Strategic Directions of the Department of Maternal, Newborn, Child and Adolescent Health For further information and publications please contact: Department of Maternal, Newborn, Child and Adolescent Health and Development (MNCAH) World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland Tel +41 22 791-3281 Fax +41 22 791-4853 Email mncah@who.int © World Health Organization 2011 Strategic Directions of the Department of Maternal, Newborn, Child and Adolescent Health Contents iii Contents 1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2. Vision, mission, goals, targets and indicators. . . . . . . . . . . . . . . . . . . . . . . . .3 3. Improving health along the continuum of care. . . . . . . . . . . . . . . . . . . . . . . .6 4. Strategic directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 5. Working across the three levels of the Organization. . . . . . . . . . . . . . . . . . . . 13 6. Working with other depart ments and with partners. . . . . . . . . . . . . . . . . . . . 14 7. Structure of the Department of Maternal, Newborn, Child and Adolescent Health . . 16 Annex: Functions of the teams and cross-cutting groups . . . . . . . . . . . . . . . . . . 18 Introduction 1 Introduction Maternal, newborn, child and adolescent health are central to the agenda of Primary Health Care. Healthy mothers can bear and raise healthy children who, when ena- bled to grow into healthy adolescents, are the foundation of future generations. Investment in one age group benets the other, and coordinated investment in all of these groups maximizes the intergenerational benets. Fostering a continuum of care that spans from pre-pregnancy, through pregnancy, childhood and adolescence not only makes programmatic sense, it is also imperative to address emerging health priorities. In pursuit of national and international goals and targets, the World Health Organization (WHO) is committed to contributing to the achievement of universal access to maternal, newborn, child and adolescent health services. Much has already been achieved in countries with the support of WHO, and since 1990, signicant progress has been made in reducing maternal and child deaths. In 2008, the global annual number of maternal deaths was esti- mated at 358,000, down 34% from 546,000 in 1990. 1 In 2009, the global number of child deaths fell to 8.1 million, down from 12.3 million in 1990. 2 In addition, 15 countries of the African Region have seen declines in HIV prevalence, much of it due to reductions in young people. 3 For maternal health, the greatest progress was made in countries of the South-East Asia and Western Pacic Regions, while for child survival, the greatest progress was made in countries of the European Region and the Region of the Americas. e overall progress in maternal and child mortality reduction was least in sub-Saharan Africa and the East- ern Mediterranean Region. 4 Despite good progress overall, the rates are not fast enough to reach Millennium Development Goals (MDGs) 4 & 5, unless greatly accelerated reductions are seen. Important challenges remain. First, median coverage of life-saving interventions remains low in most high burden countries. 5 Moreover, progress in national coverage levels does not always indicate progress in reaching the poorest and most vulnerable women, children and adolescents. Second, improving quality of care is essential for realizing the benets of improved coverage. For example, women and children oen do not receive the interventions 1 Trends in maternal mortality: 1990 to 2008, Estimates developed by WHO, UNICEF, UNFPA, and the World Bank (http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf). 2 World Health Statistics 2010 (http://whqlibdoc.who.int/publications/2010/9789241563987_eng.pdf). 3 e International Group on Analysis of Trends in HIV Prevalence and Behaviours in Young People in Countries most Aected by HIV, “Trends in HIV prevalence and sexual behaviour among young people aged 15–24 years in countries most aected by HIV”, Sex Transm Infect 2010;86(Suppl 2):ii72eii83 (http://sti.bmj.com/content/86/Suppl_2/ii72.full.pdf). 4 Countdown to 2015 Decade Report: Taking stock of maternal, newborn and child survival (www. countdown2015mnch.org/documents/2010report/CountdownReportAndProles.pdf). 5 EB128/7 “Health-related Millennium Development Goals: Report by the Secretariat”, 30 December 2010 (http://apps. who.int/gb/ebwha/pdf_les/EB128/B128_7-en.pdf). 