DFID Nepal: health outcomes. British Embassy. Slide 1

Transcription

1 DFID Nepal: Contribution to improved health outcomes British Embassy Slide 1

2 Content Health outcomes in Nepal particularly Reproductive and Maternal Health (RMH) Programmes and outcomes of DFID Nepal an overview DFID support to health, particularly RMH Future challenges Slide 2

3 Mortalities decreasing in desirable trend to meet the Millennium Development Goals (MDG) 4 and 5 Rate irths Mortality R 00 Live Bi (LB) Child M per 1, lity 0 LB nal Morta er 100,000 Matern Ratio p Under 5 Mortality Ratio Neonatal Mortality Ratio Infant Mortality Ratio Maternal Mortality Ratio Source: NFHS 1991, 1996, NDHS 2001, 2006, MMMS 2009 Slide 3

4 Increase in contraceptive use, among others, resulting in decreased fertility rates Fertilit ty Rate pe er Woman of Reprodu uctive Age (WRA) CP PR (%) Total Fertility Rate Contraceptive Prevalence Rate (CPR) Source: NFHS 1991, 1996, NDHS 2001, 2006, MMMS 2009 Slide 4

5 However, access to services is unequal In % of births were assisted by skilled birth attendants (NDHS 2006 now estimated at 30%) but: Women educated to secondary level are 8x as likely to benefit from an attended delivery as women with no education The richest fifth of women are 12x as likely to benefit from an attended delivery as the poorest fifth Town and city dwellers are 3.5x as likely to benefit from an attended delivery as rural dwellers Central hill dwellers are 2.5x as likely to benefit from an attended delivery as far western mountain dwellers 28% of women attend 4 or more antenatal care visits (NDHS 2006), but rates are 2x as high h in urban than in rural areas. Slide 5

6 and outcomes are also unequal Maternal mortality is 2x to 3x higher among Muslims, Terai/ Madhesis and Dalits (marginalised groups) than Brahmin/ Chhetris and Newars (advantaged caste groups) (MMMS 2009). Fertility rates in urban areas are a third lower than rural; education to secondary level is associated with a 50% drop in a woman s fertility rate; and the richest fifth have a fertility rate three fifths lower than the poorest fifth (NDHS 2006). Unmet need for family planning is the reverse (NDHS 2006). Slide 6

7 DFID Nepal Our Operational Plan Budget: - approx 60m per year (first two years) - over 100m per year (in the next two years) Vision: Plan focuses on a twin track approach of supporting the development of a lasting political settlement and tackling extreme poverty. Delivery of broad based poverty reduction even under increasing fragility. In all areas there will be specific measures to ensure interventions to improve the lives of girls and women. Slide 7

8 The Operation Plan Pillars Wealth Creation Governance and Security Climate Change and Disaster Risk Reduction Direct Delivery of the MDGs Slide 8

9 Programme Priorities in Each Pillar Wealth Creation Rural infrastructure Market Development Access to Finance Skills Macro-economic reform Climate Change and Disaster Risk Reduction Forestry Climate Change Disaster Risk Reduction Slide 9

10 Governance and Security Peace process Local development Security and justice Gender and Inclusion (GBV) PFM & Anti-corruption Direct Delivery of the MDGs Health, HIV & Nutrition Education Water and Sanitation Slide 10

11 Key results targets: We will: get 34,000 more children into primary education ensure 22,400 children complete primary education provide financial services, ie savings, credit, insurance to 1000,000 people build & maintain 4,232 km roads. ensure 110,000 more people will have access to toilets by 2015 enable one million adults to hold decision makers to account support free and fair elections for 18m people. give 22,000 women access to informal justice (paralegals) help 25,000 women have safe childbirth Slide 11

12 DFID Nepal Support to health (1) Our approach has evolved over time: During the civil war ( ), project approach; Early days of the peace settlement and increasing stability in Government ( ), mixture of project and programme approach; Currently, programme approach ( ), i.e. working closely with Government and providing direct funding to the health system. Priority areas: Reproductive and Maternal Health, Nutrition Addressing inequalities (gender and social group) and improved governance of the health system (efficient procurement, better public financial management and anti-corruption) Slide 12

13 DFID Nepal Support to health (2) : Funding: 25.7 million National Safer Motherhood Project; District Health Strengthening Project, Reproductive Health Programme; Support to National TB programme, Polio Eradication Programme : Funding: 71.5 million (including HIV/AIDS) Support to Nepal Health Sector Programme (Sector Budget Support and Technical Assistance) Support to Safer Motherhood Programme (Technical/Financial Assistance) : 2015: Funding: 77 million Slide 13 Support to Nepal Health Sector Programme 2 (Sector Budget Support, 6% of the sector budget, and Technical Assistance) Additional programmes in HIV/AIDS and family planning (FP) proposed

14 DFID Nepal key reproductive and maternal health achievements Safe Abortion Programme since Mar 2004 Safe abortion legalised in 2002 Safe services available since 2004 covers all 75 districts now >300k women utilized service until Jun 2009; Quality high Safe Delivery Incentive Programme (initially Maternity Incentive Scheme) since Jul 2005 Financial incentives to mothers and service providers Free delivery care in low human development index (HDI) districts only Aama Programme since Jan 2009 Slide 14 Financial incentives to mothers and service providers Free delivery care and reimbursement of delivery costs to facility

15 The innovative cash incentive scheme and free delivery has yielded results - As shown by early evaluation of Aama programme, SSMP Jun 2010 Slide 15

16 Increasing Trend in deliveries conducted by health workers, based on Expected Births (fiscal years 2003/4 to 2007/8) SDIP Initiated Aama Programme Initiated / / / / / Source: HMIS/DoHS Institutional Delivery Home Delivery By HW Total Delivery by HW Slide 16

17 Similarly, marginalized groups except Muslim have increased utilization Slide 17

18 Similarly, marginalized groups have increased utilization Slide 18

19 Future challenges Closing the equity gap by stratifying interventions more intelligently (eg, currently Aama payment higher for mountain dwellers) Ensuring right people are in the right place at the right time, with adequate tools human resource, drugs and logistics, public financial management, governance Harnessing the significant capacity of private providers and improving regulation Safer motherhood: Improving quality of care, transport and referral options, especially in remote areas FP/reproductive health: FP method mix, advising those seeking safe abortion about FP methods DFID contributed to Nepal s impressive health outcomes achievement of MDG 4 & 5 is likely however challenges remain. Slide 19

20 Leading the UK government s fight against world poverty LONDON 1 Palace Street London SW1E 5HE EAST KILBRIDE Tel: +44 (0) Abercrombie House Fax: +44 (0) Eaglesham Road Website: East Kilbride enquiry@dfid.gov.uk Glasgow G75 8EA Public Enquiry Point: If calling from abroad: Slide 20