MNCHN Situational & UN

Response
9th WFCI National convention
Baguio City
May 20, 2010

We know that------- Womens and childrens health is valuable

by itself (CEDAW & CRC)
Investing in women & childrens health
makes economic sense
Has political benefits, including social stability
& human security
Makes the health system work better

Proven and affordable ways of saving the

lives of women & children are available

Relatively Flat MMR Reduction, Philippines

Figure 2: Trend in Maternal Mortality Ratio
1990-2005
250
200

209

203

197

191

186

150

180

172

162

100
50

52.5

0
1990

1991

1992

1993

1994

MMR

1995

1998

MDG

The Philippines is one of 68 countries contributing

to 97% maternal deaths globally

2006

2015

<5 year old and Neonatal Mortality, 1988 to 2008

<5 Yr Old mortality decreased 40% (1988-1998)
Past 10 years, declined by 20%
Slow decline since neonatal mortality hasnt improved
Under Five
Mortality Rate

Neonatal
MR
DHS 88, 93,
98, 03, 08

Causes of Death in children

Undernutrition

53%

Neonatal 37%

Source: CHERG estimates of under-five deaths,

2000-03

178 Million Children Under 5 Suffer

from Stunting

Prevalence of
Stunting

90% of All Stunted Children Live in Just 36 Countries,

including the Philippines

Maternal, Neonatal & Child Health Status

Key MNCHN Indicators

2008 NDHS

At least one ANC visit

91

TT2 plus coverage

75

Skilled Birth Attended Deliveries

61.8

Initiation of BF within an hour

54

Proportion of infants less than 6 months of age exclusively

breastfed

23

Proportion of children 0-59 months of age who had diarrhea in the

past 2 weeks and were treated with ORT

58

Proportion of children 0-59 months of age who had suspected

pneumonia in the past 2 weeks and were taken to an appropriate
health care provider

50

Proportion of one-year old children fully immunized

Comprehensive Prevalence Rate

70
34

Failure of Coverage in the

Continuum of Care, 2008 NDHS

Wide Disparities in SBA/HFD 2008 NDHS

Disparities across wealth quintile

Widest poor rich gap

2008 NDHS

Number of deaths

The Problem: Deaths of Neonates by day of life,

Philippines 1998-2003, NDHS

of neonatal deaths occur 50%

in the first two days of life

Day of Life
NDHS 2003, special tabulations

The risk of maternal death is highest during

childbirth and within 24 hours after delivery

Percent of maternal deaths in

developing countries

0-1 day

2-7 days

8-14 days

15-21 days

22-30 days

31-42 days

Day of maternal death after delivery

X. F. Li et al., InternationalJoumal of Gynecology & Obstetrics 54 (1996): 1-10.

Time when Maternal Deaths Occur

5 CPC V Areas, 2000 - 2002

Neonatal Mortality is high

for Rich and Poor, NDHS 2008

Neonatal Mortality Rate

Newborn
Mortality

Nationwide

Nationwide Hospital
Study

16.0/1000

16.0/1000
Live Births *

Live Births

NDHS 2008

* Sobel, Oliveros, Nyunt-U 2009

Current State of Maternal and

Newborn Care Practices
in Philippine Hospitals

Newborn Care Practices in 51

Philippine Hospitals, 2009
Performance and timing of evidencebased interventions in immediate newborn
care are below essential newborn care
standards recommended by the WHO.
Hospital practices prevented Philippine
newborns from benefiting from their
mothers natural protection in the first hour
of life.
Sobel HL, et al, 2009

Obstetric practices in Philippine Hospitals need to realign with

the evidence-base: an observational study
Action

DOH-WHO Standard

Oxytocin

24.8% 100%

Antibiotic given

78.8% Only if indicated

Indication recorded in chart

10.4% 100% of those given

antibiotics

Antenatal steroids in PTL

23%

100%

Position of choice

100%

Maternal support

0.8%

100%

Partograph used

3.5%

100%

Cesarean section

22.2% Only if indicated

Indication for CS recorded in chart 37.4% 100% of CS

Mantaring, Sobel, Silvestre, Catibog, 2009

A Minute-by-Minute Assessment of Newborn Care

within the First Hour of Life in Philippines Hospitals (2009)

