Countermeasure for Maternal andChild Health and Child Welfare

Country Reports

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

1

2. India31

3. Myanmar

44

4. Timor-Leste73

5. Viet Nam

91

6. Yemen101

Countermeasure for Maternal andChild Health and Child Welfare

CambodiaPreparation for Course in Japan 2014
Title:
Organization:

ARI/CDD PROGRAM OFFICER
National Maternal and Child Health Centre,
Ministry of Health1) Cambodia Indicators:a) Crude birth rate (per 1000 population)
 CDHS 2000: 27.7 (CDHS 2000, page 58)
 CDHS 2005: 25.6 (CDHS 2005, page 61)
 CDHS 2010: 24.2 (CDHS 2010, page 57)
 UN data 2011: 22 http://data.un.org/Data.aspx?d=SOWC&f=inID%3A90b) Crude death rate (per 1000 population)


CIPS 2013:
Total:3.95; Urban: 2.48; Rural: 3.64
Adult mortality rates1: (15-49y)
1. CDHS 2000: Male = 4.8, Female = 3.5 (CDHS 2000, page 116)
2. CDHS 2005: Male = 5.2, Female = 3.1(CDHS 2005, page 118)
3. CDHS 2010: Male = 4.1, Female = 2.5 (CDHS 2010, page 111)
Crude death rate:
http://data.un.org/Data.aspx?q=Crude+death+rate&d=PopDiv&f=variabl
eID%3a65
1. UN data 1995-2000: 9.5(Medium variant)
2. UN data 2000-2005: 7.6 (Medium variant)
3. UN data 2005-2010: 6.4 (Medium variant)c) Leading causes of morbidities and of deaths (all ages)From 2001–2010, the 10 leading causes of morbidity in the country are:

1. Acute respiratory infection;
2. Diarrhea;
3. Malaria;
4. Cough (at least 21 days);
5. Gynaeco-obstetric issues;
6. Tuberculosis;
7. Road accidents;
8. Measles;
9. Dengue hemorrhagic fever; and10. Dysentery.
Communicable diseases are thus a leading cause of morbidity and dominate all
age groups, accounting for 83% of the reported disease burden, with 67%
among the elderly and 96% among the 0–5 year age group. Noncommunicable diseases (NCDs) are increasing significantly, now causing
an estimated 53% of deaths per year (Source: WHO 2012).

Estimated adult mortality rates for women andmen for the period 0-6 years prior to thesurvey, Cambodia 20102

Cambodia total deaths by cause in 2011:
Death causes

Deaths%1.

Influenza & Pneumonia

15,75115.18

2.

Tuberculosis

11,627

11.21

3.

Coronary Heart Disease

9,144

8.81

4.

Stroke

6,933

6.68

5.

Hypertension

4,147

4.00

6.

Diarrhoeal diseases

4,114

3.97

7.

Low Birth Weight

3,464

3.34

8.

Birth Trauma

3,153

3.04

9.

Diabetes Mellitus

3,122

3.01

10.

HIV/AIDS

3,029

2.92

(Source: http://www.worldlifeexpectancy.com/country-healthprofile/cambodiad) Infant mortality rate (per 1000 live birth) CDHS 2000: 95 (CDHS 2000, page 124)
 CDHS 2005: 66 (CDHS 2005, page 2)
 CDHS 2010: 45 (CDHS 2010, page 2)e) Leading causes of infants deathNo specific data of the leading causes of infant deaths are available. Below are
the causes of under-five death in Cambodia.
The important causes of child death in Cambodia are neonatal death (42%), of
which premature births are the leading causes of death for newborn babies,
followed by asphyxia (18%), sepsis (6%), and congenital (4%). Pneumonia
and diarrhea are the second and third causes of death for children underfive years; while Injuries are the fourth causes of death for those children.

3f) Under-5 mortality rate (per 1000 live birth) CDHS 2000: 124 (CDHS 2000, page 124)
 CDHS 2005: 83 (CDHS 2005, page 2)
 CDHS 2010: 54 (CDHS 2010, page 2)

CHILD MORTALITY RATE
from 2000 to 20104g) Top 3 diseases and morbidity rate of the under-5
The Ministry of Health has classified 10 top diseases for children seeking careat the public health facilities including acute respiratory infection, diarrhea,
tuberculosis, road traffic accidents, injuries, high blood pressure, typhoid
fever, head traumatic, gynecological diseases, and dengue fever.
Among the top 10 diseases, pneumonia is the first leading cause of morbidities,
followed by diarrhea the second cause of morbidity. The third cause ofmorbidity is tuberculosis (HIS 2013 Report).
<5 years old
Diseases

Cases

Total

%

19895

47224

53.00%

12921

9900

22821

25.61%

3. Tuberculosis

5936

4410

10346

11.61%

4. All road traffic accidents(affecting head excluded)

991

680

1671

1.88%

5. Other Injuries(mine & traffic acc. excluded)

751

473

1224

1.37%

6. High Blood Pressure

0

0

0

0.00%

7. Typhoid fever

610

626

1236

1.39%

8. Road traffic accidents affecting head

610

401

1011

1.13%

9. Gynecological Pathology

0

3

3

0.00%

1907

1656

3563

4.00%

89099

100.00%M

F

1. ARIs27329

2. Diarrhea

10. Dengue fever
Total

Source: HMIS 2013. Data were analyzed among under-fivechildren who received health care at the public health facilities in
2013
ARIs

Diarrhea

Tuberculosis

Others

9.77%
11.61%

53.00%
25.61%5h) Maternal mortality rate (per 100,000 live birth) CDHS 2000: 437 (CDHS 2000, page 2)
 CDHS 2005: 472 (CDHS 2005, page 120)
 CDHS 2010: 206 (CDHS 2010, page 112)

Maternal Mortality Ratio
per 100,000 live birth (CDHS data)

Target 2015 : 140

page 10i) Leading causes of maternal death
1. Hemorrhage (32%)
2. Hypertension (17%)
3. Unsafe abortion (9%)
4. Sepsis (8%)

6j) Does your country perform any health check for infants and children?
Yes (X) / No
If ‘Yes’,-When (at how many months)?
 after birth within 24 hours, 6 weeks, 10 weeks, 14
weeks, and 9 months.
-How many times?
 as many as possible and depends on parents/caregivers-What kinds of contents include in each?
 Measure weight and height Check for malnutrition
 Immunizationk) In the case any diseases or disabilities is confirmed, is there any support
services on them? Describe the services, if any.
 No special care for disable children as our country treats all children
the same.
l) Are there national standards for certifying disabilities in your country?
Yes / No (x)If yes, please explain briefly.
2) Preliminary Analysis
1.

Please try to describe the followings on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
1.

Strong commitment from and the leadership of the government
especially the Ministry of Health to improve the health system. As aresults high coverage has been significant increased in the terms of
immunization, ANC2, Skilled Birth Attendants, exclusive breast feeding,complementary food feeding message and family planning.

2. Policy and guidelines for the sub-national implementation including:(a) National Reproductive Health Strategy(b) National Child Survival Strategy(c) Policy on ARI/CDD Program(d) IMCI clinical Guidelines(e) Clinical Practice Guidelines for Hospitals
3.

Strong partnership with INGOs and NGOs that could contribute inproviding technical and financial supports.

② Three (3) Weaknesses/Challenges in your country / region.
1.
2.
3.

Limitation of resources including human resources (staff retired andturned over), financial resources and medical equipments for support
mother and their newborns.
limitation of skill practices in caring newborn babies
Limitation of community participation. This requires to have a strategy for
demand creation.

