The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Country Reports

Japan International Corporation of Welfare Services (JICWELS)Contents
1. Benin1

2. Indonesia

7

3. Moldova

43

4. Nepal55

5. Philippines64

6. Thailand

77

The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Benin

-1-

REPORT OF THE COUNTRY: BENIN

Located on the Gulf of Guinea, the Republic of Benin (ex Dahomey) is a state inWest Africa. He bounded to the north by Niger, to the north-west by Burkina Faso, to theeast by Nigeria to the west by Togo and south by the Atlantic Ocean.
It covers an area of 114,763 km2 and: 9,325,032 inhabitants with a population
density of 71.7 inhabitants per km2. The average annual growth rate is estimated at
3.25% for overall and 4.12% for the urban population.
Benin has 12 counties, 77 towns, 546 villages and 3747 Districts andneighborhoods of cities. Its administrative capital is Porto-Novo and Cotonou is the
economic capital.
Name and occupation of the candidate

CODJIA Estelle Arlette Déborah- Midwife graduate of State Technician in Nursing and Midwifery.
- Head of Nursing and Midwifery health zone Ouidah (Whydah Hospital).
- Overview of the applicant's organization
The hospital area Ouidah is a hospital which covers three municipalities that are:Ouidah commune, commune Kpomassè the common Tori-Bossito. This is a hospital thatreceives the reference cases came from the peripheral centers of the threemunicipalities that constitute the health area.
Different specialties exist in hospital care which promotes support for references.
- Note that the curative, preventive, rehabilitative and promotional materials areavailable in the hospital.

-2-

Supports visuels sur le pays

DRAPEAU DU BENINCARTE DU BENIN-3-

1- GENERAL INFORMATION OF THE COUNTRY PARTICIPANT
According to the Statistical Yearbook 2011, the most frequently reported diseases
in the consultations are: malaria 42.8%, 13.5% acute respiratory infections, othergastrointestinal disorders 6.7%, 5.4% Injury, Anemia 4.3%, diarrhea 3.5%
The key indicators identified in the health statistics yearbook 2011 Shows the results ofthe third Demographic and Health in Benin (EDSB) conducted in 2006 which is asfollows:• Life expectancy: 62ans• Maternal mortality rate: 397 maternal deaths per 100,000 live births• Neonatal mortality rate: 32 ‰• Infant mortality rate: 58.4 ‰• Rates of child mortality: 88.9 ‰• Contraceptive prevalence: 18.8%• Birth rate: 48%

2 - OVERVIEW OF MATERNAL AND CHILD HEALTH
System and current status of maternal health services and child
Benin has good coverage in health infrastructure (89% of the population lives within
5km of a health facility).
In 2011 we noted the following performance indicators:
 Rate of prenatal care: 97.2%
 Percentage of births attended: 94.4%
 Rate of postnatal consultations: 38.9%


consultation rates healthy children less than one year: 70.4%

Rate of consultations healthy children 12-35 months: 3.6%

Prevalence of HIV / AIDS 1.7%

The high morbidity and mortality with the persistence of communicable diseases
and the emergence of non-communicable diseases;-4- Despite a good health infrastructure coverage (89%) and an acceptable
geographic accessibility, attendance rates have remained low is 45.4%.
Strengths and weaknesses in the area of maternal and child healthForces- Free of cesarean section- Training of maternity active management of the third stage of labor- Free malaria treatment
Weaknesses- Technical Equipments often inadequate- Lack of qualified staff in the health- Inaccessibility geographical share of the population (lack of facilities)
Strengths and weaknesses in the area of child protection
Forces- Law on child protection in Benin (Act No. 2006-04 of 5 April 2006 on condition that thedisplacement of minors and combating child trafficking in Benin)- Law on child trafficking (Law n ° 2006-04 dated April 5, 2006 on condition of
displacement of minors and suppression of trafficking in children in the Republic of
Benin)- Free schooling for children in elementary school: Orientation in education: Education
for all: children all children in school
Weaknesses- After the free, all children are not yet enrolled in rural- Child abuse- In Benin, there are still street children
Programs and policies that work in Benin- Free of cesarean section- National Program for the Fight against Malaria (free treatment)- Program of free schooling for children
Issues and Challenges
Difficulties- Lack of involvement of health workers in the community-level interventions-5-

- No hospital area in several health areas- Lack of staff- Shortage of blood products

Challenges- Recruitment of qualified staff- Implementation of hospital areas throughout Benin
Difficulties in meeting the challenges- Depression in Benin
The priorities of health and wellness
1 - Vulnerable groups: pregnant women and children under 5 years
2 - priority health problem: malaria, anemia and malnutrition
3 - At the hospital area Ouidah importance will be given to the refocused antenatal andearly care of children, which will detect problems early priority health
4 - Stakeholders hospital, Departmental Directorate of Health, Ministry of Health;Partners: Project-based funding results, Project Accelerated Reduction of Maternal
Mortality and Morbidity due to malaria

3 - EXPECTATIONS IN RELATION TO THE FORMATION
Expected results and objectives through the course• Strengthen my knowledge and skills on the collaboration between the maternal andchild health and the protection of children;• Strengthen my skills on the IEC made on the protection of children.
• Strengthen my skills on the quality of nursing and midwifery.
Involvement after training• Provision of appropriate care for maternal and child health populations• Program to reduce morbidity and maternal and infant mortality.
• Restitution or Continuing Education for staff of the hospital s health facilities andquality of Nursing and Midwifery and the protection of children.
• Reduction Strategy child abuse.

-6-

The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Indonesia-7-

A. Strengths/weaknesses in the field of health and welfare for mothers
and children

1. 3 strengths in the field of Maternal and Child Welfare in my country
a. Policies
 The Indonesian”s Constitution of 1945, article No. 28
Every child has the right to survival, grow and develop as well as the rightto protection from violence and discrimination
 State Law No. 23, 2002 about Child Protection
Every child has the right to live, grow, thrive and participate reasonably inaccordance with the dignity and humanity and the protection from violenceand discrimination

 The Indonesian”s Constitution of 1945, article No. 31 :Every citizen deserve education and every citizen should obliged to adhere
to basic education
 State Law No 20, 2003 about National Education System article 34 (1)every citizen aged 6 years can participate in compulsory education (20)Government and local government guarantees compulsory education are
invited, in the level of primary education for free charge
 State Law No. 36, 2009 about health






Article 131 that infant and children health effort, aimed to prepare
healthy, smart and qualified future generations, and decrease
infants and children’s mortality rate.
article 133 paragraph (1) that all infants and children are entitledprotected from all forms of discrimination and violences that candisturb their healtharticle 136, adolescence health maintenance effort in paragraph(1) should be conducted by central government , local government
and public
article 139 that the maintenance health effort for children withdisabilities should be devoted to keep alive, healthy, and productive
in a social and economic manner and dignified-8- Government Regulation no. 66 in 2010: ( the amandement on government
regulation no. 17 of 2010 on education explanation) and theimplementation of article 53 A : for secondary education and colleges
implementer provided scholarships for students of low-income household
have potential academic 20 % of all new students
 MDG’s Goals
 Minimum service standards for the health sectorb. Budgeting Ministry of Education and Culture ; Education operational aid , school
operational assistance (elementary, junior and senior high school)
 Ministry of Health : Social health insurance for delivery care,
Operasional health budget for PHC, Social Healt Insurance for the poor
 Ministry of Internal Affairs National Community Empowerment Programand National Community Empowerment Program Smart and Healthy
Generation
 Ministry of Social
Child Sosial Welfare Program
Keluarga Harapan (Family Hope Program) National Development Planning Agency
 Ministry of Welfare Coordination(PAUD)

andProgram

PNPM Generasi, PKH Prestasi

Pengembangan Anak Usia Dini

 Ministry of women empowering and child protection

Child Friendly City

2. Raise 3 weaknesses in the field of Maternal and Child Welfare in yourcountry/province.

 Decentralization Policy since 2000
 Large number of population
 There is no derivated Central
Regulation)

Policy in regional (Governor or Mayor Limited budget alloction for health, percentage of the national healthbudget has not been increase and still less than 3% since 2006-9- double burden in health care(so many communicable diseases that mustbe handled, on other hand the morbidity and mortality non-communicablediseases are increasing) disparity in health status and in community acces toward quality healthcare

3. 3 strengths in the field of MCH in my country
A. Policies
 State Law No.36 in 2009, about Health

Article 131 paragraph (1,2)

Health maintenance efforts infant and child must: : aimed to prepare future
generations of healthy, intelligent, and quality as well as to lower infant andchild mortality
conducted since the child was still in the womb, was born and until 18 yearsof age.



Article 133 paragraph (1) ;that all infants and children are entitled protected from all forms of
discrimination and violences that can disturb their health

Article 136,

adolescence health maintenance effort in paragraph (1) should be
conducted by central government , local government and publicArticle 139

that the maintenance health effort for children with disabilities should be
devoted to keep alive, healthy, and productive in a social and economic
manner and dignified-10- Government Regulation of Exclusive breast feeding No. 33 tahun 2011 National middle term development plan for 2009-2014 (MDGS 2015)
 Presidential Instruction No 3 in 2010
about equitable development in health as a fulfillment of the child rights for
marginal groups, including children in prison, abandoned children/street
children and disabled children Health Policies in MOH
Mission :1. To improve health status of the community, through community
empowerment, and involvement of private sector and civil society

2.

To protect the community from problems by ensuring the availabilityof equitable, fair, good quality and comprehensive health services

3. To ensure availability and equity distribution of health resources
4. To implement good governance principles

Vission :an independent and justified healthy community

8 Priorities of Health Development
a. Improving maternal,infant and under 5 years of age childhealth and family planningb. Improving nutrition statusc. Controling communicable, non-communicable disease andimprovement of enviromental healthd. Fulfilling and developing health human resources
e. Enhancing avaibility, affordability, dIstribution , sqfety, quality,
utilization and supervision of drugs and foods-11-f. Health insurance for poor)g. Communty empowerment, disaster and health crisis
management
h. Enhancing primary, secondary and tertiary health services.

B. Budgeting Social health insurance program for the poor covers 19,1 million
poor and near poor households, total 76,4 million poeple
 Regional social health insurance Social health insurance for delivery care
 Operasional health budget for PHC

C. Facilities and infrastructure : Desa siaga, Village Health Post, Village Integrated Post, Public Health Services (Puskesmas), a referal Hospital,
Integrated Service Centre/ one stop service in Hospital.
 Midwives , are almost in every villages

4. weaknesses in the field of MCH in my country
a. Decentralization Policy, since 2000 ,
Based on the Law on Local Government, all powers of governance aredecentralized to the Province and District or Municipal Government.
The central Government retains the power of defense, security,
foreign affairs, justice system, monetary affairs, and religious
affairs - but basically most of the powers of governance aredecentralized to the level of District and Municipal Government –including health care. They set up its own region and priority of theconstruction, so that Regional Policy is not always in line with the policy of theCentral Government.

-12-

b. Disparities on child health indicators achievement
provincies,socioleconomic and level of community education.

amongc. Inequity of health personal and distribution,
Administratively, Indonesia is divided into 33 provinces. Each province
is divided into districts and municipalities. There are 497 districts andmunicipalities in the country. The districts and municipalities are
divided into Sub-districts and the Sub-district is divided into villages andkelurahans. The large number of districts and municipalities have a difficult
geographicalis causing the spread of health workers many concentrated incitiesd. Limited budget allocation for health. Budget allocation which tends toincrease nominally (in trillions) every year. However, if we compare to
the total national health budget, the percentage of the national healthbudget has not been increased and still less than 3%.

5. What are successful areas or programmes ? List 3 areas programmes
a. Community empowerment involving private sector andcivil societyb. Increasing of health status by improving thecommunity acces toward
quality health care

6. What are issues/challenges? List 3 issues/challenges
Regarding the above-mentioned issues/challenges, explain background, current
situation dan reason why those issues/challenges are difficult to solvea. Stagnancy decrease of MMR and IMRb.

