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Annual review meeting

Annual review meeting. HEALTH AND NUTRITION. Key areas. Immunization Maternal health PMTCT and paediatric HIV Nutrition Health systems Health and nutrition in emergencies. Partnerships. DHOs NGO partners ACF (Kaabong, Moroto) AFLI (Karamoja) CESVI (Abim, Kaabong)

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Annual review meeting

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  1. Annual review meeting HEALTH AND NUTRITION

  2. Key areas • Immunization • Maternal health • PMTCT and paediatric HIV • Nutrition • Health systems • Health and nutrition in emergencies

  3. Partnerships • DHOs • NGO partners • ACF (Kaabong, Moroto) • AFLI (Karamoja) • CESVI (Abim, Kaabong) • Concern (Nakapiripirit) • CUAMM (Karamoja) • IRC (Kotido, Moroto, Nakapiripirit) • MSF (Moroto, Nakapiripirit) • URCS (Karamoja)

  4. Way forward • Bridging plan (Jan-Jun 2010) • Maintain / consolidate • VHTs • Sponsorship • Nutrition coordination / quality care • Data / evidence base • Annual work plan 2010/11 • Maternal and newborn health • IYCF • Integration and best practices

  5. Annual review meeting Kaabong District Health, nutrition and CAA

  6. Overview of the Health, Nutrition and CAA Section • Since 2005/06 when Kaabong become a district, it became apparent that access to basic health care services was a big challenge to contributing to achieving the 4th, 5th and 6th MDGs. • The major gaps were identified in the maternal and child health and nutrition and HIV/AIDS

  7. Overview cont. • The intervention activities implemented during the year under review therefore, were aimed at improving access to basic health care services in these areas. • These activities were implemented by the district in partnership with NGOs; CUAM, CESVI, ACF and MSF

  8. Achievement/Results/Targets • DPT3 coverage improved from 50% in 2007/08 to 63% against 80% target • ANC 1st visit at 45% and 4th visit reduced from 33% to 20.4% against 60% target. • Institutional deliveries have improved from 5% during 2007/08 to 6.7% this year against a national average of 34%. • Pregnant women tested for HIV have improved from 22% last year to 34%.

  9. Achievements cont. • HIV prevalence among pregnant mothers has reduced from 2.6% last year to 1,6%. • 71% of HIV exposed children have been tested for HIV against a target of 50%. • 90.9% of these children have been started on co-trimoxazole against a target of 10%. • The number of HC IIIs and above providing PMTCT services have risen from 29% last year to 60% against a target of 100% (CESVI & MSF).

  10. Achievements cont. • Under nutrition, the district GAM has reduced from 15% in 2007 to 9.5% to date. • Under infrastructure, CUAM has constructed three staff houses and fenced two health facilities. • Staffing for midwives has improved from 5 to 10 with support from CUAM.

  11. Best Practices • Involvement of VHTs in mobilization activities. • Ringing of bells at the out post as a mobilization strategy. • Use of a mobile public address system as a mobilization strategy during implementation (use of police vehicles). • Engagement of operational partners (NGOs). • Institutional out reaches for Albendazole and TT in schools

  12. Challenges • Inadequate human resource. • Lack of infrastructure and equipment leading to poor access. • Poor data capture and management. • Unrealistic population estimates. • Poor quality of available health services. • Insecurity • Poor referral system

  13. Way fwd Increase access to quality health care through; • Task shifting. • Recruitment and training of health workers. • Establish and equip service centers. • Improve mobilization strategies. • Establish a strong monitoring and evaluation framework.

