－ 447 －－ 449 －－ 451 －11 Azerbaijan Leyla Abudullayeva

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its“Changes” compared with previous data and “Disparities within the country”. The Latter ismuch important for the coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
Country overall
18.9
16.9
18.1

1995
2005
2015

(2) Crude death rate (per 1000 population)
1995
2005
2014

Country overall
6.7
6.2
5.9

(3) Leading causes of death (1990) and (2010)
1990:1) disease of the circulatory system
2) disease of the respiratory system
3) neoplasm
2010:1) disease of the circulatory system2) neoplasm3) disease of digestive system－ 453 －

11 Azerbaijan Leyla Abudullayeva(4) Infant mortality rate (per 1000 live birth)
Country overall
23.3
12.7
10.2

1995
2005
2014

(5) Leading causes of infants death (1990) and (2010)
1990:1) disease of the respiratory system
2) some infection and parasite condition
3) certain originating in perinatal period

20101) disease of the respiratory system
2) certain condition originating in perinatal period3) congenital anomalies(6) Under-5 mortality rate (per 1000 live birth)
Country overall
43.2
17.6
12.6

1995
2005
2014

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1)
2)
3)Morbidity rate:
1)
2)
3)
2010:
Diseases:Morbidity rate:1) disease of the respiratory system
2) certain condition originating in perinatal period3) some infection and parasite of the digestive system
1)

2)

3)

(8) Maternal mortality rate (per 100,000 live birth)
Country overall
37
28,9
14.6

1995
2005
2014

(9) Leading causes of maternal death (1990) and (2010)
1990:
1)
2)
3)
2010:
1)
2)
3)

－ 454 －

11 Azerbaijan Leyla Abudullayeva(10)

Are there national standards for certifying disabilities in your country?
Yes / NoIf yes, please explain briefly.
Disability evaluation criteria based on international standards are approved by thegovernment of Azerbaijan. Azerbaijan is a member of the United Nations Convention on the
Rights of Person with Disabilities(11)

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)?
Child health care is initially provided during the first three days following thedelivery, at the hospital where the delivery took place. After discharge from thehospital , a child is visited at home by a pediatrician. Every child receives at least
one visit from a pediatrician that can be then followed by a nurse visit.
-How many times?
A mother is required to take her child for regular checkups at the policlinicand ensure the vaccination is provided several times during the childs first two year.
Doctors in polyclinic can refer children to a specialized pediatrician or for
hospitalization if necessary. After two years old check up of the children carried out
twice a year
-What kinds of contents includes in each?
Physical examination, determination body mass index, complete bloodcount (CBC) , fluoroscopy

In the case any diseases or disabilities are confirmed, is there any support services onthem? Describe the services, if any.]
Azerbaijan's Ombudsman protects and promotes human rights, the rights of vulnerable
children and people with disabilities.
People with disabilities should register at the Ministry of Labour and Social Protectionof Population of Azerbaijan to receive social assistance.
The Heydar Aliyev Foundation aims to improve the living conditions of vulnerable
children and adults, as well as assist children and adults with disabilities to integrate into
society and earn an income
The Union of Disabled People keeps statistics about people with disabilities, has
information about their rights, as well as social projects, news and a photo gallery. The
website also has links to other disabled organisations in the country.

－ 455 －

11 Azerbaijan Leyla Abudullayeva～Part (B)Preliminary Analysis～※It is recommended to analyze those strengths/weaknesses through the discussion withthe authorities concerned (health and welfare) before coming to Japan in order to facilitate
to find the way for the collaboration between health and welfare for mothers and children.
Preferably country report should be prepared in collaboration with authorities.
1. Please try to describe the followings on the surroundings mothers and children.
①

Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare：⇒Maternal and Child Health：
1. The wide array of intervention programs and strategies are approved to
improve the services provided for children and pregnant woman during perinatal ,neonatal and postneonatal periods
2. Throughout the country health care services are provided free of charge
3. Maternal healthcare services has an extensive network of facilities whichis adequately staffed with qualified personnel② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：⇒Maternal and Child Health：.
1. There are currently nearly one million of refugees and internally displaced
persons in Azerbaijan, which represents 12 percent of the countrys population
2. Deficiency of specialists at the rural areas
3. Socioeconomic condition and educational level in rural area is not satisfactory

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? with disabilities?
1. Refugees
2. With disabilities
3. With low -income
3. What kinds of services are there for the above mentioned groups?
Different kinds of benefit and social defense programs are exist－ 456 －

11 Azerbaijan Leyla Abudullayeva

4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,①In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
1.Program of Actions for Protection of maternal and child health
2. Concept of regionalization of perinatal services
3. Integrated management of childhood illnesses
4. National reproductive health program
5. State program on poverty reduction and sustainable development in the
republic of Azerbaijcan.
②What are successful areas or programmes? List 3 areas or programmes.
1. Development of 2014-2020 National Strategy of Azerbaijan Republic on
Prevention and Control of Non-communicable Diseases
Development and implementation of the NCD Prevention and Control Strategy
for 2014-2020 is one of prioritized health sector tasks included in the country's
Development Conception "Azerbaijan-2020: Future Vision". The program was
implemented in the frame of Azerbaijan Republic Health Sector Reform Project(HSRP) under the Ministry of Health of Azerbaijan Republic.
2. The work on the development and implementation of national clinical protocols
on various disease are carried out
3. The training for health care specialists are carried out②What are these challenges? List 3 challenges.
1. Azerbaijan is newly independence country
2. War condition at the Republic. Due to military aggression of the armed forcesof Armenia against Azerbaijan the 20 percent of countrys territory were occupied
3. Low educational level of the mothers in rural areas③Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
Maternal and child health care and welfare are closely linked with a broad rangeof social and economic factors.
④Describe your expectations to the training program.
To gain an understanding of Japanese MCH and Child welfare policies , toexchange opinions about approaches to the improvement maternal and child healthcare in aim to improve health care services for mother and child in our country－ 457 －

12 Azerbaijan Shahla Hasanova

ANNEX-1

Suggested Guideline for Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its“Changes” compared with previous data and “Disparities within the country”. The Latter ismuch important for the coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
Country overall
18.9
16.9
18.1

1995
2005
2015
(2) Crude death rate (per 1000 population)

Country overall
6.7
6.2
5.9

1995
2005
2014

(3) Leading causes of death (1990) and (2010)
1990:
1)disease of the circulatory system
2) disease of the respiratory system
3) neoplasm
2010:1) disease of the circulatory system2) neoplasm3) disease of digestive system(4) Infant mortality rate (per 1000 live birth)
Country overall－ 458 －

12 Azerbaijan Shahla Hasanova

1995
2005
2014

23.3
12.7
10.2

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

1990:1) disease of the respiratory system
2) some infection and parasite condition
3) certain originating in perinatal period

20101) disease of the respiratory system
2) certain condition originating in perinatal period3) congenital anomalies(6) Under-5 mortality rate (per 1000 live birth)
Country overall
43.2
17.6
12.6

1995
2005
2014

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1)
2)
3)Morbidity rate:
1)
2)
3)
2010:
Diseases:Morbidity rate:1) disease of the respiratory system
2) certain condition originating in perinatal period3) some infection and parasite of the digestive system
1)

2)

3)

(8) Maternal mortality rate (per 100,000 live birth)
Country overall
1995
37
2005
28,9
2014
14.6
(9) Leading causes of maternal death (1990) and (2010)
1990:
1)
2)
3)
2010:
1)
2)
3)
(10)

Are there national standards for certifying disabilities in your country?
Yes / NoIf yes, please explain briefly.
Disability evaluation criteria based on international standards are approved by the－ 459 －

12 Azerbaijan Shahla Hasanova

government of Azerbaijan. Azerbaijan is a member of the United Nations Convention on the
Rights of Person with Disabilities(11)

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)?
Child health care is initially provided during the first three days following thedelivery, at the hospital where the delivery took place. After discharge from thehospital , a child is visited at home by a pediatrician. Every child receives at least
one visit from a pediatrician that can be then followed by a nurse visit.
-How many times?
A mother is required to take her child for regular checkups at the policlinicand ensure the vaccination is provided several times during the childs first two year.
Doctors in polyclinic can refer children to a specialized pediatrician or for
hospitalization if necessary. After two years oldcheck up of children carried out twicea year.
-What kinds of contents includes in each?
Physical examination, determination body mass index, complete bloodcount (CBC) , fluoroscopy.

In the case any diseases or disabilities are confirmed, is there any support services onthem? Describe the services, if any.]
Azerbaijan's Ombudsman protects and promotes human rights, the rights of vulnerable
children and people with disabilities.
People with disabilities should register at the Ministry of Labour and Social Protectionof Population of Azerbaijan to receive social assistance.
The Heydar Aliyev Foundation aims to improve the living conditions of vulnerable
children and adults, as well as assist children and adults with disabilities to integrate into
society and earn an income
The Union of Disabled People keeps statistics about people with disabilities, has
information about their rights, as well as social projects, news and a photo gallery. The
website also has links to other disabled organisations in the country.

(12)－ 460 －

12 Azerbaijan Shahla Hasanova～Part (B)Preliminary Analysis～※It is recommended to analyze those strengths/weaknesses through the discussion withthe authorities concerned (health and welfare) before coming to Japan in order to facilitate
to find the way for the collaboration between health and welfare for mothers and children.
Preferably country report should be prepared in collaboration with authorities.
1. Please try to describe the followings on the surroundings mothers and children.
①

Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare：⇒Maternal and Child Health：（1.
2.
3.
1. The wide array of intervention programs and strategies are approved to
improve the services provided for children and pregnant woman during perinatal ,neonatal and postneonatal periods.
2. Throughout the country health care services are provided free of charge.
3. Maternal healthcare services has an extensive network of facilities whichis adequately staffed with qualified personnel.

② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：⇒Maternal and Child Health：1.
2.
3.
1.There are currently nearly one million of refugees and internally displaced
persons in Azerbaijan, which represents 12 percent of the countrys population
2. Deficiency of specialists at the rural areas.
3.
Socioeconomic condition and educational level in rural area is notsatisfactory.

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? with disabilities?
1.Refugees
2. With disabilities
3. With low -income
3. What kinds of services are there for the above mentioned groups?
Different kinds of benefit and social defense programs are exist
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,－ 461 －

12 Azerbaijan Shahla Hasanova①In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
1.
Program of
Actions for Protection of maternal and child health2.Concept of regionalization of perinatal services.
3.Integrated management of childhood illnesses .
4. National reproductive health program.
5. State program on poverty reduction and sustainable development in the republicof Azerbaijcan .
②What are successful areas or programmes? List 3 areas or programmes.
1.

Development of 2014-2020 National Strategy of Azerbaijan Republic on

Prevention and Control of Non-communicable Diseases
Development and implementation of the NCD Prevention and Control Strategy for 20142020 is one of prioritized health sector tasks included in the country's Development
Conception "Azerbaijan-2020: Future Vision". The program was implemented in the frameof Azerbaijan Republic Health Sector Reform Project (HSRP) under the Ministry of Healthof Azerbaijan Republic.
2. The work on the development and implementation of national clinical protocols on
various disease are carried out
3. The training for health care specialists are carried out .
②What are these challenges? List 3 challenges.
1. Azerbaijan is newly independence country
2. War condition at the Republic. Due to military aggression of the armed forces ofArmenia against Azerbaijan the 20 percent of countrys territory were occupied
3.Low education level of the mothers in the rural areas.
③Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
Maternal and child health care and welfare are closely linked with a broad range of socialand economic factors.
④Describe your expectations to the training program.
To gain an understanding of Japanese MCH and Child welfare policies , to exchange
opinions about approaches to the improvement maternal and child health care in aim to
improve healthcare services in our country.

－ 462 －

－ 463 －3 Cambodia Hun Pheakdey

ANNEX-1

Cambodia Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and
MCH”(JFY 2015)
Child Welfare Chapter-

Prepared by:

Mr. Hun Pheakdey-

Title:

Assistant to Director General of Technical Affairs.

-

Organization:

Ministry of Social Affairs, Veterans and YouthRehabilitation※Part (A) Indicators(1) Crude birth rate (per 1000 population)
Country overall
40.3
1995
25.6
2005
24.4
2015
(2) Crude death rate (per 1000 population)
Country overall
1995
11.3
2005
M=5.2, F=3.1 (7.6)
2015
7.78
(3) Leading causes of death (1990) and (2010)
1990: 1) Diseases (Bacteria, virus and micronutrient deficiency)
2) Hygiene and poverty 3) Environment and low knowledge
2010: 1) Diseases (Bacteria, virus and micronutrient deficiency)
2) Hygiene 3) Environment and low knowledge(4) Infant mortality rate (per 1000 live birth)
Country overall
1995
90
2005
66
2015
28
(5) Leading causes of infants death (1990) and (2010)
1990: 1) Diseased
2) Infection－ 465 －

3) Anemia

3 Cambodia Hun Pheakdey

2010: 1) Diseased

2) Infection3) Anemia(6) Under-5 mortality rate (per 1000 live birth)
Country overall
1995
125
2005
83
2015
35
(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1) Acute respiratory illness (ARI) 2) Fever 3)
Diarrhea
Morbidity rate:1) ARI 6% 2) Fever 28% 3) Diarrhea 15%
2010:
Diseases: 1) Acute respiratory illness (ARI) and fever2) Sever acute malnutrition And anemia 3) Diarrhea
Morbidity rate: 1) ARI 6% and fever 28% 2) Sever acute malnutrition
2.5% andAnemia 55% 3) Diarrhea 15%(8) Maternal mortality rate (per 100,000 live birth)
Country overall
1995
640
2005
472(CDHS 2005, page 120)
2015(2014)
170(9) Leading causes of maternal death (1990) and (2010)
1990:1) Hemorrhage
2) Eclampsia
3) Infection
2010:1) Hemorrhage (42,1%)
2) Hypertension (17%)3)
Unsafeabortion (9%)(10)

Are there national standards for certifying disabilities in your country?
Yes/NoIf yes, please explain briefly.
To certify the disabilities, the Royal Government of Cambodia has issued
Inter-Ministerial Declaration (Prakas) between Ministry of Social Affairs,
Veterans and Youth Rehabilitation and Ministry of Health on Classification
and Type of Disabilities. This Prakas aim to define national definition forcollecting statistic and data to implement laws, policies and programs related
to disability. Disabilities were classified 4 kinds as following:
1. Physical Disability
2. Intelligent Disability
3. Mental Disability
4. Other Disability.

