World Vision’s Little Book of Maternal and Child Health in the Asia Pacific pdf

World Vision’s Little Book of Maternal and Child Health HER & OT TH AL ILD HE CH in the Asia Pacific M Statistics and strategies to help bring Millennium Development Goals Four and Five within reach © World Vision Asia-Pacific 2009 Stories researched and contributed by World Vision communicators, 2008/2009 Editing and design: Katie Chalk Review: Laurence Gray, Dr Sri Chander To find out more about World Vision’s work with maternal and child health in Asia and the Pacific: www.wvasiapacific.org apro@wvi.org Contents: Left: Doctor Goat Thameesha has always suffered from wheezing and breathing difficulties Since he started drinking goat milk, he is stronger and his lungs less prone to asthma or infections “A villager told me that goat milk is good medicine,” says Thameesha’s father “So with World Vision’s help I went out and got a male and four female goats.” While the “medicinal” properties of goat milk are unconfirmed, its nutritional value for children is very high Thameesha’s father says since the goat’s milk was introduced to his children’s diets, their wheezing has all but disappeared Why health, why now? Who is this book for? Maternal and child health terms and definitions Part 1: Statistics 10 Part 2: Strategies 18 Part 3: Recommendations 40 References and reading 44 Photo: Hasanthi Jayamaha/World Vision Lanka Why health, why now? An introduction by Watt Santatiwat, Vice President,World Vision Asia Pacific region Maternal and child health and nutrition interventions are complex issues for the Asia Pacific region level on maternal and child health Each country faces a different set of challenges, and no country can rest just yet As statistical indicators they measure the health of a nation and the level of its development But behind those statistics are the shadows of many other urgent development issues - gender inequality, massive wealth discrepancies, inadequate education or public health spending, and the tragedy of avoidable deaths through under-prioritisation of women, children and the poor My home country of Thailand, for instance, has shown what can be possible with appropriate investment of government funds in its people.Yet even here, in a country that is often held up as a development model for others, there is room for improvement We still see unacceptable levels of preventable illness and deaths in marginalised communities, and malnutrition still exists in our children in both rural and urban areas The Asia Pacific region has made some progress in changing the health of mothers and children for the better But we still seriously lag behind in our efforts The region still makes up 43% of the world’s total maternal deaths, and well over 40% of our children are malnourished Fighting malnutrition needs to be a priority in all Asia Pacific countries, not just for children at different stages of their growth, but also for mothers Over 30% of women are malnourished in this region, harming expectant mothers and reducing the chances of survival for their children before they are even born In our region, 18 of the 29 developing countries are currently off-track to achieve Goal – to reduce child deaths by two-thirds, and 23 are off-track to achieve Goal – to reduce maternal deaths by three-quarters Spending on health and nutrition needs to be increased and improved The Asia Pacific region spends well below the world average of 5.1% of GDP In South Asia only 1.9% is currently spent on health – and one in every five children that dies worldwide is an Indian child In 2010, World Vision will commence advocacy efforts across the region to encourage solutions at national The ADB estimates that additional government investment of only around $3 per person per year, spent carefully to target specific healthcare gaps, could bring the MDGs within reach Private sector contribution to health coverage is a vital component of strategies for meeting MDGs Four and Five However, this should not detract from or replace government responsibility for public health care This region is calling out for private and public collaboration on research, improvement and promotion of healthier living, in tandem with facilities and resources to improve the health of mothers and children in the Asia Pacific’s most vulnerable communities I urge governments and donors in the Asia Pacific to recognise the way forward on sustainable, equitable health solutions to protect mothers and their children It is at once a humanitarian duty and an investment in the future resilience of every nation in the region Watt Santatiwat August 2009 Who is this book for? This book is for anyone with an interest in maternal and child health, but in particular for people who can play a role in strengthening it The Asia Pacific has some of the biggest health challenges of any region Here, health is a complex issue, at the heart of community development and wellbeing and yet held back by resources, attitudes and traditions These aspects come together as barriers to deny fair access to health for more than half the people living in the Asia Pacific As an international NGO with a strong grassroots approach, World Vision is ideally placed both to deliver health strategies in under-resourced communities, and to recognise gaps that cannot be filled without the support and mobilisation of others This