Enhancing Reproductive & Child Health in Kenya: Progress & Challenges

1. Overview and trends of Reproductive, Maternal , Newborn , Adolescent and Child health Program in Kenya ‘Investing in woman and child health …..… Dr. Mohamed .A. Sheikh Head , Division of Family health Ministry of Health .

2. INTRODUCTION . • The health status of mothers and children is an important indicator of the overall heath system status , economic of nation and well-being of a country. • Thus, The government recognizes that good health of WOMEN and CHILDREN is a prerequisite to socioeconomic development. • The government of Kenya emphasizes the health of its citizens and the improvement of health service delivery is a key priority. • Children represent the future and ensuring their healthy growth and development ought to be a prime concern for all society. • Newborns are particularly vulnerable to infectious diseases and malnutrition.

3. INTRODUCTION • Maternal health is inextricably linked with the survival of newborns. For every woman who dies, another 30 suffer long-lasting injuries and illnesses such as obstetric fistula (UNDP, WHO, UNFPA, and World Bank, 2006). • Provision of a continuum of care during pregnancy, labour and delivery, and the postnatal period results in reduced maternal and neonatal morbidity and mortality • Early childhood development is consider to be the most important phase in life which determines the quality of health . • Globally , Every year nearly 6 Million children die due to preventable and treatable causes • Kenya has made significant progress in reducing child mortality

4. Vision A Kenya where there are no preventable deaths of women, new-borns or children and; no preventable still-births, where every pregnancy is wanted, every birth celebrated and accounted for; and where women, babies, children and adolescents are free of HIV/AIDS, survive, thrive and reach their full social and economic potential

5. Key Priority Indicators • Maternal Mortality Ratio – 362 per 100,000 live births • Neonatal Mortality rate – 22 per 1000 live births • Skilled Birth Attendance – 62% • Antenatal care coverage – 96% • Under five mortality Rates – 52 per 1000 live births • Infant mortality Rate – 39 per 1000 live births • Neonatal Mortality Rate – 22 per 1000 live births • Focused Antenatal care coverage (using 4th ANC visit) • Postnatal Care coverage Targeted Postnatal Care coverage (48h and 6 weeks) • Stunting , wasting and underweight cases

6. Government Initiatives Campaign by Her Excellency, Margaret Kenyatta, First Lady of the Republic of Kenya FREE MATERNITY SERVICES FREE PRIMARY HEALTH SERVICES UHC DEVOLUTION

7. Ministry of Health Government of Kenya January 31, 2016

8. KEY ACHIEVEMENTS. • Kenya is making progress in reducing child mortality and improving maternal health services

9. Key Achievements: Maternal Health Utilization of Skilled Deliveries Maternal Mortality Ratio

10. Key Achievements: Child Health Trends in Childhood Mortality “Things are looking up!” Deaths per 1,000 live births for the five-year period before the survey

11. Key Achievements: HIV Control PMTCT • HIV Prevalence • Declined from 13% (2000) to 6.0 % (2014) • Care and Treatment • ~1M PLHIV on ART • New Treatment Regimens

12. Performance of the Immunization program; administrative reports Reported Immunization Coverage Trends (2013-2018) Unimmunized Children & Penta 3 Coverage 2013 - 2018 Number of unimmunized children is lowest since devolution.; general improvement leading to better coverage numbers.

