The Department of Health has published a Strategic Plan for MNCWH that is aligned to and supports the process of Primary Health Care (PHC) re-engineering. The three strands of the PHC – expanded school health services, ward-based outreach teams, and district clinical specialist teams – will play a key role in delivering community-based MNCWH services to communities and households, and will facilitate access to services at PHC- and hospital- levels.
The plan is aligned to achieving national and international development goals, including the following MDGs:eradicate extreme hunger and poverty; promote gender equality; reduce child mortality; improve maternal health; combat HIV and AIDS and other diseases.
The plan is aligned to achieving the following targets:
- To reduce the maternal mortality ratio from 310 per 100 000 live births in 2009, to 270 by 2014
- To reduce the U5MR from 56 to 50 per 1000 live births by 2014 and to 40 by 2016
- To reduce the IMR from 40 to 36 per 1000 live births by 2014 and to 32 by 2016
- To reduce the neonatal mortality rate from 14 to 11 by 2016.
The key to achieving these goals lies in the delivery of a cost-effective package of services to every mother, new born and child in every district. The strategic plan identifies priority interventions which will have the greatest impact on reducing maternal, new born and child mortality and enhancing gender equity and reproductive health. It also provides a roadmap on how to maximise implementation to ensure improved coverage, quality and equitable access to the services.
The priority health services identified for focussed planning and programming and which must reach every pregnant women, infant and child include the following:
- Basic antenatal care (four visits for every pregnant women, starting in the first trimester)
- HIV-testing during pregnancy with initiation of ART and other PMTT services where necessary
- Improved care during labour including access to dedicated obstetric ambulances and establishment of maternity waiting homes, and numerous others.
Essential services to ensure women’s health and equality include:
- Access to contraceptive services
- Post-rape care for adults and children
- Improved reproductive health services for adolescents through youth-friendly counselling and reproductive health services at health facilities and as part of school health services
- Improved coverage of cervical screening and strengthening of follow-up mechanisms.
Essential community interventions include:
- Provision of a package of community-based MNCWH services by generalist CHWs working as part of the ward-based PHC outreach teams
- Multi-sectoral action to reduce poverty and inequity, and improve access to basic services especially improved water and sanitation
- Development of a MNCWH communication strategy.
The strategy seeks to build on existing strategies and increase the reach and efficacy through community-based outreach programmes and national communications campaigns. For example, to improve Vitamin A supplementation coverage, Vitamin A campaigns, linked to other services, will be conducted annually. They will be strengthened by ward-based outreach teams.
In 2010, the President committed to reinstating public school health programmes. The new Integrated School Health Programme (ISHP) will build on existing school health services. These will, however, be strengthened through, inter alia, a commitment by the Departments of Health and Basic Education that every child will be reached, the provision of services to children in all four phases - foundation, intermediate, senior and FET – and the provision of a more comprehensive set of services, not only those that are barriers to learning, but also those that contribute to morbidity and mortality during child and adulthood. Importantly, a more systemic approach to implementation will be adopted, starting with the most disadvantaged schools and progressively ensuring all learners are reached.
Women’s health is prioritised for both pregnant women and those who are not pregnant. Outside of reproductive health services, the plan emphasises universal access to cervical and breast cancer screening and treatment as well as access to gender-based violence and post-rape services.
The plan emphasises the delivery of services through ward-based PHC outreach teams who will focus on the provision of maternal and child health services at community level. A draft “Framework for Accelerating Community-based Maternal, Neonatal, Child and Women’s Health and Nutrition Interventions” has been developed which identifies six delivery models. These are (1) Home visits by CHWs trained in specific tasks, (2) recruitment of mothers into organized support groups (3) regular outreach services for maternal and child health services, (4) Child Health days or weeks, (5) support to ECD centres, and 96) community and social mobilization.
A key and overarching intervention proposed by the strategy is the development of a comprehensive MNCWH communication strategy with a set of standardised messages in places. The objective will be to increase awareness of rights and services, and hence demand and increased community involvement and participation in maternal and child survival activities through delivery of the key consistent messages.
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