CLINICAL CARE RESPONSE TO MDGs 4 and 5

1. CLINICAL CARE RESPONSE TO MDGs 4 and 5 Presentation by Dr C Bannerman at the Health Summit 19th -21st November 2007 Photo- Opportunities for Africa’s newborns cb 2007

2. Outline • Introduction • Current situation • Contributory factors • Response • Conclusion cb 2007

3. Introduction • MDG 4 Reduction in child mortality by 2/3 by 2015 ( reduced to 40/1000 LB) • MDG 5 Reduction in MMR by ¾ by 2015 (??214/100000 reduced to 54/100000 LB) • Health of newborn closely linked with the health of their mothers • MDG5 MDG4 cb 2007

4. Introduction • MDG’s gained much attention • Child survival programs have saved lives of older children but not the newborns • Despite attention given to safe motherhood since 1987 the numbers of women who die in pregnancy has changed little • Safe motherhood programs focused mainly on mothers cb 2007

5. Why clinical care • Skilled attendants critical to address maternal and neonatal deaths • 50% of all deliveries occur in health facilities • 50% of all maternal and neonatal deaths occur in health facilities • Neonatal mortality constitutes a significant proportion (60-70%) of infant mortality • All pregnancies are at risk, complications cannot be predicted • Interventions in the clinical care setting can contribute to attainment of MDGs cb 2007

6. Current situation – maternal health cb 2007

7. Current situation- causes of maternal deaths(source ) cb 2007

8. Current Situation- Child health Babies and Children Stillbirth rate per 1,000 total births 24 Neonatal mortality rate per 1,000 live births 43 Infant mortality rate per 1000 LB 64 (71) Under 5 mortality rate per 1,000 live births 111 Neonatal mortality as percentage of under 5 mortality 39% and 60% of IMR cb 2007

9. National progress to MDG 4 source Opportunity for Africa’s newborn 39% of child deaths are newborns. MDG 4 cannot be met without addressing neonatal deaths. cb 2007

10. Causes of newborn deaths Birth, first day and first week critical for survival cb 2007

11. Contributory factors – • Inadequate human resource and maldistribution eg skilled attendants • Poor quality of care -poor staff attitude - inadequate skills especially for emergencies - Lack of guidelines (eg feeding for LBW, resuscitation, early sick neonate ) - poor compliance to standards/guidelines - Weak systems to ensure patient safety and assure quality cb 2007

12. Contributory Factors- • Inadequate equipment, drugs, supplies and logistics (out of 86%of facilities only 16% had all equipment) • Access (financial, geographic, socio-cultural) - Health Insurance, ? Exemptions • Delayed use of services • Weak referral system- linkages, emergencies • Weak management of health facilities • Poor supervision and monitoring cb 2007

13. Immpact studies (TRACE) • “ In Ghana clinical delivery care in facilities is of poor quality and professionalism and competencies of health providers especially doctors in charge of maternity care in hospitals need to be reviewed and improved” • “In Ghana the programme for health service quality assurance need to be reviewed and enhanced to adequately equip health providers in hospitals to effectively manage delivery complications source Immpact prb feb 2007 cb 2007

14. Quality of care cb 2007

15. Quality of care cb 2007

16. Response • Skilled attendants-Increased intake into health training institutions and retention (ensure quality and strategy for equitable distribution) • Reproductive Health strategic plan • Maternal Health road map • Child Health policy • IMCI- scaling up and Include management of the early neonate in IMCI guidelines and strengthen case management at referral hospitals • NHIS-promote NHIS in health facilities and address cover for sick newborn cb 2007

17. Response • Make the health centre “the anchor institution” for normal delivery • Invest in infrastructure, equipment, (modern equipment ) • Address inequity • Provide management training for middle level managers at health centres and hospitals • Quality assurance strategic plan (includes patient safety) cb 2007

18. Quality midwifery care (proposal) • Specific and immediate focus on clinical quality of midwifery services (maternal and neonatal) • Goal is to contribute to the reductions in maternal mortality and thus MDGs • Objective- To increase skilled attendance at delivery cb 2007

19. Specific objectives • Improve skills and competence of skilled attendants (doctors, midwives) in midwifery and neonatal care • Provide standards of midwifery and neonatal care and ensure adherence • Improve organisation of services at the facility • Improve client-provider relationship and client friendly environments in maternal and neonatal health services (customer care). • Improve infrastructure, equipment and logistics and access to basic and emergency obstetric care cb 2007

20. Strategies • Training and capacity development • Advocacy and provision of information to improve demand • Improving environment (social and physical for delivery) • Improving referral system – emergency referrals • Strengthening facilitative supervision cb 2007

21. Conclusion • Community+ outreach + quality clinical care needed to achieve reductions> 50% • Complementary strategies needed • Equity concerns must be central • Commitment and Investment in clinical quality and ensure accountability cb 2007

22. cb 2007

23. References • Immpact prb feb 2007 • 2006 RCH report • Opportunities for Africa’s newborn • DHS 2003 cb 2007

24. Thank you cb 2007

25. Skilled attendants- accredited health professional 9midwifes, doctors nurses who have been trained to manage uncomplicated pregnancies, delivery and immediate postnatal period and in identification, management and referral of complications in women and newborns • Skilled attendance- partnership of skilled attendants and enabling environment of supplies and drugs and transport for referral to EmOc cb 2007