Factors Affecting Achievement of Millennium Development Goals 4 and 5

FACTORS AFFECTING ACHIEVEMENT OF MILLENNIUM DEVELOPMENT GOALS 4 AND 5.
Mwaswere Juma Rama Lecturer:
Mwaswere, KPNC Conference-2011.
Introduction.
In 2000, 189 countries signed up to the Millennium declaration a global commitment to halve extreme poverty and achieve equitable and sustainable development for all. To date 193 countries have signed up the Millennium Declaration.
The agreement led to the creation of a historic framework revolved around eight goals: called The Millennium Development Goals (MDGs), which centre on targets around poverty, education, gender, health, environment and global partnerships- to be met by 2015.
Mwaswere, KPNC Conference-2011. 3
Goal 4: Reduce child mortality rates
Target : Reduce by two-thirds, between 1990 and 2015, the underfive mortality rate
The indicators are:

Under-five mortality rate Infant (under 1) mortality rate Proportion of 1-year-old children immunized against measles.
Goal 5: Improve maternal health

Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Indicators: Maternal mortality ratio
Proportion of births attended by skilled health personnel

Target 5B: Achieve, by 2015, universal access to reproductive health
Indicators: Contraceptive prevalence rate Adolescent birth rate

Antenatal care coverage Unmet need for family planning
Important Statistics.
Maternal mortality levels in Kenya remain unacceptably high at 560 per 100,000 live births1 .
The UN estimated in 2005 that 1 in every 39 Kenyan women die in childbirth.
1. Kenya National Bureau of Statistics and ICF Macro (2010) 2008-2009 KDHS
1 in every 19 babies in Kenya die before 1st birth day, 60% of these deaths occur in neonatal period2.
The appalling mortality statistics implicate dysfunctional health systems as being the principal obstacle for addressing these challenges.
AIDS is the global killer of women of reproductive age, in sub Saharan Africa over 60% of people living with HIV are women, the majority of whom are eligible but do not have access to ART 3.
A south African study found that 38% of maternal deaths were not related to pregnancy and primarily due to HIV, TB and pneumonia 4. Almost 80% of malaria deaths occur in children 5.
4. Every deaths counts; use of mortality audit data for decision making to save lives of mothers, babies and children in South Africa, Bradshaw D et al, 2008.
5. WHO, the global burden of diseases 2004 update. Geneva: WHO, 2008.
10
Contraception, skilled attendance at birth and clinical case management of newborn and children illnesses were priority health interventions reported as the most
significant gaps in the continuum of care 6.

6. WHO. Property interventions: HIV/AIDS prevention, care and treament in the health sector:Geneva;WHO, April 2009
11
1. Immunization coverage - erratic availability of vaccines and poor up take of vaccines in most parts of developing countries. Benefits of immunization are child health and maternal health. The goal in MDG 4 was to reduce by two thirds, between 1990 and 2015, the underfive mortality rate. Fully immunizing every child with routine and newer vaccines (pneumococcal, rotavirus) can contribute up to 25% of the needed child mortality reduction.7
The Factors That Affect Achievement
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Immunization contributes to other MDGs:
MDG 1 Eradicate extreme poverty and hunger, immunization prevents productivity losses due to adult and childhood illness and lowers out-ofpocket spending on health. MDG 2- Achieve universal primary education, immunization promotes child health; healthy children are more likely to attend school regularly and better able to learn.
MDG 5 Improve maternal health, reaching every family with immunization puts mothers in touch with maternal care services. MDG 6 Combat HIV/AIDS, malaria, and other diseases, Special immunization activities can contribute bed nets, vitamin A, deworming medications and other health interventions.
Vaccination of children impacts on women lives.
preventing illness of children through immunization liberates mothers time, energy and resources.
Utilizing child immunization services puts mother in touch with other preventives and maternal health services
Cervical cancer, the biggest cancer killer of women in the developing world. 85% of the estimated women who die of cervical cancer each year reside in developing countries. The new HPV vaccine became available in 2006, still not accessible to most women in low-income countries7 (GAVI).
7. Global Aids Vaccine Initiative Progress Report, 2010
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2. Availability and accessibility of quality health care services:
many populations are far from health facilities, many of which are understaffed with no equipment and adequate supplies.
3. Prioritization of MNCH on political agenda and inadequate investments in MNCH:
low prioritization of maternal, neonatal and child health hence lack of awareness of the scale of maternal, newborn and child
morbidity and mortality.
18
4. Lack of Enough skilled human power:
most remote facilities are manned by individuals without up to date knowledge and skills.
5. Inadequate equipment and supplies:
facilities mainly in the remote area lack basic equipment and supplies needed to save lives.
6. Socio-cultural barriers:
Leads to delays in seeking health care and cultural practices that result in poor nutrition especially for women.
WAY FORWARD.
Advocacy put maternal, neonatal and child health in public health agenda. Strengthen health systems to improve access to maternal, newborn and child health services. Governments to increase their financial commitments to womens and childrens health. Building and equipping health facilities in areas with none in the vicinity.
Emphasis on the goal of financially sustainable immunization systems. Need for Immunization Trust Fund has predictable and reliable source of immunization financing, resources for the long run (sustainability), promotes national self-sufficiency. Need for Immunization Law.
23
Human resource capacity development. Sensitize health workers and excluded minorities to improve health care for disadvantaged, marginalized, and stigmatized (particularly people affected by HIV and AIDS) populations at the Health facilities. Employ minorities and women in all programs. Train and retain health workers in the management of maternal, newborn and
Support nutrition research and programs to determine and address cultural practices that result in poor nutrition to women.
Promote community based interventions. on evidence-based interventions IMCI management of the sick children, nutrition, immunization, other disease prevention promotion of growth and development.
Focus
Integrated
community-based services
Focus on pregnant women and children in