The limited availability of strategic resources for maternal and child healthc. Lack of knowledge and community awareness about maternal and childhealth.

-13-A) Indicators
1) Crude birth rate (per 1000 population)
Country overall
1990-1995

24.5

1995-2000

21.9

2000-2005

21.0

2005-2010

19.1

2) Crude death rate (per 1000 population)
Country overall
1990-1995

8.1

3) Leading causes of death (1990) and (2010)

2001 ( Household Health Survey (2001)
1) Cardiac and Blood vessels diseases (26,3%)
2) Infection (22,9%)3) Respiratory Disease (12,7%)

2007 (Basic health research 2007)
1) stroke (15,4%)2) tuberculosis (7,5%)
3)

hypertension (6,8%)-14-4) Infant mortality rate (per 1000 live birth)
Country overall
1991

68

1997

34

2012

32

5) Leading causes of infants death (1990) and (2010)


1991:

1) Prematurity and LBW,
2) asphyxia3) Infection (Household Health Survey 2001)

1997 : 1) Neonatus problems (LBW, asphyxia and Infection ) 46,2%
2) Diarrhea (15%)3) Pneumonia 12.7% (Household Health Survey 2001)

2007 : 1) diarrhea (41,4%)2) pneumonia (23,8%)3) meningitis (9,3%) (Basic health research 2007)

6) Under-5 mortality rate (per 1000 live birth)
Country overall
1991

97

2007

44

2012

40

-15-

7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)

1995: Diseases:

1) Pneumonia
2) Diarrhea
3) Acute Respiratory Infection

Morbidity rate:1) 22.5%
2) 19,2%
3) 7% (Household Health Survey, 1995)

2007:Diseases:

1) Acute Respiratory Infection
2) Pneumonoa
3) Measles

Morbidity rate:1) 25,5%2) 2,13%3) 1,18%8) Maternal mortality rate (per 100,000 live birth)
Country overall
1991

390

2007

228

2011

246

-16-

9) Leading causes of maternal death (1990) and (2010)
1991:
1) Direct caused of maternal death almost 90% occurring in the time childbirth and immedietly after child birth (Household Survey, 2001)
2) Indirect cause are 3 delay, delay to know, delay to make decision anddelay to take adequate treatment

2007: 1) Bleeding 28%2) Eclampsia 24%3) Infection 11%10) Is there any national standards for certifying disabilities in your country?
Yes

/ No

(11) Does your country perform any health check for the diagnosis of disabilities
in infants and children ?
Yes

/ No

Yes, it performs by: tools monitoring of stimulation, early detection and intervention of childdevelopment and growth, by kader and health workers (all of theprovinces in Indonesia)
 Hypothyroid Skrining of newborn (in 8 provinces)(C) Priorities in health and welfare1) In your country/province, who are the most vulnerable populations thatshould be covered by mother and child welfare policies? List five vulnerable
groups in order of priority.
fragnancy and post partum mother

newborn and under 5 childrenChildren with special need of health protection (children with disability,
children in orphanages, child abused and neglegted, children agains with
law in prison)

-17-



poor women and childrenelderly women2) In your country/province, what are the priority health issues/programmes in
the area of maternal and child health? List five issues/programmes in order ofpriority.
The priority issues are decreasing of Maternal Mortality Rate, Infant Mortality
Rate and Under 5 Mortality Rate
The priority programs are:a. Deployment of Midwive in the villagesb. Community and family empowering by using MCH handbook
c. Birth Preparedness and complication readiness (BPCR sticker)
d. Basic Emergency Obstetric Neonatal Care (BEONC)
e. Comprehensive Emergency Obstetric Neonatol Care (COENC)

3) According to the analyses in (A), (B) and (C), what is a potential area you would liketo work on for a collaborative action plan to improve health and welfare services formothers and children (as a product of this training course). Please note that this is
only tentative and you can confirm your topic after the course started.

4) In order to implement your action plan, who are the key stakeholders (including

Ministerial departments, local government offices and their departments and NGOs)in your country/province. Please list all key stakeholders and also identify threemain partners you will closely work with.


Ministry of Social

Ministry of Internal Affair

Ministry of Woman empowering and child protection

Ministry of Education dan Culture

Ministry of Religion



Family Planning Coordination Agency-18-

PROMOTION OF THE COLLABORATION BETWEEN CHILDWELFARE AND MATERNAL AND CHILD HEALTHINDONESIA

By
Dr. Sentongo Miriam-19-

OUTLINE
1. CURRENT HEALTH RELATED SITUATION IN
INDONESIA
2. MATERNAL AND CHILD HEALTH (MCH) PROGRAM
3. STRATEGIES TO ACCELERATE THE ACHIEVEMENTOF MDG4 AND MDG5-20-

CURRENT HEALTH RELATEDSITUATION IN INDONESIA-21-

INDONESIA
Islands : 17.508
Length : 5111 km
Area: 1.910.931 km2- 33 provinces- 497 districts/cities- 6.487 sub districts- 76.613 villages-22-Poppulation of women andchildrenPopulation by Age and Sex,
Indonesia
Census 2000
2010

75+
70-74

ELDERLY

65-69
60-64

Birth Explotion(2000-2005)

55-59

Age Group

50-54
45-49
40-44
35-39
30-34
25-29
20-24

ADOLESCENT

15-19
10-14
5-9

UNDER 5 YEARS

0-4
20

15

10

5

0

5

Percentage

10
Percentage

Male

-23-

Female15

20

SOCIO ECONOMIC CONDITION
Population: 237.641.326 (2010)b
Pop. Growth: 1.49 % (2010)a
Rural Population : 57.7% (2000)
Life expectancy : 69 yearsb
Ethnic groups: 300
Poor people: 30.02 million (2011)b
Literacy rate
: 92.58% (2009)bmen: 95.65%
women: 89.68%
GDP per capita of 4.428 PPP (2010)c
Indonesia ranked 108 (HDI 2010)d
National poverty line:13.33% (1 US$
per capita/day in 2010)e

HEALTH INFRASTRUCTURE
Number of:*
-Hospitals (*2011): 1686-Community Health Centers: 9133(*2011)-Integrated service posts : 266.827- Maternity Huts
: 28.558-Village Health Posts: 51.996

Number of Health Personnel*-General Practitioners: 25.333-Medical Specialist: 8.403-Obstetrician: 1104-Pediatrician: 1800-Nurse: 160.074-Midwife: 96.551

Source: a = Centre of Data and Information MOH (2010)b = Statistic Indonesia
c = World Bank
-24d = UNDP
e = MDGs Report 2010

MID TERM DEVELOPMENT PLAN
2010 – 2014
To improve health status of thecommunity, through community
empowerment, and involvementof private sector and civil society

M
I
S To protect the community byensuring the availability ofS equitable, justified, qualified andcomprehensive health services
I
To ensure availability and an
O equal distribution of healthresources
N To implement good governance

VISIONAN
INDEPENDENT ANDJUSTIFIEDHEALTHYCOMMUNITY

principles-25-

VALUES : PRO-PEOPLE, INCLUSIVE, RESPONSIVE, EFFECTIVE AND CLEANMINISTRY OF HEALTH REPUBLIC INDONESIASTRATEGIC PLAN 2010-2014
1.
2.

3.
4.
5.

6.

Enhancing the community empowerment, private sector and civil society
in health development through national and global cooperation
Improving health care services which are equitable, affordable, goodquality and moderately implemented and planned that based on evidence
focusing on promotive and preventive measures
Increasing health budget and improving health financing, primarily tosupport the universal coverage of social health insurance
Improving the capacity and competency and equity of distribution andutilization of human resource for health
Increasing availability and affordability of drugs and medical equipment
and ensuring safety, efficacy, usefulness and quality of pharmaceuticals,
medical devices and foods.
Improving health management which is accountable, transparent, efficientand effective to strengthen the decentralization of health-26-

8 NATIONAL HEALTH PRIORITIES
1. Improving maternal, infant and under 5 years of age childhealth and family planning
2. Improving nutrition status
3. Controling communicable, non – communicable diseases andimprovement of environmental health
4. Fulfilling and developing human resources of health
5. Enhancing the availability, affordability, distribution, safety,
quality, utilization and supervision of drugs and food
6. Health Insurance for the poor
7. Community empowerment, disaster management and healthcrisis8. Enhancing primary, secondary and tertiary health services-27-

9

MATERNAL AND CHILD HEALTH(MCH) PROGRAM-28-

MDG 2015
8 Goals

Poverty & Hunger

EDUCATIONGENDER

11

CHLD HEALTH

Maternal HealthNational
Development
Plan: 2010 –2014
PRed No:
5/2010MDGs 2015
TargetImproving life
expectancy to
72 years old

Achievement
2007

--

Comm. Diseases

Decreasing
IMR to 24 per1000 livebirths

IMR 23 per
1000
livebirths

34 per 1000
livebirths(IDHS)

MMR 102
per 100.000
live births

ENVIRONMENT

Decreasing
MMR to118 per
100.000
livebirths

228 per
100.000
livebirths(IDHS)

Decreasing
prevalence ofunder fivemalnutrition to-2915 %

Prevalenceof under fivemalnutrition
18,8%

18,4% ofunder five(Basic HealthResearch)

PARTNERSHIPMATERNAL MORTALITY RATIO
DHS

500
450
400
350
300
250
200
150
100
50
0
1980

Trend

390

334

Linear (DHS)

307
248
MDG’s

102

1985

1990

1995

2000

-30-

2005

2010

2015

2020

Problem : Main Cause of Maternal
Mortality
14%
5%

28%

5%

5%
8%
24%

11%
Bleeding

Eclampsia

Infections

Puerperial Complications

Obstructed Labor
Obstetrics Trauma

Abortion
Others

Source: Basic Health Research of MOH 2007
-31-

TREND OF NEONATAL, INFANT AND U-5 MORTALITY RATE& TARGET of MDG 4

Perkembangan
Perkembangan AKB
AKB && AKBAL
AKBAL dandantargettarget MDG
MDG 2015
2015
120

SDKI
2002

Target
MDG ?

