GROUP 3 Tutor: Marcio Estrada Paneque Emmanuel Calderón Espinosa (Mexico)

1. THE STATE OF MATERNAL, NEONATAL AND CHILD HEALTH IN MALAWI AND AN ANALYSIS OF THE NATIONAL RESPONSE: A REVIEW OF CRITICAL ISSUES AND RECOMMENDATIONS FOR MEETING GLOBAL TARGETS • GROUP 3 • Tutor: Marcio Estrada Paneque • Emmanuel Calderón Espinosa (Mexico) • Rocío Fernández Méndez (Spain) • Alena Kulyapina (Russian Federation) • Thidar Pyone (Myanmar) • Rodrigo Sarmiento Suárez (Colombia) • Liaquat Ali Shaikh (Pakistan) • Mariela Silveira (Australia) • Henock Taddese (Ethiopia) www.africatravelpictures.com

2. MNCH DEFINITION Maternal and child health (MCH) refers to the health of mothers, infants, children, and adolescents. It also refers to a profession within public health committed to promoting the health status and future challenges of this vulnerable population (Breslow, 2002) Using the concept Maternal Neonatal and Child Health, MNCH, emphasizes the specific consideration of the new-born.

3. “We know how to save the lives of mothers and children and yet, every year about nine million children die and half a million women die due to pregnancy-related causes...” (World Health Organization, 2009) GLOBAL INFANT MORTALITY 2006: Under-five mortality rate of the developing world estimated at 80 per 1,000 live births (plus under-reported cases)* GLOBAL MATERNAL MORTALITY Around 500,000 women die annually during childbirth or due to complications from pregnancy (99% in developing regions)* • MDG 2008 Report • Images: http://www.worldmapper.org

4. SOME KEY MILESTONES IN MNCH AT THE GLOBAL LEVEL

5. Consideration of MATERNAL, NEONATAL AND CHILD HEALTH (MNCH) amongst the key target areas in the Millennium Development Goals, MDGs of 2000 Goal-5: Improve Maternal Health Target:Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Goal-4: Reduce child mortality Target: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate MDGs and images at: http://www.undp.org/mdg/

6. PARTNERSHIP FOR MATERNAL, NEWBORN AND CHILD HEALTH (PMNCH) • Current thinking: BROADER VIEW OF MATERNAL AND CHILD HEALTH • beyond the narrow consideration of pregnancy and child birth related issues • take into account factors affecting the health of women across their life span: social, economic and cultural issues

7. Country situation, Malawi

8. Land-locked country, highest population density (105/km2) in the southern part of Africa. • 12.9 million people, 83% rural areas • Agriculture, the major source of livelihood • One of the poorest countries in the world with a GNI of 170 USD/capita • 65.5% of its population live under the poverty line with a HDI rank of 165 out of 177 countries

9. Lake Malawi

10. Source: WHO, Country system fact sheet-Malawi, 200614 * National Statistical Office, Zomba & UNICEF (2006) Multi-Indicator Cluster Survey16

12. State of the health care system • Low access to health care services with high inequality • Severe shortage of qualified health personnel (61%) vacancies • The move for decentralisation across government ministries and sectors • Annual expenditure on health/capita= <16.6 USD. Figure on comparison of country system fact sheet on human resource comparison

13. Traditional healers and traditional birth attendants • Increase in the out of pocket expenditure Fig. 2 based on data from Thomsom, H.I. (2004) Based on data from Thomsom, H.I. (2004)

14. Trend of Maternal Mortality Ratio MMR of Malawi is 9th of 169 WHO member countries.

15. Childbirth: a joyful occasion or one of grief?

16. Trend of Infants and Child Mortality Ratios

17. State of Maternal and child health services in Malawi Sources: Country Health system fact sheet, 2006. Malawi. 1Maternal and child health, A. Phoya and S.Kang’oma

18. Fig. 5 data from UN Development Program & Government of Malawi (2008)

19. Fig. 6 data from UN Development Program & Government of Malawi (2008)1

20. Causal Chain Analysis Lack of resources: human, financial, natural Social Economic Environmental Political Poverty housing, education, low income infrastructure Inadequate health and health care Food insecurity Unhealthy living environment Inadequate nutrition of both mother and children Poor quality of health services for MCH and Primary health care Illness of mother and children Long term consequences Underweight and stunted children Poor intellectual ability Short term consequences Maternal and child: mortality, morbidity

21. Scanning the national response Malawi growth and economic development policy • Describes links between poverty and health • Maternal and child health as key objective areas for strategy • Lack of pro poor targeting and monitoring of results • No clear mechanisms for multi sectoral action

22. Health Sector • A number of policies and strategies aimed at accelerating progress • Mainly • Essential Health Package • The National Road Map for accelerating the Reduction of Maternal and Neonatal mortality • The integrated management of child hood illnesses programme (2000 – 2015)

23. ...Health Sector • Main lines of action of policies and strategies. • Decentralisation of health infrastructure • Health infrastructure development • Health personnel training and deployment • Enhancing access to basic drugs and equipments • Community health Workers – link PHC with community

25. Key observations from the SLOT • Limitations • No clear mechanism for inter-sectoral collaboration • Severe shortage of health personnel • Corruption • Low quality of health services Strengths • MCH prioritised in national policy • Coordination body for action on MCH (different partners) • Adoption of innovative, appropriate strategies for service provision

26. SOME LIMITATIONS Malawi:115th in world ranking (index 2.8) http://www.transparency.org.uk/

27. Threats • Low empowerment of women • Recurrent drought • Global economic crisis • Multi faceted effects of HIV/AIDS Opportunities • Democratisation (1994) and decentralisation (1998) • Political commitment (Health Expenditure -9.64 %) • Considerable international aid (% of aid?)

28. Stakeholders’ Analysis

29. Main conclusion points • Observed lag in maternal mortality rate • Attempts at a multi sectoral approach – lack of follow through in practice and evaluating outcome • Enhanced focus and action in the health sector, but structural challenges

31. Main recommendation points – Public Policy Level • Develop a framework for enhancing multi-sectoral action • Mechanisms for enhancing community participation • Enhance the ‘woman’s health approach’ – gender mainstreaming

32. Main recommendation points – Public Policy Level • Actively target the women and children cost of HIV/AIDS • Step up anti corruption action

33. ...Recommendations – Health Sector

34. ...Recommendations – Health Sector

35. MCH Review, milestones, current thinking and mechanisms MCH lecture Review of MNCH Situation Analysis National Context Regional context Major causes, trends and health system Global & response Actors SLOT of Policy and Programmes Current thinking National response Key Findings Review vis-a-vis International Protocols Thematic and setting agreed Population Approach and triangulation. Stakeholder Analysis matrix Conclusion Framework for actions

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