(11)

Does your country perform any health check for infants and children?

－ 466 －

3 Cambodia Hun Pheakdey

If ‘Yes’,Yes/ No-When (at how many months)?
• After birth, within 24 hours, 6 weeks, 10 weeks, 14 weeks,
and 9 months.
-How many times?
• One time per month-What kinds of contents includes in each?
• Measure weight and height• Check for malnutrition• Immunization• Presence of clubfoot(12)
In the case any diseases or disabilities are confirmed, is there any
support services on them? Describe the services, if any.
Yes, when health care staff notice a disease (e.g. HIV) or impairment (e.g.
clubfoot), the child is referred to relevant services for additional care (e.g.
pediatric ARV in HIV through the health services system; Pointed in clubfootthrough the physical rehabilitation services system). Yet, the mechanism inplace is weak and still too many health issues in children go unnoticed or are
not taken care of adequately.

※Part (B)Preliminary Analysis

1. Please try to describe the followings on the surroundings mothers andchildren.
① Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare：
1. Strong commitment from high level leadership of the government
especially the MoSVY, multi- and bi-lateral counterparts and local andinternational civil society to strengthen the social welfare system formaternal and child welfare.
2. Strengthening of social welfare legal framework in line withinternational and national conventions, goals and plans, e.g.:(a) Universal declaration of Human Rights, Convention on the Rights ofChildren, Convention on the Rights of People with Disabilities－ 467 －

3 Cambodia Hun Pheakdey(b) Sustainable development Goals(c) National Development Strategic Plan of the Royal Government of
Cambodia(d) National Strategic Plan on Orphans and Vulnerable Children(e) Etc.
3. Strong partnerships with international and local entities towards
ensuring an universal minimum package of quality comprehensivesocial services to promote equity in development opportunities forchildren and mothers:② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：
1. Weak legal framework implementation
2. Limited of resources; including human resources (staff retired andturned over); financial resources; and equipment to support
implementation.
3. Limited capacity to ensure quality services
2. In your country / region, who are the most vulnerable populations? Pleaselist three(3) groups in order of priority.
ex) groups living rural areas? with low-income? with disabilities?
1. People living in poverty
2. People living in remote and hard to reach areas
3. People living with chronic illnesses and /or impairment
3. What kinds of services are there for the above mentioned groups?
1. Poverty: ID poor card, equity fund, small scale health insurance
initiatives, income generation and livelihood programmes
2. Hard to reach: expanded outreach services, road infrastructure
improvements, family accommodation facilities at services location.
3. Integration of PwD and those identified HIV+ in ID poor card system,
equity fund to access fee exemption for treatment / care
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,
Welfare:-Continuous lobbying and advocacy on the importance of mother and child－ 468 －

3 Cambodia Hun Pheakdey

welfare towards prosperous societal development-Strengthen national legal framework towards building an effective welfare
system for mothers and children-Continue to explore the potential synergy of partnerships towards ensuring
sufficient and sustainable adequate resources to enhance quality services
in mothers and children⇒to develop the services for the most vulnerable populations,Welfare:-ensure reaching the most vulnerable with outreach and reinforced family
focused social monitoring (counseling; information about and referral toappropriate services; and follow-up)-ensure inclusion of the most vulnerable to benefit basic social services(health, education, civic).
-ensure inclusive legal framework development
A. In your country what are the priority issues/programmes in the area ofmaternal and child welfare? List five issues/programmes in order of priority.
1. Universal access to a minimum package of quality welfare services
2. Comprehensive approach builds on the synergy of cross sector
collaboration
3. Effective resources management
4. Adequate social welfare information and referral services
4. Quality social protection services
B. What are successful areas or programmes? List 3 areas or programmes.
1. High level commitment, e.g. ratification of the CRWD
2. Innovative pilots taken over by government: equity fund towards
universal access to a minimum package of health care services
3. Existing structure from central to decentralized level to provide
social welfare information and referral services
C. What are these challenges? List 3 challenges.
1. Political stability towards long term commitment
2. Effective resources management
3. Fast growing equity disparities (e.g. wealth, geographic, education)－ 469 －

3 Cambodia Hun Pheakdey

D. Regarding the above-mentioned issues/challenges, explain background,current situation and reason why those issues/challenges are difficult tosolve.
1. Young democracy
2. Young institutional development history (after war build up)
3. Fast economic development from low to almost middle income
country benefiting few, risk of middle income trap.
E. Describe your expectations to the training program.
Comparing with ASEAN countries in the region, Cambodia still has a lot of
problems to solve before to reach a strong mother and child welfare status.
Still too many children are excluded from benefiting even the most basic of
their fundamental rights, such as access to quality health care and education,
still too many are victim of neglect, abuse and exploitation; in-equity in children
with disability in norm. To tackle these problems, MoSVY strengthens it childwelfare legal framework and cross sector collaboration at central anddecentralized levels. At the same time, attention is given to enhanceresources management towards strengthening quality services system
implementation.
From this training MoSVY expects to learn from experiences in Japan andother institutions and to gain knowledge from trainers and participants fromdifference countries towards more effective solving problems andstrengthening our child and mother welfare system.

－ 470 －

4 Cambodia Heng Ngim
ANNEX-1

Preparation for Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)-

Prepared by:Title:
Organization:

Mrs. Heng Ngim, BSN, RM
Training Unit Staff, Vice President of CMA.
National Maternal and Child Health Center, Ministry of Health,Phnom Penh, Cambodia.

※Part (A) Indicators(1) Crude birth rate (per 1000 population)
Country overall
40.3
25.6
24.4

1995
2005
2015 (2014)(2) Crude death rate (per 1000 population)

Country overall
11.3
7.6
7.78

1995
2005
2015 (2014)(3) Leading causes of death (1990) and (2010)
1990: 1) Diseases (Bacteria, virus and micronutrient deficiency
2) Hygiene and poverty
3) Environment and low knowledge
2010:1) Diseases (Bacteria, virus and micronutrient deficiency
2) Hygiene and poverty
3) Environment and low knowledge(4) Infant mortality rate (per 1000 live birth)
1995
2005
2015 (2014)
Leading causes of infants death (1990) and (2010)
1990:
1) Disease2) Infection3) Anemia
20101) Disease2) Infection3) Anemia

Country overall
90
66
28

－ 471 －

4 Cambodia Heng Ngim(5) Under-5 mortality rate (per 1000 live birth)
Country overall
125
83
35

1995
2005
2015 (2014)(6) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1) ARI
2) Fever3) Diarrhea
Morbidity rate:1) ARI 6%2) Fever 28%3) Diarrhea 15%
2010:
Diseases:Morbidity rate:1) ARI and fever2) Sever Acute malnutrition and anemia
3) Diarrhea
1) ARI 6% and fever 28%
2) Sever acute malnutrition and anemia 25% and anemia 55%
3) Diarrhea 15%(7) Maternal mortality rate (per 100,000 live birth)
Country overall
640
472
170

1995
2005
2015(2014)(8) Leading causes of maternal death (1990) and (2010)
1990:
1) Hemorrhage
2) Hypertension3) Infection
2010:1) Hemorrhage (32%)2) Hypertension (17%)3) Unsafe abortion (9%)－ 472 －

4 Cambodia Heng Ngim
(9) Are there national standards for certifying disabilities in your country?
Yes/ NoIf yes, please explain briefly.
To certify the disabilities, the Royal Government of Cambodia has issued Inter-Ministerial
Declaration (Prakas) between Ministry of Social Affairs. Veterans and Youth Rehabilitation and
Ministry of Health on classification and Type of Disabilities. This Prakas aim to define national
definition for collecting statistic and data to implement laws, policies and programs related todisability. Disabilities were classified 4kinds as following:
1-Physical Disability
2-Intelligent Disability
3-Mental Disability
4-Others Disability(10)
Does your country perform any health check for infants and children?
 Yes/ 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?
• One time per month or• As many as possible and depends on parents/care givers-What kinds of contents includes in each?
• Measure weight and height• Check for malnutrition• Immunization• Presence of clubfoot(11)
In the case any diseases or disabilities are 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.
• When health care staff notice a disease (e.g HIV) or impairment (e.g. clubfoot), the childis referred to relevant services for additional care (e. Pediatric ARV in HIV through thehealth services system; Pointed in clubfoot though the physical rehabilitation services
system). Yet, the mechanism in place is weak and still too many health issues in children
go unnoticed or are not taken care of adequately.

－ 473 －

4 Cambodia Heng Ngim
※Part (B)1.

Preliminary Analysis

Please try to describe the followings on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
⇒M aternal and Child Health：
1. Strongly political commitment of Royal Government of Cambodia for National
development
2. Improving infrastructure
3. Development of Human resource for health② Three (3) Weaknesses/Challenges in your country / region.
⇒M aternal and Child Health：
1. Limitation of resources including human resources (staff retired and turned over),financial resources and medical equipments for support mother and their newborns.
2. limitation of skill practices in caring newborn babies
3. Limitation of community participation. This requires having a strategy for demand
creation.
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? with disabilities?

3.

1.

People living in remote and hard to reach areas

2.

People living in poverty

3.

People living with chronic diseases and/or impairment

What kinds of services are there for the above mentioned groups?
No special care as above mentioned. At the public health facilities, all children are treatedequally without discrimination.
o Hard to reach: expanded outreach services, road infrastructure improvements, family
accommodation facilities location.
o Poverty: ID poor card, equity fund, small scale health insurance initiatives, income
generation and livelihood programso Integration of PwD and those identified HIV + in ID poor card system, equity fund toaccess fee exemption for treatment/care－ 474 －

4 Cambodia Heng Ngim
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,
Welfare:-Continuous lobbying and advocacy on the importance of mother and child welfare towards
prosperous societal development-Strengthen national legal framework towards building an effective welfare system for mothers
and children-Continue to explore the potential synergy of partnerships towards ensuring sufficient andsustainable adequate resources to enhance quality services in mothers and children⇒to develop the services for the most vulnerable populations,Welfare:-ensure reaching the most vulnerable with outreach and reinforced family focused social
monitoring (counseling; information about and referral to appropriate services; and follow-up)-ensure inclusion of the most vulnerable to benefit basic social services (health, education,
civic).
-ensure inclusive legal framework development①In your country/province, what are the priority issues/programmes in the area of maternal and childhealth/welfare? List five issues/programmes in order of priority.
1. Universal access to a minimum package of quality welfare services
2. Comprehensive approach builds on the synergy of cross sector collaboration
3. Effective resources management
4. Adequate social welfare information and referral services
5. Quality social protection services②What are successful areas or programmes? List 3 areas or programmes.
1. High level commitment, e.g. ratification of the CRWD
2. Innovative pilots taken over by government: equity fund towards universal access to aminimum package of health care services
3. Existing structure from central to decentralized level to provide social welfare
information and referral services②What are these challenges? List 3 challenges.
1. Political stability towards long term commitment
2. Effective resources management
3. Fast growing equity disparities (e.g. wealth, geographic, education)－ 475 －

4 Cambodia Heng Ngim
③Regarding the above-mentioned issues/challenges, explain background, current situation and reason
why those issues/challenges are difficult to solve.
1. Young democracy
2. Young institutional development history (after war build up)
3. Fast economic development from low to almost middle income country benefiting few, riskof middle income trap.
④Describe your expectations to the training program.
Maternal and Child Health is a top priority of the Cambodian Government. Efforts have resultin impressive gains in expanding the reach of maternal and child services. However, despite a sustainedcommitment to the achievement of the Millennium Development Goals, Maternal and child mortality
remain a challenge for the country. However, I expect that the training program will gain knowledge ofpolicies in Japan and examine the application of these in my country.

－ 476 －

－ 477 －BY
VICTORIA OWUSU-AKYAWKUMASI, GHANA,WEST AFRICAINTRODUCTION

PART A :

INDICATORSPART B : PRELIMINARY ANALYSES
 REFERENCES－ 479 －

INTRODUCTIONDESCRIPTION OF GHANA• GHANA IS ON THE WEST COAST OF AFRICA.
• IT SHARES BOUNDARIES WITH TOGO TO THE EAST, LA
COTE D'IVOIRE TO THE WEST, BURKINA FASO TO THE
NORTH AND THE GULF OF GUINEA, TO THE SOUTH.
• IT IS MADE UP OF 10 REGIONS: ASHANTI, BRONGAHAFO, EASTERN, CENTRAL, WESTERN, GREATER
ACCRA, VOLTA, NORTHERN, UPPER EAST AND UPPER
WEST REGIONS.

－ 480 －

MAP OF GHANA SHOWING THE TEN REGIONS AND BORDERS
BURKINA FASO

LA COTE D’IVOIRETOGOGULF OF GUINEA• THE COUNTRY COVERS AN AREA OF 238,5OO SQUAREKILOMETRES.
• THE ESTIMATED POPULATION IS 25,199,609 (JULY 2013
ESTIMATE).
• IT HAS MORE THAN ONE HUNDRED ETHNIC GROUPS- EACH WITH ITS OWN UNIQUE LANGUAGE AND
CULTURE.
• ENGLISH, HOWEVER, IS THE OFFICIAL LANGUAGE, A
LEGACY OF BRITISH COLONIALS RULE.
.

－ 481 －

• GROSS DOMESTIC PRODUCT (GDP) IS 14 BILLION USD(2008 ESTIMATE)• AGRICULTURE EMPLOYS 60 % OF WORKFORCE AND
ACCOUNTS FOR 37 % OF GDP.
• EXPORT PRODUCTS INCLUDE GOLD, COCOA, TIMBER,BAUXITE, MANGANESE AND ELECTRICITY.
• OIL WAS FOUND IN 2007.

