eimc%and%maternal%newborn&childhealth% …1.#rmnch(&a)#health#l#the#context •...
TRANSCRIPT
EIMC Webinar, January 28th 2015 Janet Kayita
EIMC and Maternal Newborn & Child Health (MNCH): PerspecGves from an MNCH Point of View
Outline/session objecGves
• To contextualize/frame the integra4on of EIMC into MNCH dialogue
• Outline opportuni4es for EIMC within the MNCH community; the HIV community
• Discuss an4cipated challenges • Draw conclusions & frame a way forward towards making EIMC in MNCH clinics a reality
1. RMNCH (&A) Health -‐ the context • Global mobiliza4on to end preventable maternal newborn
and child deaths – Imminent MDG & Global Plan ‘eMTCT & KPA’ 4meline – Consensus on related post-‐2015 targets
• MMR – (2030) • U5MR– (2035) ‘A Promise Renewed’ & NMR • interim milestones for 2020
• Clarity on where, when, why & therefore what, and how • Reinforced by the Every Newborn Ac4on Plan (ENAP), and
the Every Newborn Lancet Series -‐ May 2014) • Govt. with partners held accountable -‐ tracking results and
resources for targets set – (CoIA, iERG global repor4ng) • Lessons learned from disease programs – AIDS, Malaria
No baby
stillborn
Our delivery goal
No newborn is born to die
3.7 million die ~ 280,000 die 2.9 million die
No child
stunted or dying
2.6 million die
3.5 million within a few days of birth
10 million deaths
Coverage High Impact RMNCH intervenGons in ESAR
Data sources: The State of the word children 2015; HIV data from data.unicef.org | online HIV/AIDS database 2014
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
DPT1
HEI with EID<2 mths
Postnatal care <48hrs
HIV exposed infant ARVs
Early ini4a4on of B/feeding
Skilled adendant at birth
ANC at least 4 visits
PWLHIV received ARVs
ANC at least one visit
Contracep4ve prevalence
Coverage of RMNCH IntervenGons across 0-‐59 days of age Gmeline
2. (PotenGal) opportuniGes/benefits for integraGng EIMC within the MNCH pla\orm
Opportuni4es/benefits (1) • Long-‐term Health & HIV preven4on benefits • Opportunity for postnatal contact
– 36% newborn deaths occur on day of birth; 73% first week – but what about girls???
• ‘Bundling’ with other services – PNC; DPT1 + FP & Ca Cancer screening (mom) + VMMC (father) – something for everyone
• EIMC a credible hook to engage male partners in family health – fathers & EIMC decision-‐making process – Fathers’ being circumcised, acceptance & uptake of EIMC – Poten4al for EIMC to increase referrals for VMMC
• Reinforce primary HIV preven4on in MNCH seings • Carte blanche to innovate – there are no/few experts • Avoid what did not work well e.g. for PMTCT
Opportuni4es/benefits (2): Op4mizing delivery plakorms for outcomes EIMC can strengthen and/or leverage ongoing efforts to bridge MNCH implementa4on and quality shorkalls including: • Facility-‐based quality of care improvements • Reinforce return visits for f/u and other services • Community-‐based delivery plakorms linked to high-‐quality
facility care • Outreaches including Maternal & Child Health Days • Financial plakorms (social transfers, insurance, vouchers,
PBF) • Data collec4on plakorms – ra4onalize new demands, support
move to fit-‐for-‐purpose, reliable, 4mely data • Link with exis4ng interven4ons which have dedicated funding
– e.g. malaria, PMTCT, MNTE, VMMC etc
3. AnGcipated Challenges
Challenges introducing EIMC in MNCH Some similari4es with integra4ng PMTCT in MNCH • Enabling environment
– financing & sustainability!; mo4va4ng investments for long-‐term results a challenge for poli4cians
– Legal/policy framework – e.g. who licenced, devices registered? in na4onal essen4al list?
– Moving to EIMC as a social norm – look to WCAR for lessons – Mobilizing cri4cal partnerships – RMNCH, CSOs, professional associa4ons, private sector
• Programma5c considera5ons -‐ supply – priori4za4on & buy-‐in by RMNCH (& HIV) – management/coordina4on – who is accountable? – What service model – concentrate skills & resources at high volume clinics or EIMC ‘everywhere’?
– Data and repor4ng demands – another ‘program’? register?
Challenges introducing EIMC in MNCH (2)
• Opera5onal challenges of introducing a ‘new’ service – 3 ‘Ss’ • Staff -‐ adding to providers’ exis4ng MNCH du4es • Space -‐ need for clean dedicated space • Supplies – another supply-‐chain to get right • Time – risk short-‐changing counselling
• Engaging CSOs as an a>er-‐thought • Safety, quality and poten5al to do harm – a game changer
– Overlaps a period of excess mortality – Must have an agile system to report and respond to AEs
• Transi5oning from research & pilots à prac4ce and scale up? – Former typically led by the HIV community – Lader expected to be led by RMNCH – Unclear incen4ve for either to scale up
4. Making EIMC a reality in MNCH clinics, drawing from Lessons learned from PMTCT
Conclusions • MNCH is a natural home for EIMC however: • Cri4cal that Govt makes the decision, leads, manages,
coordinates and is accountable for the service to ci4zens • Cri4cal to contextualize the incen4ves/disincen4ves for
RMNCH to integrate and sustain EIMC at scale • Plan for (poten4al) incen4ves to be realized • Minimize/pre-‐empt disincen4ves • Guarantee quality at outset • Reinforce/support ongoing efforts to op4mize delivery
plakorms • Don’t underes4mate system constraints • Start small, but with a view to scale – cul4vate partnerships • Carte blanche – INNOVATE around the challenges
Way forward EIMC in MNCH • Back to basics -‐ a public health approach, implementa4on science/art • Draw on lessons learned (good/bad) from programs which came
before • Posi4on to learn and share learning as you implement • Innovate to solve problems – no/few experts!
Acknowledgements
• Photo credits: Kim Mar4n, Marta Moroni Contributors – Slides, reviewers: • ENAP advisory group • Eric Ribaira (UNICEF, ESARO) • Lauren Bellhouse (UNICEF, NYHQ) • Tin Tin Sint (UNICEF, NYHQ) • Stephanie Marie Davis, CDC • Emmanuel Njeuhmeli, USAID