Situation Update: There is a significant increase in the utilization of antenatal care (ANC) and skilled birth attendance (SBA) in the last 10 years, from 31% and 24% (NRVA 2007/8) to 64% and 59% (AHS 2018) respectively. Under-5 child, infant and neonatal mortalities have reduced respectively from 175, 119 and 74 per 1,000 live births in 1990 (IGME) to 68, 52 and 39 in 2018 (IGME). The 2015 AfDHS reported a very high maternal mortality ratio at 1,296/100,000LB[1], a low Caesarean section rate (2.7%) and unchanged modern contraceptive prevalence for the last 10 years (20%). Maternal and child mortality remains among the highest in the region. Haemorrhage is the leading cause of maternal deaths (56%), followed by eclampsia (20%) obstructed labour (11%), and sepsis and infections (5%). Infectious diseases such as sepsis/meningitis (20%), pneumonia (17%), diarrhoea (14%), and other infections (12%) account for 63% of deaths among children under five years of age (AHS 2018).
[1] Pregnancy-related deaths seem to be overestimated. The AfDHS mortality data is under review by the global experts, including UN agencies, to produce adjusted estimates based on global UN model. MMR UN estimates are expected to be published by Feb. 2019.
Achievements:
- Supported the updating of Family Planning (FP) clinical guidelines, service standards, provider job aids and in-service training package.
- Trained 50 master trainers and over 450 health personnel on BEmONC, CEmONC, ENC, IMNCI, FP/BS, ETAT, MNDSR and adolescent health.
- Supported MoPH in strengthening RMNCAH programmes on FP, CRVS and MNDSR and improving subnational training capacity on CEmONC, BEmONC, IMNCI, ETAT, and Essential and Advanced Newborn Care.
- Introduced and supported MoPH in building an early childhood development programme.
- Supported MoPH in the adoption of the Home-Based Maternal and Child Health Book and its scale up as a national programme.
- Supported MoPH and the Health Cluster in developing national standards for the assessment, planning, implementation and M&E of emergency RMNCAH interventions targeted at IDPs, refugees and returnees.
Programme Risks and Challenges:
- Insecurity, hard-to-reach terrains, gender inequality, cultural barriers, a lack of female staff and low quality of available services affect both access to and utilization of health care for women and children.
- Despite high (95%) knowledge of contraceptive methods (amongst married women), contraceptive prevalence is low (around 20%).
- Child marriage leading to a high adolescent fertility rate of 78 births per 1,000 women aged 15-19 years.
- High illiteracy among women (84%) leading to poor utilization of ANC, SBA and FP/BS services.
- Influx of an increasing number of Afghan refugees and returnees from Pakistan and Iran.
Way Forward:
- Support MoPH technical capacity building in performance review of SEHATMANDI, with focus on quality of RMNCAH service delivery.
- Raise funds and implement the joint WHO-MoPH MDSR and FP/BS programme proposals.
- Continue technical support for revision of national clinical guidelines, service standards and provider training packages.
- Continue to build MoPH capacity in building an early childhood development programme.
- Scale up implementation of IMNCI and BEmONC pre-service training curricula at the key national medical universities.
- Continue to build MoPH research capacity on RMNCAH, e.g. by assisting in M&E of the MCH home-based handbook scaling up.