¢• THE CURRENCY IS GHANA CEDI (GH )• LIFE EXPECTANCY IS ABOUT 56 YEARS• THE FIRST PRESIDENT WAS HIS EXCELLENCY DR.
KWAME NKRUMAH• THE PRESENT PARLIAMENT HAS 275 MEMBERS• THE CURRENT PRESIDENT IS HIS EXCELLENCY JOHNDRAMANI MAHAMA－ 482 －

• GHANA HAS SEVERAL TOURIST ATTRACTIONS SUCHAS CASTLES FORTS CULTURAL CENTRES GAME RESERVES BEACHES KAKUM NATIONAL PARK WATERFALLS.

GHANA DEMOGRAPHIC AND HEALTH SURVEY HAVEBEEN UNDERTAKEN IN THE COUNTRY WITHIN A FIVEYEAR INTERVAL I.E. 1988, 1993,1998, 2008 AND 2014.

－ 483 －

 INDICATORSTHESE ARE PRESENTED IN THE TABLES BELOWYEARCOUNTRY OVERALL

1993

44.0

2005

33.0

2008

30.8

－ 484 －YEAR

COUNTRY OVERALL

1993

12.5

2005

10.0

2008

9.4

YEAR

COUNTRY OVERALL

1995

66

2005

64

2013

53

－ 485 －

1990
1. NEONATAL
2. DIARRHOEA
3. PNEUMONIA
2010
1. MALARIA
2. DIARRHOEA
3. MALNUTRITIONYEARCOUNTRY OVERALL

1993

119

2003

111

2008

80

－ 486 －

1990 DISEASE
MORBIDITY
RATE

2010

DISEASE

Malaria

MORBIDITY 29%
RATE

Other
condition

Pneumonia

20%

16%

YEAR

COUNTRY OVERALL

1995

590

2005

503

2013

319

－ 487 －

1990
1
2
3
2010
1. HEMORRHAGE
2. PRE ECLAMPSIA
3. SEPTIC ABORTION

THERE IS NATIONAL STANDARDS FOR CERTIFYINGDISABILITY IN GHANA.
IN GHANA THE THREE MOST PREVALENT TYPE OF
DISABILITY ARE VISUAL, HEARING AND PHYSICALDISABILITY.

－ 488 －



GHANA PERFORMS HEALTH CHECK FOR INFANTS
AND CHILDREN, AT BIRTH,7 DAYS, 6 WEEKS AND
EVERY MONTH TILL THE CHILD IS 5 YRS.
THE CONTENTS INCLUDE WEIGHT MONITORINGFOR GROWTH, IMMUNIZATION, VITAMINSSUPPLEMENTATION, HEALTH EDUCATION ON
EXCLUSIVE BREASTFEEDING AND NUTRITION
AND TREATMENT OF MINOR CONDITIONS LIKERASHES.

IN CASE ANY DISEASE IS CONFIRMED THE
DISEASE CONTROL UNIT UNDER PUBLICHEALTH UNIT IS ALERTED AND THE PERSONTREATED AND CONTACT TRACING DONE E.G. IN
THE CASE OF TB－ 489 －

PRELIMINARY ANALYSIS

CHILDREN UNDER 5



PREGNANT WOMENDISABILITY－ 490 －

CHILDREN UNDER 5
Child welfare clinic

PREGNANT WOMEN
Anti natal and post natal clinic


DISABILITY

Disability fund.
Vocational centers for skills training in dress making,craftsmanship etc.

1. Implementation of the Millennium Development goal 5
Accelerated framework (MAF)
Recommendations from the report on emergency obstetrics andnewborn care (EMONC)
Increased access to modern familyplanning services.

－ 491 －

2. Implement the National Child Health Policy andStrategy; increase uptake of EPI services:scale up school health programmes: train relevantCommunity health workers on integrated case managementof diarrhoea, pneumonia and malaria.
3.Implement the activities under the Adolescent Health
Policy and Strategy.

4. Develop the National Nutrition Policy and Strategy; Scale-up
essential nutrition actions for
women and children.

5. Develop and implement measures that ensure transfusion ofsafe blood and blood products; and improve access to safe
blood.

－ 492 －



IMMUNIZATIONFAMILY PLANNING

NUTRITIONHEALTH FINANCING AND FINANCIAL
ARRANGEMENT.

HUMAN RESOURCE FOR HEALTHINFRACTURE AND EQUIPMENT－ 493 －

The government withdrawal of Ghana funds to the service overthe last few years has affected service delivery especially publichealth promotion and prevention activities across Ghana. This isworsen by the continued delayed reimbursement of healthfacilities to the NHIS at all levels.

There has been improvement in increasing thenumber of skilled staffs nationwide in effort toclose the ever-widening gaps but many rural
areas still lack the minimum number of skilled
staff to enhance service delivery and quality ofcare because of the refusal to go to the rural
areas when they are posted there.

－ 494 －

The health sector has a backlog of uncompleted
projects that not only hampered the provision ofadequate office space and accommodation for
staff across all regions, but also efforts to draw
in more clients because of overcrowding infacilities. There is inadequate and in some case alack of means of transport at health facilities toundertake outreach services into hard-to-reachcommunities and for health service monitoring
activities.

It will be a pleasure to be in Japanese land . This raises myhope and dreams as far as my profession as a pediatric nurse
is concerned.
As everyone would expect from a trip like this nature theseare my expectations;
1. To quickly acclimatize myself to the culture of the peopleof japan.

－ 495 －

 To improve my knowledge concerning the current

trends in the care of children.

 To have some basic equipment and protocols that willaid in the management of some critical conditions
concerning children.

 To establish good rapport with the colleagues fromother countries that will converge at the training
program. This will enable us share ideas even after
we have departed to our various countries.

 www.who.maternal_child_adolescent/epidemi

ology/.../gha www.ghanahealthservice.org
 www.ghsdhims.org
 www.gfdgh.org/disability
 www.google.com.gh Ghana national newborn health strategy andaction plan 2014 handout－ 496 －

－ 497 －7 Myanmar Wah Wah Win Hlaing

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～(1) Crude birth rate (per 1000 population)
Urban
28
19

1995
2005

Rural
30.1
21.9

 2015 data is not available yet.
(2) Crude death rate (per 1000 population)
Urban
8.6
5.5

1995
2005

Rural
9.9
6.4

 2015 data is not available yet.
(3) Leading causes of death (1990) and (2010)
We need to know which age group?
(4) Infant mortality rate (per 1000 live birth)

1995
2005

Urban
47.3
45.1

 2015 data is not available yet.
(5) Leading causes of infants death
1990(1) Prematurity(2) Birth Asphyxia(3) Sepsis

2010
Prematurity
Sepsis and Juandice
Birth Asphyxia－ 499 －

Rural
49.7
47

7 Myanmar Wah Wah Win Hlaing(6) Under-5 mortality rate (per 1000 live birth)
Country overall
1995
2005

72.4
70.02

 2015 data is not available yet.
(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:(1) Malnutrition(2) Diarrhoea(3) ARI
2010:(1) ARI(2) Brain Infection(3) Septicaemia(8) Maternal mortality rate (per 100,000 live birth)
1995
2005

Urban
99
96

Rural
176
143

 2015 data is not available yet.
(9) Leading causes of maternal death (2004-2005)(1) Post partum haemorrhage(2) Eclampsia(3) Abortion related(10)
Are there national standards for certifying disabilities in your country?
Yes. There are national standards for certifying disabilities in Myanmar.
Health – A health is a state of complete physical , mental and social well being andnot merely the absence of disease of disease or infirmity.
Impairment – An impairment is any loss or abnormality of psychologicalphysiological or anatomical structure or function
Disability – A disability I any restriction or loss of ability to perform an activity in themanner or within the range considered normal for a human being as a result of
impairment.
Handicap – A handicap is a disadvantage for a given individual , resulting from an impairment or disability , which limit or prevents the fulfillment of a role that isnormal (depending upon age,sex,and social and cultural factors) for that individual.

－ 500 －

7 Myanmar Wah Wah Win Hlaing(11)

Does your country perform any health check for infants and children?
If ‘Yes’,Yes-When (at how many months)? Once for every year till 5 years of age-How many times? Once a year
-What kinds of contents includes in each? From head to toe examination, if
there is no abnormalities, no additional examination. No laboratory examination atall. Just physical examination.

(12)
In the case any diseases or disabilities are confirmed, is there any support
services on them? Describe the services, if any.]
There are support services
Health services, education , livelihood, empowerment services(1). Health services – assistive devices, physical rehabilitation and psychologicalsupport,occupational therapy(2). Education services – institutional and inclusive education(3). Livelihood services – basic vocation traininig and financial support to begin small
businesses(4). Empowerment services – Self help group are often initiated by disabled people
organization, peer support network,support the sharing of information and resources atcommunity level.

－ 501 －

7 Myanmar Wah Wah Win Hlaing～Part (B)Preliminary Analysis～

1. Please try to describe the followings on the surroundings mothers and children.
(1) Three (3) Strengths in our country / region.
⇒ Maternal and Child Welfare：
1. Myanmar has a good family system that is strongly attachment withinfamily members.
2. Myanmar has a good culture that children are looked after by not only
their parents but also their relatives and community.
3.
Myanmar is one member country of Convention of Right of Children.
⇒ Maternal and Child Health：
1. Political commitment2.
Dedicated and skilled health care providers
3.
More budget allocation for health(2) Three (3) Weaknesses / Challenges in our country / region.
⇒ Maternal and Child Welfare：
1. Poverty
2. Lower education level
3. Limited Resources ( Financial, Human, Infrastructure )⇒ Maternal and Child Health：
1. Human resource
2. Financial resourses
3. Geographical barriers(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? with disabilities?
1. Hard to reach population
2. Mobile population3.

Conflict areas and disaster(3) What kinds of services are there for the above mentioned groups?
- Community based interventions- Mobile clinics－ 502 －

7 Myanmar Wah Wah Win Hlaing

4. In implementing health/welfare policies and services by your organization：⇒ to develop these strengths and improve these weaknesses,⇒ to develop the services for the most vulnerable populations,(1)In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
Maternal and child health
1.Birth spacing or contraceptive service
2. Post abortal care
3. STI / RTI and HIV/ AIDS
4. Exclusive breast feeding
5. Gynaecological cancer and subfertility
Maternal and child welfare
1. Take actions on Convention on the Rights of the Child more strongly
2. To Develop Case Manager for Social welfare case assessments
3. ECCD Policy advocacy and communication
4. Establishing more new ECCD Center or preschool
5. Parental Education(2) What are successful areas or programmes? List 3 areas or programmes.
1. Take actions on Convention on the Rights of the Child more strongly
2. ECCD Policy advocacy and communication
3. Child protection(3)What are these challenges? List 3 challenges.
1. Budget
2. Limited resources
3. Coordination(4)Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
There was 35.3 million people according to census 1983. According to mostrecent census in March/April 2014 the population of Myanmar on the 29th Marchwas 51,419,420 persons. The steady increase in population size has policy
implications for all sections of the economy particularly those of education, health,employment and housing. About 70% of the population resides in rural areas. The
economic polices of Myanmar is mainly on agriculture. Poverty incidence is higher－ 503 －

7 Myanmar Wah Wah Win Hlaingin rural (29.2%) than in urban (15.7%) in 2010. Because of worse weather changes
and diasasters, people in rural areas has low income and difficulty to seek healthfacilities. Their educational standards is just read and write and only primaryeducation. They earn for their living with difficulties. They do not have money tocome to our health care facilities (transportation charges). Some are living in hard
to reach area. There is no easy and facilitated transportation system. These arebarriers to reach health care facilities. Political commitment, multisectorial
involvement and more budgets allocation are important. Limited resources of men ,money and materials are the reason to solve.
(5)Describe your expectations to the training progrgram.
- To know Japanese MCH and Child welfare policies and activities- To exchange opinions to improve the health status of mothers and child and theirwelfare- To examine methods to improve surrounding mothers and children in our country
from the viewpoint of alleviation of disparities, within the scope of MCH and childwelfare.

－ 504 －

8 Myanmar

THET Thet Aye

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its“Changes” compared with previous data and “Disparities within the country”. The Latter ismuch important for the coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
Urban
28
1995
19
2005
NA
2015

Rural
30.1
21.9
NA

(2) Crude death rate (per 1000 population)
Urban
1995
8.6
2005
5.5
2015
NA

Rural
9.9
6.4
NA

(3) Leading causes of death (1990) and (2010) We need to know which age
group.
1990:
1)
2)
3)
2010:
1)
2)
3)
(4) Infant mortality rate (per 1000 live birth)
Urban
1995
47.3
2005
45.1
2015
NA

－ 505 －

Rural
49.7
47
NA

8 Myanmar(5) Leading causes of infants death (1990) and (2010)
1990: 1) Preterm LBW
2) Birth asphyxia
2010 1) Preterm LBW
2) Sepsis/NNJ(6) Under-5 mortality rate (per 1000 live birth)
1995
2005
2015

THET Thet Aye

3)Sepsis3) Birth asphyxia

Country overall
72.4
70.02
NA

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1) Malnutrition
2) Diarrhoea
3) ARI
Morbidity rate:1) Not available
2)
3)
2010:
Diseases:Morbidity rate:1) ARI
1) NA

2) Brain infection
2)3)(8) Maternal mortality rate (per 100,000 live birth)
Urban
1995
99
2005
96
2015
NA

3) Septicaemia

Rural
176
143
NA

(9) Leading causes of maternal death (1990) and (2010)

1990: 1)Septic induced abortion

2010: 1) PPH(10)2) PPH

3) Eclmpsia
2) septic abortion with septicaemia
3) Ecalmpsia

Are there national standards for certifying disabilities in your country?
Yes / NoYes.
If yes, please explain briefly.