58
44
32

34

-32-

SUPAS
2005

2013

2012

2007

2006

20

2005

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

20

2004

20

33

2011

35

40

40

2010

46

2009

46

2008

57

60

23

2015

68

SDKI
2007

2014

81

80

0

AKBAL
AKB
AKN

97

100

PROBLEM• The main causes of neonatal deaths is related
to prematurity/low birth weight. Prevalence oflow birth weigt is 11,5%.
6%

3% 1%

4%

6%

36%

12%

32%

Respiratory Dis

Prematurity

SepsisHypotermia

Icteric and Hemorrhage Dis

Source: Basic
Health Research of MOH 2007
-33-

Postmatur

Congenital Mal

OthersCHALLENGES
1. Disparities
2. Not optimal achievement of continuum ofcare indicators
3. Availability of health facility, especially inunder-develop, remote, border and island
areas (DTPK)
4. Universal coverage of health insurance
5. Decentralization-34-

Availability of midwife atvillage level-35-

Continuum of Care – Wealth
Quintiles
100%
80%
60%
40%
20%
0%

Total_Q1

Total_Q2-36Total_Q3

Total_Q4

Total_Q5

3. STRATEGIESTO ACCELERATE THE ACHIEVEMENT OF MDG4
AND MDG5
1. Improving accessibility & quality health services
2. Community empowerment
3. Strengthening capacity of province and district
4. Strengthening health financing
5. Partnership-37-

IMPROVING ACCESSIBILITY & QUALITY HEALTH SERVICES
1. DeploymeVillage Midwife in every
villagent of
2. Deployment trained doctor at BEONC
public health center and specialist at
CEONC hospital
3. Improving of primary health care andhospital facilities, and in-service training
4. Special intervention in in underdevelop, remote, border and island
areas (DTPK)
-38-

20

COMMUNITY EMPOWERMENT
1. MCH Handbook
2. Integrated Health Post (Posyandu)

3. Village Health Post
4. Birth Preparedness and Complication
Readiness (BPCR)
5. Midwife and TBA Partnership
Taksiran persalinan::

Penolong persalinan:

Tempat persalinan::

Nama Ibu

Pendamping persalinan
Transportasi
Calon pendonor darah

-

- 200

:
:

Menuju Persalinan Yang Aman dan Selamat-39-

STRENGTHENING OFPROVINCE AND DISTRICT
1. Enhancing Provincial and District
Government role in MGDs achievement
through advocacy
2. Improving the capacity of PHO and DHO(Integrated planning through DTPS)
3. Strengthening the coordination with clear
role and responsibility of central, provinceand district level
4. Strengthening surveillans, monitoring andevaluation using MCH local monitoring(PWS KIA), child cohort recording, andmaternal-perinatal audit to improve
quality of services-40-

STRENGTHENING HEALTH FINANCING:
Breakthrough in MNCH
1. Improving budget for program activities which related with
2.
3.
4.
5.

the Minimum Standard of Services to achieve MDG(Deconcentration Allocation Budget)
Improving budget for health insurance for the poor
(Jamkesmas)
Increasing the operational budget for Primary Health Centre(BOK)
Increasing insurance for maternal health (Universal Delivery
Assurance)
Increasing Special Allocation Budget for health services
infrastructure (medical equipment, public health center andhospital facilities, and drug)
-41-

-42-

The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Moldova-43-

R EPUBLIC OF M OLDOVAC OUNTRY R EPORTP R E PA R E D F O R T H E

J I C A training course"Promotion of the Collaboration between Child Welfare and MCH”

(JFY 2012)-44-

(A) Strengths/Weaknesses in the field of Health and Welfare for Mothers andChildrenRaise 3 strengths in the field of Maternal and Child Welfare in yourcountry/province.
1. In Moldova there is already a wide range of government departments, institutions andcivil society engaged in the issues relating to Maternal and Child Welfare including: Ministryof Health, Ministry of Labor, Social Protection and Family, Ministry of Education,
Parliamentary committee for Health and Social Protection, National Council for Children’s
Rights. Policies in social protection sector has improved in the last years and as a result
many reforms were approved by the Government: National program on creating of an
integrated system of social services 2008-2012 (2008), Law on social services (2010), Law
on the accreditation of social services providers (2012), UN Convention on the rights ofpersons with disabilities (ratified in 2010), Strategy on social inclusion of persons withdisabilities (2010), Law on social inclusion of persons with disabilities (2012). Regulations
and Minimum quality standards for the development of the system of family support
services and alternatives to residential care institutions were created and are in the processof implementation. In 2012 the Nomenclature of social services was approved. In the period
2010-2012 the Regulations on Community homes for persons with disabilities, as well assuch services as “personal assistant”, “mobile team” and “respite care” were developed andapproved.
2. The social security benefits system reform was launched as an element of preventing theseparation of children from family because of poverty (families with children account for
more than 70% of social aid beneficiaries). The Expenditures ceilings for benefits andmaterial support for orphan schoolchildren and students and those under guardianship that
continue their education have been substantial increased.
3. Cross-sectorial cooperation mechanism for establishing and developing sustainable andeffective partnership in medical-social issues for preventing and reducing infant mortality
rate and mortality of children up to 5 years of age is one of the on-going reform on the track.
A first example of the cooperation between health and social sectors is the Regulation on
the mechanism of cross-sectorial cooperation for preventing and reducing the rates of
infant and under five years mortality at home, approved in 2010 by the Ministry of Healthand Ministry of Labor, Social Protection and Family.
①

Raise 3 weaknesses in the field of Maternal and Child Welfare in yourcountry/province.
1. The system of early detection and intervention is fragmented and is mostly based on
detection than on early intervention. This system does not assure the continuity of these
services.
2. There are not clear criteria for determining the vulnerability level. These criteria areinterpreted differently by different stakeholders.

②

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3. There is a low level of the mother and child social protection, and namely: maternal aid,
single aid at delivery, attendance allowance for sick child. The existing payment scales
represent a barrier for expanding foster care to include children under 3 and children withdisabilities.
③ Raise 3 strengths in the field of MCH in your country/province.
1. Policies in MCH / Mandatory Health Care Insurance. MCH is a priority in major policy
documents: Law on healthcare (1995), Law on mandatory health insurance (1998), Law on
the protection of reproductive health and family planning (2001), National Health Policy(2007), Healthcare system development strategy for 2008-2017 (2007), National strategy
for reproductive health (2005), National perinatal care program for 1997-2002 (1997),
Program for supporting and encouraging breastfeeding during the first year of a child’s life
(1998-2003), National immunization program 2011-2015 (2010), Integrated management ofchildhood diseases strategy (IMCI), National healthy lifestyle promotion program
2007-2015 (2007). The international and bilateral donors financially support programs
derived from these strategic documents. According to the Unic Program of Health
Insurance MCH is covered by the Government inclusively for: a) children under 18 years; b)
pupils and students, including post university education and c) pregnant women, parturients
and women recently confined.
2. Qualitative perinatal and pediatric health care. The reforms implemented in the field of
perinatal care have contributed to the achievement of MDGs 4 and 5. Numerous strategies
have been implemented: regionalization of care, elaboration of national policies, capacity
building, community mobilization, developing of monitoring and surveillance system, etc. As
a result three levels regionalized system was built, referral criteria for pregnant women andnewborns have been set up. The proportion of “in utero” transfer to level 3 has increased to84% (2011). 180 clinical protocols on obstetrics and neonatology have been elaborated andimplemented. Implementation of Confidential Inquires on the maternal and perinatal deathat national level have contributed to the improvement of standards of obstetrical andneonatal care. Since 2006 the phase of modernizing and restructuring the service with theimplementation of modern technologies in neonatal intensive care started, a post-NICU
follow-up service has been created, the concepts of Health Management Technologies and
the Quality Management are in process of implementation. Since 2009 throughTelemedicine there were consulted 83 pregnant women and 670 children with severe
pathologies by the specialists from level 3. These achievements have contributed to theincrease of survival of ELBW children from 5,4% to 51% and VLBW from 60,1% to 87,7%(at the end of early neonatal period), to the reduction of perinatal mortality from 15,2‰ to12,5‰ (with 17,7%) and of early neonatal mortality from 8,5‰ to 5,4‰ (with 36,4%) during
2000-2011.
Since 2008 the pediatric hospital care is in a reforming process: the regionalized pediatricintensive care and emergency services have been created at national and regional levels inorder to improve the access of sick babies to specialized medical care. The processes of-46-

capacity building of family doctors and pediatricians in issues of pediatric life support and ofdevelopment of protocols in pediatric emergencies started and are in progress.
3. Integration of Follow up Concept in Child Early Intervention Concept. Elaboration of theConcept on neurodevelopmental Follow-up, creation of the Follow up Center for children
from risk groups of neurodevelopment in the first 2 years of life were prerequisites for theelaboration and approval by the Moldovan Parliament of the Law no. 60 from 30.03.2012
on social inclusion of people with disabilities (Art. 44 regulating early intervention forchildren under 5 years).
④ Raise 3 weaknesses in the field of MCH in your country/province.
1. Insufficient cooperation between primary health care system and maternities, insufficientknowledge by pregnant women of danger signs for their own health and the health of futurechildren, especially those from vulnerable groups, contribute to the fact that women in risk
groups are not referred in time to health care facility, which leads to antepartum stillbirths
and severe maternal complications. 20% of deaths in children under five occur at home,most of them are avoidable. Injuries, poisoning and respiratory diseases represent the maincauses of infant mortality and mortality of children aged 1-5 years at home and in the first
24 hours of hospitalization, death cases are largely determined by social and cultural
factors, low level of knowledge of danger signs for baby health by mothers / caregivers andfamilies / communities.
2. Despite the high coverage of institutional deliveries the quality of maternal and neonatal
care is not always done according to standards (according to the data of the Confidential
Inquires into perinatal deaths at national level the medical care was suboptimal, grade 3, in
28,5% cases, 2010). The Needs Assessment study (carried out in the framework ofModernising perinatal system in Moldova program, 2011) has emphasized that thestandard conduct in obstetric and neonatal severe pathologies was estimated ascorresponding to standard in about 60-84% of cases.
3. The process of migration of health professionals related to economic situation in the
country, as well as the completion of the institution’s states with new untrained cadres leads
to medical errors, substandard care and low satisfaction of patients with provided medical
services. Although undergraduate and postgraduate training programs for obstetricians andneonatologists meet European standards, the training process is mainly theoretical, beingoriented towards the specialists from the same field. The approaches to conduct obstetricalcases are given differently at the Departments of Obstetrics from the Medical University.
The training process does not draw attention to the co-working of specialists within
multidisciplinary team. Obstetrical care, especially the emergency care, as well as thecollaboration among members of the multidisciplinary team remain weak areas that need to
be strengthened using new approaches.
In implementing health/welfare policies and services by your organization,⑤ What are successful areas or programmes? List 3 areas or programmes.

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1. Research Institute for Mother and Child Healthcare occupy a hierarchic (three) level inthe regionalized perinatal system in the country and plays an important role in theimplementation of the Modernising perinatal care program and Regionalized pediatricintensive care and emergency services program. Institute provides specialized medicalcare to newborns, children 0-18 years and pregnant women. Thus the most severematernal, neonatal and pediatric cases are focused here. From 2008 Republic of Moldova
implemented European standards and criteria on official registering of birth and children
from 500 gr. and 22th week of gestation. Thus, about 400 children with VLBW (below 1500g) are born and referred each year to the Institute (in utero or postnatal). Thanks to theimplementation of modern technologies the survival of babies born with birth weight below
1000g has increased in Institute from 44,2% in 2011 to 51,0% in 2012 (with 6 ,8%).
2. Based on the international experience the Follow up center for babies at high risk forneurodevelopmental problems was created in the Institute in 2008. Until 2011 1500 babies
were included in the follow-up program. Center provides specialized care to babies in theirfirst two years of life: assessment of neurodevelopment using BSID-III, EEG, audiometric,
ophthalmologic exams, brain and cardiac ultrasound examinations. Out of those 520
babies were referred to the rehabilitation institutions.
3. The Institute is an organizational and consultative center in maternal and child healthcare in the country. 111 doctors-curators (pediatricians, obstetricians, neonatologists,surgeons) provide methodological support to maternities and pediatric departments of thehospitals and 86 doctors-consultants of the emergency transportation services(obstetricians, neonatologists, pediatricians, neuro-pediatricians, surgeons, neurosurgeons,anesthesiologist) provide transportation of patients to level III.
⑥ What are issues/challenges? List 3 issues/challenges.
1. Old infrastructure and equipment, lack of financing. Although the Institute’s budget has
increased in the last years, 70% of money is spent for infrastructure maintenance. The
buildings have not been renovated since the opening of the Institute (1980), there is noventilation system in surgery theatres, IT units. Actually there are two NICUs (for inborn andoutborn babies) and two PICUs (for somatic and surgical pathologies). In case when
departments lack some equipment positions, the latter are borrowed from the departments
where the equipment is available, which leads to the spread of resistant microbes. In
Perinatal centre there are several departments of pregnant women pathology whose
rationality is discussible. The Institute’s equipment is quite old beside the equipment owned
by perinatal centre and both PICUs.
2. Lack of medical personnel, its low managerial capacity. There are insufficient skilled
health personnel, especially neonatal nurses. There is reduced managerial capacity at unit
level. There is reduced level of preparedness for emergency situations. Some technologies,
even those simple, cost-efficient, are slowly implementing because of the medical
personnel old-fashioned mentality.
3. Although efforts made in order to reach all babies included in Follow up program, the-48-