the Integrated Nutrition Program, and Feed the Future especially targeting
disadvantaged and marginalized

populations.
Train community-based workers to

identify households consistently excluded
from services, and intentionally extend services to meet their needs.

Intensify reproductive health programs.
greater coverage for family planning, antenatal care, birth preparedness training and increased delivery with a skilled birth attendant, and reduction of
post-partum hemorrhage.
29
WHAT IS HAPPENING!
The government of Kenyas March 2009 National Roadmap for Accelerating the Attainment of the MDGs related to maternal and newborn health in Kenya8 and the child survival and development strategy (20052015)9 identified several barriers for program improvement.
8. MoPHS & MoMS, GoK (2010)National Roadmap for Accelerating the Attainment of the MDGs related to maternal and newborn health in Kenya.
30
9. MoPHS,GoK (2008) child survival and development strategy 2008-2015.
Including;
lack of recognition of danger signs in pregnancy poor accessibility and low utilization of skilled attendance during pregnancy, child birth and postpartum period; limited access to essential and emergency obstetric care due to limited health provider competencies and inadequate staffing, equipment and supplies, socio-cultural barriers leading to delays in seeking care and limited national commitment of resources for maternal and newborn health.
Global health Initiative Kenya strategy (2011-2014)
focuses on health strengthening, integrated service provision and creating awareness to create demand for available services. It aims to intensify program integration and measure health outcomes related to maternal, neonatal & child health (MNCH).
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Improvement of health systems and promotion of high impact service provision interventions will require partnership between communities, health care providers, civil society, development partners, private sector, policy makers, leaders and government11
To accelerate progress on improving maternal and child health as well as reversing the AIDS , tuberculosis and malaria epidemics, ICASO recommends that political leaders : increase bilateral, domestic and multilateral investments to strengthen health care systems in low and middleincome countries., increase financing for maternal and child health., increase financing to the global fund to fight AIDS, tuberculosis and malaria.
SUMMARY.
Outcomes that will reduce child mortality include: better newborn care, nutrition and sanitation, full immunization, and increasing the time between childbirth intervals with family planning which increases child survival. Intensification of reproductive health programs.
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Factors Affecting Achievement of Millennium Development Goals 4 and 5

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FACTORS AFFECTING ACHIEVEMENT OF MILLENNIUM DEVELOPMENT GOALS 4 AND 5.

Mwaswere Juma Rama Lecturer:

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011.

Goal 4: Reduce child mortality rates

The indicators are:

Goal 5: Improve maternal health

Proportion of births attended by skilled health personnel

Target 5B: Achieve, by 2015, universal access to reproductive health

Indicators: Contraceptive prevalence rate Adolescent birth rate

The UN estimated in 2005 that 1 in every 39 Kenyan women die in childbirth.

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011.

significant gaps in the continuum of care 6.

Mwaswere, KPNC Conference-2011.

The Factors That Affect Achievement

Immunization contributes to other MDGs:

Vaccination of children impacts on women lives.

Mwaswere, KPNC Conference-2011.

2. Availability and accessibility of quality health care services:

3. Prioritization of MNCH on political agenda and inadequate investments in MNCH:

morbidity and mortality.

Mwaswere, KPNC Conference-2011.

4. Lack of Enough skilled human power:

5. Inadequate equipment and supplies:

Mwaswere, KPNC Conference-2011. 22

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011. 24

Focus on pregnant women and children in

disadvantaged and marginalized

Train community-based workers to

from services, and intentionally extend services to meet their needs.

Intensify reproductive health programs.

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011.

9. MoPHS,GoK (2008) child survival and development strategy 2008-2015.

Mwaswere, KPNC Conference-2011. 31

Global health Initiative Kenya strategy (2011-2014)

Mwaswere, KPNC Conference-2011.

Mwaswere, KPNC Conference-2011. 35

Mwaswere, KPNC Conference-2011.

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