Assessment of the Integrated Management of Newborn and Childhood Illnesses Lao PDR
Assessment of the Integrated Management of Newborn and Childhood Illnesses Lao PDR
Highlights
Although much progress has been made in reducing under 5 mortality in Lao PDR, the under five mortality rate, U5MR, is still high at 67/1000[1] Live births (LB), falling short of the MDG target of 54/1000 LB, with 44% of these deaths occurring in the first month of life, the newborn period. The majority of these deaths are preventable with the main causes being pneumonia and diarrhoea with malnutrition contributing to a high proportion of deaths with the stunting rate being 44%%. Inequity across urban/rural areas is demonstrated by the difference in mortality rates, being double in rural areas compared to urban areas (100/1000 LB in rural areas vs 45/1000 LB in urban areas), also geographical disparity with the risk of dying in early childhood being lowest in the Central region (73/1000 LB) while the risk of dying in the Northern and Southern regions exceeds 100/1000 LB[2]. Care for the specific child conditions also varies reflecting inequities in access and utilization of services including use of ORS/zinc for diarrhoea and pneumonia treatment as shown in the Lao Social Indicator Survey (LSIS) 2011-12.[3]
IMCI was adopted in Lao PDR in 1999 and implementation started in 2000, with the focus on the training of health workers at central and provincial level using the developed IMCI national guidelines. Although IMCI has three components, i) Health Worker Training, ii) Health System Strengthening and iii) Community Component, most attention was paid to the training. Following initial implementation, IMNCI stalled and has only been revitalised over the past 18 months, with the new RMNCH strategy. IMNCI is currently a project under the MCH sub-programme of the Health Social Development Plan (2016-2020).
There is recognition that in order to achieve the Sustainable Development Goal targets of ending preventable child and neonatal deaths, with targets of 25/1000 LB and 12/1000 LB by 2030 respectively, more rapid acceleration in mortality reduction is required. The government’s National Strategy and Action Plan for Integrated Services on Reproductive, Maternal, Newborn and Child Health (RMNCH) 2016-2025, clearly outlines the commitment to strengthen implementation of IMNCI. This assessment focussed on ways of achieving this, as well as facilitating factors and barriers in the implementation of IMNCI and other child health strategies, and additional ways of improving access, quality, coverage and utilization of child health services, especially important being the access to prevention and care at the community level.
The assessment included a desk review and interviews at central level in Vientaine and two provinces, Oudomxai in the north and Saravan in the South. The team found that although supportive policies are in place and IMNCI is a core component of the RMNCH Strategy, it has no clear implementation plan, and no budget line. Despite being very active the SO5 working group, but received less support than needed by partners, resulting in minimal implementation of their 2016 activities, resulting in this SO5 having the lowest implementation rate of all the eleven SOs. This requires urgent attention to development of a costed implementation plan. The plan, which will include targets down to the community level and a monitoring framework should form the basis of provincial and district planning, and be used to ensure the necessary resources are available at all levels for implementation. Additionally development of an investment case for newborn and child health as part of an overall investment case for RMNCH, would serve as an advocacy tool for financing from both government budget and development partners.
[1] Levels and Trends in Child Mortality, IGME - WHO 2015
[2] Evaluation of RMNCH strategy and plan 2009-15. 2015
[3] Ministry of Health of Lao PDR and Lao Statistics Bureau (2012) Lao Social Indicator Survey 2011-12, Final Report. Vientiane, Lao PDR: Ministry of Health and Lao Statistics Bureau.