proportion of premature newborns in follow up (versus all newborns in FU) having
completed all visits during 2 years is only 40%.
Regarding the above-mentioned issues/challenges, explain background,current situation and reason why those issues/challenges are difficult to solve.
1. The sources received by the Institute from the National Insurance House are limited andare not intended for renovations. Clear mechanisms should be identified and approved forthe rationale use of accumulated extra resources as well as better management of theInstitute finances will allow to ensure the needed materials, consumables etc. The Instituteis in its restructuring phase, it is planned to combine both NICU units in a larger section for
the rational use of equipment. It is planned to launch a campaign on collection of sources
necessary for this renovation. Departments of pregnancy pathology will be closed (thesedepartments were inherited from soviet-period). The third grant from the Japanese
Government will allow equipping the institute with modern equipment.
2. Although trainings dedicated to quality assurance/quality management were provided for
managerial and medical staff from perinatal service, such trainings have not been
conducted for other services/specialties. Clinical Internal Audit Service of the Institute israther a mechanism of control than of support for clinical Departments.
Although perinatal service staff has been trained on the use of cost-effective interventions
recommended by WHO, the over-medicalization still persists. Elaborated clinical protocols
are not always complied with, because medical staff, especially aged personnel, is based
more on its personal experience rather than on scientific evidences. There is a very little
experience in providing medical staff, especially the medium one (nurses, midwives) within-service trainings. Multidisciplinary team work is insufficient due to lack of this kind ofexperience.
3. Parents with children enrolled in Follow up program do not have sufficient sources toattend regularly (systematically) the Follow up Center, and many children leave theprogram not reaching the age of 2 years because of other barriers/ economical costs.
⑦⑧ Describe your expectations to the training course in detail.
Participating in the training and dialogue program I intend to learn the experience of Japanand of the countries whose participants will attend this training in providing accessible andqualitative health services for woman and newborn/child, as well as in strengthening
mechanism of cooperation between primary health care facilities, maternities / pediatricunits / hospitals, families / communities and social sector. This knowledge will be adjusted to
the local needs and implemented in Institution where I work as well as will be disseminatedat the national level.
The experience of international practice in the field of mother and child health care, gained
during the training and dialogue program Promotion of the Collaboration between Child
Welfare and Maternal and Child Health will be used:- To increase the survival and better development (inclusively neurodevelopment) of high

-49-

-

-

-

risk babies (especially ELBW and VLBW babies) through better functioning of
post-NICU Follow-up service and its harmonious integration into Early Childhood
Development / Intervention programs;
To identify and implement mechanisms of better collaboration between healthprofessionals in the hospital as well as between different institutions of health sector asa team for improving quality of MCH care and access to it;
To involve family, community, health care and social sectors in rise awareness process
on MCH status and in providing support to women and families at risk to overcome
health and social problems;
To strengthen the role of family and community in the supervision and monitoring ofchildren development;
To define and implement appropriate approaches of community mobilization for Mothers
and Children Health and Welfare assurance;
To define appropriate mechanisms for human resources motivation (non financial) inorder to involve them in solving Mothers and Children Health and Welfare problems.

-50-

(B) Indicators(1) Crude birth rate (per 1000 population)

Country overall
17,7
10,2
11,4

1990
2000
2010
(2) Crude death rate (per 1000 population)

Country overall
9,7
11,5
12,3

1990
2000
2010

(3) Leading causes of death (1990) and (2010)
1990:
2010:

1) cardio-vascular diseases(424,9/100.000 population)1) cardio-vascular diseases(688,1/100.000 population)2) tumors (132,3/100.000
population)2) tumors (160,0/100.000
population)(4) Infant mortality rate (per 1000 live birth)
1990
2000
2010

3) digestive diseases(90,1/100.000 population)3) digestive diseases(121,9/100.000
population)

Country overall
19,0
18,3
11,8

(5) Leading causes of infants death (1990) and (2010)
1990:

1) perinatal conditions(5,9/1000 live born)2) respiratory diseases(4,7/1000 live born)

2010:1) perinatal conditions(4,7/1000 live born)2) congenital
malformations (3,5/1000
live born)(6) Under-5 mortality rate (per 1000 live birth)
Country overall
1990
25,2
2000
23,2
2010
13,6

-51-

3) congenital
malformations (4,6/1000
live born)3) respiratory diseases(1,6/1000 live born)

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)(These indicators begin to be registered from 2000)

2000:
Diseases:Morbidity rate:
2010:
Diseases:Morbidity rate:1)

Respiratory diseases
476,5 / 100.000 population

2)

Anemia74,1 / 100.000 population

Respiratory diseases

Anemia594,95 / 100.000
population

116,24 / 100.000
population

3)
Perintal conditions
66,3 / 100.000 population
Infectious and parazitarydiseases
74,76 / 100.000 population(8) Maternal mortality rate (per 100,000 live birth)
Country overall
1990
52,9
2000
27,1
2010
44,5
(9) Leading causes of maternal death (1990) and (2010)
1990:
2010:

1) hemorrhage
1) hemorrhage2) puerperal sepsis2) puerperal sepsis3) high risk abortions
3) post abortion
complications(10) Is there any national standards for certifying disabilities in your country?
Yes. List of diseases and pathological states that establish children disability status isapproved by the Government Decision. The decision about certifying disabilities is taking
by the Medical Consultative Committee at the municipal/district Center of Family Doctors.
Medical Consultative Committee certifies disability in the form of Medical conclusion (formapproved by the Ministry of Health) and sends it to social insurance authority.
However the existing national standards don’t correspond to WHO standards, they contain
only medical criteria, not medico-social and behavioral ones. Actually these criteria are in
the revision process in order to add the lacking criteria, as well as evaluation of the level ofindividual integration into society. These new criteria will be based on functionality / abilitiesof person and not on disease with clear recommendation for integration into society and will
be based on ICF classification of health, disabilities and functionality.
(11) Does your country perform any health check for the diagnosis of disabilities in infants
and children?
Yes. Children health state is checked according to the child growth monitoring standards,
approved by the Ministry of Health. Starting with 2013 the screening for autism and referral
to social services for vulnerable children has been added.
Children with high risk at birth to develop neurological disabilities are included in the
Republican service of post-NICU follow-up. In 2012 the Regulations on Early Intervention
System for children with disabilities were developed, whose part is Follow-up service, whichis in the process of approval.
(C) Priorities in health and welfare(1) In your country/province, who are the most vulnerable populations that should
be covered by mother and child welfare policies? List five vulnerable groups inorder of priority.
- Social risk families/children (one-parent families; numerous families (3 and more

-52-

-

children); teen parents; families where parents had been left abroad for more than 6months; parents with disabilities; drug addicted parents, alcoholics)
Low-income families
Families with children with disabilities and these children
Rural population, especially from regions far from a capital (extremely northern or
southern areas)
Some ethnical groups(2) In your country/province, what are the priority health issues/programmes in thearea of maternal and child health? List five issues/programmes in order ofpriority.
- Modernizing perinatal care in Republic of Moldova program, phase 3 (2011-2014)
supported by Swiss Agency for Development and Cooperation- Regionalized pediatric intensive care and emergency services program, phase 2(2010-2013), supported by Swiss Agency for Development and Cooperation- Young generation program, phase 1, supported by Swiss Agency for Development andCooperation (2011-2013)- Elaboration of Regulation of Early Intervention system for children with disabilities in
Moldova, 2012
- Elaboration and implementation of Child and Maternal Handbook, UNICEF, 2011-2012- Development of perinatology system in Transnistria, 2010, UNDP
(3) According to the analyses in (A), (B) and (C), what is a potential area you would
like to work on for a collaborative action plan to improve health and welfare
services for mothers and children (as a product of this training course). Please
note that this is only tentative and you can confirm your topic after the course
started.
- Improvement of collaboration between PHC and hospital care in order to timely referpregnant women at high risk to appropriate medical care / elaboration, piloting andimplementation of electronic register of pregnant women which would allow to share
information about her health between different sectors and levels of MCH care.
- Improvement of counseling skills of medical staff from hospitals and PHC facilities(in cases of deaths or severe pathologies by providing the needed support) and ofsocial workers on mother and babies health and welfare issues.
- Implementing special approaches/tools to identify high risk pregnant women(drinkers, drug-addicted, etc) and prevent their potential health problems, and the
problems of fetus (stillbirth, Intrauterine Growth Restriction) and of newborn baby
health and wellbeing (sudden infant death) by providing appropriate counseling (ex.
on fetal alcohol syndrome) and offering special support.
- Antepartum stillbirths (AS) represents the opportunity gap to reduce perinatal
deaths in the country (AS accounts for 47% of perinatal mortality rate). Common
efforts of PHC, social sector, local public authority, family, community, local NGOs
through auditing of AS cases and making specific recommendation for each sector
could help avoiding these cases.

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-

Defining ways to make it possible for families with children with disabilities to havepossibility to regularly attend the Follow up service during 2-years follow-up period.

(4) In order to implement your action plan, who are the key stakeholders(including Ministerial
departments,
local government offices
and
their
departments and NGOs) in your country/province. Please list all key
stakeholders and also identify three main partners you will closely work with.
key stakeholders
MoH, Department of primary health caremain partners
MoH,
Departmentofhospitalandemergency medical care
MoH,
Departmentofhospitaland Local public administration, inclusively social
emergency medical care
workers
Ministry of Labor, Social Protection and Hospitals and Primary health facilities
Family, Social Assistance Policy Department
Ministry of Labor, Social Protection andFamily, Disabled People Social Protection
Policy Department
Local public administration, inclusively social
workers
Hospitals and Primary health facilities
NGOs

-54-

The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Nepal

-55-

Promotion of the Collaboration between Child Welfare and MCH
Country Report of Nepal
1. Introduction
Situated in the northern hemisphere, known as a land of Mt. Everest and thebirth place of Lord Buddha, Nepal is tiny landlocked country between the twomost populous and big countries of the world, India in the east, south, west andChina in the north. Nepal is a land locked country and home place of natural
beauty with traces of artifact. The northern range (Himalaya) is covered withsnow over the year where the highest peak of the world, the Mount Everest
stands. The middle range (Hill) is captured by gorgeous mountains high peaks
hills, Valleys and lakes. The southern range (Terai) is the gangitic plain of
fertile soil and consists of dense forest area national parks, wildlife reserves andother conservation areas. The temperature and rainfall differ from place to place.
Geographically, the country is divided in three ecological zones; Mountain, Hill
and Terai. Similarly, there are five development regions; Eastern, Central,
Western, Mid-western and Far-Western development regions. Further, there are
75 administrative districts. Districts are again divided into smaller units called
Village Development Committee (VDC) and Municipality. Currently, there are3913 VDCs and 58 municipalities in the country. Each VDC is composed of 9
wards, municipality ward ranges from 9 to 35. Kathmandu is the capital city of
the country.
The provision of vital information and data is central importance to thecountry’s planning for development programs as well as tracking andmonitoring of progress towards the Millennium Development Goals (MDGs)
within the national Poverty Reduction Strategy Paper (PRSP) and other thedevelopment plan frameworks. So regarding the importance of vital data, Nepal
has collected information through Nepal Demographic Health Survey in 5 years
interval and Census in each 10 years interval.