There are national standards for certifying disabilities in Myanmar.
Health - A health is a state of complete physical , mental and social well-being and not merely theabsence of disease or infirmity.
Impairment -An impairment is any loss or abnormality of psychological physiological or anatomical
structure or function
Disability-A disability is any restriction or loss of ability to perform an activity in the manner orwithin the range considered normal for a human being as a result of impairment.
Handicap- A handicap is a disadvantage for a given individual , resulting from an impairment or
disability, which limit or prevents the fulfillment of a role that is normal (depending uponage,sex,and social and cultural factors) for that individual－ 506 －

8 Myanmar(11)

THET Thet Aye

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)? Once for every yr till 5yrs of age.
-How many times? Once a year
-What kinds of contents includes in each? From head to toe examination, if
there is no abnormalities, no additional examination. No lab investigation at all, justphysical examination.

(12)
In the case any diseases or disabilities are confirmed, is there any support serviceson them? Describe the services, if any.]
There are support services.
Health services, education, livelihood, empowerment services(1). Health services-- Assistive devices, physical rehabilitation and psychological support,
occupational therapy(2). Education services- Institutional and inclusive education(3). Livelihood services-- Basic vocational training and financial support to begin small businesses(4). Empowerment. Services- Self help group are often initiated by disabled people organization ,peer support network ,support the sharing of information and resources at community level.

－ 507 －

8 Myanmar～Part (B)

THET Thet Aye

Preliminary Analysis～※It is recommended to analyze those strengths/weaknesses through the discussion withthe authorities concerned (health and welfare) before coming to Japan in order to facilitate
to find the way for the collaboration between health and welfare for mothers and children.
Preferably country report should be prepared in collaboration with authorities.
1. Please try to describe the followings on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare：（1).Myanmar has a good family system that is strongly attachment
within family members.
- (2.).Myanmar has good cultural that the children are looked after not
only their parents but also their relatives and community.
- (3.).Myanmar is one member country of convention of Right of children.
⇒Maternal and Child Health：(1) political commitment(2).Dedicated and skilled health care providers(3).More budget allocation for health.
② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：- poverty- Low education- Limited resources, Financial, Human, Infrastructure⇒Maternal and Child Health- Human resorce- Financial resources- Geographical barriers
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? with disabilities?
-

Hard to reach population
Mobile population
Conflict areas－ 508 －

8 Myanmar

THET Thet Aye

3. What kinds of services are there for the above mentioned groups?
- Community based intervention- Mobile clinic
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,① In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
For Child health
1.Strengthing of newborn care, early essential newborn care, essential
newborn care
2.Expanded Program for Immunization
3.Control of common Illness eg. Pneumonia and diarrhea
4.Child nutrition
5.Maternal education
For child welfare
1. Take actions on Convention on the Rights of the Child more strongly
2. To Develop Case Manager for Social welfare case assessments
3. ECCD Policy advocacy and communication
4. Establishing more new ECCD Center or preschool
5. Parental Education②What are successful areas or programmes? List 3 areas or programmes.
1. Expanded program for immunization

For child welfare
1. Take actions on Convention on the Rights of the Child more strongly
2. ECCD Policy advocacy and communication
3. Child protection②What are these challenges? List 3 challenges.
4. Budget
5. Limited resources
6. Coordination－ 509 －

8 Myanmar

THET Thet Aye③ Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
-

Man, Materials and Methods④Describe your expectations to the training program.
1. To know Japanese MCH and Child welfare policies and activities
2. To exchange opinions to improve the health status of mothers and child and theirwelfare3. To examine methods to improve surrounding mothers and children in our country
from the viewpoint of alleviation of disparities, within the scope of MCH and childwelfare.

－ 510 －

－ 511 －1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its“Changes” compared with previous data and “Disparities within the country”. The Latter ismuch important for the coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
Country overall(World Databank)
31
1995
27
2005
24 (2013) 24.24 (2014)
2015

Country overall(DOH Website)24
19.8
19 (2010)(2) Crude death rate (per 1000 population)
Country overall(World Databank)
1995
6
2005
6
2015
7 (2013) 4.92 (2014)

Country overall(DOH Website)
4.7
5.0
5.2

－ 513 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(3) Leading causes of death (1990) and (2010)(4) Infant mortality rate (per 1000 live birth)
Country overall(CIA World Factbook)
1995
2005
23.51
2015
17.64 (2014)－ 514 －Country overall(DOH Website)
18.6
12.8
12.6 (2010)

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(5) Leading causes of infants death (1990) and (2010)－ 515 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(6) Under-5 mortality rate (per 1000 live birth)
Country overall(CIA World Factbook)
1995
46
2005
36
2015
28

Country overall(World Databank)
58.2
34.9
28

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1)
2)
3)Morbidity rate:
1)
2)
3)
2010:
Diseases:Morbidity rate:

1)
1)

2)
2)

(8) Maternal mortality rate (per 100,000 live birth)
Country overall(CIA World Factbook)
1995
46
2005
36
2015
28

－ 516 －

3)
3)
Country overall(World Databank)
58.2
34.9
28

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(9) Leading causes of maternal death (1990) and (2010)－ 517 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(10)

Are there national standards for certifying disabilities in your country?
Yes / NoIf yes, please explain briefly.

Yes. The Philippines through the National Council on Disability Affairs and theDepartment of Health uses a system called the Philippine Registry for Persons with
Disabilities (PRPWD) that lists all PWDs in the country. They are listed and issued withidentification cards by the National Council for the Welfare of Disabled Persons (NCWDP).
This was supported by the Republic Act No. 7277, otherwise known as the “Magna Carta
for Disabled Persons” and the its amendment under Republic Act No. 9422.
(11)

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)?
-How many times?
-What kinds of contents includes in each?

Yes, the Philippines performs health check for infants and children through the
Department of Health programs offered in barangay health stations and rural health units
during the first 1,000 days of their life up to five years old.
To ensure that neonates receive quality health care services, the practice of the
Essential Intrapartum Newborn Care and conduct of Newborn Screening and Hearing
Tests are routinely done, especially if they were delivered at birthing facilities and deliveries
were assisted by skilled health professionals.
For the infancy period, the Expanded Program on Immunization (EPI) ensures that
infants receive the immunization with the right antigen and dosage, at the right route,frequency and schedule. During this time, infants are also assessed in terms of their
physical and nutritional growth and development. Hospitals and birthing facilities are
certified as Mother- Baby Friendly in support to the promotion of breastfeeding from birth
up to 6 months or two years old.
The country also has programs intended for infants and children. The“Garantisadong Pambata” ensures that Vitamin A Supplementation and Deworming aredone during April and October for children up to less than five year old children incommunities. The program on the “Integrated Management of Childhood Illnesses”
ensures that they receive appropriate care in times of illnesses. Oral health services arealso delivered with the presence of our dentists in each rural health unit.
Massive campaigns are occasionally done. The Measles- Rubella, Oral Polio
Vaccines (MR OPV) immunization campaign happened in September 2014. Through thecollaborative efforts of the Department of Health and Department of Education, SchoolBased Immunizations and National School Deworming Days were scheduled andfacilitated in the government elementary schools in the country catering to students from
Grades 1 to 6.

－ 518 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH(12)In the case any diseases or disabilities are confirmed, is there any support serviceson them? Describe the services, if any.
The Republic Act No. 7277 is an act providing for the rehabilitation,
self-development and self-reliance of disabled persons and their integration into themainstream of society and for other purposes, rights and privileges of disabled persons:equal opportunity for employment, access to quality education, National Health Program,
auxiliary Social Services, telecommunications, accessibility (barrier-free environment), andpolitical and civil rights.
Batas Pambansa 344 Accessibility Law is an act to enhance the mobility ofdisabled persons by requiring certain building, institution, establishments, and other public
utilities to install facilities and other devices.”
EO 417 – Economic Independence Program- Markets for products and services ofcooperatives of PWDS and other Organization of PWDs engaged in livelihood, accessible
work center, and provision of capital for livelihood programs.
Joint DBM-DSWD Circular No. 2003-01- Implementing guidelines for Section 29 of
the General Appropriations Act for FY 2003 Entitled “ Setting Aside 1% of Government
Agency Budget for Programs/ Projects Related to Senior Citizens and the Disabled ”, used
for Information and Education (IEC) campaign/advocacy, Human Resource Development
and Capability Building, provision of employment opportunities, Protection and Safety
Program, Group Home/Foster Home, Policy Development/Legislations, researches, andother Programs/Projects/Activities/Services related to their respective mandates.

－ 519 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH

Part (B)Preliminary Analysis～※It is recommended to analyze those strengths/weaknesses through the discussion withthe authorities concerned (health and welfare) before coming to Japan in order tofacilitate to find the way for the collaboration between health and welfare for mothers andchildren. Preferably country report should be prepared in collaboration with authorities.
1. Please try to describe the following on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare:
1. Established Inter- Agency Council on Violence against Womenand Children
2.Gender mainstreaming as a strategy to promote women’s humanrights and eliminate gender discrimination in government systems,
policies and procedures
3. Established Early Childhood Care and Development system
which includes nutrition program that provides for the needs of young
children from birth to six (6) years old end hunger and reduce infantmortality rate
⇒Maternal and Child Health:
1. Institutionalized practice of Essential Intrapartum and Newborn
Care through the upgrading of health infrastructures andequipment and enhancement of technical capabilities of the healthhuman resources
2. Ensure provision of services under the Expanded Program on
Immunization
3. Specialized programs intended for mothers and their children(National Safe Motherhood Program, Family Planning Program,
Newborn Screening Program, Expanded Program on Immunization,
Adolescent Health Program, Oral Health Program, Nutrition
Program, Mother- Baby Friendly Hospital Initiative Program,
Program for the Integrated Management of Childhood Illnesses)② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare:
1. Delay in budget appropriation of some programs pertaining tomaternal and child welfare
2. Weak monitoring system in program implementation－ 520 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH

3. Existing policies are not fully implemented⇒Maternal and Child Health:
1. Maternal Mortality remains high in spite of various multi-sectoral
efforts to improve access and utilization of health services
2. Exclusive breastfeeding remains low while formula milkmarketing is still evident even with an existing E.O. 51 otherwise kownas the milk code
3. Universal reproductive health is yet to be achieved since thecontraceptive prevalence rate still remains low at roughly 50%
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? with disabilities?
1. The indigenous populations
2. Those populations living at geographically isolated areas and areas witharmed conflicts
3. Populations considered to be the poorest of the poor as identified by the
National Household Targeting System for Poverty Reduction (NHTS-PR)
3. What kinds of services are there for the above mentioned groups?
The use of the NHTS- PR has led to 3.8 million poor households being enrolled in
Pantawid Pamilyang Pilipino Program or the Philippine conditional cash transfer program,and the poor elderly receiving social pensions. It has also led to 4,000,000 health cards
being distributed which provide state-run health insurance for to poor families.
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,To achieve the best results in the implementation of maternal and child health policies, theDepartment of Health together with its partners put special focus on five criticalinterventions such as improvement of maternal health, reduction in infant and childmortality, prevention and control of HIV and AIDS and the establishment of service delivery
network in order for the mothers and children to have access and timely referral to basic
health services.
The poor and marginalized population are prioritized.
Activities and essential
interventions are done with synchronized implementation nationwide to be able to provide
tangible outputs which should be felt within the shortest possible time.

－ 521 －

1 PHILIPPINES LAILANI P. MANGULABNAN, MD, MPH①In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
1. Maternal Health
2. Infant Health
3. Child Health (Under Five)
4. HIV AIDS
5. Service Delivery Network②What are successful areas or programmes? List 3 areas or programmes.
1. Current focus on maternal and newborn health emphasized the integrated
Maternal, Newborn, Child Health and Nutrition as a national strategy toaccelerate reduction of maternal and child mortality and brought reforms such as
mapping and designation of facilities to provide basic emergency obstetric careand enhancement of facilities
2. Integration of newborn care to the maternal care protocol and the call for
mothers to deliver in health facilities with skilled health providers
3. Nutrition is highlighted for the first 1000 days of a child which is also integrated in
the life cycle approach programs and services of the Department of Health.
②What are these challenges? List 3 challenges.
1. Maternal mortality remains high
2. Neonatal mortality rate has little improvement. Newborn deaths are seen
across all wealth quintiles.
3. Nutritionally at risk pregnant women are also seen across the reproductive age
group③Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.