book explores some of these gaps, as well as potential solutions to fill them, by sharing stories from World Vision’s field experiences A single story may not constitute “evidence” but it can bring unique insight into challenges, and how current health practices are missing the mark when it comes to pro-poor, child-focused protection of lives Born in a remote village in the district of Xieng Nguen, Baby Anoi has had his weight and height measured since birth, and passes the test each time Despite its relative poverty, Lao PDR is one of the Asian countries on track to achieve MDG Four The Laos government has announced its commitment to opening community health centres, providing better delivery care, immunisations and micro-nutrient supplements for infants and mobilizing resources to improve mother and child health World Vision currently partners with the government in rural areas to monitor child health through mobile clinics Photo: Albert Yu/World Vision Lao PDR MDG Four: Reduce child deaths (under five) by two thirds by 2015 MDG Five: Reduce maternal deaths by three quarters by 2015 On track: Bangladesh, China, Indonesia, Lao PDR, Solomon Isl.,Timor-Leste, Nepal, Sri Lanka, Thailand,Vietnam On track: China, Philippines, Solomon Isl., Sri Lanka, Thailand,Vietnam Off track: Cambodia, India, Myanmar, Papua New Guinea, Philippines, Vanuatu Off track: Bangladesh, Cambodia, India, Indonesia, Lao PDR, Myanmar, Nepal, Papua New Guinea, Timor-Leste Statistics and case studies in this book include only countries where World Vision is working in the Asia Pacific The summary above is based on World Vision’s 2009 report “Strategies that Work”: http://wvasiapacific.org/downloads/publications/StrategiesThatWork.pdf Maternal and child health terms and definitions Under five mortality rate The probability (expressed as a rate per 1,000 live births) of a child dying before reaching the age of five Infant mortality rate The probability (expressed as a rate per 1,000 live births) of a child dying before reaching the age of one year Maternal mortality ratio The probability (expressed as a rate per 100,000 pregnancies) of a woman dying during pregnancy, childbirth or the first 42 days after delivery Low birth weight A birth weight of under 2,500 grams Babies born with a low birth rate are twenty times more likely to die than babies born above the minimum weight of 2,500 grams Stunting Measures height against age: usually caused by long-term insufficient nutrient intake or frequent infections Stunting generally occurs before the age of two; effects are largely irreversible Wasting Measures weight against height in all ages: usually an indicator of acute food shortage and/or disease A high prevalence of wasting usually correlates with a high under-five mortality rate Underweight Measures weight against age: the indicator used to determine malnutrition in children under five Micro-nutrient deficiency Even in a diet where macro-nutrients (carbohydrate, protein and fat) are provided, a lack of micronutrients can lead to lasting and life-threatening malnutrition Common deficiencies include iron, vitamin A and iodine Vaccination Many childhood diseases including measles, polio, diptheria, tetanus and whooping cough are preventable through early vaccines However the measure of vaccination in statistical terms usually refers to immunisation against measles by the age of one year Improved water Access to uncontaminated, contained water sources Improved sanitation Safe disposal of excrement whereby it is separated from the possibility of human contact (usually means a toilet) World Vision is working in nearly 90 countries worldwide with health interventions to support the achievement of Millennium Goals Four and Five Across Asia and the Pacific, World Vision’s childfocused programmes are partnering at household, community and national level to: • Improve standards and increase action around maternal and child health • Empower girls and women with the knowledge to take good care of themselves and their children, including nutrition, vaccinations, first aid and family health responses, and birth spacing • Encourage governments and international donors to find ways to provide affordable, equal access for all to healthcare, in particular services for mothers and children under five World Vision Asia Pacific region encompasses: Bangladesh Cambodia China DPRK (North Korea) India Indonesia Lao PDR Mongolia Myanmar Nepal Papua New Guinea Philippines Solomon Islands Sri Lanka Thailand Timor-Leste Vanuatu Vietnam Part 1: Statistics Bangladesh % children underweight: Under mortality (per 1000): Living with improved water: Living with improved sanitation: Maternal mortality (per 100,000): 41% 61 80% 36% 320 Bangladesh’s poverty, and the constant setbacks of natural disasters, challenge its ability to remain food-secure In addition, gender inequality, including a lack of priority for girls’ education, means many mothers lack nutritional knowledge for themselves or their children All statistics in this section are taken from UNICEF’s State of the World’s Children 2009 unless otherwise noted 10 In Bangladesh today, 500,000 children are diagnosed with severe acute malnutrition The maternal mortality ratio is also high, ranging from 320-380 per every 100,000 live births As only around 7% of births are registered, this figure is an estimate and could easily be higher