Development of MCH in China. QIN Geng, Department of MCH, NHFPC

Transcription

1 Development of MCH in China QIN Geng, Department of MCH, NHFPC

2 Contents Progress and Achievement Practice and Experience Thinking and Prospect

3 Ⅰ Progress and Achievement 1. U5MR and MMR continue to decrease,achieve MDG 4 and MDG 5 ahead of schedule Progress MDG4: 8 years ahead of schedule

4 Estimated average annual reduction rate needed to achieve MDG4 Actual annual reduction rate in China U5MR, IMR, NMR in China, : Actual annual reduction rate were much higher than the estimated average annual reduction rate needed to achieve MDG4 All MDG achieved eight years ahead of the schedule: Reduce by three quarters, between 1990 and 2015

5 Progress MDG5: 1 years ahead of schedule

6 Progress and Achievement 2. Equity improved significantly in MCH U5MR, : Absolute differences between urban and rural declined 83.5% The gap between rural and urban narrowed from 3.4 times in 1991 to 2.4 times in 2014 Absolute differences between east and west region declined 82.7%, 88.3% between east and central region

7 U5MR(1/1000) U5MR(1/1000) urban rural east central west

8 MMR, : Absolute differences declined 96.8% between urban and rural Ratio between rural and urban declined from 2.2 in 1991 to 1.1 in 2014 Absolute differences among east, central and west region declined gradually Ratio between east and west region declined from 4.7 in 1996 to 2.6 in 2014

9 MMR(1/ ) MMR(1/ ) urban rural east central west

10 Progress and Achievement 3. Effective control of major diseases for maternal mortality and U5 mortality The proportion of U5 mortality due to infectious diseases dropped significantly in 2014,a decrease of 44.0%

11 Disparity of cause specific U5MR due to infectious diseases (pneumonia, diarrhoeal diseases, et al.) between urban and rural decreased significantly Reduction of pneumonia, prematurity and intrapartum complications were the main contribution to the reduction of U5MR

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13 Proportion of main causes of marternal mortality, 2014(%) Obstetric hemorrhage Amniotic fluid embolism Heart disease Venous thrombosis and pulmonary embolism Hypertensive disorders in pregnancy Puerperal infection Liver disease Other Unknown MMR due to direct obstetric causes decreased significantly, nearly 30% MMR due to obstetric hemorrhage decreased significantly MMR due to hypertensive disorders in pregnancy, puerperal infection and other direct obstetric causes also declined

14 Difference between urban and rural on cause-specific MMR due to obstetric hemorrhage reduced most significantly

15 Progress and Achievement 4. Nutrition and Health status of women and children continued to be improved, and the disease burden was reduced Underweight prevalence of U5 decreased from 13.7% in 1990 to 3.6% in 2010 Stunting prevalence of U5 decreased from 33.1% in 1990 to 9.9% in 2010% Underweight prevalence of U5, (%) Stunting prevalence of U5, (%) Existing data: ; Predictive data: Existing data: ; Predictive data:

16 The incidence of severe, multiple birth defects continued to decline NTDs (27.4) TCL (14.5) TCL (14.07) CHDs (23.96) CHDs (32.74) CHDs (40.95) CHDs (39.98) CHDs (52.06) 2 TCL (16.7) NTDs (13.6) Polydactyly (12.45) Polydactyly (14.66) Polydactyly (16.39) Polydactyly (16.73) Polydactyly (15.94) Polydactyly (17.67) 3 Polydactyly (11.6) Polydactyly (9.2) NTDs (11.96) TCL (13.73) TCL (12.78) TCL (11.43) TCL (10.36) TCL (8.51) 4 Hydrocephalus (9.2) Talipes equinovarus (8.3) LRD (7.7) CHDs (6.3) 8 Synpolydactyly (3.3) 9 Cleft Palate (2.8) Hydrocephalus (6.5) CHDs (6.2) LRD (5.2) Talipes equinovarus (4.7) Hypospadias (3.1) Synpolydactyly (3.1) CHDs (11.40) Hydrocephalus (7.10) LRD (5.79) Talipes equinovarus (4.97) Hypospadias (4.07) Synpolydactyly( 3.95) NTDs (8.84) Hydrocephalus (7.52) LRD (5.76) Hypospadias (5.24) Talipes equinovarus (5.06) Synpolydactyly (4.94) Hydrocephalus (6.02) NTDs (5.74) Talipes equinovarus (5.08) Hypospadias (4.87) Synpolydactyly (4.81) LRD (4.74) Hydrocephalus (5.47) Talipes equinovarus (5.17) Hypospadias (5.03) Synpolydactyly (4.88) NTDs (4.50) LRD (4.09) Hydrocephalus (6.27) Talipes equinovarus (5.48) Hypospadias (4.91) Synpolydactyly (4.55) LRD (4.02) NTDs (3.55) Hydrocephalus (5.81) Synpolydactyly (5.53) Talipes equinovarus (5.39) Hypospadias (4.88) LRD (3.54) Microtia (2.98) 10 Hypospadias (2.5) Microtia (2.9) Anorectal atresia (3.43) Microtia (3.60) Microtia (3.09) Microtia (2.79) Anorectal atresia (2.90) NTDs (2.81)

17 Progress and Achievement 5. Coverage and accessibility of main intervention for MCH continued to be improved Data source:national MCH annual report Trend of coverage of main intervention for MCH, (%)

18 Data source:national MCH annual report

19 Data source:national MCH annual report

20 Data source:national Health Services Survey

21 Percentage of the HIV positive pregnant women on antiretroviral treatment (ART) Data source:national prevent mother to child transmission of AIDS, syphilis and hepatitis B management information systems