Geographical Location and Area:
Latitude : 26°22' North to 30°27' North
Longitude: 80°04' east to 88°12' east
Area
: 147181 sq. km
Boarder :North – Tibet, Autonomous Region of China, East, west and SouthIndia-56-

Population :Population
Total population
Male
FemaleTotal famly
Annual population
growthurban population
growthYear
200123251423
11563921
11587502
42532202.25

201126620809
12927431
13693378
5659984
1.4

13.9

17

Vital Statistics
Indicators
Crude Birth Rate
Crude Death Rate
Average life Expectancy
Total
Male
FemaleTotal Fertility Rate
Infant Mortality Rate(per 1000 Live
Birth)
Under 5 Mortality Rate (per 1000
Live Birth)

2001
33.1
9.6

2006
27.7
8.3

2011
24.3

60.4
60.1
60.7
4.1
64

64.1
63.6
64.5
3.1
48

2.6
46

91

61

54

Mean Age at Marriage :

Year
1991
2001

Male
21.4
21.9

-57-

Female18.1
19.5

A ) Strengths/Weakness in the field of health and Welfare for Mothers andChildren
1. 3 strengths in the field of Maternal and Child Welfare in yourcountry/province:
 Child friendly local governance and GESI Strategy to avoid women
discrimination and violence Child Right Commission and National Women Commission
 Expansion of Maternal and Child Health Services throughout thecountry
2. 3 weakness in the field of Maternal and Child Welfare Domestic and women violence increasing Weak monitoring and proper implementation of legal provisions
 Inequity in health services distribution specially to DAG( Disadvantage Group)
3. 3 strengths in the field of MCH
 Promotion of Institutional Delivery and Safe delivery incentive
package Female Community Health Volunteers as the key public healthsocial mobilizers
 Free essential and basic health services
4. 3 weakness in the field of MCH
 Low ANC and coverage of institutional delivery
 Low Coverage and quality of service in hard-to-reach areas
 Early Marriage
In implementing health /welfare policies and services by organization,
5. 3 successful areas/ programmes
 Free Health Services all over the country Free immunization, childhood illness management, malnutrition
control and prevention, safe motherhood program throughout thecountry
 Early Child Care and Development program through out thecountry-58-

6. 3 issues/challenges in country.
 Inadequate trained Human resources Sustained and predictable financing to up-scale priority costeffective evidence based interventions
 Inadequate health infrastructure up to community level
7. Reason why those issues/challenges are difficult to solve.
 Current infrastructure and HR are placed as per Nationa health policyof 1991
 From that period to now population has increased; public demand has
been remarkably increased, but the number of health institutions
post of health workers has remained same.
 Donor dependency is increasing

B. Indicators
1. Crude birth rate (per 1000 population)
Year
1990
2000
2010

Country overall
41
33
24

2. Crude death rate (per 1000 population)
Year
1990
2000
2010

Country overall
1610-

3. Under 5 mortality rate (per 1000 live birth)
Year
1990
2000
2010

Country overall
148
91
54

-59-

4. Infant mortality rate (per 1000 live birth)
Year
1990
2000
2010

Country overall
97
60
46

5. Maternal mortality rate (per 100,000 live birth)
Year
1990
2000
2010

Country overall
539
281

6. Leading cause of death
Year
1990
2010

1
1

Leading cause of death232
3

7. Leading cause of infants death (1990 and 2010)
Year
1990
2010

cause of infant death
1 CDD
2 ARI
3 Malnutrition
1 Pneumonia
2 CDD
3.Malnutrition

8. Top 3 diseases and morbidity rate of the under 5 of 1990 and 2010.
Year
1990
2010

Diseases and morbidity rate of the under 5
Diseases
1.CDD
2. ARI
3. Malnutrition
Morbidity rate
1.
2 3 Diseases
1 ARI
2 CDD
3 Malnutrition
Morbidity rate
1
2
3
-

-60-

9. Leading cause of maternal death (1990 and 2010)
Year
1990
2010

Cause of maternal death
1. PPH
2 APH
3Preeclampsia
1. PPH
2 APH
3 Abortion

10. National standards for certifying disabilities
We have. There are some criteria in issuing disability certificate inDistrict level.
 Definition of disability category and level of disability by the
Disable Person Protection and Welfare Act 1992

Process: VDC recommendation
 Medical Doctors recommendation
 Citizenship if not available birth certificate
 3 copy photo
11. Health check for the diagnosis of disabilities in infants andchildren
we have some organizations working under the government.
1. HRDC (Hospital for Rehabilitation and Development of Children)is one.
2. Nepal Red Cross Society seeks the blind
3. Government hospitals- Kanti child hospitalC) Priorities in health and welfare.
1. Five most vulnerable groups that should be covered by mother andchild welfare policies in order of priority.
 Street children
 Trafficking girls
 Children living with HIV/AIDS-61-

 Children of imprisoned mothers
 Widows
2. 5 priority health issues/programmes in the area of MCH in order ofpriority.
 Free of delivery services including CS with transportation
allowances to all over the country Immunization programme Community based neonatal care programme National Nutrition Program FCHV programme
3. Potential area to work on for a collaborative action plan to improvehealth and welfare services for mothers and children Safe motherhood Program Acute malnutrition management
 Neonatal Care Program Awareness against Gender based violence
4. Key stakeholders/partners to implement action plan are:Central Level: Ministry of Health and Population
 Ministry for women, children and social welfare Local development and its departments
 WHO
 UNICEF
 Global Fund
 DFID SCF-62-

Region/ District level:







District Development Committee
District Health Office
Women and Child Office
Mission Hospital
Civil Society
Clubs

4. Main partners will be closely worked in implementation level : District Development Committee Women and Child Office Mission hospital/ INGO and NGO
Conclusion: Promotion of the Collaboration between Child Welfare and MCH
program is to be highly prioritized. We have the good principle and activities ofChild welfare and MCH program in different level but one thing is still
inadequate is collaborative activities. Different organizations have beenworking the same function but they don’t know one another; collective
approach is nearly nil. After the training it is hopefully thought to make goodcollaboration among the government and non government agencies atdifferent level for the betterment of Child Welfare and MCH.
Thanking you.

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The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Philippines-64-ANNEX-1

Suggested Guideline for Country Reportfor JICA training course"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2012)

Philippines(A) Strengths/Weaknesses in the field of Health and Welfare for Mothers andChildrenPlease describe the following items within 2-3 pages (A4 size / typed)①

Raise 3 strengths in the field of Maternal and Child Welfare in yourcountry/province.
a. There are existing policies on child protection, child development, violenceagainst women and children.
b. Institutionalized Day Care Program for children below 10 years old.
c. Conditional Cash Transfer for the poorest of the poor families.

②

Raise 3 weaknesses in the field of Maternal and Child Welfare in yourcountry/province.
a. There are no existing facilities or centers for mentally challenged
children/mothers or no centers for children in conflict with law.
b. No structured follow up programs for children who have just been released fromdetention facilities (for children in conflict with law).
c. It is difficult to identify families that can serve as foster homes for abandoned
infants/children.

③

Raise 3 strengths in the field of MCH in your country/province.
a. Existing ordinance supporting MCH e.g. facility based deliveries and newborn
screening. The approved reproductive health bill which is basically on safe
motherhood and healthy children.
b. Deployment of active community health teams that track pregnant women in thecommunity.
c. Institutionalized Garantisadong Pambata Program which aims to give children
below 5 yrs old health services and monitor their growth & development④

Raise 3 weaknesses in the field of MCH in your country/province.
a. Some municipalities have unsuccessful nutrition program for the children.
b. Interrupted supply of antigens for children’s immunization in 2011 and 2012.

-65-

c. Unmet need for birth spacing/limiting because of inadequate supply of free familyplanning commodities and couples cannot afford to buy it on their own.
In implementing health/welfare policies and services by your organization,
What are successful areas or programmes? List 3areas or programmes.
1. Expanded Program on Immunization
2. Day Care Program for children 10 yo & below.
3. Garantisadong Pambata – twice a year (April &October) immunization, giving ofVit. A, deworming, weighing, etc are done in the communities⑤

What are issues/challenges? List 3 issues/challenges.
1. Sustainability of Community Health Teams (CHT)
2. Strict implementation of local policies on MCH.
3. Staff in Day Care Centers and community volunteers are changed whenever
there is a change in political leaders.

⑥

Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
1. On CHTs, economic difficulties hinder the team to do their responsibilities ofhome visitation without money for fare to move around and to buy pens,
notebooks.
2. Some local chief executives do not implement local ordinance hence violations
are not appropriately reprimanded.
3. Newly elected local leaders identify new community health volunteers after
election. New members need to be trained again (which needs funds again).
Thereby, committed former members are demoralized.

⑦

Describe your expectations to the training course in detail.

 I am looking forward to learning systems on the collaboration of childwelfare and maternal & child health, improve monitoring our pregnant women especiallywith regards to quality prenatal visits to health facilities (4 visits).
 To know programs that will improve the care of our children with disability,
mentally challenged children.
 How to access probable development partners who can help train our mothers in
the proper care of their mentally challenged/physically disabled children.
 Identify practicable models or best practices that can work in our local situation.

(B) Indicators(1) Crude birth rate (per 1000 population)
Province
No data
1990
23.31
2000
24.01
2010

-66-

Country overall(2) Crude death rate (per 1000 population)
Province1990
No data
2000
4.16
2010
3.75

Country overall(3) Leading causes of death (1990) and (2010)
2000: 1) Pneumonia
2) Hypertensive Cardiovascular Diseases
3) Pulmonary Tuberculosis
2010: 1) Hypertensive Cardiovascular Diseases
2) Acute Respiratory Diseases
3) Malignant Neoplasms, all forms(4) Infant mortality rate (per 1000 live birth)
Province1990
No data
2000
10.09
2010
6.02

Country overall(5) Leading causes of infants death (1990) and (2010)
2000: 1) Pneumonia
2) Prematurity
3) Congenital Debelity
2010: 1) Pneumonia
2) Prematurity
3) Neonatal Asphyxia(6) Under-5 mortality rate (per 1000 live birth)
Province1990
No data2000
No data2010
No dataCountry overall(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990: No Data
Diseases:Morbidity rate:

1)
1)

2)
2)

3)
3)

2010: (Available Data is on top ten causes of mortality)-67-Diseases

Mortality Rate(per 1,000 live births)

1. Pneumonia
2. Prematurity
3. Asphyxia(No Data for morbidity)
Diseases:1)
Morbidity rate:
1)

3.3
1.10
0.65

2)
2)

3)
3)

(8) Maternal mortality rate (per 100,000 live birth)
Province1990
No data
2000
45.0
2010
74.49

Country overall(9) Leading causes of maternal death (2000) and (2010)
2000: 1) Postpartum Hemorrhage
2) Placental Retention
3) Uterine Rupture
2010: 1) Pre-eclampsia/Eclampsia
2) Placenta Previa/Postpartum Hemorrhage/Uterine atony/Placental
retention3) Ruptured Ectopic Pregnancy(10) Is there any national standards for certifying disabilities in your country?
Yes / NoIf yes, please explain briefly.
(11) Does your country perform any health check for the diagnosis of disabilities in
infants and children ?
Yes / No(C) Priorities in health and welfare(1) In your country/province, who are the most vulnerable populations that should becovered by mother and child welfare policies? List five vulnerable groups in order ofpriority.
 Infants
 Children below 5 y.o.
 Indigent mothers Children with disability/mentally challenged/street & abandoned children

-68-



Teenage mothers(2) In your country/province, what are the priority health issues/programmes in the areaof maternal and child health? List five issues/programmes in order of priority.
 Family planning Facility based deliveries
 Functionality of the community health teams
 Nutrition program in some municipalities
 Incentives for CHTs
(3) According to the analyses in (A), (B) and (C), what is a potential area you would liketo work on for a collaborative action plan to improve health and welfare services formothers and children (as a product of this training course). Please note that this is
only tentative and you can confirm your topic after the course started.
(4) In order to implement your action plan, who are the key stakeholders(including Ministerial departments, local government offices and their departments
and NGOs) in your country/province. Please list all key stakeholders and also
identify three main partners you will closely work with.








