CHANGES IN UNDER-FIVE MORTALITY RATE IN TURKEY

Transcription

1 CHANGES IN UNDER-FIVE MORTALITY RATE IN TURKEY Decrease in Under-5 Mortality Rate in Turkey (U5MR) A CASE STUDY December 2010 Dr. Sema ÖZBAŞ General Directorate of Mother and Child Health and Family Planning Unite for Children

2 4th Millennium Development Goal proposes to Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. Until today, all the regions in the world and the world in total have fallen behind the schedule for realizing this goal by the year Turkey, on the other hand, has realized MDG4, which means U5MR has been reduced by two-thirds and is now one of the few countries that may go beyond this.

3 Table 3.1: Comparative State of U5MR in Turkey World Region/Classification Decrease in % of U5MR (90-07) Industrialized Countries 40.0% Developing Countries 28.2% Least Developed Countries 27.4% Middle East and North Africa 41.8% Middle/Eastern Europe, Commonwealth of Independent Countries 52.8% WORLD 26.9% Turkish Republic 72.0% (Source: UNICEF State Of The World s Children Report 2009)

4 U5MR ANALYTICAL FRAME INPUTS OUTPUTS CONTEXT Demographic factors in population Economic factors Rural-urban migration Mother's education Policies Health Planning Health Reform Preventive Efforts Prevention of Infectious Diseases Family Planning Child Care and Child Survial Antenatal Care Perinatal Care Systems Maternity Wards of Hospitals Neonatal Care Post-neonatal Care Personnel in Mother and Child are RESULTS Infant mortality Neonatal deaths Post-neonatal deaths Child mortality EFFECT Decrease in U5MR

5 DEMOGRAPHIC CHANGE While the Yearly Population Growth Rate was 2.3% in Turkey between the years 1970 and 1990, this rate decreased to 1.6% in period. And in 2007, it decreased to 1.2%. In , Turkey's urban population grew approximately by 14% and reached 49.5 millions. Rural population, on the other hand, decreased by 1.4 percent to 23.4 millions. As a matter of fact, Turkey has become a country with a mainly urban population in which 68% of the population live in cities in the last decades. In the previous decades, while urban population was increasing, family size dropped from 5.3 in 1980 down to 3.9 in Sources: OECD, Turkey Statistics Profile, 2009., UNICEF, State of World's Children, 2009.

6 HDI 2009 The Relationship between population and under 5 mortality rate , , Total Fertility Rate Population Growth Rate U5MR 1, , Low income group Middle income group High income group World Turkey 0

7 ECONOMIC FACTORS Table 5.2 GDP Per Capita ($), Turkey Year GDP Per Capita ($) Source: OECD, Turkey Statistics Profile, 2009 Turkey's economy annually grew by 1.9% during the period and GDP Per Person increased by 2.2% between the years 1990 and 2007.

8 THE RELATIONSHIP BETWEEN GNP PER CAPITA AND UNDER FIVE MORTALITY RATE GNP U5MR HDI 2009 Low Income Group Middle Income Group High Income Group World Turkey 0

9 EDUCATION LEVEL OF FEMALE POPULATION (%) TURKEY CITY COUNTRY UNEDUCATED/NO PRIMARY SCHOOL DEGREE PRIMARY EDUCATION 1ST STAGE PRIMARY EDUCATION 2ND STAGE HIGH SCHOOL TNSA (TURKEY Demographic and Health Survey)

10 INPUTS: PROGRAMS, POLICIES AND INCLINATIONS IN RESOURCES

11 MOTHER AND CHILD HEALTH PROGRAMS Marriage and Pre-pregnancy Consultation Program Family Planning Program Antenatal Care Program Urgent Obstetrical Care Program Delivery and C-section Program Postnatal Care Program Maternal Mortality Monitoring Program 11

12 MOTHER AND CHILD HEALTH PROGRAMS Neonatal Resuscitation Program Infant and Child Monitoring Program Neonatal Intensive Care Program Neonatal Scanning Program Mother and Child Nutrition Program Child Infection Prevention Program Infant Mortality Monitoring Program 12

