Progress towards MDG 4 and 5 MDG4 and Kenyas position, where are we?

Outline
MDG 4 Status of child health High impact interventions Progress Challenges opportunities

MDG 4&5
GOAL 4: REDUCE CHILD MORTALITY Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate GOAL 5: IMPROVE MATERNAL HEALTH Target 5.A: Reduce by three quarters the maternal mortality ratio Target 5.B: Achieve universal access to reproductive health

Global status of child mortality

Globally 8.8 million children under five die every year. 4.4 million are from the Sub-Saharan Africa About 96,200 are from Kenya (birth cohort of 1.2 million)

Status in the African Region: Progress towards MDG4 in Africa 2008

According to the latest evidence Kenya is one of the high burden disease country with high under five mortality rates that is not on track to attain the MDG 4 targets.

Current Child Health Status in Kenya

Under 5 mortality rate: Under 1 mortality rate: Newborn mortality rate: 74/1000 live births 52/1000 live births 31/1000 live births

60% of infants deaths occur during the first month of life

Prevalence of Low-birth weight:10%

Prevalence of stunting: 35%

Infant and Under-five Mortality Rates, Kenya 1990/2009 (KDHS and KIHBS)

Causes of under-five child deaths in Kenya *

Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008 : a systematic analysis. Lancet : 12 May 2010 ; 375 : 1969-87.

Global Evidence Based Cost Effective Interventions

Table 2a: Cost Effective Preventive Interventions: Lancet 2003
Breastf eeding ITM Complementary f eeding Zinc Clean delivery Hib Vaccine Antenatal steroids Water Sanitation Hygiene New born Temperature Management Tetanus Toxoid Nevirapine and replacement f eeding Antibiotics f or premature rupture of membranes Antimalarial f or IPT in pregnancy

0%

5%

10%

15%

Universal coverage with a few interventions can prevent over 6 million deaths in a year
Prevention Intervention
Breastfeeding Insecticide-treated materials Complimentary feeding Zinc Hib vaccine Water, sanitation, hygiene Vitamin A Deaths Prevented as proportion of All child deaths 13% 7% 6% 5% 4% 3% 2%
10

Treatment Intervention
Oral rehydration Antibiotics for pneumonia Antimalarials Zinc Antibiotics for dysentery

Deaths Prevented as proportion of All child deaths 15% 6% 5% 4% 3%

Source: KDHS 2009, UNGASS 2009

Priority High Impact Interventions by Level of Care, Cohort and Intervention Area Community- L1
Demand creation for early initiation of ANC Individualised birth plan and Emergency preparedness Community actions to promote skilled care

Facility level- L2, L3, L4

Four timely focused ANC visits with a focus on: Individualised Birth Plan and Emergency Preparedness Prevention and management of pregnancy complications ( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics, Magnesium sulphate, Manual removal of placenta, removal of retained POCs, Assisted delivery, Blood transfusion, and caesarean section Active management of third stage labour Monitoring labour using partogram Skilled attendance within first 24-48 hours after delivery PNC Long acting and permanent FP methods Conduct maternal and perinatal death reviews Hand washing with soap by caregiver Temperature management Antibiotics for neonatal infections Newborn resuscitation ARV prophylaxis Early initiation and EBF Complementary feeding Vitamin A Immunization LLITN ORT and Zinc ACT Antibiotics for childhood pneumonia Early Infant Diagnosis of HIV ART

BCC for FP, PNC, Newborn and child care practices BCC to promote skilled attendance with first 24-48 hours after delivery Hygienic cord care Newborn temperature management Hand washing with soap by caregiver

Early initiation and EBFComplementary fee ding Vitamin A Immunization LLITN ORT and Zinc Safe drinking water ACT Antibiotics for childhood pneumonia

Progress has been made..

Some of these interventions are already at over 50% coverage and this needs to be sustained and increased.
Coverage of LLITNs, Water and sanitation and hygiene Hib and measles immunization

New vaccines: Pneumococcal vaccine this year and Rotavirus in 2013

What can be done to Accelerate child Survival

Focus on: Commonest Killers HIIs to address these killers Urgency to scale up these interventions Continuum of care and responsibility from family, community level to HF level

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Status of Maternal Health

Population: Estimated at 40m Women of childbearing age: 9.6m MMR: 488/100,000 live births (2008-09) Skilled birth attendance: 44%
? Quality

ANC 92%- once, 47%- 4 times

Unmet need for FP: 26%

Adolescents and youth: 30%

18% of young women age 15-19 have begun childbearing 21% of women have suffered sexual violence Provision of youth-friendly services still a great challenge

With less than 5 years to 2015, Kenya is far from achieving MDG 5 targets:

Indicator
MMR SBA BEOC

KDHS 08
488 44% 15%

MDG 15
147 90% 100%

Trends in Maternal care indicators in Kenya (KDHS 2008-09)

Family PlanningTrends

Availability of Delivery Services:

All Health Care Facilities
(Table 6.5)
Percent of all facilities (N=690)

Safe Motherhood Ideal vs Real

Ideal World
All deliveries have a skilled attendant.
Increasing the access of women to EmOC Facilities. Hospital based EmOC is the foundation of the SMI. Mortality rates will be decreased by reducing the 3 delays.

Reality in Kenya
53% delivers at home (decline by 2% in five years). Non-skilled attendants at the community level. Institutions with maternity do not meet standards for safe delivery and newborn care (KSPA).

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EAvailability of Services in Facilities Offering Deliveries ncyEquipment and (Table A-6.36) Services Percentage of facilities offering delivery services where specific services, equipment,and supplies
are available (N=207)

Assist labour

Remove retained products

Challenges in Scaling up
Health Systems Challenges Human resources- numbers, skills, attitude, Health Financing(current expenditure/woman is 2USD, recommended is 40USD) Reliable Data Referrals Commodity security Governance Policy gaps at community level service delivery Access Geographic, Financial, socio-cultural Multi-sectoral challenges
Infrastructure, safe water, status of women, education

Opportunities
Current Constitution Devolution of resources & health Rights Increased GOK budget allocation to FP and Output Based Approach (OBA) Community Strategy Economic stimulus program: More HWs and health facilities Increased Global interest in Maternal Health - Global Health Initiative Other funding modalities (HSSF,CDF) Free Primary & Highly subsidized Secondary Education Increasing public private partnerships Mobile Technology

Conclusion
No/Slow progress in indicators related to maternal and newborn health in Kenya We continue to work on improving institutional deliveries and care at health facilities. In the meantime, we need to focus on
The major killers of mothers, newborns and children HIIs to address these killers Identify the barriers in scaling up these interventions Address these barriers incl. mobilize sectors outside health to address these
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Goal: Ensuring, availability accessibility and acceptability of services even for this woman and her baby