  14. Annual review meeting Health, nutrition and CAA Kotido district

  15. Kotido District profile • 1 HSD-District with 17 health units • Total district population of 188,100 • 38,561 under fives. • 9,405 pregnant women • 38,000 WCBA. • 8,088 infants

  16. Annual review meeting Health, nutrition and CAA

  17. Kotido District profile • 1 HSD-District with 17 health units • Total district population of 188,100 • 38,561 under fives. • 9,405 pregnant women • 38,000 WCBA. • 8,088 infants

  18. Overview of the Health, Nutrition and CAA Section • EPI • Mass polio activities. • Support to routine outreaches. • Sunday TTV non pregnant WCBA. • Build capacity of health units to plan for catchment pop. • Maternal health • Integrated PMTCT/ANC outreaches. • Build capacity for commodity management to ensure no stock-outs of commodities for ANC in all HC 3 and 4's • C.A.A • Support establishment of ART clinic and monthly Paediatric ART outreaches . • Procure supplies and logistics for PMTCT and pediatric care services. • PMTCT outreaches

  19. Overview of the Health, Nutrition and CAA Section • Nutrition • Opening of TFC in Kotido H.C.4 • Provision of supplies to the TFC and OTP. • Trained 3 H/W’s from Kotido H.C.4 on mgt of acute malnutrition. • Child days plus activities • Strengthening community based systems • Rollout of the VHT system in the district • Production of monthly reports. • Strengthening facility based health systems • Promotion of the retention and usage of all LLITNs in the district • Community Education/ campaign about ITN

  20. Achievement/ (up to September 2009) • DPT 3 5,278 (65.3%) • TTV 2 non pregnant 12,473 (32.8%) • TTV 2 Pregnant 5,509 (58.6%) • TTV 2 Non Pregnant 5,509 (43.6%) • ANC 4th visit 2,193 (23.3%) • IPT 2 2,783 (29.8%) • Deliveries 1,034 (11.3%) • PMTCT 4,737 (50.4%) • VHT ,330(100%) Coverage • Vit A(1st round- 111% , 2rd round -106%) • Deworming(1st round- 75% , 2rd round -66%)

  21. Best Practices • Use of VHT’s in mobilize of the population(mass polio & measles campaigns. • Use of religious leaders to help boost TTV non pregnant. • Setup of a coordination mechanism at the district health office to regulate the use of the village health teams by the different partners.

  22. Challenges • Frequent campaigns interfered with routine activities. • Difficulty in data capture as indicators are not present in HMIS(PMTCT & Nutrition). • VHT's not adequately involved in routine mobilisation and monitoring especially EPI. • The VHT reporting format requires serious review.

  23. Way Forward • Train VHT’s in the different modules. • Training members of the VHT's on use of child health card as a monitoring tool for assessing EPI coverage in villages. • continue the Sunday TTV non pregnant initiative and expand to schools & institutions. • Continue with integrated outreach activities • Train 30 health workers in mgt of malnutrition at TFC and OTP level. • Organize a strategy to target the 6-14 year olds, especially those to be found in the grazing areas(leave albendazole with the VHT's overnight for 3 days to continue administering the drugs)

  24. Annual review meeting Health, nutrition and CAA Moroto District 20thNov 2009

  25. District Profile • Population: 276,000 • WCBA: 63,480 • Preg. Women: 14,352 • Children <5 Yrs: 56,580 • Children <1 Yr: 11,868 • 3 HSDs with 2 Hospitals, 9 HC IIIs, 9 HC IIs and 2 Mobile Clinics

  26. Overview of the Health, Nutrition and CAA Section • EPI • Micro-planning for Outreaches • Routine Outreaches • Outreaches to the Hard to Reach Areas • 5 rounds of Mass polio Immunisation campaigns. • One round of Mass Measles Immunisation • Child Days Plus activities in July • Maternal Health • Training of Health Workers on ANC +. • Support to the Supply Chain Management. • Support to integrated Community Outreaches.

  27. Overview of the Health, Nutrition and CAA Section • VHTs • Involved in the community mobilisation in support for the Mass Polio Immunisation campaigns. • CAA • Support for Early Infant Diagnosis through DBS. • Support for Integrated Outreaches. • Support Supervision and Monitoring of the PMTCT and Paediatric HIV AIDS programmes.

  28. Achievements(Jan to Sept)

  29. Best Practices • Involvement of Stakeholders in Routine Activities and campaigns • Involvement of VHTs in Community Health service delivery • Coordination of Health, Nutrition and HIV/AIDS SGs

  30. Challenges • The Numerous Polio Campaigns. • Not all indicators are Captured in the HMIS, incomplete and late reporting • Low VHT coverage and the drop out rate is high for the trained. • Late release of funds Vs work plans. • Excessive bureaucracy and paper work in requests and reporting. • Little or no involvement of LGs in partners proposal reviews.