Strategy: Ensure mothers know benefits of exclusive breastfeeding and an appropriate diet Twenty-five-year old Sorufa Begum is excited to see her two sons growing so fast now that they eat improved khichuri (lentil curry) three times a day She says, “My three year old is growing faster than his older brother ever did.” The challenges of child malnutrition in Sorufa’s community in Bangladesh come not just from household poverty but also from the lack of nutrition knowledge in parents Sorufa only went to school till grade five and her husband Ferdous Ali, 30, is an illiterate rickshaw puller earning around taka 100 (USD 1.43) a day If health messages about food groups and the benefits of breastfeeding existed in their community, neither parent had previously heard them Now Sorufa is part of ongoing PD (Positive Deviance) Hearth demonstrations During Hearth training, groups of women congregate at one member’s house to cook nutritious meals, feed their malnourished children together and measure their children’s progress 34 The PD Hearth process provides 12 sessions, including demonstration of cooking and feeding, to the group After that they take on the responsibility themselves, cooking khichuri in their own houses and starting new groups of their own Sorufa says “Previously we used to cut the vegetables before washing, but now we cut the vegetables after washing When we cook rice we absorb, not boil, to preserve more goodness We used to cook khichuri with just rice, lentil, salt, chillies; but now we mix eggs and a variety of vegetables that give the food much more value for the growth of our children.” With the first year a crucial one for ongoing health in children, mothers are also learning to time their babies’ sleeps and to breastfeed exclusively for months They now understand that the colosterum (first milk) immediately after birth is the most important, and allow their babies to have it “All these are essential for the sound growth of children,” says Sorufa, “We didn’t know all this specifically before.” Photo: Raphael Palma/ World Vision Bangladesh 35 Above: Schoolgirls in Bangkok brush up on their food groups as part of a school health project administered by World Vision A surprisingly high level of malnutrition remains in Thai children from poor urban communities, whose families may not have the means or knowledge to provide a balanced diet, including exclusive breastfeeding Children who know the basics of nutrition can share this information and even start to make choices themselves for a lifetime of healthier eating Photo: Mathira Sutiwananiti/World Vision Thailand 36 Right:World Vision’s handwashing campaign reached children in schools throughout Jakarta to teach them about the importance of good hygiene Photo: Bartolomeus Marsudiharjo/ World Vision Indonesia Strategy: Inform and involve children 37 Strategy: Encourage mothers to recognise and share their child health achievements 38 Scenes from a PD (Positive Deviance) Hearth afternoon - a participatory nutrition approach that groups women together to learn about nutrition, prepare nutritious foods and feed their children together Left: Curious baby boy Mehedi Hasan crawls across to watch a nutrition volunteer preparing eggs for the baby food Mehedi is a new member of a World Vision Positive Deviance Hearth nutrition centre in Deopara Kaliganj Above: A community volunteer takes children through the basics of sanitation - use a toilet, wash your hands afterwards and always use soap Photos: Amio Ascension/World Vision Bangladesh 39 Part 3: Recommendations World Vision is currently spending $150 million a year globally on health programming and $300 million a year on in-kind contributions However, the size of the problem requires the mobilisation of much larger resources and the implementation of structures at a far larger scale than NGOs can provide To meet this urgent and pressing need requires commitment and effective implementation by each developing country government, and co-ordinated and well-targeted support by the international donor community In Hien,World Vision’s strategy for child health is two-fold - improve local food supply through home gardening, and educate mothers on healthcare and nutrition Mrs Along Got, a proud participant, shows off her breastfed baby and her home-grown produce Photo: Le Thiem Xuan/World Vision Vietnam 40 Students in Kampong Speu adding nutrient “sprinkles” to their morning meal, received through a World Vision School Feeding Project, 2007, delivered in partnership with the WFP The sachets contained vital micro-nutrients to help with problems of under-nourishment in the community’s children Photo: Sopheak Kong/World Vision Cambodia 41 World Vision’s Global Health Recommendations Donor nations need to: • Allocate at least 10% of their sector-allocable Overseas Development Aid to strengthening communityand district-level health systems, in order to provide universal maternal and child health services and support the scale-up of responses to HIV and other major infectious diseases • Alternatively, donor countries should contribute their fair share of the minimum $15 billion per year in aid required for basic health services by 2010; • Accelerate the increase in funding for HIV and AIDS, TB and malaria through the Global Fund, and other mechanisms where appropriate, in order to meet donor countries’ commitments to universal