Malawi and MDG4: Early adopter, early achiever

Transcription

1 MALAWI IN-DEPTH COUNTRY CASE STUDY FINDINGS Malawi and MDG4: Early adopter, early achiever Lilongwe, Malawi 27 July 2015

2 Background Countdown to 2015 for Maternal, Newborn and Child Survival ( Countdown ) tracks progress in coverage for proven interventions in maternal, newborn and child survival Countdown is supporting a series of in-depth country case studies to produce generalizable lessons about scaling-up RMNCH programs Malawi (NSO) competed successfully to conduct one of the Countdown case studies

3 Trends in U5MR from 1990 to 2015 as estimated by IGME using all surveys up to MDG Endline Survey 247 U5 deaths per 1,000 live births 64 U5 deaths per 1,000 live births

4 Malawi Case Study Objectives 1. To explain how Malawi achieved MDG4 at national level 2. To examine roles of other programs (nutrition, maternal health, HIV), equity and contextual factors 3. To describe variations in district progress 4. To share lessons learned so that they can guide future policies and programs in Malawi and similar countries

5 Organization of the work: 5 teams Mortality Coverage/ nutrition Program documentation Financing National, regional, district 5 household surveys with full birth histories, Lives Saved Tool (LiST) National, district 5 household surveys, Recalculation and quality assessment of all indicators Consistency LiST: measured national estimates Contribution of specific interventions National: 25 interviews, document & data base review 10 districts: 150 key informant interviews; Review of district HMIS & program reports Tracking of contextual factors National: National Health Accounts; Countdown ODA data Districts: Integrated Financing Management Information System; AID data; 41 in-depth interviews. Analysis and writing workshop to bring components together and synthesize.

6 Process Working meetings: 1. November 2013, Lilongwe 2. March 2014, Ku Chawe 3. November 2014, Lilongwe Participants: Government of Malawi

7 Findings

8 Under-five mortality, national, Malawi will have reduced U5MR by 5.4% per annum between 1990 and 2015 Substantially faster than the 4.4% goal of MDG-4 In absolute terms, decline is remarkable: 247 to 64 per 1,000 live births Neonatal mortality declined more slowly, at only 3.3% per annum 247 Trends in U5MR from 1990 to 2015 as estimated by IGME in

9 Under-five mortality rates, district, 2000 & ( ) ( ) Under-five mortality rate Chitipa Karonga Nkhata Bay Rumphi Mzimba Kasungu Nkhota Kota Ntchisi Dowa Salima Lilongwe Mchinji Dedza Ntcheu Mangochi Machinga Zomba Chiradzulu Blantyre Mwanza/Neno Thyolo Mulanje Phalombe Chikwawa Nsanje Balaka Chitipa Karonga Nkhata Bay Rumphi Mzimba Kasungu Nkhota Kota Ntchisi Dowa Salima Lilongwe Mchinji Dedza Ntcheu Mangochi Machinga Zomba Chiradzulu Blantyre Mwanza/Neno Thyolo Mulanje Phalombe Chikwawa Nsanje Balaka North Central South North Central South

10 Child lives saved

11 Lives saved in 2013 by intervention group, National

12 Yearly lives saved by intervention group , National

13 Trends in intervention coverage

14 Trends in coverage vary widely by intervention, national, Sources: 2000, 2004, 2010 DHS, 2006 MICS, 2013/14 MDGE

15 Important reductions in undernutrition among children under five! National, Sources: 2000 DHS, 2013/14 MDGE

16 Programs and policies

17 Health sector policies: focus on women and children From 2005, a focus on women and children in national health sector strategies complimented by specific acceleration plans.

18 Technical policies for high impact interventions Essential child health programmes continuously updated to include state-of-the-art, evidence-based interventions

19 Addressing major risk factors nutrition and HIV Combating HIV and improving nutrition essential for sustaining and enhancing child health and development

20 Integration, access and quality of high impact interventions Providing quality, integrated child health services across all levels of the health system including the community

21 Health system bottlenecks to progress Health workforce: A substantial proportion of positions in the establishment plan are vacant (analysis in progress) Performance of trained personnel not meeting required standards (IMCI QoC survey, hospital assessments) Medicines and supplies: Stock-outs of essential life saving commodities in health facilities and in village health clinics (iccm evaluation, EmOC assessments, SPA) Mentorship and skills improvement Infrequent supervision (iccm evaluation, IMCI QoC survey) Limited observed clinical practice Governance Limited predictability of health sector funding at district level (case reports) Budget allocations too low for needs (case reports)

22 Financing

23 % Share of government budget going to health remains well below Abuja target GoM Health Budget/Total Government Budget (Domestic + General Budget Support) GoM Health Budget / Total Domestic Budget Abuja target Source: NHA 2010; NHA 2012/13

24 Total health expenditure by financing source Gradual increase with speed up post 2009 Very dependent on partners (66-70%) increase post-2009 driven by partner funding Government and Household contributions have been stable (14-17% government and 10% households) Constant 2013 billion Kwacha Donor Gvt HH Other Source: NHA 2010; NHA 2012/13

25 Key Messages

26 Good news on child survival! Under-5 mortality in Malawi has declined sharply from 1990 to 2014 by 5.4% per year Malawi will easily exceed the MDG-4 target Most of the decline has been between the ages of 1 and 60 months Much slower improvements in neonatal mortality All parts of the country have seen rapid declines, but they have been faster in the North than in the South But some standout districts in all regions Differences in risk of child mortality by education of mother and urban-rural residence are small And the differences by education of mother have gotten even smaller between 2000 and 2010

27 Major gains in some areas Overall, the Malawi Government has been an early adopter of policies supportive of child survival Solid gains in increasing coverage for effective interventions and reducing deaths, for example: pneumonia (Hib and pneumococcal vaccines, careseeking for pneumonia) malaria (ITNs, treatment) HIV (prevention and treatment) Access to interventions is highly equitable few differences between urban and rural, educated and less educated mothers. Important gains in reducing child undernutrition.

28 Important work remains to be done Increased efforts are needed for newborns. Overall decline of 3.3% per annum There is an unfinished agenda for children aged 1-59 months. High and equitable coverage must be maintained Further gains needed in coverage for treatment of childhood illnesses Increased focus on service quality, and ensuring every service contact is used to provide high-impact interventions Some districts are performing much better than others, and this gap must be closed. Analysis is ongoing. Health system strength must continue to improve: continuous supplies of drugs and commodities; human resources and supports for health worker performance.

29 Thank you