④Describe your expectations to the training program.
After the completing this training I expect to have achieved the following:• Comprehensive understanding of existing maternal and child health and childwelfare policies in Japan and how these policies were successfully implemented• Shared and discuss opinions on how to achieve equity in health and welfare acrossall populations• Learned strategies to minimize or eliminate disparities with regard to basic
maternal and child health and child welfare indicators－ 522 －

－ 523 －2 Thai THONGMEE Nardnarumon
Nardnarumon | 1Country report (Thailand)

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and
MCH”(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but
also its “Changes” compared with previous data and “Disparities within the
country”. The Latter is much important for the coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
1995
2005
2015

Country overall
17
13
11 (2013)

source: http://data.worldbank.org/indicator/SP.DYN.CBRT.IN?order=wbapi_data_
value_2013+wbapi_data_value+wbapi_data_value-last&sort=asc(2) Crude death rate (per 1000 population)
Country overall
1995
6
2005
7
2015
8 (2013)
Source: http://data.worldbank.org/indicator/SP.DYN.CBRT.IN?order=wbapi_data_
value_2013+wbapi_data_value+wbapi_data_value-last&sort=asc(3) Leading causes of death (1990) and (2010)－ 525 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 2Country report (Thailand)
1990:

1) Ischemic heart disease2) Road injury
3) Lower respiratory tract infection(8.8%)(6.5%)(5.8%)

2010:

1) HIV / AIDS
2) Ischemic heart disease3) Road injury(8.5%)(7.8%)(7.0%)

Source:http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_thailand.pdf(4) Infant mortality rate (per 1000 live birth)
1995
2005
2015

Country overall
23.7
15.3
10.5

Source: http://www.childmortality.org/index.php?r=site/graph&ID=THA_Thailand(5) Leading causes of infants death (1990) and (2010)
1990:
1. Birth asphyxia
2. Preterm birth
3. Congenital abnormally
Source: Bureau of Technical Advisors, Department of Health2010:
1. Condition in perinatal period
2. Congenital Malformation, deformation & chromosome abnormally
3. Disorder relating, preterm + fetal growth
Source: Health Information unit, Bureau of Policy & Strategy(6) Under-5 mortality rate (per 1000 live birth)
1995
2005
2015

Country overall
28.3
17.8
12.3

Source: http://www.childmortality.org/index.php?r=site/graph&ID=THA_Thailand(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)－ 526 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 3Country report (Thailand)

1990:
Diseases:
1) Condition in perinatal period
2) Congenital abnormally3) Diseases of respiratory system other that the upper
respiratory tract
Morbidity rate:1) 1.82) 1.53) 0.72010:
Diseases:
1) Gastrointestinal infection2) Influenza and pneumonia
3) Lower respiratory infection
Morbidity rate:1) 3.212) 3.113) 2.19
Source: bps.ops.moph.go.th/HealthInformation/ill55/ill-full2555.pdf(8) Maternal mortality rate (per 100,000 live birth)
Country overall
23
26
20

1995
2005
2015

Source:http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality2015/en/(9) Leading causes of maternal death (1990) and (2010)1990:
1. Obstruction of labour
2. Hemorrhage of pregnancy and child birth
3. Abortion
Source: http://bps.ops.moph.go.th/E-book/statistic/2533/image/6.pdf
2010:
1. Intra- and post – partum hemorrhage
2. Sepsis and Embolism
3. Indirect causes (HIV, Malaria)
Source: UNICEF Thailand Situation Analysis of Children and Women 2011(10)
Are there national standards for certifying disabilities in your country?
Yes / No－ 527 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 4Country report (Thailand)

If yes, please explain briefly.
There are 7 types of disabilities in Thailand
1. Visual Impairment
2. Hearing Impairment
3. Physical Disabilities
4. Psychiatric Disabilities
5. Intellectual Disabilities
6. Learning Disabilities
7. Autism Disorder
Source: http://www.ratchakitcha.soc.go.th/DATA/PDF/2555/E/119/22.PDF: http://www.person.ku.ac.th/new_personweb/per_6/per_6_4/per_6_4-6.pdf: Department of Empowerment of Persons with Disabilities(11)

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)?
-How many times?
-What kinds of contents includes in each?

Health check for infants and children
Times
Age
1

0-7 day2

2 months (+-7 days)

3

4 months (+-15 days)

4

6 months (+-15 days)

5

9 months (+-15 days)

6
7

12 months (+-15 days)
18 months (+-1 month)8

2 years (+-1 month)9

2 1/2 years (+-1 month)

10

4 years (+-1 month)Contents

Vaccination (BCG, HBV)
Complete physical examination
Vaccination (DTP+ HBV1, OPV1)
Development evaluation by DENVER II
Complete physical examination
Vaccination (DTP+HBV2, OPV2)
Development evaluation by DENVER II
Vaccination (DTP+HBV3, OPV3)
Development evaluation by DENVER II
Hematocrit
Vaccination (MMR1, JE1 JE2 next 4 wks.)
Development evaluation by DENVER II
Development evaluation by DENVER II
Vaccination (DTP booster)Development evaluation by DENVER II
Vaccination (JE3)
Development evaluation by DENVER II
Vaccination (MMR2)
Development evaluation by DENVER II
Vaccination (DTP booster)Development evaluation by DENVER II
EQ evaluation
Blood pressure
Urinalysis
Visual Acuity

Source: Department of health, Pediatric Infectious Disease Society of Thailand－ 528 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 5Country report (Thailand)(12) In the case any diseases or disabilities are confirmed, is there any support
services on them? Describe the services, if any.]
1. Disability identification card.
2. Medical services: Rehabilitation and treatment, prostheses and orthoses,
equipment, assistive devices and materials are provided without charges.
3. Education: Entitled to education and education facilities, tools, services
and other assistance without any charges up to bachelor’s degree.
4. Allowance: monthly disability allowance 800 Baht/month (2015).
5. Personal assistant: severe disabilities are eligible to apply for a personal
assistant for help with their routine daily activities with the maximum
service period of 6 hours/day or 180 hours/month.
6. Sign language interpretation services.
7. Fund for Empowerment: entitled to receive loans without interests to startup small enterprises with a five-year payback period.
8. Provision of assistive devices and mobility aids.
9. Modification of housing environment.
10. Disability Employment.
Source:: http://www.ohchr.org/Documents/Issues/Disability/LiveIndependently/Thailand.doc: Department of Empowerment of Persons with Disabilities～Part (B)Preliminary Analysis～－ 529 －

2 Thai THONGMEE Nardnarumon
Nardnarumon|6
2 Thai THONGMEE
Nardnarumon
Nardnarumon | 6Country report (Thailand)
Country report (Thailand)～Part(B) Preliminary
Analysis～※It
is recommended
to analyze
those strengths/weaknesses through thediscussion
with the authorities
concerned(health and welfare) before
coming※It
is recommended
to analyze
those strengths/weaknesses
through
the
to
Japan
in
order
to
facilitate
to
find
the
way
for
the
collaboration
betweendiscussion with the authorities concerned (health and welfare) before coming
healthandinwelfare
forfacilitate
mothers toandchildren.
Preferably
country reportbetween
shouldto Japanorder tofind
the way
for the collaborationbepreparedin collaboration
withandauthorities.
healthand welfare
for mothers
children. Preferably country report should
be prepared in collaboration with authorities.
1. Please try to describe the followings on the surroundings mothers and1. children.
Please try to describe the followings on the surroundings mothers andchildren.
① Three (3) Strengths in your country / region.
Maternal
and ChildWelfare：① ⇒Three(3) Strengths
in yourcountry / region.
1.
National
strategy
focusingon MCH welfare.
⇒ Maternal and Child Welfare：2.
networkon MCH
welfare.
1. Area
National
strategy
focusingon MCH welfare.
3.
Fund
allocatetovulnerable
mothers and children
2. Area network on MCH welfare.
3. Fund allocate to vulnerable mothers and children⇒ Maternal and Child Health：
1. Benefit
packagein termsof health care for mothers and children⇒
Maternal
and Child
Health：2.
MCH-standard
publiccare
hospitals
1. Certified
Benefit package
in termsinofallhealthfor mothers and children
3.
High
coverageofMCH
healthservices
2. Certified MCH-standard in all public hospitals
3. High coverage of MCH health services② Three (3) Weaknesses/Challenges in your country / region.
Maternal
and Child Welfare：
② ⇒
Three
(3) Weaknesses/Challenges
in your country / region.
1.
Lack
of
accessibilityinsomeareas.
⇒ Maternal and Child Welfare：2.
violence
abusedchildren
1. HIV
Lackinfected,of accessibility
in or
some
areas.
3.
trafficking
2. Human
HIV infected,
violence or abused children
3. Human trafficking⇒ Maternal and Child Health：1.
Low public-private
and private hospital participated in⇒ Maternaland Child partnership
Health：national
program partnership and private hospital participated in
1. Low
public-private
2. Lowestof exclusive breastfeeding
nationalrate
program3.
of exclusive
health information,
2. Inaccuracy
Lowest rate ofbreastfeedingmanagement and referral
system
3. Inaccuracyof health information, management and referral
system
2. In your country / region, who are the most vulnerable populations? Please list
groups/ inorderwhoof priority.
2. threeIn your(3)country
region,are the most vulnerable populations? Please listEx)groupslivingrural
areas?
three (3) groups in order of priority.with low-income? with disabilities?
Low-income
peopleEx) 1.
groupsliving rural
areas? with low-income? with disabilities?
2.
Peoplewithdisabilities
1. Low-income people
3.
infectedchildren
2. HIV
Peoplewith disabilities
3. What kindsof services
there for the above mentioned groups?
3. HIV
infectedarechildren
3. What kinds of services are there for the above mentioned groups?
－ 530 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 7Country report (Thailand)

1. In terms of health services, those above mentioned groups can access tohealth care for free under the national health insurance.
2. In terms of social welfare, those people with disabilities will receive
monthly allowance 800 bath/person.
3. In term of child welfare, those children will receive support undercover by“The Child life project” that co-operated by Thai government, privateorganizations and NGOs.
4. In implementing health/welfare policies and services by your organization：⇒ to develop these strengths and improve these weaknesses,
MOPH should work with multi-partner to raise the important of mothers
and children at top priority of national agenda. Then, all stakeholders review andimplement necessary benefit packages for MCH health as regular.
To improve the weakness, the national authority should review past andcurrent situation in order to find gaps of existing policies and determine thesolutions to improve weakness especially how to involve private hospitals to takepart in national program.
⇒to develop the services for the most vulnerable populations,Thailand has universal health coverage scheme which covers all people
who are not covered by civil servant medical schemes and social security scheme.
So, all low-income people could access to health services for free especiallymaternal and child health care in public hospitals wherever they live.
What should be developed is the quality of health care. All people should
receive good care regardless of their abilities to pay and the type of health carefacilities. The MOPH tries to set standard and guidelines and also monitoring
system to monitor health services delivered by health care facilities.
① In your country/province, what are the priority issues/programmes in thearea of maternal and child health/welfare? List five issues/programmes in orderof priority.
1. Prevention and protection on teenage pregnancy.
2. Improve child rearing practices and increase child development.
3. Prevention and protection on maternal and child dead.
4. Maternal and Child nutrition promotion.
5. Stop human trafficking.

② What are successful areas or programmes? List 3 areas or－ 531 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 8Country report (Thailand)

programmes.
⇒ In term of health
1. MCH handbook
2. Certified MCH-standard in all public hospitals
3. Re-organize MCH board③ What are these challenges? List 3 challenges.
⇒In term of welfare
1. Violence against children and women
2. Human trafficking
3. Low exclusive breastfeeding④ Regarding
theabove-mentioned
issues/challenges,
explainbackground, current situation and reason why those issues/challenges are
difficult to solve.
For Violence against children and women issue, According to a report by
the Child Watch Project, approximately 3,825 children younger than 18 years
were sexually abused in 2005; the figure rose to nearly 5,300 in 2006,
representing a 36 per cent increase. Violence against children and womenconstitutes a serious violation of their human rights. Most commonly it takes
place in the home and family but is also present in schools, institutions,workplaces and communities. Violence can have a profound and life-long impact
on a child’s social, emotional and cognitive development and lead to anincreased chance of risky behavior, such as substance abuse, and exposure tomental health and social problems. The Crimes against Children, Juveniles andWomen Suppression Division of the Royal Thai police specializes in investigating
and responding to violence against women and children, however a relatively
strong legal framework, in practice, only a limited number of cases of violence
are reported, investigated and/or prosecuted. Enforcement of the legal
framework remains weak, particularly at the community level. This is exacerbatedby lack of resources for government services, in particular those of the Ministry ofSocial Development and Human Security, and the weak coordination between
agencies that are meant to prevent, monitor and respond to cases, which is why
this problem is difficult to solve.
For breastfeeding issues, the MICS 4 surveyed in 2012 showed that only
12% of mothers exclusively breastfed their children. This is the lowest rate of
EBF among ASEAN countries which is really need to be improved. From national
research, the main reasons why mother discontinue breastfeeding are 1)
returning to works, 2) misunderstanding and improper attitudes towards
breastfeeding and 3) lack of supports. The challenge for this problem is how toraise awareness of other sectors on the important of breastfeeding and seek theircooperation in order to build enabling environment for promoting breastfeedingpractices, for example, how to deal with the labor sector to increase maternity
leave to 6 months, how to deal with the company to control their advertisement
about infant formula.

－ 532 －

2 Thai THONGMEE Nardnarumon
Nardnarumon | 9Country report (Thailand)⑤ Describe your expectations to the training program.
1. To learn how to integrate Child welfare to maternal and childhealth.
2. To learn the best practices and experiences from Japan and othercountries.
 The Japanese health and welfare programmes for MCH on
1. The MCH book.
2. The promotion of breastfeeding in Japan.
3. How to promote reading culture for children in Japan.
4. MCH major health problems and how to solve it.
3. To share my experiences and views on maternal and child healthin Thailand.

－ 533 －

－ 535 －Part (A)Indicators

1. CRUDE BIRTH RATE-CBR (per 1000 population)
CBR indicates the number of live birth occurring during the year, per 1000 population
estimated at midyear. CBR-CDR provides the rate of natural increase, which is equal torate population change in the absence of migration.
YEAR

Country overall (According to DNETL)

1995

40,3

2005

40,3

2015

－ 537 －

2.CRUDE DEATH RATE-CRD (per 1000 population)
CDR indicates the number of death occurring in the year, per 1000
population estimated at midyear. CDR-CBR provides the rate of natural
increase, which is equal to rate population change in the absence of
migration.