HIV prevention, treatment, care and support by 2010 and their commitments to combating other infectious diseases; • Work with high-burden countries to assist them in developing comprehensive, adequately funded and workable health plans that focus on effective health systems, with particular focus on delivering an essential package of care through strengthened community and district health interventions; • Work in a co-ordinated and transparent manner with other donors, through mechanisms such as the International Health Partnership (IHP), to ensure more effective and long-term support for health in developing countries; • Work with the international financial institutions to ensure that they not unduly influence or impose on developing countries fiscal conditions that hinder the provision of effective basic health services; • Support and adequately fund the WHO in its efforts to revitalise the Alma Ata commitments on Public Health Care 42 Photo: Kit Shangpliang/World Vision India High-burden countries need to: • Allocate at least 15% of government budgets to health by the end of 2010; • Provide detailed reports to national parliaments from this year, and each year thereafter, on progress in improving health and incorporating indicators of maternal and child health as key measures of health system performance; • Develop comprehensive, evidence-based, costed strategies that grant high priority to community- and district-level maternal, neonatal and child health services; • Ensure that all women and children have access to essential health services by 2011 and that cost is not a barrier to accessing treatment; • Set up and adequately resource national health monitoring systems that include birth and death registration 43 References and reading Reports/Publications MDGs Four, Five and achieving maternal and child Accelerating progress towards Six can only be met if thehealth health needs of families and in South-East Asia Millennium Development Goals andcommunities are met This requires mobilising the World Health Organization 2008 resources to bridge http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdfsystems the gaps between national health care local health care needs and Recommendation:The “7-11” approach Protecting mothers: conception through to post-natal care Adequate diet Iron/folate supplements http://whqlibdoc.who.int/hq/2005/WHO_CDS_CPE_PVC_2005.14.pdf 3.Tetanusfor the ASEAN Socio-Cultural Community 2009-2015 toxoid immunisation of which are not traditionally associated with Blueprint Malaria prevention 2008 intermittent preventive treatment health in the Nutrition in Asia” ADB periodical Vol 17 14th ASEAN Summit and “Investing in Child narrow sense, and include child and Healthy timing and spacing of delivery maternal (mal)nutrition interventions (among them John Mason, Joseph Hunt, David Parker,and Urban Jonsson 1999 http://www.14thaseansummit.org/pdf/Outcome_Document/ASEAN%20 Socio%20Cul%20Com%20Blueprint.pdf breastfeeding education and provision of microhttp://www.adb.org/documents/periodicals/ADR/pdf/ADR-Vol17-Mason-Hunt- De-worming Access to maternal health service: antenatal and postnatal Parker-Jonsson.pdf water and sanitation for hygiene, as well nutrients), Pacific Forum Statement on Health care, skilled birth attendance, Prevention of Mother-to-Child as other disease prevention, immunisation, and PFD Plenary, 2007 Investing in Maternal, Newborn and Child Health; the Case for Asia Transmission, HIV/STI screening access to community-based interventions in case of http://www.forumsec.org.fj/pages.cfm/newsroom/speeches/ and the Pacific Asian Development Bank and partners 2007 illness speeches-2007/pacific-forum-statement-on-health-pfd-plenary http://www.adb.org/Documents/Brochures/Maternal-Child-Health/InvestingProtecting children: Maternal-Child-Health.pdf html?printerfriendly=true newborn to two years If we are to minimise the number of child and Progress on Drinking-Water and Sanitation maternal deaths, we need to recognise the critical Appropriate breastfeeding health care, Putting children at the centre of WHO/UNICEF Jointand communities in identifying and role of families Monitoring Project 2008 World Vision briefing paper Essential Newborn Care 2009 http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index http://www.globalempowerment.org/PolicyAdvocacy/pahome2.5.nsf/ responding to their own health care needs, and Hand washing html cractionnews/A61AC8CC31F83B80882575B30040AEE1?OpenDocument& ensure that they have the access they need to Appropriate complementary feeding (6-24 months) quality basic Child and Maternal Deaths in the Asia Pacific: Adequate iron Reducing Newborn,health care services Who’s counting? 