13 MOTHER AND CHILD HEALTH PROGRAMS Youth Health Program Older Age Reproductive Health Program Sexual Health Program Program for the Involvement of Males in MCHP Services International Education Program 13

14 MAIN FACTORS THAT AFFECT THE PROGRAMS Political Commitment Scientific Support Support of Vocational NGOs Support of NGOs Monitoring and Evaluation Personnel Motivation 14

15 POLITICAL COMMITMENT Why does mother and child health matter? What political good does it bring to politicians? How does it affect the economic policy? What benefits does it have for prompting an economic boon in medium and long term? What would be the costs if we did not provide these services? 15

16 POLITICAL COMMITMENT We talked to universities We talked to the Ministry of Finance We talked to the Private Sector We talked to members of the parliament We talked to the NGOs We ensured consensus, We prepared the Women's Health Strategic Plan, Then we talked about it to decision makers together and ensured political support. 16

17 SCIENTIFIC SUPPORT It was necessary to have some strong scientific support for the programs to be internalized across the country. We created scientific committees for each program consisting of scientists from; Universities Hospitals of the Ministry of Health Hospitals of the Private Sector 17

18 SCIENTIFIC SUPPORT All the programs were prepared and followed in corporation with these scientific committees. In order to ensure standardization across the country, clinic application guides and work flow schemes were prepared for each program. Therefore, it was ensured that all the institutions in service could internalize the programs. 18

19 SUPPORT OF VOCATIONAL NGOs In order for the programs to be internalized by the implementing health personnel, we ensured cooperation with specialized associations. 19

20 SUPPORT OF NON GOVERNMENTAL ORGANIZATIONS There were two respects that made the support of NGOs important; Ensuring Political Commitment Creating demand for health services 20

21 MONITORING AND EVALUATION Monitoring and evaluation indicators were prepared for each program. A data glossary was prepared, indicators were described, personnel responsible for registry and notification were determined. Computer programs were created for monitoring the data in digital media. 21

22 MONITORING AND EVALUATION There were 3 stages to Monitoring and Evaluation: The process was monitored by Directorates of Health on Province Level General Directorates on Ministry Level Besides, there was constant monitoring by field coordinators that were not connected to routine bureaucratic ranks but directly connected to the Minister. 22

23 MONITORING AND EVALUATION The evaluations of those who utilized the Health Service were also taken. The data was checked with the demographic and Health Surveys (TNSA). User opinions were taken through satisfaction surveys. 23

24 PERSONNEL MOTIVATION People keep struggling as far as they know and they believe; they do not struggle for what they don't know or don t believe; they determine their goals and expectations within these limits. First, we made ourselves believe that we were going to accomplish these goals. Then, we organized a set of meetings to make our personnel believe that too. We rewarded success also in financial terms. We brought about the performance system. We counted Pregnancy and infant monitoring and other indicators among performance criteria. 24

25 OUTCOMES: STRENGTHENED MOTHER-CHILD HEALTH SYSTEMS

26 DEVELOPMENTS IN PREGNANT CARE AND DELIVERY Prenatal Care Helper of Delivery Place of Delivery TDHS-1993 TDHS-1998 TDHS-2003 TDHS

27 Table 7.3 Neonatal Intensive Care Systems and Resources, Turkey, Turkey- MoH MoH Other Total Neonatal Centers Turkey/Target Neonatal intensive care beds Mobile incubator Ventilator Neonatal specialists Nurses in Neonatal Service Source: Ministry of Health, 2009

28 DEVELOPMENTS IN DELIVERY (%) TDHS 1993 TDHS 1998 TDHS 2003 TDHS 2008 DELIVERIES BY MEDICAL PERSONNEL HOSPITAL DELIVERIES 28

