MOHAN PAUDEL

Views:
 
Category: Entertainment
     
 

Presentation Description

A CRITICAL ACCOUNT OF THE POLICY CONTEXT OF PERINATAL SURVIVAL IN NEPAL

Comments

Presentation Transcript

Slide1:

“A CRITICAL ACCOUNT OF THE POLICY CONTEXT OF PERINATAL SURVIVAL IN NEPAL ” MOHAN PAUDEL

A Critical Account of the Policy Context of Perinatal Survival in Nepal :

Mohan Paudel 1 , Sara Javanparast 2 , Gouranga Dasvarma 3 1 PhD Scholar, Southgate Institute for Health, Society and Equity, Flinders University 2 Deputy Director Planning and Research , Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia 3 Associate Professor in Population Studies, School of the Environment, Flinders University, Adelaide, Australia A Critical Account of the Policy Context of Perinatal Survival in Nepal 2 nd  International Conference on Public Health " Bridging the gap between research and policy and creating a global platform to discuss evidence based health policies and interventions in public health ." Date - 28th - 29th July 2016 | Venue - Colombo, Sri Lanka

Presentation Outline:

Presentation Outline Global picture of perinatal deaths Nepal : Still a Nation with poor perinatal survival International call to prevent newborn deaths and stillbirths Aim of this r eview Methods and review process Key policy values Key policy/strategy/guidelines (documents) Key policy strategies (strategic interventions) Key highlights and conclusions

1. Global picture of perinatal deaths--inequity, injustice and poor quality of care! :

1. Global picture of perinatal deaths--inequity, injustice and poor quality of care! Photo: Mother with her newborn in Nepal, Source: Save the Children, Australia; http:// www.savethechildren.org.au/savenewborns/solutions; Accessed on 7 Jan, 2015 2.6 million annually 7,178 deaths a day 99% in developing countries, 3/4 th in South Asia and Sub-Saharan Africa 2.7 million annually 7,397 deaths a day 99% in developing countries, 3/4 th in South Asia and Sub-Saharan Africa Approximately 1 million on first day, and 2million on first week of life Source: WHO. ( 2015a). Fact Sheet: Maternal, newborn, child and adolescent Health, Accessed 12 July at http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ WHO (2015b), Global Health Observatory (GHO) Data, neonatal mortality: situation and trends , Accessed 12 July at http://www.who.int/gho/child_health/mortality/neonatal_text/en / Source: WHO, 2015 Perinatal Deaths

2. Nepal: Still a Nation with poor perinatal survival—in-country inequities:

2. Nepal: Still a Nation with poor p erinatal s urvival—in-country inequities Trend of Childhood Mortalities at National Level in Nepal (1996-2011) Indicator National Mountain Neonatal Mortality Rate 33 46 Perinatal Mortality 37 >40 Source: Nepal Demographic and Health Survey, 2011 Stable neonatal mortality rate in the last 2 consecutive national Demographic and Health Surveys, 2006 and 2011 Omission and misreporting of stillbirths

3. International call to prevent newborn deaths and stillbirths:

3. International call to prevent newborn deaths and stillbirths Neonatal Mortality and Still Birth Targets by 2020, 2025, 2030 and 2035 Source : Every Newborn-An Action Plan to Reduce Preventable Deaths, WHO, 2014

4. Aim of this review:

4. Aim of this review To examine policy related documents for a critical account of the policy context related to perinatal survival in primary healthcare context of Nepal Provide a foundation for qualitative study (proposed) about perinatal survival focusing on mountainous region of the country Nepal in Map

5. Methods and review process:

Overall project in: First Phase Policy related document review Second Phase: Field Work: Qualitative interviews of women and their family members, health service providers, health volunteers and stakeholders in mountainous villages of Nepal 5. Methods and review process This presentation focuses only of the First Phase

5. Methods and review process…:

Web sites search + Physical and Email contacts with professionals working in Ministry of Health and Population, Department of Health Services, and Non-governmental organisations in maternal and newborn health in Nepal Identified documents : 6 Annual Reports (2009 to 2014); Program Assessment Reports (related to birth preparedness, newborn care (2); National policy, plan and strategies (6); Implementation Guidelines (6), Training/program management guide (1) Selected 6 documents Criteria: ( i ) Related to perinatal survival--that describes the key country policy intent/strategies in primary healthcare settings, recommended by the experts involved in maternal and newborn health activities of government and non-governmental 5. Methods and review process… The review process Qualitative content analysis (Bowen, 2009; Hsieh and Shannon, 2005), following a document review framework adapted from Newman et al. (2006ab) and Walt and Gilson (1994). Documents were organised in NVivo 10.00