7

2.

In your country / region, who are the most vulnerable populations? Please list three(3) groups in order of priority. ex) groups living rural areas? with low-income? withdisabilities?




3.

Disable and poor children living in the remote and rural areas
Children living with HIV
Orphan/street children

What kinds of services are there for the above mentioned groups?

No special care as above mentioned. At the public health facilities, allchildren are treated equally without discrimination.

3) Documents to bring

Policies of your country (MCH)
Please print them out.
Policies of your country (Child Welfare)
Please print them out.
MCH handbook (if any)
MCH Records kept at home (if any)
Records of Check-Ups (for mothers and child)
Record of Delivery
Records of Immunizations
Records of Weight and Height graph
Records of Development of child

8

CAMBODIA

JICA training course"Countermeasure forMaternal and Child
Health and Child
Welfare”(JFY 2013)02 February 2014 – 01 March 2014
Tokyo, Japan

Contents
1.

Background of Cambodia

2. JICAPart A (Indicators)
Part B (Standard Guideline &Policy)

9

1.

Background of Cambodia

Back Ground of Cambodia
1

Area

181,035 sq km

2

Coastline

443 km3

Highest point Phnom Aural

1,813 m4

Population

13,607,069 (2005)

5

Population density

77 persons per sq km

6Urban population distribution

19 percent (2003 )7

Rural population distribution

81 percent (20038

Official language

Khmer

9

Infant mortality rate

72 deaths per 1,000 live births (200510Gross domestic product (GDP in U.S.$)$4.23 billion

11

Unemployment rate

1.8 percent (2001)

10

MoSVY’s Structure

Ministry of Health (Structure)11

2. JICAPart A (Indicators)
N

Indicators , sours (CDHS)

2000

2005

2010

1

Crude birth rate (per 1000 population) -

27.7

25.6

24.2

2

Crude death rate (per 1000 population) - CDHS

8.3

8.3

6.6

3

Leading causes of death
From 2001–2010, the 10 leading causes of morbidity in the country are:
1. Acute respiratory infection;
2. Diarrhea;
3. Malaria;
4. Cough (at least 21 days);
5. Gynaeco-obstetric issues;
6. Tuberculosis;
7. Road accidents;
8. Measles;
9. Dengue hemorrhagic fever; and10. Dysentery.

2. JICAPart A (Indicators)

N

Indicators , sours (CDHS)

2000

2005

2010

4

Infant mortality rate (per 1000 live birth)

95

66

45

5

Leading causes of infants deathNo specific data of the leading causes of infant deaths are available. Below are thecauses of under-five death in Cambodia.
The important causes of child death in Cambodia are neonatal death (42%), of
which premature births are the leading causes of death for newborn babies,
followed by asphyxia (18%), sepsis (6%), and congenital (4%). Pneumonia anddiarrhea are the second and third causes of death for children under five years;
while Injuries are the fourth causes of death for those children.

122. JICAPart A (Indicators)

N

Indicators , sours (CDHS)

2000

2005

2010

6

Under-5 mortality rate (per 1000 live birth)

124

83

54

7

Top 3 diseases and morbidity rate of the under-5
Source: HMIS 2013. Data were analyzed among under-fivechildren who received health care at the public health facilities
in 2013
ARIs

Diarrhea

Tuberculosis

Others

9.77%
11.61%

53.00%
25.61%

2. JICAPart A (Indicators)
N

Indicators , sours (CDHS)

2000

2005

2010

8

Maternal mortality rate (per 100,000 live birth)

437

472

206

9

Leading causes of maternal death- Hemorrhage (32%), - Hypertension (17%), - Unsafe abortion (9%)
Three (3) Strengths in my country / region- law, Policy, Standard, Guideline,…….were establish- We have the structure form National and sub-National level.
- we have the stage for Government, Partnership, NGOs are met and sharesome information every month and Quarter through NOVCTF..
Three (3) Weaknesses/Challenges in my country- The implementation on the law, Policy, Standard, Guideline are not completed- M&E Data collection are not work in the hold country- Resource of Budget, human, equipments and knowledge are limited

13

10

Does your country perform any health check for infants and children?
The table of children grow up under 5 year.

The table of children grow up under 5 year.

142. JICAThe healthiest Foods on the planet

Part B (Standard Guideline &Policy)

I. Minimum Standards on Alternative Care for Children– MINIMUM STANDARDS ON RESIDENTIAL CARE FOR CHILDREN– MINIMUM STANDARDS ON ALTERNATIVE CARE FOR CHILDREN IN THE COMMUNITYII.

Policy on Alternative Care for Children– Non-residential care (a. Foster care, b. Kinship care, c. Adoption ,d. Pagoda (Wat) andother faith based care , e. Children headed household, f. Group-home based care
– Residential care (a. Recovery or child protection centers , b. Orphanages )– Minimum standards of alternative care

III. Standards and Guideline for the Care Support and Protection for OVC
a, General, b. Food and Nutrition, c. Health, d. Education, e. Social, Emotional, andPsychological, f. Economic, and lively hood and Strengthening, and Other.

15

National Strategic plan for OVC ( OVC Indicators)
1. Percentage of OVC whose households received income generation andlivelihood support and success
2. Percentage of caregivers trained in caring for OVC
3. Percentage of service provider trained to provide care and support for OVC
4. Percentage of communes/sangkat with at least one organization providing
care and support to OVC
5. percentage of communes/sangkat that integrated OVC’s issues into its CIPs
and CDPs
6. Percentage of institutional care center/community and families’ compliancewith the minimum standards of alternative care for children
7. Percentage of OVCs who successfully reintegrated with their families

National Strategic plan for OVC ( OVC Indicators)
8. Percentage of household with OVC receive equity card
9. OVC whose households received at least 3 type of external care andsupport
10. Percentage of children with advanced HIV infection receiving ART
11. Level of implementation of policies, guidelines, and laws related to thecare, support, and protection of the orphans and vulnerable children
12. Level of OVC participation in planning, implementing, and monitoring andevaluating of response mechanism related to orphans and vulnerable
children
13. Progress made in strengthening the OVC M&E system at all levels(measured by the 12 Components Systems Strengthening Tool)
14. Effectiveness score for national, sub-national, and community
coordination mechanism for OVC
15. Total number of POVCTF established16

THANKS For ATTENTION

17

CAMBODIA’S PROFILE• Areas:• Population:– Urban:– Children <15 y:

181,035 square/Km
14.6 million (ICPS 2013)
21.4% (ICPS 2013)
29.4% (ICPS 2013)– Disabilities: 2.1% (<15 y = 11.31%)• Annual grow rate:
1,46% (ICPS 2013)• Density:
82/ sq.Km2• Literacy rate of pp >15 and more (ICPS 2013)– Total:
79.7% (Urban: 90.3%; 76.5%)• Capital City: Phnom Penh
Khmer
• Language:• Religion:
90-95% (Buddhist);• Government: Constitutional monarchy• GDP:$805 (International Monetary Fund, 2010)• Population under the poverty line:
30% (MoP*, 2011)• Life expectancy: Male: 60.5 ; Female: 64.3 (Census 2008)* Ministry of Planning

18

BASIC CHARACTERISTIC OF ADMINISTRATIVE
•
•
•
•
•
•
•
•

Number of municipality:
Number of province:
Number of Cities/Krong:
Number of Khan:
Number of Districts:
Number of Sangkats:
Number of Communes:
Number of villages:

1
24*
26
9
159
204
1,429
14,119-Source: ICPS 2013
*One new province is established

HEALTH STRUCTURE AND ADMINISTRATIONCENTRAL LEVEL(MOH)

PROVINCIAL LEVELPHD = 24
OPERATIONAL
DISTRICT LEVEL• Public Health Facilities– National Hospital: 8– Provincial Hospitals: 24– Referral Hospitals: 62– Health Centres:
1,024– Health Post:
121(source: National Health Congress Report , 2012)

ODO= 81

19

HEALTH INDICATORS
Indicators
Crude Birth Rate(per 1000
population)

RESULTS /YEARS
27.7
25.6
24.2
(2000) (2005) (2010)

Crude Death Rate 9.5
7.6( per 1000
(2000) (2005)
population)
Adult Mortality
Rate (15-49 y)

M: 4.8 M: 5.2
F: 3.5 F : 3.1(2000) (2005)

Sources
CDHS

22
UN(2011) Data
6.4
UN
(2010)
Data
3.95
ICPS
(2013)
M:
CDHS
4.1
F: 2.5(2010)LEADING CAUSES OF DEATH
Death causes

Deaths%

1. Influenza & Pneumonia

15,75115.18

2. Tuberculosis

11,627

11.21

3. Coronary Heart Disease

9,144

8.81

4. Stroke

6,933

6.68

5. Hypertension

4,147

4.00

6. Diarrhoeal diseases

4,114

3.97

7. Low Birth Weight

3,464

3.34

8. Birth Trauma

3,153

3.04

9. Diabetes Mellitus

3,122

3.01

10. HIV/AIDS

3,029

2.92

Source: www.worldlifeexpectancy.com/country-health-profile/cambodia

20

CHILD MORTALITY RATECAUSES OF UNDER-5 DEATHS

Source: Countdown to 2015

21

TOP 3 DISEASES AND MORBIDITY RATE OF
THE UNDER-5

MATERNAL
M
ATERNAL M
MORTALITY
ORTALITY R
RATIO
ATIO
per
p
er 100,000
100,000 live
live bbirth
irth ((CDHS
CDHS data)
data)

Target 2015 : 140

22

LEADINGL
EADING CAUSESCAUSES OOF
F MATERNAL
MATERNAL D
DEATHSEATHS

HEALTHH
EALTH P
PROBLEMS
ROBLEMS HAVEHAVE BEEN
BEEN ADDRESSEDADDRESSED• Prevention before birth: FP, ANC campaign, birthpreparedness education• Prevention during birth: EmONC• Prevention after birth:– Immunization: polio and measles elimination);– Vit A; exclusive breast feeding and complementary
feeding– PNC visit (withing 24 h afterbirth)– ARI/CDD prevention and malnutrition measure• Care & Treatment & Rehabilitation in connection
with the community.
23

STRENGTHSSTRENGTHS• Strong commitment from and the leadershipof the government especially the Ministry of
Health to improve the health system• Policy and guidelines for the sub-national
implementation including:– National Reproductive Health Strategy– National Child Survival Strategy– Policy on ARI/CDD Program– IMCI clinical Guidelines– Clinical Practice Guidelines for Hospitals• Strong partnership with INGOs and NGOs.

KEYK
EY CHALLENGES
CHALLENGES
Health service delivery and access to services
•

•

•

•

Limitation of resources: human resources,financial and medical equipments barriers forsurvival of mothers, newborns and children.
limitation of qualified health staff in caring
newborn babies and sick children => poor
quality of care
Limitation of community participation andinadequate of referral systems. This requires tohave a strategy for demand creation.
Poor collaboration between MoH and MoSVY 24STEPS
TEP FORWARD
FORWARD• Build capacity of health staff• Build on the existing partnership with
NGOs/INGOs for further support on MCH• Strengthen the referral system and thecoordination between health careservices and the community.
• Possibility of linkages MCH and Child
welfare activities.

Ministry of Social welfare
Veterans, and Youth Rehabilitation
The National Multi-Sectoral Orphans
and Vulnerable Children (NOVCTF)

25

MoSVY’s Structure

1- Coordination System Structure of NOVCTF
Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY)

Achievements

NOVCTFTA teamSecretariat Unit

Executive Committee

Technical Working Group(Members)

M&E Sub-Committee

Advocacy Sub-Committee

RM- sub-Committee

Kg-Spue, P.Veng, Kg-Cham,
Kg-Thom, BMC and SR, POVCTFBTBPOVCTFRKRPOVCTFTKPOVCTF

Kg ChnPOVCTF

KratiePOVCTF

S.Treng
POVCTF

26

Structure of NOVCTF System coordinator(Prakas)

Secretariat of State is Chairman
Vice Chair : NAA, NCHAD, CNCC, Director general of technical Affairs

Secretariat

Ministries areWork with OVC•MoI. MoH.

•MoEYS•MoWA•(CARD)
•NAA

-

MoCR,

-

MoLVT

-

MoP

-

MoJ

-

MoT

Partner Ship Civil Society All Provincial
level
édKU
GgÁkarPOVCTF
GPivDÆn_ sgÁmsuIvil

Structure of POVCTF System coordinator(Decision)
Government of the Provincial is
Chairman

Department of Social Affair Veterans,
and Youth Rehabilitation (Permanent)
Secretariat of POVCTF

Departments areWork with OVC
In the province

Civils sociality
Are work
with OVC
In theprovince

DoSVY

Districts
NCDD

Commune
CWCC

27

3. Key achievement

National Multi-Sectoral Orphans andVulnerable Children Task Force

I. Minimum Standards on Alternative Care for Children– RESIDENTIAL CARE FOR CHILDREN– ALTERNATIVE CARE FOR CHILDREN IN THE COMMUNITY

II. Policy on Alternative Care for Children– Non-residential care (a. Foster care, b. Kinship care, c. Adoption ,d. Pagoda and otherfaith based care , e. Children headed household, f. Group-home based care
– Residential care (a. Recovery or child protection centers , b. Orphanages )– Minimum standards of alternative care

III. Standards and Guideline for the Care Support and Protection for OVC
a, General, b. Food and Nutrition, c. Health, d. Education, e. Social, Emotional, andPsychological, f. Economic, and lively hood and Strengthening, and Other.

IV. Service directory for Vulnerable People
V. M&E Guideline for OVC

28

National Strategic plan for OVC ( OVC Indicators)

1. Percentage of OVC whose households received income generation andlivelihood support and success
2. Percentage of caregivers trained in caring for OVC
3. Percentage of service provider trained to provide care and support for OVC
4. Percentage of communes/sangkat with at least one organization providing
care and support to OVC
5. percentage of communes/sangkat that integrated OVC’s issues into its CIPs
and CDPs
6. Percentage of institutional care center/community and families’ compliancewith the minimum standards of alternative care for children
7. Percentage of OVCs who successfully reintegrated with their families

National Strategic plan for OVC ( OVC Indicators)
8. Percentage of household with OVC receive ID Poor card
9. OVC whose households received at least 3 type of external care andsupport
10. Percentage of children with advanced HIV infection receiving ART
11. Level of implementation of policies, guidelines, and laws related to thecare, support, and protection of the orphans and vulnerable children
12. Level of OVC participation in planning, implementing, and monitoring andevaluating of response mechanism related to orphans and vulnerable
children
13. Progress made in strengthening the OVC M&E system at all levels(measured by the 12 Components Systems Strengthening Tool)
14. Effectiveness score for national, sub-national, and community
coordination mechanism for OVC
15. Total number of POVCTF (Provincial Multi-Sectoral Orphan and
Vulnerable Children Task Force) established.