29 POST-NATAL INFANT CHECK ,1 79, ,8 94,1 95,4 70,5 88, TNSA (TURKEY Demographic and Health Survey) 29 29

30 RESULTS: NEONATAL AND POSTNEONATAL INFANT AND CHILD MORTALITY

31 , ,8 23,4 29, CHANGES IN PERINATAL, NEONATAL, POSTNEONATAL INFANT AND UNDER FIVE MORTALITY RATE Prenatal Mortality Rate Neonatal Mortality Rate Postnatal Mortality Rate Infant Mortality Rate TNSA

32 Reason of death unknown birth trauma congenital anomaly CHD Prematurity Perinatal asphyxia Special cases Sepsis LRTI meningitis intra-ventricular hemorrhage diarrhea neonatal tetanus malignancy accident other 5% 1% INFANT MORTALITY ACCORDING TO THE REASONS IN % 1% 1% 2% 11% 19% Bilinmiyor Unknown 15% 6% 5% 28% 6% dogum birth travması trauma konjenital congenital anomali anomaly CHD KKH Prematurity prematürite Perinatal asphyxia perinatal asfiksi Special cases özel durumlar Sepsis sepsis LRTI ASYE Meningitis menejit intra-ventricular İVHhemorrhage ishal Diarrhea neonatal tetanos tetanus malignite Malignancy kaza Accident diger other INFANT MORTALITY ACCORDING TO THE REASONS IN

33 INFANT MORTALITY ACCORDING TO THE REASONS IN % 5% 1% 4% 2% 2% 11% 5% 29% 42% 7% 5% 1% 1% 16% 9% 1% 2% 1% 1% dogum birth trauma travması konjenital Congenital anomali anomaly KKH CHD prematürite prematurity perinatal Perinatal asfiksi asphyxia diğer other sepsis ASYE LRTI menejit meningitis İVH IVH ishal diarrhea neonatal Neonatal tetanos malignite malignancy kaza accident tetanus 6% 2% 1% 1% 1% 1% 3% 1% 1% 2% 1% 1% 1% postmatürite Postmaturity hidrosefali Hydrocephalia NEK IU enfeksiyon infection hepatit Hepatitis ensefalit Encephalitis diger Otherenfeksiyon infection RDS pnömotoraks Pneumothorax MAS PHT diger Other sol.sis.prob. resp.sys.prob. sok Shock diger Otherkalp heart hast. dis. nöromusk.hast. Neuromusc.dis. genetik Genetichast. diseases metabolik Metabolical hast. dis. metabolik Metabolicbzk. mal. nöro.prob. Neuro. Prob. imm.yetm. İmm. Fail. endok.prob. Endok. Prob. bobrek Renal Failure yetm. diger Other renal prob. kanama Bleedingbzk. prob. HF anemi Anemia malnutrisyon Malnutrition postop.nedenler Post-op. Reasons ABO ihmal-ist. Negligence/abuse ayrışmamış Unclassified

34 EFFECT: DECREASE IN U5MR IN TURKEY

35 COMPONENTS OF UNDER FIVE MORTALITY RATE

36 Table 9.1 Under Five Mortality Rate (U5MR) in Turkey according to various sources, Research Year TDHS UNICEF/TURKSTAT Estimates 1990 TDHS TDHS TDHS TURKSTAT Estimates 2004 TURKSTAT Estimates 2005 TURKSTAT Estimates 2006 UNICEF/TURKSTAT Estimates 2007 TDHS U5MR Resources: TDHS: Demographic and Health Survey of Turkey, 2008; TURKSTAT Estimates: Health at a Glance 2007; UNICEF State of World's Children 2009

37 MOTHER AND CHILD HEALTH Marriage and Pre-pregnancy Consultation Program Postnatal Care Program PROGRAMS Neonatal Resuscitation Program Infant and Child Monitoring Program Neonatal Intensive Care Program Neonatal Scanning Program Mother and Child Nutrition Program Child Infection Prevention Program Child Emergency and Intensive Care Education Program 37

38 THANK YOU