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BY
DR OKORO EUSEBIUS N.
FAMILY MEDICINE DEPT. MMSH, KANO.
INTEGRATED MATERNAL NEWBORN &
CHILD HEALTH STRATEGY
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OUTLINE
 INTRODUCTION
 SITUATION ANALYSIS
 WHY IMNCHS?
 THE STRATEGY
 PRIORITY AREAS
 LEVELS OF INTERVENTION
 ANALYSIS OF BOTTLENECKS
 PHASES OF IMPLEMENTATION
 MONITORING & EVALUATION
 THE PARTNERSHIPS
 THE CHALLENGES
 CONCLUSION
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INTRODUCTION 1
 Women and the young ones are essential for
global development. Women are mothers of
the nation while the newborn today are
tomorrows decision makers.
 However as essential as they are, some
factors including health risks, social and
economic issues pose serious threat to them
from childhood, adolescence, through
pregnancy, childbirth and motherhood.
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INTRODUCTION 2
 In order to tackle the dreaded challenges, world
leaders have over the years tried to formulate
strategies aimed at saving our mothers and the
young ones.
 Some of the global strategies evolved so far
include ; MDG, RMNCH “continuum of
care”, IMCHI, IMNCHS, IYCF, IDSR, ACSD etc.
 Our discussion today is on IMNCHS which
deals directly on MDGs 4&5 and indirectly on
other MDGs.
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INTRODUCTION 3
 The MDG (UN millennium summit-NY,2000) has 8
interconnected developmental goals/18 targets
with 48 indicators to be achieved by 2015 viz -

G1- eradicate extreme poverty & hunger.
G2- achieve universal basic education.
G3- promote gender equality & empowerment.
G4- reduce child mortality.
4a= reduce by 2/3 U5 MR b/w 1990-2015.
G5- improve maternal health.
5a=reduce by 3/4 MMR b/w 1990-2015.
5b=achieve by 2015, universal access to
reproductive health.
G6- combat HIV/AIDS, malaria & other diseases.
G7- ensure environmental sustainability.
G8- develop a global partnership for development.
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SITUATION ANALYSIS 1
 So far, what is on ground?
 Nearly 9mil U5 die every year globally- WHO 2007
report. (Nigeria 2% of world population takes a lion
share of 10% of these deaths).
 Approximately 70% of these deaths are due to
preventable or treatable causes; with access to
simple, affordable interventions.
 Leading causes of U5 mortality include -
pneumonia, diarrhoeal
disease, malaria, measles, HIV/AIDS & neonatal
health problems.
 Over 1/3 of all U5 deaths are linked to malnutrition.
 MD4 is still long way ahead ( 1990-12mil ), 2/3 of
12mil reduction by 2015 is 4mil; presently we are still
battling with 9mil. How can 3yrs make the
difference?
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SITUATION ANALYSIS 2
 Approximately 1000 women die daily & 358,000
annually from pregnancy related causes.
(Nigeria again takes a lion share of 10% of
these deaths).
 Ninety nine % of all MMR occur in sub-saharan
Africa & south Asia.(rural
areas/ignorance/poverty).
 Between 1990/2008, MMR dropped 1/3rd
globally, about 2.3% average annual fall rate as
against the expected 5.5% MDG fall rate.
 Causes of MMR include- haemorrhage,
infection, hypertension/ecclampsia, obstructed
labour, unsafe abortion. 7

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CAUSES OF MMR CAUSES OF U5 MR
Hemorage
Infection
Eclampsia Malaria
Obst.Lab. ALRI-Pn
Unsafe Ab DDx
Malaria Measles
Anaemia HIV
Others NN
DIRECT CAUSES OF MMR/U5 MR
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CAUSES 0F NMR
Target is from 48/1000 to 18/1000 by 2015
Birth Asp.
Severe NNS
Preterm B.