29

THANKSFor
ATTENTION

30

Countermeasure for Maternal andChild Health and Child Welfare

India

31

Part A1) crude birth rate-22/1000 (2009),21/1000(2012)(2) crude death rate-8/1000(2009),7.4/1000(2012)(3) leading cause of death-non communicable diseases ( in general
population)(4) infant mortality rate-49/1000 (2009),44/1000(2012)(5) leading cause of infant
death-(a) prematurity/LWB (perinatal conditions 28%),(b) pneumonia (15%) (c) diarrhea(11%)(6)
under 5 mortality rate 64/1000(2009),56/1000(2012)(7) top 3 diseases and morbidity rate of theunder 5 (a) perinatal conditions(52%) (b) respiratory conditions(15%) (c)diarrhea(11%)(8)
maternal mortality rate 212/100000(2009) to 178/100000(2012)(9) leading cause of maternal
death - direct cause heamorrhage(37%), indirect cause anemia(10) in India there is as such noroutine health check up for infants and children.
Children only come for routine immunization in health clinics. Government of India has recently
started in 2013 Rashtriya Bal Swasthya Karyakram (RBSK) for child health screening and earlyintervention services under national rural health services(11) in cases of disability govt. of india
has laid down specific laws and regulations under persons with disability act,1995.(12) there is adisability act,1995 for certifying disability in india. The act has provisions for following services. (a)Early detection and prevention ( periodic screening of children at risk and training of health staff
at primary health centers (b) free education for disabled children (c) employment provision fordisabled persons (d) affirmative actions (e) provisions in relation to non discrimination
Part B
Strengths in our country(1) Ample amount of human resources.(2) Well developed Public Healthinfrastructure.(3) Govt. policies especially targeting theunderprivileged and low socio-economic group
Weaknesses in our country(1) Illiteracy(2) Various social stigmas related to health and lack ofhealth seeking behavior in our community(3) Huge burden of Population explosion.
2. Most vulnerable populationa) Low Socioeconomic status.
b) Rural population.
c) People with disability.
3. Government of India have started various programs specialy targeting the most vulnerable
groups. Some of these programs are as follows:a) Janani Suraksha Yojna - To promote institutional delivery among people of socioeconomic data.
b) Laadli Yojna - To promote girl child education.
c) Rashtriya Bal Swasthya Karyakram for child health screening.
d) National Rural Health Mission.

32

Maternal and Child health.
India.

Demographic profile of India.
• Second most populated country , with over 1.21 billion
people (2011 census), a sixth of world .
• India occupies 2.4% of the world's land area and supports
over 17.5% of the world's population.
• There are 35 states and union territories .
• 72.2% of the population lives in about 645,000 villages andthe remaining 27.8% lives in more than 5,100 towns and over
380 urban agglomerates.
• India has more than two thousand ethnic groups, and every
major religion is represented.
• Religions 75.5% hindus, 17.4% muslims, 3.3% of christians and1.9% of christians ( rest are minors).

33

Comparative demographics(World bank Indicator databank 2012)

Category

Global Ranking

Notes

Area

7th

2010

Population

2nd

2010

Population growth rate

102nd of 212

2010

Population density(people per square
kilometer of land area)

24th of 212

2010

Male to Female ratio, at
birth

12th of 214

2009

Demographic profile of india.
Growth rate

1.51% (2009 est.)

Birth rate

20.22 births/1,000 population (2013 est.)

Death rate

7.4 deaths/1,000 population (2013 est.)

Life expectancy

68.89 years est.)• male67.46 years (2009 est.)• female

72.61 years (2009 est.)

Fertility rate

2.5 children born/woman (SRS)34

Rural Health Infrastructure in India• Subcenters- most peripheral center and provide primary healthcare. There are 1-2 ANMs or Midwifes.
• Total no. of subcenter 1,48,124.
• It cover 5000 pop. in plains and 3000 in hills• Primary Health Centers- 6 sub center.
• Total no. in india 23,887.
• It covers 30,000 pop in plains and 2000 in hills.
• It has 4-6 beds. There is one MBBS Medical Officer.
• Community health centers – covers 4 PHCs.
• Total no in India 4,809.
• Specialist in Obstetrics, Medicine, Surgery and Pedia. are available.
• 20- 30 beds available.
• First referral Units – Distict hospitals.
• Second referral Units

Maternal Mortality• Globally 287,000 maternal death occurred in2010.
• India accounted for 19% of all.
MMR

Year

480

1995

254

2005

212

2009

176

2012

35

Maternal deaths are segregated into 2
groupsDirect obstetric causes• Pregnancy• Labor• Postnatal period• Incorrect treatment

Indirect obstetric causes• Resulting from previous
existing disease• Or disease that developed
during pregnancy

Medical causes
Obstetric cause• Sepsis 11%• Hemorrhage 37%• Hypertension 5%• Obstructive labor 5%• Unsafe abortion 8%• Other 34%

Non obstetric cause.
• Anemia (most common)• Malaria.
• Associated diseases:
cardiac, renal, metabolic,
infection.
• Malignancy• Accidents36

Major causes of Maternal Mortality.

Haemorrhage 37%
Sepsis 11%
Hypertension 5%

Obst. Labour 5%
Abortion 8%
Others 34%

Social causes• Young age at child birth.
• Parity• Too close pregnancy, unmet need for contraception.
• Family size
• Malnutrition• Poverty• Illiteracy• Ignorance• Delivery by untrained birth attendants.
• Poor communication and transport facility• Social customs• Poor environmental sanitation
37

Preventive and social measures to reduce
MMR:
z Early registration of pregnancy.
z At least 3 antenatal checkups.
z Risk screening and timely referral to higher center.
z Dietary supplements: iron folic acid.
z Prevention of infection and hemorrhage during laborz Prevention of complications eg. Eclampsia, malpresentation
and ruptured uterus.
z Treatment of medical conditions.
z Tetanus prophylaxis.
z Clean delivery practices.
z Training to local dais.
z Promotion of institutional delivery.
z Promotion of family planning.
z Identification of every maternal death and searching for its
cause.

Infant mortality rate.
• Globally 76 lakh children died in 2010.
• India, Nigeria, Democratic Republic of Congo,
Pakistan and China accounted for half.
• India alone accounts for 20%.
IMR

Year

1998

70

2005

56

2009

49

2012

44

38

Medical causes of Infant Mortality
Neonatal mortality• LBW and prematurity 51%• Diarrhea 15%• Pneumonia 11%• Tetnus.
• Birth injury and difficult labor.
• Sepsis.
• Congenital anomalies.
• Hemolytic disease of newborn.
• Conditions of placenta and cord.

Postneonatal mortality• Diarrhea• ARI• Malnutrition• Congenital anomalies• accidents

39Factors affecting infant mortality
BIOLOGICAL FACTORS• Birth weight• Age of mother• Birth order• Birth spacing• Multiple births• Family size
• High fertility
Economic factors

Cultural and social factors
Breast feeding
Early marriage
Sex of childQuality of mothering
Maternal education
Quality of health care
Broken families
Brutal habits and customs
Untrained dais
Bad sanitation
40

Preventive and social measures
Multipronged approach• Prenatal nutrition.
• Prevention of infection – clean delivery practices.
• Breast feeding.
• Growth monitoring.
• Family planning.
• Sanitation.
• PHC- high risk approach.
• Socioeconomic development.
• Education.