  31. Way fwd • There is need to harmonise the selected indicators with the available data tools • HMIS strengthening at the District and the LLUs including appropriate HRs, Trainings, Support Supervision and Mentoring are very essential. • VHTs; An appropriate selection, Training, supply of tools, Motivation as well as support for the routine running costs should be catered for. • Timely release of funds! • The bureaucracy; can the hassle be reduced?! • It is important that the LGs are involved in reviewing the Project Proposals of the District implementing partners

  32. Thank You ALAKARA NOOI

  33. Annual review meeting Health, nutrition and CAA ABIM DISTRICT

  34. District profile • 1 HSD-District with 18 HUs and a district hospital • Staffing position at 60.4% & technical at 44.6% • Doctor patient ratio, 1 to 30,328 people • Midwives, 1 to 348 pregnant mothers • Health system strengthening on track; district league standing from 52 to 49 to 29 in the past three FYs

  35. Overview of Health, Nutrition and CAA • 5 rounds of mass polio-March to October • Child days-April & October • Trainings-HMIS, TT, full ANC package • Setting up ORT corners in all the HUs • Routine EPI outreach support to all HUs • Radio messages on malaria, diarrhea and pneumonia • Training of pediatric core team/TOTs • PMTCT outreaches + CESVI • HSD/DHT/Integrated monitoring of CSD&CAA

  36. Achievement/Results/Targets

  37. Achievement/Results/Targets

  38. Best Practices • Involvement of VHTs, Red Cross Volunteers, LCs, Parish chiefs & teachers • Through & through involvement of stakeholders & development partners • Strong supervision from HSD& DHT • Mentoring/training on data management, human resource for health • Use of ICT for reminders on key issues • Coordination meetings for CAA and CSD

  39. Challenges • Data management incapacities • Human resource inadequacy • Medical supply management problems cf gas/vaccines, medicines. • Inadequate transport for referrals, outreaches & follow up • Numerous new settlements e.g. Kobulin & Camkok • Insecurity cf mass polio • VHT functionality ????? Ownership and facilitation • Population (54,000-111,400) cf 90,713

  40. Way forward 1 • Strengthen community involvement and participation in health service delivery cf VHTs, TBAs, LCs, Parish chiefs and Development partners • Strengthening supervision by DHT/HSD and HCIIIs • Continuous training/mentoring on data and health logistics management • Harmonizing coordination of core teams for CAA and CSD

  41. Way forward 2 • Use of ICT for communication/data base set • Human resources; recruitment and training of new personnel e.g. midwives cf 32 • New acceptable population figures Can UBOS support be tapped? • Facilitate monthly mobile clinics

  42. A Woman moving to the PMTCT outreach point

  43. Couple Counselling

  44. PMTCT Outreach

  45. Cross cutting issues • BDR • VHTs • Data collection and management • Social mobilization for child survival • School health (deworming, TT) • Disaster risk reduction and emergency preparedness / response • Human resources

  46. Annual review meeting Health & nutrition CAA by District Health Officer Nakapiripirit

  47. Overview of the Health, Nutrition and CAA Section Overview: • 3 HSDs • 2 HC IV, 1 HOSP, 6 HC III, 7 HC II • Staffing at least stands at about75% • Most health facilities are with in 5km from catchment populations • Doctor patient ratio is 1:46,000 • 8 ANC/PMTCT/Paediatric sites • Partners:UNICEF, WFP, SAVE THE CHILDREN, CUAMM, IRC,CONCERN

  48. Achievement/Results/Targets • NUTRITION • Target At least 50% of children with severe acute malnutrition are identified and treated • 2 TFCs and 10 OTCs operational in the district • U 5 Screened 58,502 and 740 treated

  49. Health systems strengthening • ITN coverage >90% • 100% coverage of VHTs; 240 VHTs functional • DPT3 coverage 60% • Measles coverage 85% • TT2 coverage 34%

  50. CAA

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