Year

Country overall (According to DNETL)

1995

-

2005

9,7

2015

9,7

3. Leading causes of death (1990) and (2010
1 1. Lower respiratory infection
9 2. Diarrheal diseases
9 3. Measles
0
2 1. Lower Respiratory infections
0 2. Diarrheal diseases
1 3. Preterm birth complications
0－ 538 －

4. Infant mortality rate (per 1000 live birth)
Year
1990
2010
2015

Country overall (according to DHSTL) 2009-10
83/1000 lb (10-14 yrs before survey)
68/1000 lb (5-yrs before survey
22 /1000 lb

According NHSSP 2011-2030, IMR decrease to 15/1000 lb

5.Leading causes infants of death (1990) and (2010Year

Leading causes of death

1. Lower respiratory infection
1990 2. Diarrheal diseases
3. Measles

17
12.4
7.8

1. Lower respiratory infection
2. Diarrheal diseases
2010 3. Preterm birth complication

13.5
12.4
7.8

NB: cited from: www. healthdata.org onGlobal Burden
Disease profile in Timor Leste－ 539 －

6. Under - 5 Mortality rate ( / 1000 live birth)

Country overall (According to DHSTL) 2009-2010

Year
1995
2005
2015

83 (10-14 years before survey)
68 (5-years before survey)
22

The decline in National Planning and Strategic2011-2030 is TL
promise to resolve neonatal, infant and under-5 health, reduce infant
and under-5 mortality to reach the target for Millennium
Development Goal (MDG) 4, that is, to reduce under-5 mortality from
61to 27, infant mortality from 44 to 21 and 15 / 1000 live birth in
2030.
Cited in－ 540 －

7. Top 3 Diseases and Morbidity Rate of under -5 of (1990) and (2010)
Disease

1. Lower respiratory infection
1990 2. Diarrheal diseases
3. Measles

Morbidity
Rate
17
12.4
7.8

1. Lower respiratory infection
2. Diarrheal diseases
2010 3. Preterm birth complication

13.5
12.4
7.8

Year

NB: cited from: www. healthdata.org onGlobal Burden
Disease profile in Timor Leste

8. Maternal mortality rate (MMR) /100.000 lb

The recent Demographic Health Survey indicates a stable decrease on maternal mortality
rate from 660/100.000 reported in 2003 to 557/100.000 in 2010.

Years

Country Overall (According to DHSTL) 2009-2010

1995

1000

2005

557

2015

252 (MDG target)－ 541 －

9. Leading Causes of Maternal Death
Maternal death difine as death of mother during pregnancy, delivery
and 1 or 2 month after delivery.
The major direct complications of pregnancy reported are hemorrhage,eclampsia, obstructed labor and sepsis. A complication of pregnancy onhemorrhage is reported by 50.2% and indirect causes ismalnutrition,anemia and malaria

10. Are the National standards for certifying
Yes, there are－ 542 －

11. Does your country perform any health check for infants andchildren ?
•Yes,they do; follow to Livrinho Saude inan ho oan (Lisio)•start from 0- 11 months, until 5 years old,
• Contents incluiding Immunization and monitoring child growth anddevelopment graph, Vitamin A.

Part B
Preliminary Analysis－ 543 －

12. In the case any diseases or disabilities are confirmed, is there any
suport servises on them ? Describe the services, if any
Yes there is.

• Through collaboration of multi Ministerial approach to assist people with disabilities inTimor Leste as stated by TLDHS 2010 report that out of total population of 1.066.409,
approximately, 48.243 of people suffer from some type of disabilities such as 20.593 frommotor disability, 29488 from visual impairment, 17.672 from hearing impairment and 13.308
from mental disability. These figures show that there are people who have more than one
type of disabilities and thus will have risk of not getting the opportunity to work and accessto educational facilities. This report has made such an enormous impact on the IV
Constitutional government lead by PM Xanana to finally come up with the approval of
National Policy for Inclusion and Promotion of the Rights of People with Disabilities that wasapproved and signed by PM Xanana on April 2012. The policy stated that multi Ministerial
approach to assist and liaise with Disable persons in Timor Leste through subsidized financial
assistance.
• Assistance of Non Governmental Organizations (NGOs) to respective disabilities group• There is also group exist so called “ National Association of Disable Persons In Timor Leste”

1. Please try to describe the following on the surroundings mothers
and children
1. Maternal and child HealthThree (3) strength in your country / region
Maternal and child health• Health system follows an integrated approach• Nearly 1000 new graduated doctors are in the system now• The donor and partner co-ordination and support of MoH
Three (3) Weakness:• Budget constraints/Limited budget ( 4.5% of total state budget)• Low capacity of the human resources ( both for managers and clinical staff)• Weak health system with less stewardship/leadership• Geographical inaccessibility• Less demand for health services/low utilisation of health service delivery－ 544 －

2. Maternal and Child welfare:- Strength: there is law in place/exist to protect them, state support- Weakness: limited budget, isolation and discrimination•

2. In your country /region, who are the most vulnerable population (list 3)

Most vulnerable populations would be:• Children• Women• Elderly
Disabled persons• Rural areas: mainly isolated in hilly areas and separated by rivers, enclaved
population, lack of access to information and facilities• Low income population: although treatment/service is free, buttransportation is not available and costly in the rural areas, MoH’s referral
services is very weak,• Disabilities: unable to perform daily routines, isolation and discrimination－ 545 －

3. What kinds of services are there for the above mentioned groups?
Services available are:
• SISca/ mobile clinic• Plan for domiciliary visit by team of health professional ( guidelines
are on the process of the development)• All services are free of cost
• Free maternity packets• Social support/NGOs

4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,
1. In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
• SMH program to combat high MMR, move towards facility delivery• Strengthening PNC by home visits• Maternal perinatal death reviews and response• Strengthening hospital for treating sick newborn and managingcomplications in fivereferral hospital• Mobile message for increasing ANC, delivery and postnatal care

－ 546 －

2. What are successful areas or programmes? List 3 areas orprogrammes.
• Establishment of maternity clinic at sub-district level for increasing
institutional delivery• Strengthening 5 referral hospital including national hospital forcomprehensive EmOC services

3. What are these challenges? List 3 challenges.
• Many facilities still lack basic utilities such as water and electricity• No health post available in remote communities, CHCs should provide
basic mobile clinic services on a regular basis by motorbike on atwice-per-week basis.
• Stock out of essential medicine, equipment (logistic issues)• All midwives are not trained on EmOC, not able to manage
complications-under skilled－ 547 －

4. Regarding the above-mentioned issues/challenges, explain background,current situation and reason why those issues/challenges are difficult tosolve.

Timor-Leste is a small country covering half the island of Timor.
Regarding the above-mentioned issues/challenges, that situation will
be afect to health servise and difucult to resolve maternal child health
Problem in the future.

5. Describe your expectations to the training program.
- I would like to learn more about Japan’s experience and how to resolve thechallenges－ 548 －

－ 549 －13 Ukrine Iuliia Iakubovska

I uliia

Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its“Changes” compared with previous data and “Disparities within the country”. The Latter ismuch important for the coming discussion.
For your reference:■ THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)

Country overall
9,6
9,00
10,8

1995
2005
2014
(2) Crude death rate (per 1000 population)
1995
2005
2014

Country overall
15,4
16,6
14,7

(3) Leading causes of death (1990) and (2010)
1990:1) cardiovascular diseases,2) oncology,3) external causes
2010:1) cardiovascular diseases,2) oncology,3) external causes(4) Infant mortality rate (per 1000 live birth)
Country overall
1995
15
2005
10
2014
7,7

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13 Ukrine Iuliia Iakubovska

I uliia(5) Leading causes of infants death (1990) and (2010)
1990:
1) perinatal conditions ,2) congenital malformations,3) external causes
2010:1) perinatal conditions ,2) congenital malformations,3) external causes(6) Under-5 mortality rate (per 1000 live birth)
Country overall
1995
19
2005
15
2014
9,5
(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990:
Diseases:
1)
2)
3)Morbidity rate:
1)
2)
3)
2010:
Diseases:Morbidity rate:

1)
1)

2)
2)

(8) Maternal mortality rate (per 100,000 live birth)

3)3)Country overall

1995
2005
14,7
2014
11,6
(9) Leading causes of maternal death (1990) and (2010)
1990: 1) extragenital pathology,2) bleeding,3) tromboflebiya
2010: 1) extragenital pathology,2) bleeding,3) tromboflebiya(10)

Are there national standards for certifying disabilities in your country?
Yes / NoIf yes, please explain briefly.
Full or partial incapacity to work due to a general disease (including a non-industrial injury anddisability from childhood),
Degree of disability:
Group I, 100%;
Group II, 90%;
Group III, 50%.

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13 Ukrine Iuliia Iakubovska

I uliia

According to Article 1 of the Law of Ukraine "On the Rehabilitation of the Disabled in Ukraine" isa disabled person with persistent disorder of body functions and the interaction with theenvironment can lead to restriction of its life, so that the state must create conditions for therealization of its rights on a par with other citizens and ensure social security.
The person recognized invalid, depending on the disorder and functions of body systems andlimit its life is set I, II or III disability. I disability group is divided into subgroups A and B,
depending on the degree of disability and scope of health needs constant care, assistance orsupervision.
Conduct medical and social examination of persons applying for disability, disability isdefined by the Regulations on medical and social examination approved by the Cabinet of Ministers
of Ukraine of 03.12.2009 p. 1317 number.
The same decree the Cabinet of Ukraine approved the Regulations on the procedure and theconditions and criteria for disability (hereinafter - Regulation).
Instructions on establishing disability groups approved by the Ministry of Health of Ukraine of
05.09.2011, № 561.
Medical-social examination is to determine on the basis of a comprehensive survey of all
systems of the particular person measures the loss of health, the degree of limitation of life causedby persistent disorder of body functions, disability, cause and time of occurrence, as well asrecommendations regarding possible for a person for health types of work and working conditions,the need for outside care, appropriate types of spa treatment and social protection for the mostcomplete recovery of all functions of life person.
According to paragraph 27 Provisions basis for establishing group I disability is stable, much
more severe severity of functional disorders in the body caused by disease, trauma or congenital
defect, leading to significant disability persons inability to self-service and shall rise to the need forpermanent outside supervision, care or assistance.
To the group I belong to those with the most difficult health reasons that are not fully
capable of self-service, require permanent outside supervision, care or support, totally dependent onothers in the performance of vital welfare functions or are partially able to implement someelements of self .
The basis for the establishment of group II disability are persistent, severe severity offunctional disorders in the body caused by disease, trauma or congenital defect, leading tosignificant disability persons with intact capacity for self-service and do not result in the need forpermanent outside supervision, care or assistance.
By II disability groups may include persons who have two or more of the diseases that lead todisability, trauma or birth defects, and combinations thereof, which together cause significant
disability identity and disability.
The basis for the establishment of group III disability is stable, moderate functional
impairment in the body caused by disease, injury or consequences of birth defects that led tomoderate disability persons, including its efficiency, but require social assistance and social
protection.

－ 553 －

13 Ukrine Iuliia Iakubovska

I uliia(11)

Does your country perform any health check for infants and children?
Yes / No
If ‘Yes’,-When (at how many months)?
-How many times?
-What kinds of contents includes in each?
Clinical protocol
Care Healthy Child
AGED 0-12 months (monthly), 12 months - 3 years (monthly), 3-6 years (each 3 months), 6-18
(yearly) years.
1. GENERAL PROVISIONS
2. Aims of Protocol
Clinical protocols developed to implement unified measures to create, maintain and strengthen
the health of children.
The protocols are based on the concept of an integrated approach to the provision of care forchildren recommended by the World Health Organization, which provides priority preventive
measures in the implementation of medical care for the child and family in order to attract allround development.
The Protocol defines the terms and scope of mandatory preventive medical examinations ofchildren, basic principles of care for development, rational feeding and nutrition, assessment ofphysicalandpsychomotor
development,
targetedcounselingparents.
If you notice deviations in the health of the child appointed additional medical intervention,according to current protocols of care to children with indications. Medical care for healthy
newborn baby is under the orders of the Ministry of Health of Ukraine of 04.04.2005 p. 152
number.
The protocol is based on the basic principles of EBM (Annex 1 to the Protocol).
All medical interventions envisaged in the protocol are carried out with the obligatory accountthe requirement of consent, parents (guardians, trustees) or their legal representatives.
1.2. Concepts and terms
Medical care for the child - a set of activities performed by health workers with the involvementof the family in accordance with the needs of each age period of child development and aimed
to create optimal conditions for its healthy harmonious development (physical, mental, social) in
a supportive safe environment, to ensure the rational feeding and nutrition, prevention of
diseases and injuries, formation of healthy lifestyle.
The list of components of medical care for the young child, which should be accessible to every
child:- Mandatory prophylactic medical examination;- Rational feeding and nutrition;- Care for development;- Creating a safe environment.

－ 554 －

13 Ukrine Iuliia Iakubovska

I uliia

2. ORDER OF MANDATORY preventive medical examination of CHILD
2.1. Terms
Mandatory medical preventive examinations of children are carried out in order to monitor theirhealth status and implementation of effective measures to protect the health and development ofchildren
in
this
age
group
by:
- Assessing the health of the child;- Assessing the physical, mental and motor development;- Evaluation of feeding and nutrition;- Early detection of diseases and pathological conditions;- Vaccination;- Advising parents on child care, nutrition, child development, prevention of accidents andinjuries, etc;
- Determining the tactics of further medical observation and examination of the child by the
results of mandatory health checkups.
(12) In the case any diseases or disabilities are confirmed, is there any support serviceson them? Describe the services, if any.
Special allowances for children with disabilities
Paid to one of the parents of a disabled child where that parent is capable of work but is not
actually working, or paid to a person who replaces that parent. If that parent or guardian is engaged
in the full-time care of the disabled child up to the age of 16 years she/he is entitled to assistance.
This assistance is equal to 100% of the national minimum wage per month.
Assistance to single mothers for their children is given to the amount of:
100% of the minimum wage to single mothers (widows, widowers) who were deprived of theirparent’s care and brought up in children’s homes (residential schools) and who have children aged
up to 16 years (18 if they are still at school);
Universal in-kind benefit , entitlement to people in need of care due to the health conditions,organized regionally on the municipal level and financed by local budget .
The need for long-term care is defined by different categories of persons using several criteria(basically age and health conditions). Old age criteria: the recipient should reach the age of 60.
Health criteria: children with disabilities and people unfit to work and to perform every day selfcare and movements.
Help of professional with house work and personal hygiene, free food delivery.
Possibility of receiving a care for a few hours in stationary for receiving a help of personal hygiene.
The state provide full-time nursing care in institutions such as state old-age, invalid and psychiatriccare homes.
Providing of special equipment and organization of training courses for recipient’s family members
or another person.
The state provides a cash payment to a family member or another person, who provides care to theperson who need it. This compensation depends of the degree of need of the person requiring careand determined in percentage of a base amount of minimum vital for able-bodied person.
15% - for caring invalid of Ist group of invalidity;－ 555 －

13 Ukrine Iuliia Iakubovska

I uliia

10% -for caring invalid of IInd group of invalidity, elderely people and childrens with desabilities;
7% - for caring invalid of IIIrd group of invalidity, persons who needs permanent care (regulationof Ministry of health)At the onset of other insured events (taking care of sick child under 14, another sick family member,a child under three or an invalid under 16, in the event of illness of the mother or caregiver)
temporary disability benefits are paid to insured individuals from the first day of disability from
Temporary Disability Fund.