1 2 Introduction they need when they need them, whether that be access to antenatal care, care during and aer childbirth, or services for eectively managing childhood illness. ere are major gaps in the continuum of care, in particular in the post-natal period, when the risk of mortality is high for the mother and her newborn. ird, adolescent health needs are still neglected. While many countries have included adolescents in national health policies and strategies, large scale programmatic action is limited. Pregnancy in young adolescents is associated with a higher risk of mortality and morbidity to the mother and her child, yet more than 2 mil- lion girls aged 10–14 years and around 16 million girls aged 15–19 years give birth every year. Also, there are currently 5.7 million young people aged 15–24 years living with HIV and an estimated 900,000 more infected with the virus each year. e slow progress in improving reproductive, maternal and newborn health is underpinned by the many burdens of gender discrimination, poverty and inequity, lack of economic opportunities, lack of education and other forms of exclusion that prevent women in poor countries from exercising their right to health. Five years remain to achieve MDG 4: Reduce the child mortality and MDG 5: Improve mater- nal health. Opportunities exist as never before. e UN Secretary General’s Global Strategy for Women’s and Children’s Health provides the platform for joint action. Governments and partners have committed to its implementation. is paper presents the strategic directions through which WHO’s Department of Maternal, Newborn, Child and Adolescent Health (MNCAH) will address the key challenges and take the lead in formulating the Organization’s contributions to attaining MDGs 4 and 5. It high- lights the linkages of MNCAH with other health areas, goals and targets, in particular those related to: reproductive health goals; MDG 1: Eradicate extreme hunger and poverty; MDG 3 Promote gender equality and empower women; MDG 6: Combat HIV/AIDS, malaria and other diseases; and the broader agenda for women, children and adolescents beyond 2015. MNCAH will act as the platform for the equitable delivery of quality, integrated health serv- ices for mothers, newborns, children and adolescents. Vision, mission, goals, targets and indicators 3 Vision, mission, goals, targets and indicators Vision: A world where every pregnant woman, newborn, child and adolescent enjoys the highest attainable standard of health and development. Mission: e Department of Maternal, Newborn, Child and Adolescent Health will work closely with other technical units in HQ, WHO Regional and Country Oces and partners to: • Generate and synthesize evidence and dene norms and standards for maternal, new- born, child and adolescent health; • Support the adoption of evidence-based policies and strategies which conform to interna- tional human rights standards, including universal access to health care; • Build capacity for high quality, integrated health services for pregnant women, newborns, children and adolescents; 6 and • Monitor and measure progress in implementation and the impact of those strategies on survival, health, growth and development. Goals and targets: Departmental goals and targets (up to 2015) In line with the Medium Term Strategic Plan, and recognising the importance of the Secre- tary General’s Global Strategy for Women’s and Children’s Health which prioritises action in the 49 highest burden, low-income countries. e department has set the following goals and targets: • High-burden countries are supported to ensure evidence-based policies and strategies are in place to achieve universal access to high quality health services for MNCAH; • High-burden countries to increase coverage and quality of eective MNCAH interven- tions among pregnant women, newborns, children and adolescents; – 25 high burden countries have an integrated policy and costed strategy on universal access to eective interventions for maternal, newborn, child and adolescent health; – e 25 countries with highest maternal mortality burden will have increased coverage of skilled care at childbirth to >50%; 6 WHO Packages of interventions for family planning, safe abortion care, maternal, newborn and child health. Geneva: World Health Organization, 2010. 2 4 Vision, mission, goals, targets and indicators – e 25 countries with highest neonatal mortality will have introduced home visits in the postnatal period for mothers and their newborns; – Linkages between HIV and MNCAH services will have been systematically made in the 20 highest HIV burden countries; – Access to treatment of major childhood illness will have increased in the 68 high-bur- den countries that account for 95% of maternal and child mortality 7 through expansion of IMCI to more than 75% of districts, and community case management of childhood illness; and, – e 68 Countdown countries and those countries which have been identied through interagency initiatives (e.g. UNAIDS group on HIV and young people, UN Adolescent Girls Task Force) will have functioning adolescent health programmes. 