Intervention

Percentage and
Median Time

DOH-WHO Standard

Cord Clamp

12 sec
99% in < 1 min

Until pulsations stop (13 mins)

Drying

97% at 1 min

100% Immediately

Immediate Skin-to-skin
contact

9.6% at 5 min

>90% (except those needing

resuscitation)

Put on cold surface

12%

None

Not dried

2.5%

None

Head not dried

6.2%

None

84% at 8 min

>6 hours

17%

All

Wash
Temp taken before

Office of the WHO Representative

in the Philippines

A Minute-by-Minute Assessment of Newborn Care

within the First Hour of Life in Philippines Hospitals (2009)

Intervention

Median Time or
Percentage

DOH-WHO Standard

Breast feed

69.3% at 10 min

Within 1 hour (but when

baby shows signs)

Separated from
mother

92.9% at 12 min

>1 hour

Weigh

100% at 13 min

> 1 hour

Exam

75.7% at 17 min

> 1 hour

Hepatitis B Vaccine

69.4% at 20 min

>1 hour

Nursery

52% at 19 min

Never

Rooming in

83% (155 min)

Immediately with mother

Sobel, Silvestre, Mantaring, et al, 2008

Office of the WHO Representative

in the Philippines

Resuscitation action of 26 infants with apnea:

Action

Suctioning

24 (92.3%)

Bag and Mask

12 (46.1%) at 120 seconds

Slapping back

7 (26.9%)

Intubation

2 (7.7%) at 3 and 6 min

Chest compressions/ Epi

2 (7.7%) at 4 min

Drying ***

1 (3.8%)

*** Should be first action, immediately, for full 30 seconds

Sobel, Silvestre, Mantaring, et al, 2008

Office of the WHO Representative

in the Philippines

Unnecessary Resuscitation
Of the 455 who were breathing
94.9% suctioned once
84.0% suctioned more than once

Sobel, Silvestre, Mantaring, et al, 2008

Differences in Practices
There was minimal difference in timing or
performance of immediate newborn
interventions regardless of whether the
attendant at delivery was a pediatrician,
nurse or midwife

Variation in Sequence of Interventions

Sobel, Silvestre, Mantaring, Oliveros, 2009

Maternal, Newborn & Child Health

> Maternal & neonatal health has fallen far behind
advances in child survival
> Inextricable link between maternal and infant
survival
> Maternal and child health indicators mirror the
overall effectiveness of the health system
> Saving the lives of mothers & their children
requires more than just medical interventions
> It requires an enabling environment that
empowers women and respects their rights

WAY FORWARD: Evidence-based interventions and

operational strategies using a life-cycle approach
within the health system; health sector reforms; &
rights-based approach
Adolescence

Adulthood

Childhood
Critical
Physiological
Stage of Health
and Nutrition
(pre-pregnancy- 3 years)

Newborn

Pre-pregnancy,
Pregnancy &
birth

Skilled Care at Pregnancy, and

Delivery
Empowered Community
Enabling environment
Skilled attendants
Skills to promote
utilisation of
delivery care,
conduct normal
deliveries essential
newborn care

Referral

Skills to provide
comprehensive
emergency
obstetric &
newborn care

Skills to provide basic

emergency obstetric &
newborn care

Reduce the number of mothers

Reduce the number of

who die because of pregnancy or

newborns who die within first 28

childbirth

days of life
Planned, spaced & wanted pregnancy,
Care throughout pregnancy, safe
delivery and newborn care

National Health Sector Reform Agenda

Maternal, Newborn, & Child Health & Nutrition (MNCHN)

Strategy & Policy

Joint Programme
on Maternal & Newborn Survival
(UNICEF UNFPA DOH WHO)

UN JP MNH Sites:Transition Phase

Cordillera Region = Ifugao
National Capital Region = Navotas,
Malabon, Makati, Paranaque, Taguig, Quezon
City,
Eastern Visayas =Eastern Samar, Tacloban
City
SOCSARGEN = Gen. Santos City, Sarangani,
North Cotabato
ARMM = Maguindanao, Lanao Sur