9.2 million children - the cost of inaction 6.Vitamin A supplementation Strategies that Work World Vision briefing paper 2009 Children and mothers need Oral Re-Hydration Therapy/Zinc World Vision/Nossal Institute 2009to be placed at the http://www.globalempowerment.org/PolicyAdvocacy/pahome2.5.nsf/cractionne centre of health care responses to ensure that the http://wvasiapacific.org/downloads/publications/StrategiesThatWork.pdf Care seeking for fever ws/4B6E7BA075FEFB218825754700192613/$file/WhosCountingWEB.pdf gap between available resources at a national level, Full immunisation for age The and the the World’s Children 2009: and communities, is State of local needs of families Why the G8 matters to 10 Malaria preventionchildren Maternal and Newborn Health World Vision briefing months) bridged 11 De-worming (+12 paper 2009 Deworming for health and development World Health Organizationnumber of areas, some These gaps exist in a 2004 Government/briefing papers UNICEF 2009 http://www.globalempowerment.org/PolicyAdvocacy/pahome2.5.nsf/alleports/0 73DCFF71ADD29258825758A0020E2EC?OpenDocument http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 44 Articles “A Global Challenge on our Doorstep: Improving Pacific health outcomes” Reference sites World Vision Asia-Pacific region http://wvasiapacific.org World Vision Global Empowerment http://www.globalempowerment.org ChildInfo Immunisation: Statistics by Region, UNICEF http://www.childinfo.org/immunization_status.html Regional facts on water, sanitation and hygiene, UNICEF http://www.unicef.org/eapro/wes_revised_factsheet_2009.pdf Nutrition status overview Vietnam, World Health Organization http://www.islandsbusiness.com/news/index_dynamic/containerNameTo Replace=MiddleMiddle/focusModuleID=130/focusContentID=16499/ tableName=mediaRelease/overideSkinName=newsArticle-full.tpl “India, China hold key to world meeting millenium development goals: UNICEF” http://www.thaindian.com/newsportal/lifestyle/india-china-hold-key-to-worldmeeting-millenium-development-goals-unicef_10080148.html “2 million children wasting in Bangladesh, UN warns” UN News Centre 2009 http://www.un.org/apps/news/story.asp?NewsID=30329&Cr=bangladesh& Cr1 “New survey reveals West Timor’s acute food security crisis” Church World Service/Reuters http://www.alertnet.org/thenews/fromthefield/284081/121146418139.htm http://www.wpro.who.int/vietnam/sites/dhp/nutrition/ Six mothers happily demonstrate breastfeeding in front of other“Worms stunting the growth of children” mothers and villagers during the celebration of World Breastfeeding Initiative website World Health Organization 2009 Positive DevianceWeek in Samlot district, early August After attending a three-day nutrition course organised and taught by how to protect http://www.wpro.who.int/media_centre/press_releases/pr_20020912.htm their children from being malnourished “I am delighted to see my daughter is healthy As a mothers’ group team leader, I have shared the information with other women who have “Prioritising maternal health in Sri Lanka” Keychildren in my Asia andsays Pacific, old Neav Channy (third from right) indicators for village,” the 27 year http://www.positivedeviance.org/about_pd/impact.html better World Vision staff, they understand much Asian Development Bank 2008 http://www.adb.org/Documents/Books/Key_Indicators/2008/pdf/Goal-04.pdf Photo: Bun Ying/World Vision Cambodia UNICEF 2009 http://www.unicef.org/devpro/46000_48498.html 45 46 Back cover: Serving up Sprinkles Distribution of Sprinkles, a mixture of essential micro-nutrients to make up for deficiencies common in Mongolian children, at a kindergarten in Selenge As a result of World Vision’s models for child health in the district, the malnutrition rate has gone from being one of the worst to the best in the country, and the Mongolian government has recently agreed to partially fund similar models Photo: Justin Douglass/World Vision Mongolia Left: Not cows, say breastfed children On the sixth floor of a busy department store in Jakarta, 30 children dressed as cows hand out balloons to passers-by “Are you cows’ children?” calls the facilitator “No,” chant the children “Are you breastfed children?” asks the leader “Yes!” they reply The event was part of a campaign around World Breastfeeding Week in early August 2008, arranged by World Vision to heighten public awareness of the importance of exclusive breastfeeding For more information on World Vision’s work in maternal and child health: Laurence Gray Asia Pacific Regional Advisor, Advocacy (Bangkok) laurence_gray@wvi.org Esther Indriani Maternal & Child Health, Nutrition Sub-regional Specialist (Indonesia) esther_indriani@wvi.org Bradley Thompson Health and HIV Advisor, World Vision India (India) bradley_thompson@wvi.org Photo:World Vision Indonesia 47 This book is for anyone with an interest in maternal and child health, but in particular for people who can play a role in strengthening it As well as a resource for collating and comparing statistics, it provides case studies and strategies from World Vision’s health projects across the Asia Pacific region to show what is possible with the right investment, planning and prioritisation World Vision is a Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice Motivated by our Christian faith,World Vision works with the world’s most vulnerable people.World Vision serves all people regardless of religion, race, ethnicity or gender ... right from the beginning.” “Since then, we have seen a positive increase in the interest of the mothers in their children’s health Every month the clinic is packed with over 50 mothers.” Strategy:... http://www.adb.org/Documents/Brochures /Maternal- Child- Health/ InvestingProtecting children: Maternal- Child- Health. pdf html?printerfriendly=true newborn to two years If we are to minimise the number of child and Progress on Drinking-Water... exists in our children in both rural and urban areas The Asia Pacific region has made some progress in changing the health of mothers and children for the better But we still seriously lag behind in