7 Identied by the Countdown to 2015: Afghanistan, Angola, Azerbaijan, Bangladesh, Benin, Bolivia, Botswana, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, China, Congo, Democratic Republic of the Congo, Côte d’Ivoire, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, e Gambia, Ghana, Guatemala, Guinea, Guinea-Bissau, Haiti, India, Indonesia, Iraq, Kenya, Democratic People’s Republic of Korea, Lao People’s Democratic Republic, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Philippines, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tajikistan, United Republic of Tanzania, Togo, Turkmenistan, Uganda, Yemen, Zambia, and Zimbabwe. [...]... Structure of the Department of Maternal, Newborn, Child and Adolescent Health  MNCAH department structure Director’s office Finance, advocacy and programme management Research and Development Policy, Planning and Programming Epidemiology, Monitoring and Evaluation Maternal and Perinatal Health Newborn Health Child Health Adolescent Health Structure of the Department of Maternal, Newborn, Child and Adolescent. .. Surveys and Demographic and Health Surveys) The MNCAH Department will work closely with RHR and IER to assess and disseminate epidemiological information on the causes of maternal, newborn, child and adolescent mortality and morbidity through the (Maternal and) Child Health Epidemiology Reference Group The Department will develop mechanisms to better monitor the implementation of health policies and track... form the mainstay around which the Department will organize its support to governments and partners These are: 1 The Integrated Management of Pregnancy and Childbirth (IMPAC); 2 The Integrated Management of Childhood Illness (IMCI), and improving care of children in hospitals; 3 Increasing access to care and support in the community (IFC,8 iCCM9); and 4 Strengthening the health sector response to adolescent. .. qualitative and quantitative data contribute to an understanding of the needs of pregnant women, children and adolescents, and the types of interventions that will result in the highest possible gains in health, growth and development Therefore, the Department will play a leading role in promoting and supporting research and development that will inform policy, guide norms and standards and improve... maternal, newborn and child survival; and the accountability framework that will be designed in line with the UN Secretary General’s Global Strategy for Women’s and Children’s health The Department will: • Develop and maintain an epidemiological database on causes of death for mothers, newborns, children and adolescents, develop perinatal mortality estimates, further build on the work of the Child Health Epidemiology... and sick children, and to have health workers who are sensitive to the needs of adolescents requires collaboration While the Department has a clear mandate to assist governments and partners to develop evidence-based policies and strategies to improve maternal, newborn, child and adolescent health, it will work with the Health Systems and Services (HSS) cluster and other relevant departments in WHO... Lead specialist Newborn Health Lead and promote visibility of Newborn health in the work of the department Ensure Newborn specific issues reflected in cross-cutting guidelines Lead the work on newborn specific guidelines Coordinate with other departments as appropriate Lead specialist Child Health Lead and promote visibility of Child health in the work of the department Ensure Child specific issues reflected... obligations 12 Strategic directions 5  Working across the three levels of the Organization The Department will take full advantage of WHO’s three-tiered structure to support countries in translating knowledge into effective action for the achievement of maternal, newborn, child and adolescent health goals • Headquarters is responsible for ensuring WHO technical guidance on maternal, newborn, child and adolescent. .. is a member of relevant UNAIDS Task Teams, the UN Adolescent Girls Task Force and other partnerships working to consolidate evidence, advocate for investment, and facilitate the harmonization and alignment of inputs and resources The Department is and will continue to lead the effective interventions area of work and be an active member of the Partnership for Maternal Newborn and Child Health (PMNCH)... services for all adolescents, with a special focus on those who are at higher risk of health and social problems Improving health along the continuum of care 7 4  Strategic directions The following three strategic directions will guide the work of the Department They are in line with the mission statement and goals stated earlier in this document 4.1 Develop evidence-based norms and standards to support . Strategic Directions of the Department of Maternal, Newborn, Child and Adolescent Health For further information and publications please contact: Department. woman, newborn, child and adolescent enjoys the highest attainable standard of health and development. Mission: e Department of Maternal, Newborn, Child and