010

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4 Vision, mission, goals, targets and indicators

the postnatal period for mothers and their newborns;

the 20 highest HIV burden countries;

of IMCI to more than 75% of districts, and community case management of childhood illness; and,

interagency initiatives (e g UNAIDS group on HIV and young people, UN Adolescent Girls Task Force) will have functioning adolescent health programmes

7 Identified by the Countdown to 2015: Afghanistan, Angola, Azerbaijan, Bangladesh, Benin, Bolivia, Botswana,

Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, China, Congo, Democratic Republic of the Congo, Côte d’Ivoire, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, The Gambia, Ghana, Guatemala, Guinea, Guinea-Bissau, Haiti, India, Indonesia, Iraq, Kenya, Democratic People’s Republic of Korea, Lao People’s Democratic Republic, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Philippines, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tajikistan, United Republic of Tanzania, Togo, Turkmenistan, Uganda, Yemen, Zambia, and Zimbabwe

Vision, mission, goals, targets and indicators 5

Millennium Development Goals:

Targets directly related to MNCAH

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer

from hunger

indicator 1.8: prevalence of underweight children under five years of age.

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

indicator 4.1: under-five mortality rate;

indicator 4.2: infant mortality rate.

Target 5.A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality

ratio

indicator 5.1: maternal mortality ratio;

indicator 5.2: proportion of births attended by skilled health personnel.

Target 5.B: Achieve, by 2015, universal access to reproductive health

indicator 5.4: adolescent birth rate;

indicator 5.5: antenatal care coverage (at least one visit and at least

four visits).

Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

indicator 6.1: HIV prevalence among population aged 15-24 years;

indicator 6.3: proportion of population aged 15-24 years with

comprehensive correct knowledge of HIV/AIDS.

Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and

other major diseases

indicator 6.8: proportion of children under five with fever who are treated

with appropriate anti-malarial drugs.

indicator 5.4: adolescent birth rate;

indicator 5.5: antenatal care coverage (at least one visit and at least

four visits).

Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

indicator 6.1: HIV prevalence among population aged 15–24 years;

indicator 6.3: proportion of population aged 15–24 years with

comprehensive correct knowledge of HIV/AIDS.

Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and

other major diseases

indicator 6.8: proportion of children under five with fever who are treated

with appropriate anti-malarial drugs.

6 Improving health along the continuum of care

Improving health along the continuum of care

The Department of MNCAH is committed to working with countries to improve access to, coverage and quality of health services for MNCAH, as specified below

Care during pregnancy, child birth and the postnatal period: The

majority of maternal and perinatal deaths are caused by preventable and treatable tions which can be addressed by ensuring universal access to skilled care at birth Even at current levels of coverage, improving the quality of care in health facilities would prevent

condi-a lcondi-arge number of mcondi-aterncondi-al condi-and perincondi-atcondi-al decondi-aths The Depcondi-artment will focus on promoting appropriate standards for maternal and perinatal health and strengthening health service delivery This will include supporting governments in building the capacity and availabil-ity of health professionals in first- and referral-level facilities to provide quality care during pregnancy, childbirth and the post-natal period, with special attention to the needs of ado-lescent mothers and vulnerable groups The provision of essential care for every baby and the management of problems that can occur immediately after birth are important elements

of quality services Particular emphasis will be given to the promotion of integrated service delivery aligning with disease specific programmes such as HIV, malaria and nutrition The capacity of health services to work with women, families and communities will be strength-ened to ensure improved care and support in the home and that services respond to their needs Community health workers, where they exist, will be encouraged to promote skilled care in pregnancy, childbirth and the post-natal period and appropriate home care for moth-ers and babies

Care in the newborn period and in childhood: Care and support for health,

growth and development and prompt treatment of common newborn and childhood illness are essential A child’s first days and months of life are critical, as this is the period when the risk of mortality is highest and deficits in growth and development are difficult to reverse Adequate nutrition, starting with exclusive breastfeeding, followed by adequate and appropri-ate complementary feeding, preventive interventions and access to treatment when required are essential Data show clearly that too few children are reached with effective interventions

to protect and promote health and manage illness (such as ORS and zinc for diarrhoea, biotics for pneumonia and insecticide-treated nets and antimalarials) In addition, currently too few children have access to early diagnosis and treatment for HIV, or receive prophylac-tic co-trimoxazole when HIV positive The Department will work with countries to build capacity of health workers in communities and first- and referral-level facilities to promote health, ensure adequate nutrition and integrated care for sick children It will also promote the engagement and development of capacity of community health workers to support fam-ilies in the adoption of good care practices such as for infant and young child feeding, play and communication as part of early childhood development

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Improving health along the continuum of care 7

Care during adolescence: Adolescents aged 10–19 years make up an increasing

pro-portion of the population in many countries Adolescents complete their physical, emotional and social transition into adulthood in a world that contains both opportunities and risks Many do so in good health Many others do not They face sexual and reproductive health problems such as those resulting from too-early and unprotected sexual activity, including pregnancy and HIV infection They also face injuries resulting from accidents and violence, mental health problems, problems resulting from substance use, problems resulting from under nutrition and over nutrition, and endemic diseases (e g tuberculosis and malaria) Some of these health problems affect the individual during adolescence (e g death caused by

a road traffic crash, suicide resulting from a premarital pregnancy, or the consequences of an unsafe abortion) Others affect the individual later in life (e g cardiovascular disease result-ing from unhealthy eating and lack of physical exercise, smoking and other habits initiated during adolescence) Competent and caring health workers in responsive and friendly health services and systems can help those adolescents who are well to stay well, and help those who are ill or injured to get back to good health The focus of the Department’s work will be to systemize and standardize efforts to improve the quality and expand the coverage of health services for all adolescents, with a special focus on those who are at higher risk of health and social problems

This model of programme development meets the need for WHO norms and standards to be based on the best available scientific evidence from a wide range of disciplines Epidemiolog-ical data on the incidence and prevalence of health problems, and protective and risk factors are needed to estimate disease burden, to develop appropriate interventions, and to evaluate their outcomes and impact Evidence about the safety, efficacy and cost-effectiveness of inter-ventions are prerequisites for successful implementation at population level Both qualitative and quantitative data contribute to an understanding of the needs of pregnant women, chil-dren and adolescents, and the types of interventions that will result in the highest possible gains in health, growth and development

Therefore, the Department will play a leading role in promoting and supporting research and development that will inform policy, guide norms and standards and improve delivery strate-gies, relevant to the needs of pregnant women, children and adolescents For research related

to maternal and perinatal health the Department will work closely with the Department of Reproductive Health and Research The focus will not only be on identification of cost-effec-tive interventions and delivery approaches, but as a member of the Implementation Research Platform (IRP, APHSR, HRP, TDR, MCH) also examine implementation factors that deter-mine the success of scaling-up intervention packages and programmes, and how they can be applied in various contexts

Specifically, the Department will:

part-ners to promote and support their investigation, e g evidence for best ways of scaling up,

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