Provincial Health Office
Department of Social Welfare and Development
Philippine National Police, Bureau of Corrections
Department of Education
Local Government Units
TESDA
NGOs like parents organizations, development partners, rotary clubs, localorganizations-69-

Suggested Guideline for Country Reportfor JICA training course"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2012)
Position: Nurse III
Name of Office: PROVINCIAL HEALTH
OFFICE BANGUED, ABRA, PHILIPPINES(A) Strengths/Weaknesses in the field of Health and Welfare for Mothers andChildren
3 Strengths on the field of Maternal and Child Welfare in the Province of Abraa. Presence of trained health personnel and social welfare service workers in the different
municipalities of Abra committed to render services to the communities.
b. Presence of health facilities and existing health programs in the municipalities
c. Presence of Center-Based Programs of the Social Welfare office at the Regional Office tocater to the needs of women and Children in especially difficult circumstances.
3 Weaknesses in the field of Maternal and Child Welfare in the Provincea. Weak collaboration between agencies like the Health sector, Social Services and otheragencies concerned on protecting women and children.
b. Women crisis center in the province is not used solely for its purpose and nopermanent employees trained to man the center.
c. Services rendered to women and children are not holistic. The health sector provides
the health concerns not integrating other concerns of the welfare of the clients.
3 Strengths in the field of Maternal and Child Health Programs in the Provincea. Presence of policies concerning women and child health regarding Family Planning,
Annual Pap Smear Screening of Women, Immunization.
b. Support from the Department of Health in Upgrading Health facilities in terms ofproviding equipment and the repair and construction of the facilities. The Province
receives annual MNCHN Grant from the DOH.

-70-

c. Presence of the support of the JICA Project in 6 municipalities to support the MCH
program of the Province.
3 Weaknesses in the field of Maternal and Child Healtha. There are only 10 out of 27 municipalities in Abra with permanent Municipal Health
Officers. The RHUs are manned by Nurses and in one municipality by a Rural HealthMidwife.
b. There is no existing referral system in the Province.
c. There are no accredited Rural Health Units on Maternal and Child Package of the Phil
Health.
In the implementation of health/welfare policies and services:A) What are the successful areas or programs list 3 areas or programsa) One of the successful areas is on the facility based deliveries attended by healthworkers. There is a significant increase from home delivery to facility based delivery from 40%
in 2006 to 70% in 2011.
b) The use of the Family Health Diary to tract the record of the pregnant woman and the
Newborn.
c) The enrolment of the indigent families to Phil Health for free hospitalization ingovernment hospitals and no excess bill payment under this program.
B) What are the issues/Challenges and explain background, current situation and why this issue
is difficult to solve.
a. The challenge in promoting facility based deliveries is the presence of traditional birthattendants especially on the remote areas of the province. The families in the communities still
prefer to go to the traditional birth attendants especially so when they do not have healthinsurance and are not ready to shoulder cost of hospitalization. The Traditional Birth
Attendants were trained to handle uncomplicated deliveries but were not allowed then tohandle deliveries in early 2000. Only few Rural Health Units handle deliveries in the center. Its
either because buildings are due for repair or equipment and essential medicines and supplies
are not available.
b. The use of the Family Health Diary is at place. However, in some cases clients do not takecare of this document and some Obstetricians especially the private sector use other forms forrecording and so follow up of cases is very difficult. Proper referral is not in place.

-71-

C .Under the Indigency Program of Phil Health, the poor families is enrolled either by the
National Government, Provincial or municipal. At the municipal level, there was a decrease in
the enrolment due to increase in premium payments set by the Phil Health.
Describe your expectation to the Training Course in Detail.
I express my appreciation to all those who made possible my attendance to this Training
course. I am very grateful and in return I will do my best to make a difference or to implement
whatever learnings I will acquire in the training.
I expect in this training, of course that it will enhance my knowledge and capabilities interms of delivering health and welfare services to the mothers and children. The present
situation in our province is, the services to mothers and children in the aspect of health areprovided by the health sector and their welfare services are provided for by the social welfare
sector. In rare instances, there is collaboration between health and welfare office when clientsare referred for medical examination due to violence or abuse. What I expect to learn and to beable to apply in my province is how to integrate the health and welfare services in our daily
activities. I expect also to be able to integrate into the Family Health Diary the Women andChild Welfare Services or if not into the daily treatment record of individual patient in a healthfacility.

(B) Indicators(1) Crude birth rate (per 1000 population)

province
17.05
20.25
19.31
21.51
20.33

2007
2008
2009
2010
2011
(2) Crude death rate (per 1000 population)
2007
2008
2009
2010
2011

province
1.8
2.8
4.3
4.24
20.33

-72-

(3) Leading Causes of Death
CausesPneumonia
Cardio Vascular Accident
Cerebro Vascular Accident
Cancer(all types)
COPD
Diseases of the Heart
Hypertension
Myocardial Infarction
Cardio Respiratory Arrest
Senility
SepsisGunshot Wound/Stabbed
HPN/Renal Failure
Peptic Ulcer Disease
Asthma

2009
274
81
77
60
44
36
35
33
25
25

2010
250
161
87
78

2011
440
165
55
96
39
114

31
32
50
55
36
30

47
82
40
34

(4) Infant Mortality Rate (per 1000LB)
year
2007
2008
2009
2010
2011

Province
23.58
6.23
8.60
3.42
12.32

(5) Leading Causes of Infant Deaths
CausesPneumonia
Diseases of the Heart
SepsisPrematurity
Sudden Infant Death
Syndrome
Meningitis
Meconium Aspiration
Syndrome
Congenital Heart Disease

2009
11
7
3
3
2

2010

11
25

2
5
2

-73-

2011
12
15
6
16

(6) Under-5 mortality rate (per 1000 live birth)
Country overall/province
2007
13.58
2008
8.72
2009
11.61
2010
14.65
2011
0.89
(7) Top 3 diseases and morbidity rate of the under-5
No Data available(8) Maternal mortality rate (per 1,000 live birth)
2007
2008
2009
2010
2011
(9) Leading causes of maternal deaths

Country overall/province
.95
1.03
0.43
0.19
0.41

2009
1. Chronic HPN, Pre-eclampsia
2. Pulmonary Edema sec. to Severe Pre-eclampsia
2010
1. CVA, Hemorrhage, PIH, Pulmonary Edema2011
1. Multiple Organ Failure disseminated intra-uterine atony, hypovolemic shock sec.
to amniotic embolism.
2. Post partum sepsis

-74-

(10)

Is there any national standard for certifying disabilities in your country?

Yes, the Municipal Social Worker identifies the persons with disability and coordinates with theMunicipal Health Officer in the area to determine the type of disability the person has. The
Municipal Social Worker then issues the Certificate of disability to the disabled person.
(11) Does your country perform any health check for the diagnosis of disabilities in
infants and children?
Yes, health facilities perform health check for the diagnosis of disabilities in infants andchildren. C) Priorities in health and welfare(1) In your country/province, who are the most vulnerable populations that should becovered by mother and child welfare policies? List five vulnerable groups in order ofpriority.
The most vulnerable population are the:a. Under Five Children
b. Pregnant and lactating mothersc. Adolescentd. Newborns
e. Disabled persons(2) In your country/province, what are the priority health issues/programmes in the areaof maternal and child health? List five issues/programmes in order of priority.
a. Immunizationb. Facility based Deliveries and Skilled Birth Attendantsc. Enrolment of poor families to NHIP ( National Health Insurance Program)d. Upgrading/accreditation of health facilities to be CEmONC/BEmONC capable
e. Organization of Community Health Team
(3)According to the analyses in (A), (B) and (C), what is a potential area you would liketo work on for a collaborative action plan to improve health and welfare services formothers and children (as a product of this training course). Please note that this is
only tentative and you can confirm your topic after the course started.
As per analyses of the above data, the services on Maternal and Child Health Welfare are inplace, however, there is no system on the proper referral to concern agencies to be able tostrengthen collaborative efforts in the delivery of services to mothers and children. I also would
like to think of including information to be asked during a health check regarding social welfare
services.

-75-

(4)In order to implement your action plan, who are the key stakeholders (including Ministerial
departments, local government offices and their departments and NGOs) in yourcountry/province? Please list all key stakeholders and also identify three main partners you willclosely work with.
List of Key Stakeholders
1.
2.
3.
4.
5.

Provincial Social Welfare Office
Provincial Health Team Leader
Rural Health Unit
Municipal Social Welfare OfficeCommunity Health Teams

Three Main Partners
1. Provincial Social Welfare Office
2. Rural Health Units
3. Municipal Social Welfare Office-76-

The Study Programme for the Promotion of the Collaboration
between Child Welfare and Maternal and Child Health～What can be done to attain Welfare and MCH collaboration for the
benefit of mothers and children～

Thailand-77-

Country report for JICA training course“Promotion of the Collaboaration between Child Welfare and MCH”
(A)Strengths/Weaknesses in the field of Health and Welfare for Mothers and Children
Please describe the following items within 2-3 pages (A4 size / typed)
1. Raise 3 strengths in the field of Maternal and Child Welfare in your country/province.
1. Regulation and policy that support sustainable working in the field of Maternal and Child welfare The National Economic and Social Development Plans No.11(2012-2016) have placed people
at the centre of the development, focusing on their holistic development, physically,
intellectually and mentally. Office of the National Economic and Social Development Board, thenational focal point for MDGs, is responsible for coordinating among many public, private andcivil society and the UN agencies.
 In education, policies aimed at education reform, expansion of education opportunities andimprovement of education quality, supported by the National Education Act of 1999, andstrategies aimed at improving access and quality of education at various levels, ranging fromsmall-sized schools to tertiary and non-formal education, as well as education for specificgroups of children. Currently, the National Education Act of 2012-2016, free of charges in first
12 years of education for Thai children.
 In the Child Protection Act of 2003, Child and Youth Development Plan of 2002-2006, National
Plan on the Prevention and Solutions for Children in Especially Difficult Circumstances (20022006).
 Plan of Action of “a world fit for children” in 2007-2016.
2. We have the King of Thailand who is a great man and centre of Thai people Based on the principle of economic sufficiency by our king. Thai people realize capacity
building of families and communities under concept of economic suffiency.
3. In the be violated maternal and child, the collaborative team among MOPH, Ministry of Justice,
Ministry of social development and human security, Ministry of education, and NGOs develop One Stop Crisis
Center (OSCC).
2. Raise 3 weaknesses in the field of Maternal and Child Welfare in your country/province.
1. Migration of people increased in the period of time association with the rapid growth of economy
then it is difficult to provide any welfare-78-2. Changing of family’ s structure in Thailand. In the past, extended family was the major type. There
were many people who could support the government policy and take care of family member.
In present, Most of family in Thailand is single family and aiming in earn money for living. So,
concerning about others especially it spend significant times.
3. Quality of government unit ,which supports maternal and child welfare, has a wide range of variation.
For example, limitation of staff in some area must associated with stricted area of evaluation and assistance.
3. Raise 3 strengths in the field of MCH in your country/province.







1. Regulation and policy
Policies on public health reform, improvement of access and quality of health services, and healthpromotion as provided for in the National Health Act of 2007.
HRH Princess Srirasm, Royal consort to HRH the Crown Prince Maha Vajiralongkorn is president insaiyairak hospital project that ministry of health is main responsible which create and support maternaland child health promotion in hospital and their community.
Primary care unit is a good integration system between health system and community so it looks like a
tailor made for health in their context.
2. Significant improvement of national database and reaccreditation systems to follow up patients andevaluate the strategy.
3. Cooperation between community and government section. Most of people in community would be
encouraged to participate the programmes or activities which are generated by local officers.