Under 5 mortality rate
• UNICEF considers this as best single indicatorof social development and well being as it
reflects income, nutrition, health care andbasic education.
• Developed countries – 7 /1000 LB• India – 56 /1000 LB (2012).

41

Cause for under 5 mortality 2010.
Neonatal deaths
52%
Pneumonia 15%
diarrhoea 11%
measles 3%
meningitis 2%
Injuries 4%

Strengths in India.
• Ample amount of human Resources.
• Well developed Public Health Infrastructure.
• Govt. Policies especially targeting the low
socioeconomic group and under privileged
section of indian society.

42

Weakness in India.
• Illiteracy and ignorance• Various social stigmas related to healthservices.
• Huge burden of population explosion.

Programs of Indian Govt. for mostvulnerable groups• National Rural Health Mission 1995.
• Janani Suraksha Yojna 2005.
• Laadli Yojna 2008.
• Rastriya Bal Swasthya Karyakram 2013.

43

Countermeasure for Maternal andChild Health and Child Welfare

Myanmar44

Overview of Maternal and Child
Health in Myanmar

Department of Health
Ministry of Health
MyanmarContents
Objectives
Policy Guidelines
Strategic Approach for Reproductive HealthOrganization setup
Activities undertaken by MCH
Output / Indicators
Challenges

45

Objectives

General Objective• To improve the health status of mother and children
including newborn by reducing maternal, neonatal andchild mortality and morbidity
Specific Objectives• To increase access to universal coverage of quality
maternal and newborn health services in Myanmar
through- antenatal care
- deliveries by skill birth attendant- Emergency Obstetric Care
- Post abortion Care and Birth Spacing- Essential Newborn Care
46

Policies and Strategies

Policy guidelines• National Health Policy– Guidelines of National Population Policy• National Population Policy– Awareness promotion on reproductive
responsibility and paternal involvement• Myanmar Reproductive Health Policy

47

Strategic Approach for Reproductive Health

1. Setting enabling environment;
2. Improving information base for decision
making;3. Strengthening health systems and capacity
for delivery of quality reproductive healthservices;
4. Improving community and family
practices.

Organization Set up48

Organization Set Up (Central level)
DG

Dy DG
(Disease Con)

Dy DG
(PH)

Dy DG

Dy DG

(Medical Care)(Admin)Director (PH)DD
(MCH))DD(WCHD)AD (MCH)

AD (MCH)

MO (MCH)

MO (MCH)

DD
(BHS)

DD
(School H)

DD(Nutrition)

DD(BHS,
Training

DD(EH)

2 (DDs)(HE)

Activities for MCH49

1) Training
2) Provision of supply and equipment
3) IEC development and distribution
4) Research
5) Infrastructure development
6) Supervision, monitoring and evaluation
7) Community empowerment andstrengthening of referral system
8) Integration with other health services
and partnership(1) Type
yp of Trainingg conducted byy MCH section
Pregnancy Childbirth, Postpartum and Newborn Care
Essential Newborn Care
Post Abortion Complicationpand Birth Spacing
IUD insertion training
Emergency Obstetric Care Training (Comprehensive/Basic)
AMW training
AMW Refresher training, MCHP training
Male involvement for RH through effective BCC strategy

Adolescent RH counseling
Quality RH Training
50

(2)Provision of Supply & Equipment
IEC and Books for Quality AN CareAN RegistersgHome Based Maternal Record (HBMR)
MCH handbook
Pregnancy calendar
q p
Equipments
for Quality AN Care
Urine Test Strips
p (100(pcs/
p pack)p )Pregnancygy Test Strips (100 pcs/pack)Hb Colour scale

Rapid
p Plasma Reagent
g Test ((RPR test)
Rapid test kit for Syphilis(2)Provision of Drug Supply
Drugs
g for Emergency
gObstetric Care
Injectionjmagnesiumg
sulphate
Misoprostolp
Injection Oxytocin
Contraceptive Commodities
OC ppills- Microgynon
gy
Injectionj
Depop
MulitloadCommodities for safe and clean delivery
CDK
MW kitAMW kitPartograph51

(2) Provision of Equipment
Item nameSpot light
Sterilizer
Labour bed and Baby Cot

Trolley with stretcher
Vacuum aspirator

Zoe gynecological simulator(3) IEC Development and Distribution• Development of TV Spot and Media for
Community• Vinyl Billboard for Health Education for
Antenatal, Delivery , Postnatal and Newborn Care
• Poster on Danger Signs, Safe Motherhood,
Congenital Syphilis• Pamphlets and Posters• MCH handbook52

(4) Research• Base line survey for Essential Newborn Care• Effectiveness of provision of Trollergies for referral• MCHPs system assessment• Training Need Assessment for Emergency Obstetric
Care• End line survey for Male involvement• End-line research on ENC in first phase townships• Assessment of AMW Training Package• Providers’ perceptions and problems in providing
Newborn Health services in selected townships(5)Renovation of Infrastructures• Renovation of Rural Health Centers,
Sub Centers and MCH centers withsupport of some donor agencies

53

(6) Supervision and monitoring• Monitoring and Supervision with Supervisory
check list by Central and S/D MCH MOs andMonitoring Field Officers• Supervision on Training and Training records• Post training assessment(7) Community empowerment andstrengthening of referral
Conducted Advocacy meeting at different levelsfor• Increased AN care coverage Increased utilizationof Skill Birth Attendants• Post Abortion Care and Birth Spacing• Emergency Obstetric Care• Essential Newborn Care
Establishment of Community Health Volunteer Systeme.g Maternal and newborn team, Community Support
Group, MCH promoters
54

MCH Promoter system• Community Health Volunteers ( 1 in each 30
households) started in two townships with supportof JICA/JOICFP and expanded to 32 townships• Bridging between BHS and Community• Increased community awareness and referral• Increased MCH health care coverage and reduced
MMR and U5MR
• 17,000 MCHP in 34 townships(8) Integration with other healthservices and Partnership• (1)Inter-Departmental¾ e.g - HIV/ AIDS (NAP) - PMCT, syphilis screening andtreatment)¾ Nutrition (B1, Iron, F/A, Deworming, Prevention andtreatment of Anaemia)¾ EPI(2) Local NGOse.g (MMCWA)(3) Other Ministries
Local authority (Generral Administration Department)(4) UN Agencies
UNFPA, WHO, UNICEF
55

Grassroot Level Community Health Education

Growth Monitoring Programme56

Community Nutrition Centre

Awareness Raising Health Talks
at Village Food Bank

Immunization Programme

Providing Measles Vaccine for Mass Measles
Immunization
57

Project Funded MMCWA’s Health Activities
IPPF-

UNFPA

Adolescents and SRH
AIDS/ HIV
Abortion (prevention of unsafe abortion)
Access to birth-spacing & SRH services
Advocacy- RH/IEC/BCC Project- Scaling up of existing RH Services project- Maternity Waiting Homes Project

Maternity Waiting Homes Project (MMCWA +DoH+ UNFPA) With UNFPA providing service for hard to reachcommunity in risk pregnancies for safe delivery. Project

townships:

058

Maternity Waiting Homes Project (MMCWA +DoH+ UNFPA) With UNFPA providing service for hard to reachcommunity in risk pregnancies for safe delivery. Project

townships:

2

Viewing the display of Sewing Performance at Vocational
Class by CEC Members (2012)

Training

59

Volunteerism
Performing an act of kindness , freely
giving of talent , time , effort for the simple
fulfillment of community expectations.

