Issues and impact
Despite the gains of the 1980s, the current levels of infant (IMR) and maternal (MMR) mortality remain considerably higher than in the 1990s. The current IMR is 19/1,000 live births (Census, 2008) and MMR is 81/100,000 live births as per ‘Trends in Maternal Mortality’: 1990 to 2010 WHO, UNICEF, UNFPA and The World Bank Estimates, 2012. In the 1980s, the IMR was 13 per 1,000 live births and MMR was 50 per 100,000 live births. The Government is working to improve these rates in order to achieve Goals 4 and 5 (reducing the IMR by two thirds and the MMR by three quarters by 2015).Lack of access to quality reproductive healthcare, including family planning, newborn and child health services, is a key constraint. Additional challenges include: insufficient resources to expand essential service packages throughout the country; limited information on international standards and best practices and inadequate monitoring and supervision capacities; old infrastructure coupled with lack of essential medicines and equipment affects provision of quality basic services. In addition health personnel require updated skills and knowledge particularly in rural areas; inadequate nutritional status of women before pregnancy has causal effect on maternal mortality and morbidity and needs to be addressed. UNICEF’s Health programme provides an integrated package of high-impact evidence-based interventions towards achieving the millennium development goals 4, 5 and 6: programmes in support of reducing infant and child mortality, maternal mortality, and treatment of malaria and tuberculosis. UNICEF, in collaboration with GAVI and WHO, supports Child Health Programmes, particularly the immunization programme, which is one of the most successful and sustainable public health programs in DPRK. Routine immunization coverage remains high, above 95% for all the antigens in 2012. A nation-wide cold chain replacement plan was completed in June 2010. This is a critical step in infra-structure building and strengthening the immunization programme in the country. Pentavalent vaccine was introduced in June 2012 with a national coverage of 95.7% as of end of 2012. The Child Health Programme also continuously focuses on the prevention and treatment of acute diarrhea and pneumonia which are still the main causes of child morbidity and mortality amongst children under five in DPRK after neo natal causes. For the effective management of acute diarrhea, zinc tablets and locally produced ORS sachets are also distributed throughout the country in cooperation with IFRC. Capacity-building of household doctors at the rural areas is one of the major focuses for UNICEF. The household doctor training package was developed in collaboration with WHO, UNFPA, and IFRC and training at the county level started in October 2010 up to now.
With regards to its Maternal Health Programme, UNICEF has created an antenatal care package (in close collaboration with WHO and UNFPA) and has distributed EMoC kits for safe deliveries at county hospitals and midwifery kits for ri clinics.Malaria prevails in varying degrees in eight out of ten provinces and two main cities although the country managed to dramatically reduce the annual caseload from 296,540 cases in 2001 to 23,537 cases in 2012. UNICEF has exceptionally accepted the request to act as the Principal Recipient, with the World Health Organization (WHO) undertaking the role of Sub Recipient, for GFATM from 2010 to 2015. The key strategies are: enhancing case management through maximizing the use of confirmatory diagnosis and delivery of effective anti-malarial therapies, scaling up of vector control activities, integrating community involvement as a successful way to raise awareness on the prevention and management of malaria, enhancing components of the national malaria and TB control programme. The present estimate of tuberculosis remains high and in 2012 the National TB Program reported a total of 91,248 cases and 31,746 are new smear positive cases. The GFATM-supported TB Program supports the National Strategy, which aims to decrease the morbidity and mortality of TB by half by 2015. Crucial to this is increasing early diagnosis of all forms of TB, and sustaining successful treatment of all smear positive cases. UNICEF TB programme also included improvement of diagnosis of children as well as initiating diagnosis and treatment of and those affected by with MDR-TB. The key strategies are: providing DOTS services to all TB patients, establishing partnerships with non-health sectors, departments and organizations to increase access to quality TB services, improving advocacy, enhancing communication and social mobilization to improve awareness and utilization of services, the development and implementation of interventions under the Programmatic Management for MDR-TB (PMDT) and finally, contributing to health systems strengthening.