4. Raise 3 weaknesses in the field of MCH in your country/province.
1. Reproductive education in teenage children don’t suitable for them because of the lacking in welltrained staff who can suggest the good advice about sexuality and contraception. That had been shown ashigh rate of teenage pregnancy and increase rate of unintended pregnancy.
Premature sexual relations and early marriage are also a problem that needs attention.
2. Migration of people increased in the period of time association with the rapid growth of economy , so
it is not correlate to national registry and effect health care accessability and universal health carecoverage of population .
The policy of Thailand is local health care system by primary health care unit in community
before transfer to tertiary care hospital. If patients are not start at their local hospital, they can not getcoverage by universal health care program except emergency situation.
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3. The Limitation of coordination between organization especially government and private company.
It is recommended to analyze those strengths/weaknesses through the discussion with the authorities
concerned (health and welfare) before coming to Japan in order to facilitate to find the way for thecollaboration between health and welfare for mothers and children. Preferably country report should be
prepared in collaboration with authorities.
In implementing health/welfare policies and services by your organization,
5. What are successful areas or programmes? List 3areas or programmes.
Child health and welfare
1. One stop service care for disabled child include all aspect of health care and performed
identification cards
2. Bye Bye Bottle campaign in well child clinic.
3. Development model collaborates with relevant health units for surveillance campaign aboutlead exposure in Thai children and pregnancy in high risk area.
Maternal health
1. Breast feeding programme.
2. Referral system for complicated maternal complication.
3. Risk reduction of postpartum hemorrhage.
What are issues/challenges? List 3 issues/challenges.
Child health and welfare
1. Lead screening in population at risk.
2. Promote Breast feeding in sick baby, teenage mother.
3. Implement Bye Bye bottle campaign in child aged 1-1 1/2 year old success in other hospital.
Maternal health
1. Teenage pregnancy
2. Late antenatal care and No antenatal care
3. Postpartum clinic
Regarding the above-mentioned issues/challenges, explain background, current situation and reason
why those issues/challenges are difficult to solve.
1. Teenage pregnancy-80-

Background and current situation : Prevalence of teenage pregnancy in Thailand was around 10-13% which
was higher than other countries. This rate increased over a few years. Teenage pregnancy is associated withobstetric complication and family problems.
Solving problem : Difficult to implementing education about sexuality to school-age population andmodernization from western countries make change to culture.
2. Late antenatal care and No antenatal care
Background and current situation : In present, There are 40% of pregnant women come to antenatal clinic after
12 weeks of gestational age and more than 5% with never get antenatal care before delivery. These areassociated with bad obstetric outcome and also maternal and child health.
Solving problem : Accessibility of health care unit and poverty are the important factors that involed.
3. Postpartum clinic
Background and current situation : There was a small number of mothers which came back to postpartum andfamily planning clinic. So, important informations , such as breast feeding and contraception, could noteduacate to women to taking care her baby.
Solving problem : Most of the mothers who delivered in our hospital has distance hometown ( moved to city forjobs and went back during baby’s care).
Describe your expectations to the training course in detail.
- To learning about improvement of MCH in Japan in health services and social welfare.
- Disabled group, the process of screening, diagnosis, intervention and the social support_education,trasnsport,
budget to develop them in the way a full potential human being.
- Knowledge from this course would help us to initiate new programme in maternal and child health.
(B)Indicators(1) Crude birth rate (per 1000 population)
1990
2000
2010

Country overall
17.0/1000
12.7/1000
12.0/1000(2) Crude death rate (per 1000 population)
1990
2000
2010

Country overall
4.5/1000
5.9/1000
6.5/1000-81-

(3) Leading causes of death (1990) and (2010)
1990:
1) The Heart disease
51.3/100000 population
2) Accident and Poisoning 41.9/100000 population
3) Malignant neoplasm
39.3/100000 population
2010:
1) Neoplasm
2) Infectious and parasitic disease3) Accident and external cause

91.2/100000 population
64.9/100000 population
62.7/100000 population(4) Infant mortality rate (per 1000 live birth)
1990
2000
2010

Country overall
8.0/1000
6.2/1000
7.0/1000(5) Leading causes of infants death (1990) and (2010)
1990:
1. certain condition originating in the perinatal period
1.8/1000 live birth
2. congenital anomaly
1.5/1000 live birth
3. disease of the respiratory tract system other than the upper respiratory tract 0.7/1000 live birth2010:
1. certain condition originating in the perinatal period
3.4/1000 live birth
2. congenital malformation, deformation and chromosomal abnormalilties 1.2/1000 live birth
3. Disorders relating to length of gestational and fetal growth
1.1/1000 live birth(6) Under-5 mortality rate (per 1000 live birth)
1990
2000
2010

Country overall
12.8
11.9
9.8

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
no record
1990:
Diseases:
1)
2)
3)
-82-

Morbidity rate:

1)

2)

3)

2010:
Diseases:Morbidity rate:

1)
1)

2)
2)

3)
3)

(8) Maternal mortality rate (per 100,000 live birth)
1990
2000
2010
(9) Leading causes of maternal death (1990) and (2010)
1990:1) Obstruct labor
2) Haemorrhage3) Toxemia

1)
2)
3)

Country overall
0.2/1000 live birth13.2/100000
10.2/100000

2010:
Complication of labor and delivery
Hypertensive disorder
Abortion(C) Priorities in health and welfare(1) In your country/province, who are the most vulnerable populations that should be covered by mother andchild welfare policies? List five vulnerable groups in order of priority.
The most vulnerable populations depend on use either money metric indicators measure levels of deprivation
based on income or the quality of life calculated by consumption expenditure or non-monetary indicators
measure deprivation based on opportunities to access or receive essential basic services, or vulnerability of life
situations, such as loss of parents and disability.
1. Low socioeconomic status
2. People who need special support /care
3. Underprivileged / Disadvantaged- Orphans- Without nationality / Immigrant or refugees / people who lived in border
4. Maternal and child HIV infection
5. Teenage pregnancy-83-

(2) In your country/province, what are the priority health issues/programmes in the area of maternal andchild health? List five issues/programmes in order of priority.
- In 2013-2016, one of flagship project in Thailand labels about quality of life of thai people include all life
expectancy. The area of maternal and child health, MOPH creates concept “EWEC = every woman every
child” is flagship project in this year and continue to 4 year in the future. Encorage health care accessibility inevery populations and improvement of policy ”Universal health insurance coverage”
Aim: improved maternal health, reduced child mortality rate, improved child health and development
1. Promote maternal and child health care with various indicators
Indicators
1. Rate of antenatal care before GA 12 weeks
2. Pregnant women with iodine deficiency
3. Iodine use in household
4. Birth asphyxia
5. Low birth weight ( BW < 2500 gm )6. Breast feeding
7. Weight for age
8. Height for age
9. Normal posture for age
10. Normal development for age in 0-5 years
11. Teeth cleaning with fluorinated toothpaste
everyday in child care
12. Teeth cleaning before bedtime to children
1-2 years by parent everyday

2553
50

AIM ( percent )
2554
2555
55
60

<8.5
20
70
83
78
90
99

<8
30
72
85
80
90
99

<7.5
40
78
88
82
90
99

2556
65
<50
90
30
<7
50
85
93
85
90
99

70

75

80

85

- Saiyairak , Family’s health : Increase Breast feeding rate from 20% to 60%
2. Improvement of intelligence quotient of Thai children
3. Support the violence victims
4. Improve antenatal care programme and generate effective guideline for intrapartum care to decrease
perinatal morbidity and mortality
5. Support antiretroviral drug to HIV-infected mothers, decrease neonatal HIV infection from 3.5% to 1.5% in2015
6.Thalassemia screening during pregnancy-84-

(2) According to the analyses in (A), (B) and (C), what is a potential area you would like to work on for acollaborative action plan to improve health and welfare services for mothers and children (as a product of
this training course). Please note that this is only tentative and you can confirm your topic after the course
started.
Child health and welfare- To develop and implement a new screening / preventive model in the field of maternal and child healthby integration relevant systems among government bodies concerning children issues especially teenage
group who have risk to be unplanned pregnancy, the environment hazards example lead exposure;
carcinogen from food contamination, table ware; micronutrient deficiency or depletion such as iron; birthdefect registry;. How to dissemination of knowledge and development of suitable system for population atrisk in service.
- Improvement of maternal & baby friendly services by setting up high quality well child clinic, learning
center for family in order to educate them on particular issues such as raising a child in safety environment,
healthy and happy home/community, breast feeding corner and collaboration of child welfare in home carepatient, and a good data base system.
- To support mother and child who need special help for independent living in their community/social by
improvement of equally accessing into health care services, education and referral system especially those
who need special supports such as disable children, single parent and teenage parent in respect offriendly environment for maternal and child by employing QNISCH as a pilot case.
Maternal health- Teenage pregnancy
Thailand is the second most country that has high rate of teenage pregnancy. These risk is
associated with obstetrics complication and significant effect on community problems such as preterm birth,
low birth weight, perinatal mortality and especially unintended pregnancy leading to illegal abortion. Teenage
mothers trend to be sperated from normal educational systems and leading to child care problems and social
problems. This problem could not be solved in few years or by single organization. However, we canimplement education or important information to teenage mothers for good taking care with her pregnancy andher child after delivery.
Knowledge course at first visit of antenatal care could help to educated her and families.

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(A) Strengths/Weaknesses in the field of Health and Welfare for Mothers andChildrenPlease describe the following items within 2-3 pages (A4 size / typed)①Raise 3 strengths in the field of Maternal and Child Welfare in your country/province.
1.
Regulation and policy that support sustainable working in the field of Maternal and Child
welfareThe National Economic and Social Development Plans No.11(2012-2016) have placed
people at the centre of the development, focusing on their holistic development,
physically, intellectually and mentally. Office of the National Economic and Social
Development Board, the national focal point for MDGs, is responsible for coordinating
among many public, private and civil society and the UN agencies.
 The policies aimed at education reform, expansion of education opportunities andimprovement of education quality are supported by the National Education Act of 1999.
There are strategies aimed at improving access and quality of education at various levels,
ranging from small-sized schools to tertiary and non-formal education, as well as
education for specific groups of children. Currently, the National Education Act of 20122016 provides education for Thai children free of charge in first 12 years.
 We have specific regulation& policy for child and youth protection and development
including Child Protection Act of 2003, Child and Youth Development Plan of 2002-2006,
National Plan on the Prevention and Solutions for Children in Especially Difficult
Circumstances (2002-2006), and the newest policy, Plan of Action of “a world fit forchildren” in 2007-2016.


2.

Based on the principle of economic sufficiency advised by our king. Thai people realize
significance of capacity building of families and communities under that concept.

3.

The collaborative team among Ministry of Public Health(MOPH), Ministry of Justice,
Ministry of social development and human security, Ministry of education, and NGOs
have developed One Stop Crisis Center (OSCC) for abused maternal and child.

②Raise 3 weaknesses in the field of Maternal and Child Welfare in your country/province.

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1.

2.
3.

The migration of people has increased during the period of time association with therapid growth of economy, making it difficult for the government’s MCH to reach people
working outside of their coverage area.
The changing of family’s structure in Thailand, from extended family to single family
effect to detach the community.
Unstable government causes inconsistencies in implementation and development ofmaternal and child welfare policy, there are a wide range of variation.

③Raise 3 strengths in the field of MCH in your country/province.
1.

Regulation and policy

Policies on public health reform, improvement of access and quality of health services,and health promotion as provided for in the National Health Act of 2007.

HRH Princess Srirasm, Royal consort to HRH the Crown Prince Maha Vajiralongkorn ispresident in saiyairak hospital project that ministry of health is main responsible which createand support maternal and child health promotion in hospital and their community.
2.
Primary care unit is a good integration system between health system and community
and it helps to communicate about health education for people in their context especially somearea have unique culture and belief.
3.
The improvement of national database system makes us to evaluate health problem andthe strategies.
④Raise 3 weaknesses in the field of MCH in your country/province.
Reproductive education in teenage children don’t suitable for them because of thelacking in well-trained staff who can suggest the good advice about sexuality and contraception.
That had been shown as high rate of teenage pregnancy and increase rate of unintended
pregnancy.

