MDG 5 in Kenya - Kenyatta National Hospital

The Role of KNH/UON in Accelerating the Achievement of MDGs 5 and 4 MNCH Symposium 10 January 2013 Dr. Gathari Ndirangu Reproductive Health

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MDG 5 in Kenya • MDG 5 is off target – MMR target: 147/100,000 live births by 2015 – Universal access to RH – Current MMR: 488/100,000 live births*, up from 414 in 2003**

• Newborn part of MDG 4 has stagnated – Neonatal mortality rate 31/1000 live births* – 60% of IMR

• Commendable progress in the other MDGs (especially 1, 2, 3) *KDHS 2008-09 **KDHS 2003

Socioeconomic Determinants of Maternal Mortality • Illiteracy, poverty and poor women empowerment • Pregnancy too soon, too frequent, too many • Inadequate access to RH/MNH/FP services • Delivery under unskilled care • Limited accountability at all levels

Policy Environment

KNH’s Strengths to Accelerate Achievement of MDG5 • Strategic objectives to fulfil national mandate, vision and mission – To improve quality specialized reproductive healthcare – To reduce maternal and perinatal morbidity and mortality – To enhance training and research – To contribute to national RH planning and policy formulation – To strengthen institutional linkages and collaboration – To contribute to corporate social responsibility and improve on hospital image

MNH Strategic Objectives • Reduce maternal and perinatal morbidity/mortality – Service provision from primary to tertiary care – PMTCT program

• Training and research – Graduate and undergraduate levels, paramedical – Vibrant and respected research community – Translation of research into policy and practice

• Contribute to national RH planning and policy formulation • Institutional linkages and collaboration, including PPP

Challenges • Heavy client load (outstrips capacity) – Non-booked ANC clients (~60%) – Late referrals

• High MMR – 1223/100,000 LB (Jan-Nov 2012)

• High NMR 116/1000 LB (Jan-Dec 2012) – – – –

Prematurity NN Sepsis Term RDS Birth asphyxia

KNH’s Opportunities for Improving MNH Indicators • Highly trained workforce • Favorable policy environment – – – – – – – –

National referral hospital Devolved governance Strengthen lower tier health care facilities Effective knowledge and skill transfer Mentorship Timely and supportive feedback to referring HCFs Satellite health care facilities Modern technology

KNH’s Opportunities for Improving MNH Indicators • Proactively creating modalities to realize full potential in MNH services – – – – –

Advocacy Participation in national RH planning including MPDSR Training Research Collaboration including PPP

• Provision of full range of FP services (LAPM) • Timely reporting to the national HMIS for national planning

Threats • • • • • • •

Political interference and uncertainty Poverty Inadequate financial resources Commodity insecurity/inadequate equipment Increased litigation Industrial strife Inadequate health workforce

National Vision 2030 MNH target • MMR- 113/100,000 LB (77% reduction) – From 1223 to 281/100,000 LB

• NMR- 13/1000 LB (59% reduction) – From 116 to 47/1000 LB

• Together, we are up to the task!