Nigeria. Regional Global Every Newborn Ac4on Plan Dakar July 2013

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Antony Barber
5 years ago
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MNH Advisor, Save the Children Dr Garba Safiyanu, Health Specialist, MNCH, UNICEF Mrs Catherine

1 Nigeria Dr Nnenna Ihebuzor, Director PHC Systems Development, NPHCDA Dr Joy Ufere, Head Newborn Care, FMoH Dr Abimbola Williams, Senior MNH Manager, Save the Children Dr Manuel Oyinbo, Senior MNH Advisor, Save the Children Dr Garba Safiyanu, Health Specialist, MNCH, UNICEF Mrs Catherine Ojo, Chief Nursing Officer, ABUTH Regional Global Every Newborn Ac4on Plan Dakar July

2 Nigeria s profile: Epidemiology and demography FederaOon of 36 States and FCT PopulaOon: 167 million + WCBA 38m (NDHS 2008) U5 pop: 33m Large birth cohort: 6m+ per year Benin Oyo Ogun Lagos Kebbi Kwara Atlantic Ocean Map of Nigeria Showing the Six (6) Geo-Political Zones Sokoto Niger Ekiti Osun Zamfara Ondo Edo Delta Kogi Katsina Kaduna FCT, Abuja Enugu Anambra Ebonyi Imo Abia Kano Nassarawa Cross River BayelsaRivers Akwa Ibom Niger Benue Jigawa Plateau Bauchi Gombe Taraba Yobe Adamawa Borno Cameroun Chad Zone Southsouth Southeast Northcentral Southwest Northeast Northwest NDHS 2003 NDHS 2008 MDG Targets NMR U5MR MMR Child deaths (<5 years) are declining BUT s4ll liqle progress for neonatal deaths... Now 34% of under five deaths, up from 24% (in 2008) 2

3 Nigeria s profile: Epidemiology and demography Child and neonatal mortality by wealth quin4le Inequality in coverage for MNCH interven4ons is greatest for skilled birth aqendant, family planning, antenatal care, and immuniza4ons NMR also varies by region (36-50 in southern states vs in northern states Nigeria s s4llbirth rate remains high at 42 / 1000 live births 3

aqendant at birth % of live births 13% +555% Contracep4ve prevalence % of women of reproducove age 4% Poorest 20% 21%

4 Mul4ple antenatal care (ANC) visits % of pregnant women The poorest Nigerian women have significantly less access to MNCH services than richer women MCH service access by the poorest and richest women in Nigeria, % 91% 85% +196% Skilled aqendant at birth % of live births 13% +555% Contracep4ve prevalence % of women of reproducove age 4% Poorest 20% 21% +469% Richest 20% SOURCE: World Bank: Socio- economic Differences in Health, NutriOon, and PopulaOon within Developing Countries 4

hospitals Primary Health Care FaciliOes DeconcentraOon SMoH DelegaOon NPHCDA, NASCP DevoluOon LGAs for PHC Health on the concurrent list Some States and LGAs do not priorioze

5 Nigeria s profile - Health system: policy, leadership, finances Per capita total expenditure on health: $59 (2010) Official development assistance to maternal and newborn health per live birth : $14 (2009) Government Tier Federal State Local Government Responsibility NaOonal policy; Monitoring; TerOary hospitals PopulaOon health in State; Referral State hospitals Primary Health Care FaciliOes DeconcentraOon SMoH DelegaOon NPHCDA, NASCP DevoluOon LGAs for PHC Health on the concurrent list Some States and LGAs do not priorioze health resulong in inconsistent health services across states and local government areas Generally, health services, uptake and indicators in southern States befer than in northern States

6 Scaling up maternal & newborn health: MNCH policies Child health policy; RH policy; IMNCH strategy with MNCH targets NMR target 12/1000 live births by 2015 Vital registraoon by NPopC but coverage about 30% NaOonal HRH (2007/8) policy and plan. To ensure adequate numbers of skilled and well- moovated health workforce are available and equitably distributed for quality health service MSS and SURE- P MCH ensure availability in underserved areas ( respecovely by end 2013) Long term increased producoon from SoM and SoN InternaOonal Code of MarkeOng of Breastmilk SubsOtutes policy enforced Postnatal home visits in first week of life for maternal and neonatal health; coverage low NaOonal standard clinical treatment guidelines 2010 (comprehensive, not specific for MNCH) 6

7 Scaling up maternal & newborn health: Situa4on analysis / coverage DHS 2008 DHS Variable coverage along the con4nuum of care for most intervenoons 7

The Midwives Service Scheme has delivered visible results within two years

789 584-26% Neonatal mortality rate Deaths per 1,000 live births 11 9-22%

aqendant at birth % of births 12% 16% +33% Use of family planning methods

8 The Midwives Service Scheme has delivered visible results within two years of implementa4on Maternal mortality ra4o Deaths per 100,000 live births % Neonatal mortality rate Deaths per 1,000 live births % Pregnant women with focused ANC % of pregnant women 41% 50% +22% Skilled aqendant at birth % of births 12% 16% +33% Use of family planning methods % of reproducove age women SOURCE: Midwives Service Scheme 1% % % 8

9 Scaling up MNCH: Ongoing ini4a4ves EWEC UNCoLSC Nigeria is co- Chair Framework for COIA NSHDP APR NaOonal Health Bill PHC fund for HRH, commodioes, equipment Health insurance RH commodioes security US$3m/ year Saving One Million Lives Ini4a4ve (6pillars; 2 cross- cufng ) Delivery of integrated package of MNCH intervenoons to increase SBA, ANC coverage Increase RI / eradicate polio emtct Scale up access to essenoal medicines and RMNCH commodioes Control of malaria Improved child nutrioon 2 cross- cumng enablers ICT and innova4on / unlocking private sector poten4al Logis4cs and supply chain management 9

The SURE- P MCH programme will build on the impact of MSS through supply and demand- side interven4ons along the con4nuum of care Supply Inputs Human Resources for Health Con4nuum of care Demand

10 The SURE- P MCH programme will build on the impact of MSS through supply and demand- side interven4ons along the con4nuum of care Supply Inputs Human Resources for Health Con4nuum of care Demand Inputs CondiOonal Cash Transfer Recruitment Deploy- ment Training Antenatal Payment CondiOons Ident- ificaoon visit 1 Midwives and CHWs recruited from school or unemploy- ment database, VHWs from commu- nioes Midwives and CHWs deployed aner enrolment, VHWs deployed aner training All cadres receive a one- week training Antenatal visit 4 Skilled afendant at birth Postnatal care Women who meet condioons are paid a set incenove value Women are encour- aged to meet programme condioons (i.e. to access MCH services at PHCs) Pregnant women in the community idenofied by VHW, CHW, or midwife Family Planning SOURCE: PIU team 10

Scaling up maternal & newborn health: challenges, boqlenecks Health system blocks Leadership and governance HRH - density of doctors, nurses and midwives (per 10,000 populaoon) is 20.1 (2008).

11 Scaling up maternal & newborn health: challenges, boqlenecks Health system blocks Leadership and governance HRH - density of doctors, nurses and midwives (per 10,000 populaoon) is 20.1 (2008). Main issue inequitable distribuoon Finance CommodiOes and Service delivery SBA including EONC, ANCS ENBC including CHX Demand creaoon Con4nuum of care Delivery plaporms Access to care geographic, financial, socio- cultural Community based care QoC at facilioes 11

12 Thank you 12

NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses

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