Outcomes and Indicators

60Midwives Coverage and Institutional
Delivery• AMW : Villages – 1:3• MW : Villages – 1:7• MW+AMW : Villages – 1:2( No of villages – 64910, No of AMWs – 19,974, No of MWs – 11,000)

Rural Health Centers or Sub Centers withlabour room

2003

2009

120

295

Deliveries with Skilled Birth Attendants (%)(2012)

Deliveries with
Skilled Birth Attendants (%)
71 - 80

61- 70≤ 60

61

Maternal Mortality Ratio (per 1000 LBs)
(2010 – 2012)Maternal Mortality Ratio in Myanmar
600

520

500

Per 100,000lb

380
400

300

300

230

200

200
130

100
0
1990

1995

2000

2005

2010

2015

Source: UN interagency estimate, 201062

Infant and under 5 mortality
200

150

130

100

98

U5MR

82.4
77.77

IMR

66.1
50

55.4

46.1

55.1

43.3

45.7

32.7

37.5
0
1990

1995

1999

2000

2003

2005

2009

2010

2015

Source: MICS 2010

Leading Causes and Disparity

63Vulnerable populations in
Myanmar• Mothers and Children (60% of total
population)• Poor people who live in rural area andurban slum
• Those who live with disabilities

4.23% 1.41%

7.04%

7

35.21%

8

6

8.45%

5

1

4

9.86%

3

16.90%

2

16.90%

1. Haemorrhage
2. Hypertensive disease of pregnancy in cluding eclar
3. Abortion related
4. Prolonged/obstructed labour
5. Puerperal sepsis
6. Postpartum anaemia causes
7. Embolism
8. Indirect causes

Figure3. Causes of Maternal Death (n=71)64

0DWHUQDO0RUWDOLW\E\8UEDQ5XUDO5HVLGHQFH

8UEDQ

5XUDO

Maternal Deaths by Place of Delivery (%)

Hospital
Transit

2.5
10
87.5

Home
65

U5MR by Region
RegionU5MR

1. Hilly
2. Coastal
3. Delta
4. Central Plain

66.3
58.7
59.0
76.8

Union

66.1

Place of Death (U5MR)• Disproportionately higher in rural areas( 87% ) compared to that of urban areas(13%)

Place of Death
13 %- Urban Area

87%- Rural Area

66

Distribution of Under 5 Deaths By Age (Years)(n =778)
No of Deaths

600

570 (73%)

500
400
300
200
58 (7%)

83 (11%)47 (6%)

100
0

20
(3%)
<1

2

3
Age (Years)

4573 % of Death Occurs Under One YearNo Of Deaths

Distribution of Under 1Year Deaths by Age in Months(n=570)
200
180
160
140
120
100
80
60
40
20
0

192(34%}109(19%)93(16%)
64(11%)
24(4%)
18(3%)14

<1

1

2

3

4

5

6

12

13

7

8

11

8

12

9

10 11

70 % of Death Occurs Under Three Months
34% Death Occurs Under One Month67

Leading Causes of Neonatal Deaths
30.9%
19.1%
25.5 %

Pre-maturity
LBW

Sepsis24.5 %

Asphyxia

Other

Leading Causes of Post Neonate Deaths
28 %

18 %

22%

17 %
8%

ARI

Diarrhoea

Brain
Infection

Malaria

7%

Beri
Beri

Other

68

Health Care Seeking pattern
60
40

49%
44%

20

7%

0
Trained

Untrained Traditional㻠㻠㻌㻑㻌㼠㼞㼑㼍㼠㼑㼐㻌㼣㼕㼠㼔㻌㼡㼚㼠㼞㼍㼕㼚㼑㼐㻌㻌㼜㼑㼞㼟㼛㼚㼟㻌㼎㼑㼒㼛㼞㼑㻌㼐㼑㼍㼠㼔㻚㻌

Summary
Main causes of deaths for MMR were
• PPH
• Severe PET or Eclampsia• Abortion complications
Main causes of deaths for U5MR were
• Neonatal Diseases• Infectious diseases which can be preventable andcurable• Strongly related to key family practices
Most of the deaths occurred• In rural area
• Young infants and Neonate
69

Challenges and Strengths

Challenges• Monitoring and supervision mechanism• Inadequate man power/human resource at
different levels• Over workload of BHS• Reporting status• Not well established infrastructure(ambulance, communication tools,
facilities)• Less health expenditure70

Challenges in country and region• Rural resident is high 75%• Different racial groups and languages(135)• Geographical barriers (hilly and delta)• Insufficient health manpower• Weak Infrastructure and communication

Strengths in Country• Reform moment in Social Sector(including health sector)• Increase in government expenditure forhealth• More investments and partnerships inhealth by international organization

71

72

Countermeasure for Maternal andChild Health and Child Welfare

Timor-Leste73

TIMOR – LESTE COUNTRY INDICATORPART ( A ) INDICATORS Under-5 mortality rank
 Under-5 mortality rate (U5MR), 1990
 Under -5 mortality rate (U5MR) 2011
 U5MR by sex 2011, male
 U5MR by sex 2011, female
 Infant mortality rate (under 1), 1990
 Infant mortality rate (under 1), 2011
 Neonatal mortality rate 1011
 Total population (thousands)2011
 Annual no. of births (thousands) 2011
 Annual no. of under-5 deaths (thousands) 2011
 GNI per capita (US$) 2011
 Life expectancy at birth (years) 2011 Total adult literacy rate (%) 2007-2011*
 Primary school net enrolment ratio (%) 2008-2011*

51
180
54
57
51
135
46
24
1154
44
2
2730
62
58
86

DEMOGRAPHIC INDICATOR
 Population (thousands) 2011, total
 Population (thousands) 2011, under 18
 Population (thousands ) 2011, under 5 Population annual growth rate (%), 1990-2011
 Population annual growth rate (%), 2011-2030
 Crude death rate, 1970
 Crude death rate, 1990
 Crude death rate, 2011
 Crude birth rate, 1970
 Cude birth rate, 1990
 Crude birth rate, 2011
 Life expectancy, 1970
 Life expectancy, 1990
 Life expectancy, 2011 Total fertility rate, 2011
 Urbanized population (%), 2011 Average annual growth rate of urban population (%), 1990-2011
 Average annual growth rate of urban population (%), 2011-2030










1154
616
201
2
3
23
18
8
42
43
38
40
46
62
6
28
4
4

Concraptive prevalence (%) 2007-2012*
Antenatal care (%) 2007-2012*, At least one visit
Antenatal care (%) 2007-2012*, At least four visits
Delivery care (%) 2007-2012*, Skilled attendant at birth
Delivery care (%) 2007-2012*, institutional delivery
Delivery care (%) 2007-2012*, C section
Maternal mortality ratio, 2007-2011*, Reported
Maternal mortality ratio, 2010, adjusted
Maternal mortality ratio, 2010, Lifestime risk of maternal death (1 in:)

22
84
55
29
22
2
560
300
55

74

Nutrition
 LOW birthweight (%) 2007-2011* Early initiation of breastfeeding (%), 2007-2011*
 Exclusive breastfeeding <6 months (%, 207-2011* Introduction of solid, semi-ssolid or soft foods 6-8 months (%), 2007-2011* Breastfeeding at age 2 (%), 2007-2011* Underweight (%) 2007-2011*, moderate & severe Underweight (%) 2007-2011*, severe Stunting (%) 2007-2011*, moderate & severe Wasting (%) 2007-2011*, moderate & severe Overweight (%) 2007-2011*, moderate & severe Vitamin A supplementation full coverage (%) 2011
 Iodized salt consumption (%) 2007-2011*

