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Support to the National Integrated Plan to Achieve Mdgs 4&5

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Support to the National Integrated Plan to achieve MDGs 4&5 Reporting Period: 1 January – 31 December 2014 Country, Locality(s), Priority Area(s) / Strategic Programme Title & Project Number Results1 Programme Title: Support to the National Integrated Country/Region: Mozambique Plan to Achieve MDGs 4&5 Health and Nutrition Programme Number SC 12 0131 & SC130257 (UNICEF) Priority area/ strategic results MPTF Office Project Reference Number: 00081835 Participating Organization(s) Implementing Partners WFP, WHO, UNFPA, UNICEF Ministry of Health; Provincial Health Directorate of Zambezia Province; National Institute for Social Communication (ICS); Grupo de Teatro do Oprimido (GTO); Associacao Mocambicana de Desenvolvimento da Familia (AMODEFA); Ministry of Women and Welfare (MIMAS); Women and Welfare Provincial Directorate (DPMAS); Ministry of Youth and Sports (MJD); Youth and Sports Provincial Health Directorate (DPJD) Programme/Project Cost (US$) Programme Duration Total approved budget as per project document: Overall Duration (months): MPTF /JP Contribution: 44 months USD 20.422.671 Start Date: 26/01/2012 Original End Date: 31/12/2015 Current End date: 30/09/2015 Programme Assessment/Review/Mid-Term Eval. Report Submitted By Assessment/Review - if applicable please attach o Name: James McQuenPatterson Yes No Date: dd.mm.yyyy o Title: Health and Nutrition Chief Mid-Term Evaluation Report – if applicable please attach o Participating Organization (Lead): UNICEF Yes No Date: dd.mm.yyyy Email address: [email protected] 1 Strategic Results, as formulated in the Strategic UN Planning Framework (e.g. UNDAF) or project document; Page 1 of 52 EXECUTIVE SUMMARY CIDA funding has supported activities to reach the MDG4&5 in Mozambique since 2012. This has been done through four UN agencies: UNFPA, UNICEF, WFP and WHO. The four agencies have supported National, Provincial, Districts and community level in implementing activities aiming at improving principally maternal, neonatal and child health. The year 2014 has been the third year of implementation of this partnership. CIDA informed UN agencies and MOH that the project would be extended from an initial end date of December 2014 to September 2015. The majority of the field activities have occurred in Zambezia Province as priority Province related to the poorness of Maternal – Neonatal – Infant & Child Health (MNICH) indicators. Many activities implemented in 2013 were consolidated in 2014 aiming at reducing the burden on MNICH morbidity and mortality related to diseases such as malaria but also reinforcing many aspects of Sexual and Reproductive health (SRH) as well as Health Promotion. The 11 indicators that had been agreed upon for assessing somehow the success of the support given, show a positive trend since 2011. An in-depth MDG4&5 evaluation is currently on-going and shall produce its report towards the second semester of 2015. This report should inform future policy decisions related to activities that would have proven most efficient to the achievement of MDG 4&5 goals. CONTEXT Under-five mortality was estimated at 201 per 1000 live births in 1997, at 178 in 2003 (Demographic and Health Survey, DHS), 138 in 2008 (Multiple Indicator Cluster Survey, MICS). According to recent data from Mozambique’s 2011 Demographic and Health Survey, the under-five mortality rate is now estimated at 97 per 1,000 live births (2011 DHS). Progress has been slower, however, in reducing neonatal mortality (mortality within the first 28 days after birth). Evidence shows that neonatal complications or infection, malaria, diarrhea, pneumonia and AIDS still account for more than 30 per cent of all deaths of children under five in the country. A critical underlying cause of mortality is malnutrition, with 43 per cent of Mozambican children reported chronically undernourished2. Between 2008 (MICS) and 2011 (DHS), chronic under nutrition remains `very high` contributing not only to child mortality, but to its negative effects on cognitive development in early childhood and its irreversible nature, has serious implications for national human capital and its development. Interventions exist to address these conditions: they are known, available, affordable and proven to have an immediate impact on child mortality. Current data from Mozambique also show moderate progress in reducing maternal mortality and achieving universal access to reproductive health. Despite the reduction in recent years, the ratio of maternal mortality (408 per 100,000 live births / 2011 DHS) is still