13. Key Achievements: Nutritional Status of Children Percent of children under 5

14. Trends of Stunting, Wasting and Underweight

15. Contraceptive use increasing and fertility declining Contraceptive Use Fertility

16. Progress in Key RMNCAH Indicators

17. KEY ISSUES AND CHALLENGES

18. CURRENT STATUS: Women & children die from preventable illnesses

19. Maternal and Neonatal deaths in Kenya Maternal & Newborn situation • 2014 KDHS  • Maternal mortality ratio (MMR) at 362/100,000 live births • New-born mortality rate as 22/1000 livebirths • 15 out of the 47 counties contribute to 98% of all maternal deaths in Kenya • One maternal death = 30 maternal morbidities Counties with High Maternal Deaths

20. Direct Causes of Maternal Mortality Meghna D, Penelope A et al (2013). An Analysis of Pregnancy-Related Mortality in Health and Demographic Surveillance Sytestem in Western Kenya. PLOS One July 2013 | Volume 8 | Issue 7 | e68733

21. Causes of Neonatal mortality in Kenya

22. SELECTED INDICATORS COUNTIES PERFORMANCE

23. Counties with increased skilled attendance coverage: Makueni,Mandera,Nandi,Nyandarua,Laikipia,Muranga,Marsabit,Nyeri,Kirinyaga,Kiambu

24. SBA Trend,2014-2018

25. SBA Coverage Per County 2018

27. Kenya’s S-Curve of mCPR % of MWRA 7% 8% 16% 64% 5% 1%

28. Counties with the highest burden of teenage pregnancy and motherhood (Above National average of 18%)

29. QUALITY OF CARE OF MATERNAL AND CHILD HEALTH SERVICES

30. Period of death- when are our mothers dying? Most deaths occurred outside working hours Week day working hours: Monday-Friday 8am-5pm Week day out of hours: Monday-Friday 5pm to 8am

31. Trends in Maternal Deaths and Audits

32. Comparison of 4th ANC and at least ANC visit coverage • Antenatal care (ANC) from a skilled provider is important to monitor pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery.

33. Postnatal care visits • The postpartum period is particularly important for women, since during this period they may develop serious, life-threatening complications. • Evidence has shown that a large proportion of deaths occur during the postpartum period, with postpartum haemorrhage being a major cause . • A postnatal care visit is a time to educate a new mother on how to care for herself and her newborn. Newborn care is essential to reduce neonatal health problems and death. To identify, manage, and • prevent newborn health complications, • the government of Kenya recommends at least three postnatal • checkups for the newborn within the seven days after delivery, which is considered a critical time period. • 1WK, 7-14 after birth, 4-6 wk after birth.

34. Moving forward , key issues to address • Quality of care of Maternal and Child health services along the continuum of Care ,ANC, Deliveries, postnatal care, first 1000days • Apply High impact interventions • Strengthen MPDRS • Address high Teenage Pregnancy • Malnutrition • Introduction of new vaccines HPV Vaccine, Yellow Fever vaccine expansion, Menegococcal Vaccine

35. Opportunities • Improving coverage for RMNCAH indicators is a priority for the government of Kenya.as reflected • Constitution of Kenya • Vision 2030 • Health sector strategic and investment plan • Free maternity and linda Mama • Beyond zero campaign etc.

36. UHC DAY AND UHC LAUNCH IN KISUMU KENYA DECEMBER 2018

37. UNIVERSAL HEALTH COVERAGE PROGRESS-PILOT COUNTIES Attainment of 100% Universal Affordable Health Coverage 2nd October 2018

38. UHC Aspirations For Kenya • By 2022, in Kenya • Each person can access a health benefit package that addresses their health needs • Essential health interventions are provided to all areas of the country including hard-to-reach areas • All Kenyans are protected from potential financial catastrophe arising from use of health services. Special focus is given to the poor and vulnerable • Ensuring adequacy of Health resources /Ensure that resource base is appropriate for delivery of health services .

39. WAYFORWARD

40. WE NEED TO MOVE AWAY FROM THE FRAGMENTED APPROACH TO MATERNAL AND CHILD HEALTH MOVE TOWARDS TAKING A HOLISTIC VIEW OF THE HEALTH OF WOMEN AND CHILDDREN FOCU ON TH E CONTIMUUM OF CARE , PREGNANCY , PREGNANCY , DELIVERY , POSTNATAL , CHILD HEALTH AND ADOLESCENT

41. THANK YOU