NNT
Congenital
DDx
Others
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TREND IN MMR (1990-2015)
1200
1000
800
MGD Trend(1000 to 250)
600 Current Trend(1000 to
540)
400 Series 3
200
0
1990 2000 2005 2010 2015
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TREND IN U5 MR (1990-2015)
250
200
MDG Trend(230 to 77)
150
IMNCH Trend(230 to 59)
100
Current Trend(230 to
167)
50
0
1990 2000 2005 2010 2015
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WHY IMNCHS ?
 1. Mother, newborn & child are inseparable.
 2. High MMR, NMR & U5MR are due to weak
health system & low coverage of MNCH
intervention.
 3. Maternal deaths, stillbirths & neonatal deaths
are strongly linked in terms of cause, time &
place of death and delays in access to care.
 4. They have similar solutions and so must be
linked.
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THE STRATEGY (IMNCHS)
 IMNCHS is an initiative of paradigm shift in the
health care services involving health resource
distribution and utilization, with emphasis on
continuum of health care service delivery in a
cost-effective, impact-maximizing ways.
 It was developed within the framework of
National Health Sector Reforms & in the context
of NEEDS.
 Goal – To reduce MNC morbidity and mortality
in line with MDG 4&5.
 Targets – 1. Reduce MMR by 3/4 in 2015
 2. ↓ U5MR by 2/3 in 2015 13

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STRATEGIC OBJECTIVES
 1. Improve access to good quality Health
Services.
 2. Ensure adequate provision of medical
supplies, drugs etc.
 3. Strengthen family & community capacity to
take necessary MNCH actions.
 4. Improve capacity for organization & mgt. of
MNCH services.
 5. Establish financing mechanism that ensures adequate
funding & efficient use of funds.
 6. Strengthen monitoring & evaluation systems.
 7. Establish & sustain partnerships to support
implementation of IMNCH strategy.
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PRIORITY AREAS
 Focused ANC
 Intrapartum Care
 EmONC
 Routine Postnatal Care
 Newborn Care
 Infant & Young Child Feeding strategy
 Use of ITN & IPT
 Immunization Plus
 PMTCT
 Management of common Childhood illness & care of HIV
exposed or infected children
 Water, Sanitation & Hygiene
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LEVELS OF INTERVENTIONS
 1. Family Oriented/Community Based
Interventions.
 2. Population Oriented Interventions.
 3. Individual Oriented Clinical Interventions.
 Note; The vision of these interventions is to build up the
Health Practices from what is obtained now to the 2015
Goal.
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FAMILY ORIENTED/COMMUNITY BASED
INTERVENTIONS.
 1. Family preventive services; ITN, clean
water/environment, hand wash, condom use.
 2. Family neonatal care; Clean
delivery/cord care, early BF, care of
LBW/temperature mgt.
 3. Infant & child feeding; Proper B/F
, complementary/supplementary feeding
 4. Community mgt of illnesses;
ORT, ZnSo4 for DDx, Vitamin A for
measles, use of ACT for malaria.
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POPULATION ORIENTED INTERVENTIONS.
 1. Preventive care for adolescents/adults;
Reproductive health/Family planning.
 2. Preventive pregnancy care;
ANC, TT, Deworming, Detection & Rx of
asymptomatic bacteriuria / Syphilis, Prevention &
Rx of Fe def. anaemia, IPT.
 3. HIV/AIDS prevention & care; PMTCT(testing &
counseling), AZT + sd NVP & infant feeding
counseling, Condom use, SP prophylaxis for HIV
mothers & their exposed children.
 4. Preventive Infant & child care;
Vaccines(EPI), Hep B, Hib, Pentavalent(DPT-Hib-
Hep B), Vit A supplementation. 18

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INDIVIDUAL ORIENTED CLINICAL
INTERVENTIONS.
 1. Clinical 1º level skilled M & N care; Skill del
care, Resusc. of asphyctic NB, Steroids for preterm
labour, Antibiotics for P/PROM, Mgt. PIH(use of
MgSo4), Mgt. of NNS @ PHC.