12
82
52
82
33
45
15
58
19
6
59
60

Immunization
 Routine EPI vaccines financed by government (%) 2011
 Immunization coverage (%) 2011, BCG
 Immunization coverage (%) 2011, DPT1
 Immunization coverage (%) 2011, DPT3
 Immunization coverage (%) 2011, polio3
 Immunization coverage (%) 2011, MCV
 Immunization coverage (%) 2011, HepB3
 Immunization coverage (%) 2011, Hib3
 Immunization coverage (%) 2011, Newborns protected against tetanus

100
68
69
67
66
62
67
81








Pneumonia (%) 2007-2012*, Care seeking for suspected pneumonia
Pneumonia (%) 2007-2012*, Antibiotic treatment for suspected pneumonia
Diarrhoea (%) 2007-2012*, Treatment with oral rehydration salts (ORS)
Malaria (%) 2007-2012*, Antimalarial treatment among febrile children
Malaria (%) 2007-2012*, Children sleeping under ITNs
Malaria (%0 2007-2012*, Households with at least one ITN

71
45
71
6
42
42

LEADING CAUSES OF MATERNAL DEATH
 Haemorrhage 35%
 Hypertension 18 %
 Unsafe abortion 9 % Sepsis 8 % Indirect 18 %
 Other direct 11 %
 Embolism 1 % Anaemia

75LEADING CAUSES OF CHILD UNDER 5 DEATH
 Malnutriton
46% are underweight-for-age;
15% are severely underweight-for-age;
49% of the children under five are stunted;
28% are severely stunted
 Diarrhoe
MalariaPneumonia
LEADING CAUSES OF INFANTS DEATHS Diarrhoe
 Pneumonia
 Tetanus
Yes In Timor Leste we perform health check for infant and children through monthly visit tohealth facilities or SISCa for Immunization, weighing also for consultation
In case of any diseases or disabilities : Diseases giving treatment based on the diseases ordiagnosis or it may refer to Hospital for further diagnosis or treatment. However if the cases of
disability we have one NGOs that running to support disability children.
At moment we haven’t had any standard for certifying disabilities children.
PART ( B ) Preliminary Analysis
1. Three Strengths in my Country
a. Availablelity of Health facilities
b. Accessibility of the health services
c. Affordablelity of the community (free of charge)
2. Weaknesses or challenges
a. Awareness of Community to use health facilities still low
b. Attitude of health workers still questioning by communityc. Health workers not providing services as schedule.
3. Vulnerable population :a. Pregnant women in very remote areas lack of access to professional services
b. Disabilities children who live in remote areasc. Infant and children under 5 who live in remote areas
4. Kinds of services that available for the above mentioned group such as services are provided
in monthly bases we called SISCa this services conducted every month in every Village,
however sometimes health workers not visiting the village as been schedule, for this reason
most of pregnant women, infant, children will not accesses to the service and they must wait
for next month.

76

COUNTRY PRESENTATION
BY MAXIMIANO NENO

COUNTRY PRESENTATIONCountermeasure for Maternal and Child andChild Welfere
Formosa Community Health Center

㻌
㻌
㻌
㻌

TIMOR LESTE

77

INTRODUCTION
AREA: 15.410 SQ KM (5,400 SQ MI), LOCATED ABOUT 640 KM (400 MI) NORTHWEST
OF DARWIN AUSTRALIACOLONIZED BY PORTUGAL IN 16TH CENTURY
IN 1975 DECLARED ITS INDEPENDENT BUT LATER THAT YEAR WAS INVADEDAND OCCUPIED BY INDONESIA AND WAS DECLARED INDONESIAN’S 27TH
PROVINCE THE FOLLOWING YEAR.

Popular Consultation
August 30, 1999
Indonesia relinquished control of theterritory and Timor Leste be come thefirst new sovereign state of the 21st
century on May 20, 2002㻌

㻾㼑㼟㼡㼘㼠㻌㻦㻌㻣㻤㻚㻡㻑㻌㼛㼒㻌㻱㼍㼟㼠㻌㼀㼕㼙㼛㼞㼑㼟㼑㻌㼍㼞㼑㻌㼢㼛㼠㼑㼐㻌㼒㼛㼞㻌㼠㼔㼑㻌㻵㼚㼐㼑㼜㼑㼚㼐㼑㼚㼏㼑㻌㻌㻌78

Name of the Country: Republic Democratic of Timor Leste(East Timor)
Population: 1,200,000 (2011 census)
Capital City: Dili

13 Districts, 65 Sub Districts, 442 Villages㻌

Languages: Official languages: Tetum and Portuguese.
Also spoken: Bahasa Indonesia, English and Spanish and
13 local languages, 99% Catholic.
Currency: US Dollar
79

㻌
㻌
㻌
㻌
㻌
㻌
㻌
㻌
㻹㼍㼖㼛㼞㻌㻱㼤㼜㼛㼞㼠㼟㻦㻌㻻㼕㼘㻌㼍㼚㼐㻌㼚㼍㼠㼡㼞㼍㼘㻌㼓㼍㼟㻘㻌㼏㼛㼒㼒㼑㼑㻌㻱㼍㼟㼠㻌 㼀㼕㼙㼛㼞䇻㼟㻌 㼜㼑㼠㼞㼛㼘㼑㼡㼙㻌 㼞㼑㼟㼑㼞㼢㼑㼟㻌 㼍㼞㼑㻌 㼠㼔㼑㻌 㼜㼛㼠㼑㼚㼠㼕㼍㼘㻌 㼗㼑㼥㻌 㼠㼛㻌 㼠㼔㼑㻌㼏㼛㼡㼚㼠㼞㼥䇻㼟㻌 㼜㼞㼛㼟㼜㼑㼞㼕㼠㼥㻚㻌 㼀㼔㼑㻌 㼓㼛㼢㼑㼞㼚㼙㼑㼚㼠㻌 㼔㼍㼟㻌 㼑㼟㼠㼍㼎㼘㼕㼟㼔㼑㼐㻌 㼍㻌 㼠㼞㼡㼟㼠㻌㼒㼡㼚㼐㻌㼠㼛㻌㼙㼍㼚㼍㼓㼑㻌㼕㼠㼟㻌㼜㼑㼠㼞㼛㼘㼑㼡㼙㻌㼞㼑㼢㼑㼚㼡㼑㼟㻌㼟㼡㼟㼠㼍㼕㼚㼍㼎㼘㼥㻚㻌㻌㻌㻌㻭㼠㻌 㼠㼔㼑㻌 㼑㼚㼐㻌 㼛㼒㻌 㻰㼑㼏㼑㼙㼎㼑㼞㻌 㻞㻜㻝㻜㻌 㼠㼔㼑㻌 㼒㼡㼚㼐䇻㼟㻌 㼎㼍㼘㼍㼚㼏㼑㻌 㼟㼠㼛㼛㼐㻌 㼍㼠㻌 㼁㻿㻐㻌㻢㻚㻥㻌㼎㼕㼘㼘㼕㼛㼚㻚㻌WORLD MAP

7LPRU
/HVWH

80

INDONESIAN MAP

7LPRU
/HVWH

TIMOR ISLAND MAP

81

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ORGANIZATION CHART OF DISTRICT HEALTH SERVICES

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THANK YOU90

Countermeasure for Maternal andChild Health and Child Welfare

Viet Nam

91

Maternal and Child
Health in Vietnam
VietnamPresentation Outline• Country Profile.
• MCH Services.
• Challenges and existing• Solution• Conclusion.