－ 556 －

13 Ukrine Iuliia Iakubovska～Part (B)I uliia

Preliminary Analysis～※It is recommended to analyze those strengths/weaknesses through the discussion withthe authorities concerned (health and welfare) before coming to Japan in order tofacilitate to find the way for the collaboration between health and welfare for mothers
and children. Preferably country report should be prepared in collaboration withauthorities.
1. Please try to describe the followings on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
⇒ Maternal and Child Welfare ： （ 1. Ukraine's independence and economic
growth led to some achievements for children. The infant mortality rate in 1991 wasreduced by half. In 2001 the country adopted the first national program to prevent
transmission of HIV from mother to us-ment. During the period, 2001-2009. Suchtransfer is reduced by two thirds. In 2011 the Institute wasfounded Commissioner President of Ukraine on children's rights.
⇒Maternal and Child Health：
1. Legislation health of women and children in Ukraine includes most internationallyrecognized human rights.
2. Basic medical care is free of charge
3.
Since Ukraine's independence in order to improve the system of maternity andchildhood created a number of new pediatric structures such as PC; Medical
and genetic counseling; family planning centers; hospitals, child-friendly to young
people; centers of reproductive medicine, cardiac surgery, primary health care,prevention of HIV / AIDS, medical and social rehabilitation of children; hospices andmore.
② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：
1. Insufficient knowledge of parents regarding the education of children
Knowledge of parents about child development is very selective, full of
misconceptions, often dependent on commercial advertising or vice versa outdated
traditional approaches and, consequently, inadequate. The most effective training
programs parents work in integration with primary health care for mothers andchildren, which achieves maximum coverage of parents and young children and tosupport families interested in obtaining knowledge since the child waiting period to six
years. But between the sectoral approach and the involvement of social workers,
psychologists, teachers, specialists in early intervention and development of children
with special needs, are essential.
2. Abandoned children. With eight million Ukrainian children are around 94,705
children in specialized institutions (2012). Among the main causes of childabandonment - poverty, unemployment of parents, family and devaluation of moral
values, alcoholism and drug use. Abandonment of children can also be seen in thegrowth of the last decade the number of children living and working on the street.
3. Poverty among children and youth is also the risk of falling into the hands oftraffickers for sexual exploitation and forced labor. The lack of social opportunities
and drug addiction are pushing young people on the path of conflict with the law.

－ 557 －

13 Ukrine Iuliia Iakubovska

I uliia⇒Maternal and Child Health：
1. Low quality of primary health services for mothers and children. The quality ofprimary health services for mothers and children is low and access to services,
especially for vulnerable groups and rural population limited. The knowledge
and skills of parents for the care, nutrition and child development are insufficient. For
these reasons, the level of exclusive breastfeeding in Ukraine is only 18% and remains
one of the lowest in the region. Insufficient number of pediatricians and gynecologists.
2. Prevalence of diseases caused by iodine deficiency.
3. The lack of national standards for child development Ukraine does nothave national standards development. Accordingly, there can be parent
education quality standards, or standards for providing comprehensive basic
services to children, as they are based on accepted standards in the state development.
2. In your country / region, who are the most vulnerable populations? Please list three(3)groups in order of priority.
1. with disabilities
2. with low-income
3. groups living rural areas）
3. What kinds of services are there for the above mentioned groups?
Cash and in kind benefits.
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,⇒to develop the services for the most vulnerable populations,①In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
The transition from centrally planned economy to a free market also led to increased
unemployment and social inequality - the factors which affect children, particularly as a result of
the weakening of the state system of social security. The gap between rich and poor is widening.
Unemployment is increasing, especially in rural areas. Single parents and families with more than
one
child
were
in
very
difficultcircumstances.
Trying to stop this negative trend, in 2011 the government began reforming social support forchildren and families in Ukraine. However, towards the healthy development of children in Ukraine
are still many problems.
Beginning of life for many children is not good due to lack ofknowledge of their parents care and development in early childhood, outdated health system and is
not legally regulated advertising of breast milk substitutes and other potentially harmful products.
Only eighteen percent in the first half of mothers fed their babies only breast. Each year an
estimated 80 percent of infants are not protected from iodine deficiency disorders, caused by lack ofiodine in the diet of their mothers during pregnancy and in their own diet in the first years of life.
When children become teenagers, they face new challenges to their health in the form of drugs,
alcohol, tobacco, and unprotected sex.
Ukraine is the worst affected by HIV / AIDS country in Europe. HIV prevalence among the adult
population in Ukraine is the highest among all the countries of Europe and Central Asia. Since 2001
the number of new HIV cases are identified each year in the country, has doubled. As of 2010 HIVinfected people is 1.1 percent of the adult population. Eighty percent of them - young people.

－ 558 －

13 Ukrine Iuliia Iakubovska

I uliia

Although the main cause of transmission is sharing needles injecting drug users, but HIV isspreading rapidly among the general young population through unprotected sex. As a result, more
and more children are born with HIV. Number of infected pregnant women in the last five years has
doubled. In the center of the HIV epidemic in Ukraine - with the minor risk groups. So far, little
attention is paid to ensuring their access to health and social services. In 2004, in Odessa was tested
for HIV 29 children living in the street. Twenty of them were found HIV.
Care and treatment of children and families affected by HIV / AIDS are insufficient. From 1995
to 2012 HIV positive mothers 32,504 children were born; Of these, 21,916 have negative status;
another 6,735 children aged under 18 months waiting to confirm their status as 2814 - HIV positive.
In 752 children developed AIDS and 287 have died from AIDS-related diseases.
More children with positive HIV status is born in socially disadvantaged, young families, where
85 percent of parents - a person younger than 30 years. Ten percent vidmovlyayutsya positive
mothers from their children, and they fall into the state of children's institutions. Lack of knowledge
about HIV / AIDS among the general population and among trustees generates fear andstigmatization of people living with HIV and leads to violations of human positive children. There
are numerous examples of discrimination against children living with HIV. Often they do not
simply let attend kindergartens or schools, neglected and isolated from other children.
With eight million about 96,000 Ukrainian children living in state residential institutions orphanages, boarding schools and shelters. Families Poverty, unemployment, alcoholism and drug
abuse - the main reasons that parents abandon children. Thousands of children fleeing from theviolence that prevails in their home. They find refuge in the streets, where the risk of contracting
tuberculosis and HIV through injecting drug use. Many children fled from their homes because theyareleftalone,
butparentshavegone
abroadinsearchofwork.
Creating a juvenile justice system that is focused on prevention of juvenile crime is a complex
problem. Still not no special juvenile courts or juvenile insufficient number of trained judges,
prosecutors and lawyers who have engaged children in conflict with the law. Instead, the majority
of offenders are sent to the colonies, then the chances of reintegration into society are low. Little
attention is paid to fundamental social factors that primarily pushing minors into conflict with thelaw.
Ukraine - one of the sources for human trafficking. Although the true scale of the problem is
unknown, data from the International Organization for Migration show that a large number ofhuman trafficking victims - a young woman, and a smaller part - children from families with low
incomes, which are sold for sexual exploitation or forced labor. Children abandoned by parents,
especially the risk of becoming victims of traffickers.
②What are successful areas or programmes? List 3 areas or programmes.
Ukraine has made a number of commitments to improve the wellbeing of children - particularly
by signing and ratifying the Convention on Rights of the Child (in 1991) the Optional Protocol to
the Convention on the Sale of Children, Child Prostitution and Child Pornography (2003), theConvention on the Elimination All Forms of Discrimination against Women (in 2003) the Optional
Protocol to the Convention to participate in armed conflict (in 2004) the UN Convention against
Transnational Organized Crime (February 2004)
Ukraine was among the countries in 2001 initiated the General Assembly Special Session on HIV /AIDS. In 2002 Ukraine approved the final document of the UN Special Session on Children "WorldFit for Children".
In July 2007 the Verkhovna Rada of Ukraine adopted the Law of Ukraine On the State
Programme "National Action Plan to implement the UN Convention on the Rights of the Child'until 2016.

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13 Ukrine Iuliia Iakubovska

I uliia

In July 2007 the Cabinet of Ministers of Ukraine approved the Concept of the State program"Healthy Child" for 2008-2017 under the European WHO strategy "Health and development ofchildren and adolescents."
As of September 2013 Ukraine has not adopted the Law "On general salt iodization" aimed atprevention of disorders caused by iodine deficiency in children at risk of such disorders affected
80% of all newborns.
Verkhovna Rada of Ukraine not ratified the International Code on marketing of breast milk
substitutes, which negatively affects the quality of food young children. According to a study
conducted by UNICEF, the manufacturers of baby food sells its products in 65 percent of medical
institutions of Ukraine.
②What are these challenges? List 3 challenges.
（1.
2.
3.
）
③ Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
④Describe your expectations to the training program.
To learn international experience in the above matters, including the experience of Japan, to use it inwork on improvement of legislation on social protection and children’s welfare in Ukraine.
Learned experience will be used for:1. Develop an Action Plan to implement the National Strategy on human rights in the rights ofthe child subject to the provisions of the UN Convention on the Rights of the Child and
other
legal
acts.
2. Draft Law of Ukraine "On the State Programme" National Action Plan to implement the
UN Convention on the Rights of the Child "for the period till 2021".
3. Ensure submission to the Government a draft decree of the Cabinet of Ministers of
Ukraine "On approval of a comprehensive action plan to provide housing for orphans andchildren deprived of parental care, and persons from among them."
4. Draft Resolution of the Cabinet of Ministers of Ukraine concerning improvement ofProcedure of identification of children separated from their families, who are not citizens of
Ukraine and stated their intention to be recognized as refugees or persons in need ofadditional protection, and cooperation between executive power in carrying out their social
security
5. Draft Law of Ukraine "On the National Bank data on the children."
6. Develop a draft law on amendments to the Family Code of Ukraine and the Law of
Ukraine "On Protection of Childhood" in the part of the child's consent to adoption,
placement
under
guardianship,
fosterfamiliesandfamily-type
homes.
7. To approve the guidelines for consideration of the interests and opinions regarding thechild's consent at the device to family care (taking into account age and child development).
8. Provide support bill "On Ukraine's accession to the Convention for the Protection ofChildren and Cooperation in Respect of Intercountry Adoption."
2. 10. To approve the State Standard of Social Services Integration graduate institutions.
11. Provide a comprehensive study of the system of protection of children in Ukraine(statistical and qualitative data on the parameters of institutional care of children, support
services to children and families, adoption and review mechanisms for decisions on theplacement of children, etc.).
12. To ensure alignment of regulations with the Law of Ukraine "On Amendments to the
Law of Ukraine" On the health and recreation of children "on the health of children－ 560 －

13 Ukrine Iuliia Iakubovska

I uliiacombatants, children, one of whose parents died in the area of anti-terrorist operations or
military operations armed conflict or during mass actions of civil protest and children
registered as internally displaced persons. "－ 561 －

－ 563 －14-15 Uzbekistan
ANNEX-1

Shukurali ESHKABILOV Mashkhura ISMAILOVA

Suggested Guideline for Country Report for

JICA Knowledge Co-Creation Program(Countermeasure for Maternal and Child Health and Child Welfare)"Promotion of the Collaboration between Child Welfare and MCH”
(JFY 2015)～Part (A)Indicators～

Please confirm data of following Indicators: Not only data of ‘country overall’ but also its “Changes”
compared with previous data and “Disparities within the country”. The Latter is much important forthe coming discussion.
For your reference:■THE STATE OF THE WORLD’S CHILDREN 2015: Executive Summary（UNICEF）
http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf■World Population Dashboard 2015（UNFPA）
http://www.unfpa.org/world-population-dashboard(1) Crude birth rate (per 1000 population)
1995
2005
2015
(2) Crude death rate (per 1000 population)
1995
2005
2015

Country overall
29,8
20,4
20,8
Country overall
6,4
5,4
6,7

(3) Leading causes of death (1990) and (2010)
1990:
1)
2)
2010 1) Coronary Heart Disease 2) Stroke(4) Infant mortality rate (per 1000 live birth)
1995
2005
2015

3)
3) Liver disease

Country overall
57,05
48,39
42,45

(5) Leading causes of infants death (1990) and (2010)
1990:
1)
2)

－ 565 －

3)

14-15 Uzbekistan

Shukurali ESHKABILOV Mashkhura ISMAILOVA

2010: 1) pneumonia, 2) prematurity, 3) congenital malformations(6) Under-5 mortality rate (per 1000 live birth)
1995
2005
2015

Country overall
68,62
58,37
51,41

(7) Top 3 diseases and morbidity rate of the under-5 of (1990) and (2010)
1990: Diseases:
1) Diseases of the respiratory system (J00-J99)
2) Certain conditions originating in the perinatal period (P00-P96)
3) External causes of morbidity and mortality (V01-Y98)
2000: Diseases:
1) Diseases of the respiratory system (J00-J99)
2) Certain conditions originating in the perinatal period (P00-P96)
3) External causes of morbidity and mortality (V01-Y98)

Morbidity rate:1) 270.3
2) 115.9
3) 50.1
Morbidity rate:1) 204.22) 110.9
3) 38.8(8) Maternal mortality rate (per 100,000 live birth)

Country overall
1995
32,0
2005
42,0
2015
36,0
(9) Leading causes of maternal death (1990) and (2010)
1990:
1)
2)
3)
2010:
1) bleeding2) septic condition(10)

Are there national standards for certifying disabilities in your country?
Yes, There is a LAW OF THE REPUBLIC OF UZBEKISTAN«On social protection of disabilities in the Republic Uzbekistan(11)

Does your country perform any health check for infants and children? - Yes-When (at how many months)? - On third and 15th days of life of infants and further every
month for a year
-What kinds of contents includes in each? - Anthropometry, Vaccination, Fortification(12)
In the case any diseases or disabilities are confirmed, is there any support services on them?
Describe the services, if any.]
In our country, health care for children free and always available－ 566 －

14-15 Uzbekistan～Part (B)

Shukurali ESHKABILOV Mashkhura ISMAILOVA

Preliminary Analysis～※ It is recommended to analyze those strengths/weaknesses through the discussion with theauthorities concerned (health and welfare) before coming to Japan in order to facilitate to find theway for the collaboration between health and welfare for mothers and children. Preferably country
report should be prepared in collaboration with authorities.
1.