 2. Mgt of illness @ 1º clinical level; Antibiotics for
U5 pneumonia/DDX/Enteric fever, Vit A for
measles, ZnSo4 for DDx, ACT for children & pregnant
women, Mgt. of complicated malaria (2nd line
drugs), ART for children & pregnant women with AIDS.
 3. Clinical 1st referral illness mgt; B-EONC, Mgt. of
severely sick children (referral IMCI), Mgt. of
NNJ, Universal emergency Neonatal Care (asphyxia
after care, mgt. of serious infections, mgt. of
VLBW), Mgt. of complicated malaria.
 4. Clinical 2nd referral illness mgt; C-EONC, other
emergency acute care, Mgt.
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ANALYSIS OF BOTTLENECKS 1
 The Marginal Budgeting for Bottlenecks(MBB)
identifies Health Care Delivery System bottlenecks
@ 5 progressive levels viz;
 1. The AVAILABILITY of critical Health system
inputs such as Drugs, Vaccines, Supplies &
Human Resources.
 2. The physical ACCESSIBILITY of people to
Health services viz the presence of skilled staff @
community level, villages reached @ least
once/month by outreach services, and the time
taken to reach a facility providing B-EONC
services.
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ANALYSIS OF BOTTLENECKS 2
 3. The UTILIZATION of Health Care Services
which can be proxied by 1st use of multi-contact
service i.e. members of catchment population
actually using the services when it is available
(e.g. ANC / Immunization).
 4. The CONTINUITY (or adequate coverage) in
utilization of services or adherence. E.g. % of
children receiving DPT3, or % of women attending
3ANC.
 5. The QUALITY (or effective coverage) of the
services provided or received. I.e. skill for correct
diagnosis/intervention/use of equipment & advise
appropriately. Also that potential users are using
services in a correct & effective manner.
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PHASES OF IMPLEMENTATION
 Phase 1 – 2007 to 2009
Immediate removal of bottlenecks.
 Phase 2 – 2010 to 2012
Implementation reinforced @ service delivery
modes.
 Phase 3 – 2013 to 2015
- 80% effective coverage of clinical
intervention @ basic health care.
- 70% @ 1st & 2nd referral care.
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STEPS FOR ROLLING OUT IMNCHS
 1. Formation of IMNCH national team & national
partnership.
 2. Targeted advocacy, communication & social
mobilization for IMNCH.
 3. Development of IMNCH State/LGA-specific roll out
Plan of Action.
 4. Establish State/LGA level IMNCH p/ship.
 5. State/LGA specific situation analysis & needs
assessment.
 6. Development of States/LGAs IMNCH plans.
 7. IMNCH enhancing capacity building for paradigm
shift.
 8. Supervision, monitoring & evaluation plan.
 9. Technical support to States & LGAs for IMNCH
initiation.
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MONITORING & EVALUATION
 Critical to make this a continuous process.
 Key indicators used for tracking progress
(Mortality, Maternal/Child/Newborn Health
Immunization, Case mgt., Water & Sanitation
Health Facility, Supervision, Costing, Improved
stewardship Role of Government).
 Data to be collected @ all levels including routine
data, supervisory visits, follow up after
trainings, population based national surveys
(Demographic & Health Survey-DHS, Multiple
Indicator Cluster Survey-MICS, National HIV/AIDS
& Reproductive Health Survey-NARHS).
 The flow of data & their mgt to be strengthened
through capacity building @ all levels.
 Tools & appropriate mechanism including an
IMNCH data base to be developed for tracking.
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PARTNERSHIPS
 All tiers of the Govt.
 Agencies, parastatals e.g. NACA, MDG
 Medical institutions
 Professional associations
 Private sectors, NGOs etc
 Donors & international dev. Partners
 All relevant stakeholders
(traditional/religious)
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THE CHALLENGES
 Government structures – 3 tiers
 Political commitment / corruption
 Govt. funding
 Coordination – The FP should come in for
efficient coordination.
 Human resources skills & number
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CONCLUSION
 Only a focused & well coordinated effort in
health care delivery / universal access can
save the mothers, newborns & the young
child.
 May we all rise up to the clarion call.
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