6. Key policy/strategy/guideline (documents) :

6. Key policy/strategy/guideline (documents) 2004 2006 2002 2006 1997 2003 2014 2005 2007 2009 2013 1997 2007 2015 Note: Years denote initiation and successive revisions

7. Key policy values:

7. Key policy values

8. Key policy strategies (strategic interventions):

8. Key policy strategies (strategic interventions) Skilled Birth Attendants to provide care Mobilisation of Female Community Health Volunteers Support from district health team, safety and security and living arrangements for SBAs in rural areas Financial incentives to promote pregnancy and birthing care from health institutions Behaviour change —focusing on women, husbands, mothers-in-law Birthing Units in rural areas 24 hours a day, 7 days a week quality birthing care Emergency obstetric and neonatal care , referral support

9. Key highlights and conclusions:

The policy content focusses mainly on System : improvement in provision of birthing facilities such as birthing units ; S taff (SBAs as birth attendants) and Consumers (providing incentives for women to attend formal institutions for pregnancy checks and delivery) Policy acknowledgement of values Respect of culture ; equity ; women centred pregnancy, birthing and postnatal care; right based approach ; and gender and social inclusion 9. Key highlights and conclusions

9. Key highlights and conclusions…:

Policy tension in balancing home versus institutional births ; and focus remained mainly on changing health related behaviours Policy formulation only at national level, a growing focus on saving women and newborns, poor policy focus and direction on preventing stillbirth Policies mention of disadvantaged, rural and marginalized groups; no explicit policy direction targeting geographic belt such as mountain except monitory travel incentive for women to attend institution 9. Key highlights and conclusions…

Slide15:

Thank you for your attention! Any questions and comments ??? Could be reached at: mohanpdl@gmail.com

List of References :

Department of Health Services [Nepal]. (2015). Community Based Integrated Management of Neonatal and Childhood Illness (Program Management Module). Kathmandu (Nepal): Child Health Division [Department of Health Services ]. Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative research journal, 9 (2), 27-40. Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative health research, 15 (9), 1277-1288. Ministry of Health and Population [Nepal]. (2004). National Neonatal Health Strategy. Kathmandu (Nepal): Department of Health Services (Child Health Division) Ministry of Health and Population [Nepal]. (2006a). National Policy on Skilled Birth Attendants [ Supplementatry to Safe Motherhood Policy 1998). Kathmandu (Nepal): Department of Health Services (Family Health Division). Ministry of Health and Population [Nepal]. (2006b). National Safe Motherhood and Newborn Health Long-Term Plan, 2006–2017, MOHP, Kathmandu (2006). Kathmandu (Nepal): Department of Health Services (Family Health Division). Ministry of Health and Population [Nepal]. (2007). Safe Delivery Incentive Programme , Implementation Guideline 2005 (First Amended Version 2007) . Kathmandu (Nepal): Family Health Division ( Deapartment of Health Services). Ministry of Health and Population [Nepal]. (2013). Mother’s Protection Program-Implementation Guideline, 2008 (Second Amendment 2013). Kathmandu (Nepal): Department of Health Services (Family Health Division). Ministry of Health and Population [Nepal]. (2014). Maternal and Perinatal Death Surveillance and Response (MPDSR) Guideline, 2014 Kathmandu (Nepal): Department of Health Services (Family Helath Division). Ministry of Health and Population [Nepal], New ERA, & ICF International Inc. (2012). Nepal Demographic and Health Survey-2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland . Walt, G., & Gilson, L. (1994). Reforming the health sector in developing countries: the central role of policy analysis. Health policy and planning, 9 (4), 353-370. WHO. (2014). Every newborn: an action plan to end preventable deaths (draft) (pp. 41). Geneva: The WHO . WHO. (2015a). Fact Sheet: Maternal, newborn, child and adolescent Health, Accessed http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en / WHO. (2015b). WHO (2015b), Global Health Observatory (GHO) Data, neonatal mortality: situation and trends, Accessed 12 July at http://www.who.int/gho/child_health/mortality/neonatal_text/en/ Newman, L., Baum, F., & Harris, E. (2006a). Federal, state and territory government responses to health inequities and the social determinants of health in Australia. Health Promotion Journal of Australia, 17 (3), 217. Newman, L., Baum, F., & Harris, E. (2006b). 'Review Framework’, Australian Governments & Health Inequities Project. http://som.flinders.edu.au/FUSA/PublicHealth/AHIP/projects_list.htm List of References

authorStream Live Help