92

Country Profile• Location: Southeastern Asia, bordering the Gulfof Thailand, Gulf of Tonkin, and South China Sea,
alongside China, Laos, Cambodia.
• Area: total: 329,560 sq km, land: 325,360 sq km,
water: 4,200 sq km.
• Climate: tropical with hot, rainy season (mid-May
to mid-September) and warm, dry season (midOctober to mid-March).
• Population: 90M.
93

Country Profile• Women at reproductive ages (15-49) 28%;Adolescent ~ 23%; Adolescent and youth ~32%;• ~ 70% living in rural area.
• HDI: 0.572 ~113/169 nations• Adult literacy rate: 93.3%• GDP/capita: ~ 2050 USD• Health expenditure: 8% of GDP (education:
13%);• Life expectancy: 74.9 (71.9 M & 75.7 F)• % of HHs living <1.25 USD/day: 21.5%

ministry of health
MCH DEPARTMENT

N. Pediatric Hosp.

N.OB/GYN Hosp.

N.Inst.Nutrition

Prov. Hospital

RH Center

Sec. Med. School

Internal/Ped.Dept

Surg./Ob. Dept.

Internal/Ped.Fac.

Surg./Ob. Fac.

District HospitalInternal/Ped Dept

Surg.OB DeptInter-commune
Policlinics

Dist. H. center
RH wardCommune Health Station

Village Health Workers

Maternity(Uban)

Maternity94

RH services• % of communes having midwife: > 95%;
• % of HHs access to clean water: 85%;
• % of HHs having appropriate latrine: 61%;
• EPI coverage: 97% (measles: 95%).
• CPR: ~ 72% (model methods).
• ANC 3+: 86% (at 3 trimesters)• Delivery attended by SBA: 97%• PNC: 87% (at first week)

RH INDICATORS
1990

2012

Target 2015
(MDGs)CBR (%)

18,6 (2001)

16,9

CDR (%)

5,3 (2005)

7

TFR

3,5

2,01

MMR (per100.000LB)
NMR (‰)

244

62

58,3

N/A

12

<10

IMR (‰)

44

15

14,8

U5MR (‰)

58

22,5

19,3

UWP (U5)

32

16

15
95

Challenges (1): Disparities
Plain

Mountain(minorities)

MMR (per100.000 lb)

36

108

IMR (‰)

12

26

U5R(‰)

18

38

Challenges (2)
•
•
•

•

The reduction of MMR is low after 2010. Main causes
are: serious bleeding, eclampsia, infection (in moutain),embolus, obstructed (in plain).
IMR, U5MR has been reduced, but neonatal death rate
is till high with main causes as asphixia, premature,congenital malformation, infection...
Underweigth prevaence has been reducing but stillhigh. Stunting prevalence is very high. Overweight andobeisity as well as NCDs has been increasing (double
burden on nutrition).
Sex ratio at birth is high (113) and increasing

96

Existing••••

MCH netwrok and quaity of services has not met
the demands particularly in emergency andreferal system for mother and newborn care.
M & E system are stll weak. Data collection isless reliable.
BCC activities and services available is not strong
enough then the service utilization is still low atmountainous areas
Buget invested is very limited, not meet thedemands.

Solutions (1)• Improve quality of services and accessibility
to the MCH services. High priority forremote areas:– Bridges the gap of human resources, upgrade facilities,
equipment for district hospital in remote area toperform EmOC (incl. emergency operation & bloodtransfusion and newborn care (NICU) including referral
system– Increase the coverage of ANC, PNC and deliveries
assisted by SBA.
– Training of Village minority ethnic trained birthattendants for hard-to-reach areas– Set up the mobile team to provide RH services inremote areas .
97

Solutions (2)
•
•

•
•

For the rest areas: Improving the accessibility inorder to have universal access to all the RH
services.
Prioritize investment for high risk people like thepoor, migrants, pregnant women having high risks
such as having chronic, and heart diseases, andHIV (+) people.
Improve M & E system including data collection,
conducting operational research for making
appropriate interventions.
Strengthen BCC activities integrated with services
provision.

Conclusion• MMR, IMR, U5MR have been reducing
remarkbly. VN could reach the MDGs 1, 4, and 5.
• Neonatal death in VN is still high and accounted
for 70% of IMR, 50% of U5MR. The reduction isstill slow.
• Disparity bt socio-economic regions is large.
• Improvement of accessibility and quality ofservices should be paid more attention,
especially for the remote areas, and forvulnerable groups.
• Commitments and supports from local
governments will determine the successfulness'of the MCH program.
98

The Turtle Tower in the Sword Lake

One Pillar Pagoda

99

Thank you for your attention!

Have fun!

100

Countermeasure for Maternal andChild Health and Child Welfare

Yemen

101

Preparation for attendance JICA training course.

Part (B) Preliminary Analysis:NO

Data information

1

Crude birth rate (per 1000 population)

2

Crude death rate (per 1000 population)

39.7
According to
2004 census
9
According tocensus 2004

pneumonia (22%),
diarrhoea (11%),
neonatal sepsis (6%) andmalaria (1%) accounted for 40%
of all deaths which occurred inchildren under 5 in Yemen in2010. Prematurity was responsiblefor 18% and birth asphyxia for
13% of under3

Leading causes of death4

Infant mortality rate (per 1000 population)

75 (2003)

5

Leading causes of infant death





6

Under-5 mortality rate (per 1000 live birth)102(2003)

7

Top 3 diseases and morbidity rate of the under-5





8

Maternal mortality rate (per 100,000 live birth)430(2003)

91068.5(2006)

Preterm 34 %Asphyxia 24%
Infections 22 %78.2(2006)

Diarrhea
Pneumonia
Malnutrition
366(2006)

 Hemorrhage 32 %
 Hypertension 13 %Leading causes of maternal death Abortion 9%
 Sepsis 7 %Does your country perform any health check for infants and children?
If ''yes"* When (at how many months?)* How many times?
* What kinds of contents include in each?

Yes , at the exposure to the Health facilities
1112

In cases any diseases or disabilities is confirmed, is there any support services on them? Describe
the services , if any.

Yes , through the disability centers in the big Cities , but there is a chronic shortage
Are there national standards for certifying disabilities in your country?
Yes / NoIf yes explain briefly.

Yes, through a team in the big hospital , but in limited areas102

1- Mothers and children health care strong and weak points.
Strong points;-

Well functioning vaccination system (routine and campaigns).
Functioning IMCI program.
Reproductive program.
Integrated primary health services.

Weak points;-Limitations in mother and child health services as a result to lack ofinfrastructures.
-Illiteracy and low social awareness about maternal and child health.
- Deficiency in qualified health personnel.

2 - Most vulnerable populations; Homeless and people with no constant income (daily workers)
 IDPs (internal displaced peoples) at Harad IDPs camps displaced fromtheir original locations in Sa`ada governorate ( north of yemen )because of the war and the resultant complicated social context.
 Poor farmers in Rural areas 70% of Yemeni population are living incountryside mainly in western coast low lands (Alhodaida governorate).

3- Kind of services exist for above mentioned groups.
-

Charity local societies.
Governmental and NGOs (nongovernmental organizations )e.g WHO,
Unicef, WFP MSF …
National fund for social care.

103出典：平成 25 年度 JICA 集団研修カントリーレポート

平成 25 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.jp104