22 Number of pregnant women receiving HIV / syphilis / hepatitis B testing,

23 National and regional neonatal screening rates, % 80% 60% 40% 83% 52% 41% 88% 57% 48% 32% 92% 63% 54% 40% 94% 70% 62% 49% 97% 78% 71% 62% 101% 88% 81% 82% 98% 91% 88% 88% National East Central West 20% 24% 0%

24 Ⅱ Practice and Experience 1. Improving Laws, regulations and policy for MCH Law of People's Republic of China on Maternal and Child Health (1994) Implementation Guidelines of Law of People's Republic of China on Maternal and Child Health (2001) Outline on Women Development in China( ) Outline on Women Development in China ( ) Pre-Marital Health Care Service Standards Preconception Health Care Service Standards(for Trial Implementation) Regulations on Prenatal Diagnostic Technology Management Prenatal Care Management Regulation, and Standards National Child Health Care Standards Neonatal Screening Management Regulations Neonatal Screening Technology specification Regulations on Health Care Work in Nurseries and Kindergartens

25 Practice and Experience 2. Improve MCH service system Provide comprehensive, continuous, and personalized health care services for women and children. It takes MCH institutions as the core, and primary health care as the basis, with the technical support by national academic institutes. MCH institutions at all levels are the organizer, managers and providers of MCH services Large and medium-sized medical institutions and research institutions District-level MCH institutions County-level MCH institutions Community Health Center Urban Provincial and municipal MCH institutions Rural Township hospitals Community health service stations Village clinic

26 Provide warm and convenient MCH services around the life cycle of women and children Pre- Pregnancy Pregnancy Menopause Old age Adulthood Premarital Women's Health Adolescence Perinatal care Children s Health Intrapartum Postpartum Newborn Infant School age Early childhood

27 3. Improving MCH system Practice and Experience Promoting maternal and child health service equalization Provide basic MCH services for free ensure basic, and wide coverage Implement major public health service projects for maternal and child health catch key points, and resolve the outstanding problems of women and children health Full coverage of medical insurance for women and children: Basic medical insurance for urban workers Basic medical insurance for urban residents The new rural cooperative medical system Gradually increase the medical care of major diseases for women and children Major diseases guarantee of the new rural cooperative medical system, Medical Assistance, serious diseases insurance for urban and rural residents

28 Implementation of the national basic public health services project Implementation of 12 basic public health services such as immunization programs, Maternal Health Management, 0-6 years old children's health management et al. Subsidy standard increased to 40 yuan per capita, and gradually extended services Children Health Management:include neonatal home visit, child health management, preschool child health management et al. Maternal Health Management:include first trimester, second trimester, third trimester health management, Postnatal visit, health check at Day 42 after delivery et al. 28

29 Implementation of major public health service projects for women and child Decreasing MMR and eliminating neonatal tetanus project (Hospital delivery subsidy in rural area + Service Capacity development+ Social promotion) Hospital delivery subsidy project in rural area Breast cancer and cervical cancer screening among rural women Prevention of mother to child transmission of AIDS, syphilis and hepatitis B Improving nutrition status of children in poor areas National pre-pregnancy health examination program Program on folic acid supplement to prevent neural tube defects Pilot program of prevention and control on thalassemia Newborn screening project in in poor areas

30 Practice and Experience 4. Established a completed MCH information system to provide support for policy development, and public health intervention and project evaluation MCH information system development history in China National MCH annual report 1986 National maternal mortality monitoring 1991 National MCH surveillance 2004 National MCH institutions 2007 Major special MCH project information system system system monitoring system Early 1980s National birth defects monitoring system 1989 National U5 mortality monitoring system 1996 Established a number of MCH information work 2005 The initial establishment of a national vital registration 2009 standards system

31 5. Broad international cooperation, learning advanced concepts and technology

32 Ⅲ Thinking and Prospect 1. Face up to the challenges Large population, large absolute number of maternal and child deaths Unbalance development, and disparity of MCH level between different regions and populations still exist Major diseases such as breast cancer, cervical cancer, leukemia, and congenital heart disease, seriously threaten the health of women and children. Nutritional diseases, and mental disorders have become increasingly prominent public health problem The overall incidence of birth defects is still high-ranking. Prevention and control situation is still grim Improving the health status for the left behind children and migrant women and children are still the challenge and focus

33 Thinking and Prospect 1.. Face up to the challenges (continued) MCH service system needs to be further strengthened, particularly in ethnic minorities, border and poor areas MCH guarantee system needs to be further improved, and also the guarantee level MCH service capabilities and management need further improvement Difficulty of access to medical treatment for children becomes increasingly prominent After the implementation of selective two-child policy, the proportion of elderly maternal and critical pregnant women increased. It has brought greater challenges to MCH services

34 Thinking and Prospect 2. Development goals SDG:strive to achieve all, and do better for the achieved goals Thirteen Five-Year plan of health and family planning, and Health China( ) Preliminary target: MMR 18/100,000,IMR 8,U5MR 10

35 Thinking and Prospect 3. Policy and strategy Implementation of Outline on Women Development in China, Thirteen Five-Year plan of health and family planning, and Health China ( ) Recently focus on Promote the integration between MCH and family planning technical service resources Develop and revise MCH related regulations and standards Promote MCH facility construction and capability development Strengthen comprehensive prevention of birth defects Strengthen supervision of MCH services Continue to implement major public health projects in MCH, and gradually expand the scope and content of projects Strengthen MCH information management and promote information technology

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