Please try to describe the followings on the surroundings mothers and children.
① Three (3) Strengths in your country / region.
⇒Maternal and Child Welfare：
1. reduced maternal and perinatal mortality;
2. better relationship between health care provider and community; and3. complete and happy families.
⇒Maternal and Child Health：
1. Improvement of the health system as a whole;
2. Reduced mortality; and3. Improved qualifications of the health workforce;② Three (3) Weaknesses/Challenges in your country / region.
⇒Maternal and Child Welfare：
1. Further improving the availability and quality of care
⇒Maternal and Child Health：
1. Constant and continuous improvement of staff qualification
2. The need for strengthening the material and technical base
3. Further monitoring of the implementation of clinical protocols

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? with disabilities?
1. groups living rural areas 2. with low-income 3. with disabilities
3.

What kinds of services are there for the above mentioned groups?
1. Health check and treatment by governmental finance
2. Given financial support
3. To living rural areas send high qualified doctors for consultation, if they needed qualified
help direct to branch hospitals
4. In implementing health/welfare policies and services by your organization：⇒to develop these strengths and improve these weaknesses,• Desire to improve the quality of care by improving the results of surgical treatment of children
with congenital malformations• Develop high technology and minimally invasive surgery in newborns with congenital
malformations－ 567 －

14-15 Uzbekistan

Shukurali ESHKABILOV Mashkhura ISMAILOVA⇒ to develop the services for the most vulnerable populations,• Created a National Center of Neonatal Surgery at the Republican Perinatal Center and 4
branches of neonatal surgery center in the regions• It is organized a course on neonatal surgery in our center for doctors from the regions,
who will work for population living rural areas① In your country/province, what are the priority issues/programmes in the area ofmaternal and child health/welfare? List five issues/programmes in order of priority.
1. Guarantee of safe motherhood is one of the priorities of Uzbekistan state policy
2. System of obligatory premarital examination
3. Free medical care for vulnerable populations
4. Programs to improve nutrition of population
5. Implement international standards and recommendations for the motherhood andchildhood protection (WHO, UNICEF, UNFPA and etc.)②What are successful areas or programmes? List 3 areas or programmes.
1. Developed a network of Maternity and Child care clinics
2. 23% of budget funds were allocated for Health Care System
3.
Legal and regulatory framework of a public health system②What are these challenges? List 3 challenges.
（1.
2.
3.
）
③ Regarding the above-mentioned issues/challenges, explain background, current
situation and reason why those issues/challenges are difficult to solve.
④Describe your expectations to the training program.
• Exchange of experience• Lean something new to improve my practice• Familiarity with colleagues from other countries• See the fairyland Japan !!!

－ 568 －

－ 569 －Maternal Child Health & Child
Welfare in Viet Nam

Dr. Duong Thi Hai Ngoc
Maternal & Child Health Dept.-MOH
Tokyo, February 2016

Presentation Outline
1. Country Profile
2. MCH system
3. Main policies on MCH
4. Maternal & Child Health and Child
Welfare situation
5. Advantages & Challenges
6. Solution
7. Conclusion.
－ 571 －

 Location: South-East
Asia. Bordering the Gulfof Thailand, Gulf ofTonkin, and South China
Sea; alongside China,
Laos, Cambodia.

 Square: 329,560 km2
 Weather: monsoon in thenorth, tropical in the south 6 social-eco areas.
 63 provinces, 708
districts/towns, 11.055
communes, 110.000
villages－ 572 －

Country Profile Population: 90.7 mil Women of Rep age: 26.2 mil U15 pop: 23.1 mil
 Pop. Density: 274 people/km2
 Averaged Life Expectancy: 73.2
Male: 70 Female: 76.4
 Total Fertility Rate:
2.09
 Crude Birth Rate:
17.2%o Crude Death Rate:
6.9%o Sex Ratio at birth:
112/100
 IMR:
14.9%o MMR:
59/100,000 LB
Source: GSO 2014

Crude Birth and Crude Death Rateper 1,000 live birth－ 573 －

2. MATERNAL AND CHILD HEALTH,SYSTEM IN VIETNAM

HEALTH CARE SYSTEM IN VIETNAMMINISTRY OF HEALTH (MOH)
INSTITUTIONS, HOSPITALS, MEDICAL AND
PHARMACEUTICAL UNIVERSITIESDEPARTMENTS, AGENCIESPROVINCIAL HEALTH DEPARTMENTS (PHD) (63)
GENERAL AND SPECIAL HOSPITALSDEPARTMENTS (RH, PREVENTIVE, HIV)

DISTRICT HEALTH DEPARTMENTS (708)
HOSPITAL

DEPARTMENTS (RH, PREVENTIVE, HIV)COMMUNE HEALTH STATIONS (11.000)
DOCTORS/ DOCTORS ASSISTANTs, MID-WIVEs, NURSEs, PHARMACISTs

VILLAGES (110.000)
VHWs/SBAs－ 574 －

DEPARTMENTS AND AGENCIES OF MOH
AGENCIES/ADMINISTRATIONDEPARTMENTS• MOH Cabinet• Health insurance• International Cooperation• Mother and Child Health.
• Equipment and Civil
Works• Planning and Finance• Health Legislation• Human Resource• Health Inspection

Nationallevel: MOH,
institute,
hospital

Pro. level

Medi. Ser.

MCHD

Preventive

Pediatric Hos.

Obstetric Hos.

Ins. Nutri.

Provincial hospital
Obstetric

Dis. Level

Repro. HealthPreven. Health

Pediatric

District Health Dep.

District Hos.
Obstetric

RH Dep.

Pediatric

Prevent Dep.

Commune Health Station

Com. Level
Village• Medical Service• Traditional Medicine• Science and Training• Preventive Medicine• Health Environment
Management• HIV/AIDS Prevention• Drug• Food Safety• Informatics Technology• Population and Family
Planning

VHW/VBA

VHW/VBA

VHW/VBA

Chart of Reproductive Health care
－ 575 －

VHW/VBA
Cooperation
Directly Supervise

3. MAIN POLICIES ON MATERNALAND CHILD HEALTH, WELFARE IN
VIETNAM

Constitution in 1992 (Article 40) and 2013
(Article 36): The State shall protect the rights ofMother and Child.
Law on Protection People’s Health in 1989:
Chapter VIII: Implementation of family planning &health protection of women, children
Law on Health Insurance in 2008, amened 2014:
Law on Labour in 1995,.. 2012:+ Chapter 10. Regulation for Women workers+ Chapter 11. Regualtion for Juvenile employees
Law on Protection, Care & Education Children
in 2004 and amened in 2016
－ 576 －

Law on Social Insurance in 2006 & 2014
Law on Disability People in 2010
Decree guiding the implementation of the Law on
Disability in 2012.
Decree on trading and using nutritional products
for infantsDecree on policies to support health care for poor
women is ethnic minorities residing in remoteareas
Decision of the Prime Minister for approval
National Strategy on Protection, Care andEnhancing People’s Health phase 2011-2020, witha vision to 2030
Decision of the Prime Minister for approval
National Strategy on Reproductive Health Carephase 2001-2010; 2011-2020
Decision of the Prime Minister for approval
Plan of disabled assistance period 2006 – 2010
Joint Circular between MOH & MOLISA,
MOF, MOET providing for the determination oflevels of disabilities determination by council
performance level with disabilities (in 2012)－ 577 －

4.Maternal & Child Healthand Child Welfare situation

Maternal Health situation
Indicators

2011

2012

2013

2014

2015

ANC at least 3 times/4 times*
during 3 trimester pregnancy
(%)

79.1

89,4

90,4

90.6

86*

Facility Based Deliveries (%)

94.1

95.8

96.2

97.5

98

Deliveries Attended by Trained
Health Professional (%)

96.9

97.7

97.8

98

98

Post natal care within the 1st
week (%) ( within 1st and 42
days)

79

77.9

77.9

78.7

81.7

－ 578 －

Maternal Mortality Ratio in VN
Number of maternal death/100,000 live births
160
140

140
110

120

95

100

80

80

68

60

59

58.3

2014

2015

40
20
0
1990

1995

2000

2005

2010

Health Statistics, MOH

Leading cause of Maternal death
1990

%

2010

%

Haemorrhage

41

Haemorrhage

48

Exclampsia

21.3

Embolism

18.7

Obstetrical Infections

16.6

Exclampsia

14.6－ 579 －

Neonatal, Infant and Under 5 Child Mortality
in Vietnam 1990- 2015 (per 1,000 LB)
60
50
40
30

51
44

44

Neonatal
Mortality

36.7

32

26.8
22

20

23.8

19
17.8

17.8
15.8

10

22.4

22.3

14.9
12

14.8
11.9

0
1990

1995

2005

2010

2014

2015

Source: DHS , GSO, MICS and the state of the world’s children 2014

Leading cause of Infant death
1990

2010

Birth Asphyxia & Birth Trauma

Preterm birth complication

Preterm birth complication

Congenital abnormalies

Neonatal sepsis

Birth Asphyxia complication－ 580 －

InfantMortality
U5
Mortality

Evolution of Causes of death of children <5 years in
Vietnam
100%

6%

6%

7%

Prematurity

90%
80%
70%
60%
50%
40%

20%

18%

3%

5%

9%

9%
1%
4%

5%
6%
5%
3%

15%

10%

18%

22%

7%
3%
14%

18%

Other noncommunicablediseases
Other Group 1
Measles
Injuries

30%

14%

20%

8%

7%

15%

15%

12%

2000

2005

2010

10%

Sepsis and other infectious
conditions

10%

0%

Diarrhoeal diseases
Congenital anomalies
Birth asphyxia and birth trauma
Acute lower respiratory
infections

Child Nutrition Situation－ 581 －

Top 3 diseases of Child under 51990%

Acute Respiratory
Infections(for each child per
year)

5-8 times
ARI accounts for 3040 % of cases tohospitalization
among infants .

Acute Diarrhoeal
Diseases(for each child per
year)

4-9 times
ARI accounts for
35 % of cases tohospitalization
among infants .

2010

%

Acute Respiratory Infections(for each child per year)

4-6
times

Acute Diarrhoeal Diseases(for each child per year)

The disease can beprevented by vaccines(Measles)Other Viral Infections

Other factors:
Malnutrition (Stunting& Underweight)

Other factors: Accident,
Drowning, accident,
Overweight48-50%

3-4
times

5. Advantages and challenges－ 582 －

Advantages

 Commitments of the Government as well as Ministry of
Health and other minitries
 Health insurance coverage is relatively high (≈ 70%)
 Wide health care network, from central to village Success of family planning program: rate of using
contraception > 68%
 Deliveries supported by health staffs > 90%
 Vaccinations for children > 90% (TB, DPT, measles,
polio, hepatitis B, HIB) MMR and IMR tends to achieve the MDGs

Challenges (1)• NMR and MMR reduced but tends to slow down.
• Difference in health and nutrition of mothers andchildren among regions: availability, accessibility andquality of services.
• NMR remains high: 50% U5MR; 70% of IMR• Change in disease pattern in children: communicablediseases, disorders, injuries, mental health (autism)• Double burden of nutrition (underweight and obesity)• Unavailable data on abortion of large gestational age atprivate clinics.

－ 583 －

Challenges (2)• Reproductive health care for vulnerable groups
including adolescents, migrants, workers in industrial
zones or the elderly receives little attention.
• The private sector is growing rapidly, but limitedly
updated in regulations and supervision.
• Health management information system: limited
quality, inaccurate, incomplete and untimely reported,lack of data from private sector.
• Government budget is limited, funding is reduced(Vietnam become a middle income country)

6. Priority Solution－ 584 －

1. Increasing quantity and quality of services and accessiblility to
MCH services, welfare services, high priority for remote areas
2. For the rest areas: Improving the accessibility in order to have
universal access to all the MCH services.
3. Prioritize investment for vulnerable population like the Lowincomes; Group living remote areas or minority ethinic people;
Pregnant women & Child have chronic diseases, incl. HIV
infected and disability;
4. Improve M & E quality system in maternal and child health,including surveillance & respond.
5. Strengthen Behaviour Change Communication activities
integrated MCH services & welfare services.

30－ 585 －

7. Conclusion

Conclusion
 MMR, IMR, U5MR have been reduced remarkably, Viet Nam
could reach the MDG 1, 4 and 5.
 But Neonatal death is still high accounted for 70% of IMR,
50% of U5MR. The reduction is till slow.
 Disparity between socio-economic regions is large Improvement of accessiblity and quality of services should be
paid more attention, especially for the remote areas, forvulnerable group.
 Commitments and supports from local government and other
donnors is necessary and will determine the successfulness of
the MCH status.

－ 586 －

Expectation• Gain and understand of Japanese MCH and Child
welfare policies and activities.
• Exchange opinions about approaches to theimprovement surrounding mothers and children
health care activities and child welfare.
• Learn and methods to analysis the status of MCH
and Child welfare• Learn and apply the experience from the Japanese
MCH and Child welfare policies on development.

Thank you for your listening!

Sổ TDSKBMTE tại một số quốc gia: Băng- La- đét, Cộng hòa
Dominica, Indonesia, Kenya, Lào, Palestine, Philippin, và Mỹ－ 587 －