Presentation of Jacqueline F. Kitong, M.D., MPH, technical officer for Maternal and Child Health and Nutrition, World Health Organization at the PhilHealth Maternal, Newborn and Child Health Summit

1. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Maternal, Newborn and Child Health:
A Global Perspective…..
The Joint Programme on Maternal and
Newborn Health(JPMNH);
a Joint DOH-UNFPA, UNICEF & WHO
Intervention with funding from AusAID
Jacqueline F. Kitong, M.D., MPH
Technical Officer for Maternal and Child Health & Nutrition
WHO Philippine Country Office

2. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Presentation Guide
1. Introduction
2. Facts and Figures on MNCH
3. Issues and Challenges
4. The JPMNH; an intervention to the RMNH gaps
and challenges in the Philippines.

3. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Introduction
 Maternal health refers to the health of women during
pregnancy, childbirth and the postpartum period.
 Good maternal health and nutrition are important
contributors to child survival.
 lack of essential interventions to address maternal health
and nutrition, and other health conditions often contribute
to indices of neonatal morbidity and mortality
 Poor maternal, newborn and child health remains a
significant problem in developing countries.

4. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Statistics (as of December 2011)
 Worldwide, 358 000 women die during pregnancy and
childbirth, annually
 estimated 7.6 million children die under the age of five.
 majority of maternal deaths occur during or immediately
after childbirth
 common medical causes for maternal death include
bleeding, high blood pressure, prolonged and obstructed
labour, infections and unsafe abortions.
 A child’s risk of dying is highest during the first 28 days of
life

5. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Statistics (as of December 2011)
 40% of under-five deaths take place, translating into
three million deaths
 Up to one half of all newborn deaths occur within the first
24 hours of life and 75% occur in the first week.
 Globally, the main causes of neonatal death are preterm
birth, severe infections and asphyxia
 Children in low-income countries are nearly 18 times
more likely to die before the age of five than children in
high-income countries.

6. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Key facts (As of May 2012)
 Every day, approximately 800 women die from preventable
causes related to pregnancy and childbirth.
 99% of all maternal deaths occur in developing countries.
 Maternal mortality is higher in women living in rural areas and
among poorer communities.
 Young adolescents face a higher risk of complications and death
as a result of pregnancy
 Skilled care before, during and after childbirth can save the lives
of women and newborn babies.
 Between 1990 and 2010, maternal mortality worldwide dropped by
almost 50%

7. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Key facts
• Every day, +8 000 newborn babies die from
preventable causes.
• Nearly 99% of all neonatal deaths occur in low- and
middle-income countries.
• 70% of global deaths among newborn babies happen
in just two WHO regions: Africa and South-east Asia.
• Essential maternal and newborn care and access to
care for complications can save the lives of mothers
and newborn babies.

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28 May 2013, WHO Philippines, Manila

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28 May 2013, WHO Philippines, Manila

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28 May 2013, WHO Philippines, Manila

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28 May 2013, WHO Philippines, Manila
 Highest maternal, neonatal and under-five mortality rates
are in sub-Saharan Africa and in Southern Asia.
 Substantial progress has been made towards achieving
MDGs 4 and 5 but rates of decline in maternal, newborn
and under-five mortality remain insufficient to achieve
these goals by 2015.
 Interventions and strategies for improving reproductive,
maternal, newborn and child health and survival are closely
related and must be provided through a continuum of
care approach.

12. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Inequity in maternal and newborn health
The health of the mother and newborn is inseparable

13. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
When do they die?
Up to 50%
of neonatal
deaths are in
the first 24 hours
75% of neonatal
deaths are in
the first week –
3 million deaths

14. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
• Maternal, perinatal and newborn health and
mortality are closely linked:
• risk of dying from neonatal conditions- lessened
by improved access to skilled care at birth- key
interventions provided during pregnancy and
birth for the mothers and immediate post
partum/postnatal period (within 48 hours).

15. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
What we do…
 Improving maternal, newborn and under-five health and
survival is one of WHO’s priorities.
 Work to reduce maternal, newborn and under-five
mortality by providing clinical and programmatic
guidance, setting global standards, and providing
technical support to Member States.
 WHO advocates for more affordable and effective
treatments, designs training materials and guidelines for
health workers, and supports countries to implement
policies and programmes and monitor progress.

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28 May 2013, WHO Philippines, Manila

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28 May 2013, WHO Philippines, Manila
Joint Programme on Maternal and
Newborn Health
Delivering as One

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28 May 2013, WHO Philippines, Manila
UNDAF Sub-outcomes related to JPMNH
 Sub-Outcome 1.2: Universal Health Care
By 2018, the health care system is able to
provide equitable access to health care and
address inequities in health outcomes
 Sub-outcome 1.3: Reproductive, Maternal
and Neonatal Health :
By 2018, increased utilization of high quality
reproductive, health, maternal and neonatal
(RHMNH) services by women and their
neonates, young people and men.

19. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Transitional Phase (2009-2011):
– was not anchored on the past UNDAF
Upcoming Implementation Phase (2012-2016) :
– Shall refer to the 2012-2018 UNDAF and contribute to the Joint
Implementation Plan
– Is seen as a subset of the Sub-outcome 1.2 (Universal Health
Care) and Sub-outcome 1.3 (Reproductive, Maternal and
Neonatal Health)
Joint Programme on Maternal and
Neonatal Health

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28 May 2013, WHO Philippines, Manila
Elements of a Joint Programme
a common work plan,
a budget,
the coordinating and management
mechanism and;
 signature of the parties to the joint
programme

21. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Continuum of Care
Pre-
pregnancy
Pregnancy Birthing Post-
natal/Post-
partum
 Unmet
need for FP
 CPR
modern
method
 Teenage
pregnancies
 At least 4
antenatal
care visits
• Deliveries by
Skilled health
professionals
• Facility based
deliveries
• EmOC met need
• Caesarian Section
rate
• Case fatality rate
• Post-partum
visits (eg. Check
for
signs of
complications,
Early
Breastfeeding)

22. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Area Focal Agency(ies) Supporting Partners
Family Planning UNFPA, WHO UNICEF
Antenatal Care UNICEF, WHO UNFPA
Skilled Attendance at Birth WHO, UNFPA, UNICEF
B-EmONC UNFPA, UNICEF WHO
C-EmONC WHO, UNFPA UNICEF
Post-partum WHO, UNFPA UNICEF
Newborn care WHO, UNICEF UNFPA
Maternal-Neonatal Nutrition UNICEF, WHO UNFPA
Role of the UN agencies

23. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
The 3 UN agencies will support adolescent sexual
reproductive health (ASRH), monitoring and
evaluation (M and E) and MNH in humanitarian
situations.
UNFPA will pilot demand-side financing in cooperation
with UNICEF and WHO
AusAID will provide technical/financial support (M&E
development, CQI through missions, South-to-South
cooperation, fellowship)
Role of the UN agencies

24. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
WHO-focus (urban poor
areas in NCR):
 CAMANA and Quezon
City and General
Santos City
UNFPA-focus:
 Eastern Samar, Ifugao,
Lanao Sur
UNICEF-focus:
 Maguindanao, Sarangani
and North Cotabato
Transition Phase Project Areas:
North Cotabato and
Maguindanao
Eastern Samar
Sarangani
MAP OF PROJECT AREAS
S. Kudarat
NCR: Malabon-
Navotas,
Quezon City
Surigao Norte

25. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Major Accomplishments
 Support to MCP Accreditation of health facilities thru
support to:
– BEmONC training
– EINC Quality Improvement Workshops
– Reaching the Urban Poor(RUP) for RMNH services
 Evidence-based clinical practice guidelines for MNH care
developed and disseminated (ENC Protocol and Policies
Mandating Safe and Quality Care for Mothers and
Newborns; CPG for Intrapartum and Immediate
Postpartum Care

26. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Major Accomplishments
 Support to the strenghtening of the vital registration
– ICD Training to enhance reports on deaths, especial maternal
and newborn deaths
– MNDRS
– MDRRS
 Technical assistance in the development of evidence
based social marketing communication materials on
breastfeeding and in EINC.

27. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Phase 2 Proposal
 The JPMNH team selected convergence areas to enable
all three agencies to work together.
 starting point -municipal level as the bottom of the
service delivery triangle ,as this was the smallest
geographical area where UNICEF, UNFPA or WHO
worked with communities.
 Once these had been defined overlapping higher levels
with agency presences were mapped.

28. Maternal , Newborn and Child Health Summit
28 May 2013, WHO Philippines, Manila
Considerations for the choice of Phase 2 sites:
 LGU with potential for SDN at 3 levels: LGU, provincial,
regional;
 Building on gains in Transition phase- common areas
where some components of SDN: EINC in CEMONC,
RUP activities, family planning commodities and systems ;
 Convergence of the three participating UN agencies’
activities / common country program sites

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28 May 2013, WHO Philippines, Manila
JPMNH Areas: Service Delivery Network

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28 May 2013, WHO Philippines, Manila
The Buzz Words
Accountability for Results
National Ownership
Harmonization
Alignment
Capacity buildingJoint Programming from a UN perspective supports national
goals for more coherence, effectiveness and efficiency.

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28 May 2013, WHO Philippines, Manila
http://www.who.int/topics/maternal_health/en/ /http://www.who.int/maternal_child_adolescent/en