The migration of people increased, effecting the health care access and universal healthcare coverage of population .

The policy of Thailand, local health care system in community are main responsible fortaking care their local people. If patients are not start treatment at their local hospital, they can
not get coverage by universal health care program except emergency situation.



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The Limitation of coordination between organization especially government and privatecompany.
In implementing health/welfare policies and services by your organization,⑤What are successful areas or programmes? List 3areas or programmes.
Child health
QSNICH provides One stop service care for disabled child that included all aspect ofhealth care and performed identification cards to them.
Development model collaboration with relevant health units for surveillance campaign
about lead exposure in Thai children and pregnancy in high risk area.
Health promotion: We have started campaign “Bye Bye bottle for thai children aged 111/2 years old” to promote healthy eating behavior and oral health.

1.

2.

3.

Maternal health
Breast feeding programme.
Referral system for complicated maternal complication.
Risk reduction of postpartum hemorrhage.

1.
2.
3.

⑥What are issues/challenges? List 3 issues/challenges.
Child health
Health screening: Implementation about blood lead screening in population at risk.
Promote Breast feeding in sick baby, teenage mother.
To Support the Bye Bye bottle campaign in child aged 1-1 1/2 year old in hospital.

1.
2.
3.

Maternal health
1.
2.
3.

Teenage pregnancy
Late antenatal care and No antenatal care
Postpartum clinic-88-⑦Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
Child Health
1. Lead exposure screening
Background and current situation : Lead toxicity effects to health and intelligence and lifelong
effect especially children aged the first 5 years old. Due to low level of lead is asymptomatic,
moreover no safety level for lead in human so prevention and health education are the next
actions which should be taken in order to eliminate lead exposure. In Thailand, we don’t know
prevalence of lead exposure in general children population and the high risk group, we have
only several study reported to show that Thai children were exposed to lead toxicity.
Solving problem:
1. Blood lead screening in well child clinic for the children aged 1-2 years old.
2.To create the questionnaires for finding the risk group
Limitation: budget, unrecognized this problem, No database to show magnitude of thisconcerning
2. Promote breastfeeding / Bye Bye Bottle
Background and current situation: Breastfeeding decreased infection rate in children andpromote bonding and attachment between maternal and child, additionally, public hospital arebaby friendly hospital. The preterm baby and teenage pregnancy are active health problem inThailand which breastfeeding could improve maternal and child health outcome and family’s
economic.
Solving problem:
1. To set the health policy and guideline for these unique group.
2. To create model development (pilot study to implement)
Limitation: limited of well trained staff, old culture and belief, labor laws do not support forworking mother.

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Maternal health
1.Teenage pregnancy
Background and current situation : Prevalence of teenage pregnancy in Thailand was around 1013% which was higher than other countries. This rate increased over a few years. Teenage
pregnancy is associated with obstetric complication and family problems.
Solving problem : Difficult to implementing education about sexuality to school-age populationand modernization from western countries make change to culture.
2.Late antenatal care and No antenatal care
Background and current situation : In present, There are 40% of pregnant women come toantenatal clinic after 12 weeks of gestational age and more than 10% with never get antenatal
care before delivery. These are associated with bad obstetric outcome and also maternal andchild health.
Solving problem : Accessibility of health care unit and poverty are the important factors thatinvoled.
3.Postpartum clinic
Background and current situation : There was 30% of mothers which came back to postpartum
and family planning clinic. So, important informations , such as breast feeding and contraception,
could not eduacate to women to taking care her baby.
Solving problem : Most of the mothers who delivered in our hospital has distance hometown( moved to city for jobs and went back during baby’s care).
⑧Describe your expectations to the training course in detail.
-To learning about improvement of MCH in Japan in health services and social welfare.
For disabled group, the process of screening, diagnosis, intervention and the social
support: education, trasnsportation, and budget to develop them in the way a fullpotential human being.

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(B)Indicators(1) Crude birth rate (per 1000 population)
Country overall
17.0/1000
12.7/1000
12.0/1000

1990
2000
2010
(2) Crude death rate (per 1000 population)

Country overall
4.5/1000
5.9/1000
6.5/1000

1990
2000
2010
(3) Leading causes of death (1990) and (2010)

1990:
1) The Heart disease
51.3/100000 population
2) Accident and Poisoning 41.9/100000 population
3) Malignant neoplasm
39.3/100000 population
2010:
1) Neoplasm
2) Infectious and parasitic disease3) Accident and external cause

91.2/100000 population
64.9/100000 population
62.7/100000 population(4) Infant mortality rate (per 1000 live birth)
Country overall
8.0/1000
6.2/1000
7.0/1000

1990
2000
2010

(5) Leading causes of infants death (1990) and (2010)-91-

1990:
1. certain condition originating in the perinatal period
1.8/1000 live birth
2. congenital anomaly
1.5/1000 live birth
3. disease of the respiratory tract system other than the upper respiratory tract 0.7/1000 live birth2010:
1. certain condition originating in the perinatal period
3.4/1000 live birth
2. congenital malformation, deformation and chromosomal abnormalilties 1.2/1000 live birth
3. Disorders relating to length of gestational and fetal growth
1.1/1000 live birth(6) Under-5 mortality rate (per 1000 live birth)
Country overall
12.8
11.9
9.8

1990
2000
2010

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
I’m sorry that I could not find top 3 diseases and morbidity rate of the under-5, however, thistable showed the data of the year loss to disability (injury and illness) of the under-5 in 2003.

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(8) Maternal mortality rate (per 100,000 live birth)
Country overall
1990
0.2/1000 live birth
2000
13.2/100000
2010
10.2/100000(9) Leading causes of maternal death (1990) and (2010)
1)
2)
3)
1)
2)
3)

1990:
Obstruct labor
Haemorrhage
Toxemia2010:
Complication of labor and delivery
Hypertensive disorder
Abortion(10) Is there any national standards for certifying disabilities in your country?
Yes
If yes, please explain briefly.
1.
The regulation for disabled mentions
To support and promote quality of life in 2007.
To provide and administer education for disabled in 20082.
The regulation of Identification card for disabled มีอายุ 6 ปี นับตัง้ แต่ วนั ออกบัตร
3.
Type of disabled in Thailand is
Blindness/visual impairment
Deafness/communication disorder
Physical disability
Mental or behavior disorder or autistic
Cognitive deficit / mental retardation
Learning disorder(11) Does your country perform any health check for the diagnosis of disabilities in infants andchildren ?
Yes

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(C) Priorities in health and welfare(1) In your country/province, who are the most vulnerable populations that should be coveredby mother and child welfare policies? List five vulnerable groups in order of priority.
-

The most vulnerable populations depend on use either money metric indicators
measure levels of deprivation based on income or the quality of life calculated byconsumption expenditure or non-monetary indicators measure deprivation based on
opportunities to access or receive essential basic services, or vulnerability of life situations,such as loss of parents and disability.
1. Low socioeconomic status
2. People who need special support /care
3. Underprivileged / Disadvantaged- Orphans- Without nationality / Immigrant or refugees / people who lived in border
4. Maternal and child HIV infection
5. Teenage pregnancy(2) In your country/province, what are the priority health issues/programmes in the area ofmaternal and child health? List five issues/programmes in order of priority.
In 2013-2016, one of flagship project in Thailand labels about quality of life of thai people
include all life expectancy. The area of maternal and child health, MOPH creates concept“EWEC = every woman every child” is flagship project in this year and continue to 4 year in the
future.
Encourage health care accessibility in every populations and improvement of policy“Universal health insurance coverage”
Aim: improved maternal health, reduced child mortality rate, improved child health anddevelopment
1. Promote maternal and child health care with various indicators-94-

Indicators
1. Rate of antenatal care before GA 12 weeks
2. Pregnant women with iodine deficiency
3. Iodine use in household
4. Birth asphyxia
5. Low birth weight ( BW < 2500 gm )6. Breast feeding
7. Weight for age
8. Height for age
9. Normal posture for age
10. Normal development for age in 0-5 years
11. Teeth cleaning with fluorinated toothpaste
everyday in child care
12. Teeth cleaning before bedtime to children
1-2 years by parent everyday

2553
50

AIM ( percent )
2554
2555
55
60

<8.5
20
70
83
78
90
99

<8
30
72
85
80
90
99

<7.5
40
78
88
82
90
99

2556
65
<50
90
30
<7
50
85
93
85
90
99

70

75

80

85

- Saiyairak , Family’s health : Increase Breast feeding rate from 20% to 60%
2. Improvement of intelligence quotient of Thai children
3. Support the violence victims
4. Improve antenatal care programme and generate effective guideline for intrapartum care to
decrease perinatal morbidity and mortality
5. Support antiretroviral drug to HIV-infected mothers, decrease neonatal HIV infection from
3.5% to 1.5% in 2015
6.Thalassemia screening during pregnancy(2) According to the analyses in (A), (B) and (C), what is a potential area you would like to workon for a collaborative action plan to improve health and welfare services for mothers andchildren (as a product of this training course). Please note that this is only tentative and you
can confirm your topic after the course started.
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- To develop and implement a new screening / preventive model in the field of maternal andchild health by integration relevant systems among government bodies concerning children
issues especially teenage group who have risk to be unplanned pregnancy, the environment
hazards example lead exposure; carcinogen from food contamination, table ware;
micronutrient deficiency or depletion such as iron; and birth defect registry. How todissemination of knowledge and development of suitable system for population at risk inservice.
- Improvement of maternal & baby friendly services by setting up high quality well childclinic, learning center for family in order to educate them on particular issues such as raisinga child in safety environment, healthy and happy home/community, breast feeding cornerand collaboration of child welfare in home care patient, and a good data base system.
- To support mother and child who need special help for independent living in theircommunity/social by improvement of equally accessing into health care services, education
and referral system especially those who need special supports such as disable children,
single parent and teenage parent in respect of friendly environment for maternal and childby employing QNISCH as a pilot case.
- Teenage pregnancy: Thailand is the second most country that has high rate of
teenage pregnancy. These risk is associated with obstetrics complication and significant
effect on community problems such as preterm birth, low birth weight, perinatal mortality
and especially unintended pregnancy leading to illegal abortion. Teenage mothers trend tobe sperated from normal educational systems and leading to child care problems and social
problems. This problem could not be solved in few years or by single organization. However,
we can implement education or important information to teenage mothers for good taking
care with her pregnancy and her child after delivery. Knowledge course at first visit ofantenatal care could help to educated her and families.

-96-出典：平成 24 年度 JICA 集団研修カントリーレポート

平成 24 年度 JICA 集団研修「母子保健福祉行政」

International Corporation of Welfare Services (JICWELS) was established with the sanction of
the Minister for Health, Labour and Welfare in July 1983 and implements international technicalcooperation programmes with purpose of contributiing to the promotion of health and social welfare
activities in the friendly nations.
Japan International Corporation of Welfare Services (JICWELS)
Toranomon YHK Bldg. 4F, 2-3-20, Toranomon
Minato-ku, Tokyo 105-0001 JAPAN
Phone: +81-(0)3-6206-1137
Fax: +81-(0)3-6206-1164
http://www.jicwels.or.jp

公益社団法人国際厚生事業団（JICWELS）は、国際的な保健・福祉分野の国際協力に貢献することを目的として、1983 年（昭和 58 年）7 月 7 日に厚生省（現厚生労働省）から社団法人の認可を受け設立されました。開発途上国の行政官研修や WHO フェローの受入れ、調査
企画や研究開発並びに情報の交換及び広報活動など、海外諸国との国際交流活動を推進しています。

広報活動委員会〒105-0001
東京都港区虎ノ門 2-3-20 虎ノ門ＹＨＫビル 4 階
電話 03-6206-1137（事業部） Fax03-6206-1164
http://www.jicwels.or.jp-97-