unacceptably high, resulting from a limited range of either direct causes - mainly uterine rupture (29%), obstetrical bleeding (24%), 2 DHS 2011 Page 2 of 52 puerperal sepsis (17%), and post abortion - or of indirect causes, such as HIV / AIDS (54%) and malaria (40%). The country is thus not on track to achieve MDG5 on maternal mortality. Despite progresses, the pathway towards the achievement of Millennium Development Goals 4&5 still presents significant challenges, due to structural weaknesses of the health system in providing equitable, high quality essential services for women and children, as well as to the limited capacity and involvement of communities in promoting actions for health and social change. In this scenario, the UN plays an important role in supporting the Ministry of Health in the design, planning and implementation of high impact and equitable interventions that have an immediate effect on women and children’s lives. Therefore, in the frame of a broader platform of cooperation with the Government of Mozambique, set out by the United Nation Assistance Development Framework for Mozambique (UNDAF 2012-2015), in early 2012 UNICEF, WHO, UNFPA and WFP engaged in a joint initiative aiming to accelerate progress towards the achievement of the Millennium Development Goals 4 and 5 in the country: the MDGs 4&5 joint program. In particular, this joint effort is designed as a contribution of the UN to the implementation of the Mozambique National Integrated Plan for the Achievement of MDGs 4&5: this entails technical and financial assistance to maternal, newborn and child health and nutrition (MNCHN) policy and programs at national level, as well as a focused effort in support of the province of Zambezia, which is the most critical province of the country in terms of development and health indicators. In 2014, the MDGs 4&5 program engaged in sustained investment at both policy and service delivery level. Some of the major pieces implemented this year are: The global strategy known as Reach Every Child (REC), to further strengthen health facility capacity to plan, implement and monitor the delivery quality and equitable integrated MNCH services; The community based Family Planning to bring closer the FP consultation (follow-up visits and contraceptives distribution) to community via activists or MCH nurses (mobile brigades and health fairs); The perinatal and Neonatal Death Audits (CMPNDA) as a way to use of mortality audit data for decision making to save the lives of mothers and children through the identification of avoidable or modifiable factors and the implementation of local solutions. The support to the Zambezia Multi-sectorial Action Plan of Reduction of the Chronic Malnutrition, which is not limited to approach the problem of the chronic malnutrition and the prevention measures but, it also considers the factors that limit the capacity of the government institutions in its implementation. The MDGs 4&5 contribution to program implementation supported the Ministry of Health in addressing key needs and gaps at national and provincial level (Zambezia), through the support to essential policies and interventions along the continuum of care. Page 3 of 52 PURPOSE The goal of the MDGs 4&5 joint program is to contribute to the reduction of maternal, newborn and child morbidity and mortality nationwide with a focus in Zambézia Province. The specific objectives of the intervention are in line with the objectives set out by the Ministry of Health through its National Integrated Plan for the Achievement of MDGs 4&5 objectives: Objective 1: Increase and improve the quality of Maternal, Neonatal, Child, School and Adolescent health services. Objective 2: Reinforce the health system to improve the availability of Maternal, Neonatal, Child, School and Adolescent health services and increase access for the target population. Objective 3: Strengthen the involvement and capacity of communities in the promotion of Maternal, Neonatal, Child, School and Adolescent health. Objective 4: Increase commitment and mobilization of resources and strengthen coordination and M&E mechanisms to ensure the implementation of the Integrated Plan Mozambique to Achieve MDGs 4&5. The MDGs 4&5 joint program is aligned with the United Nation Assistance Development Framework 2012-2015 (UNDAF). In particular, it will contribute to the achievement of the UNDAF outcome 4 “Strengthening the capacities of the public institutions to provide quality and essential social services for vulnerable groups”, and of the UNDAF outcome 5 “Empowering right holders to demand, access and use equitably delivered social services”. Page 4 of 52 RESULTS A limited set of 11 indicators was agreed by the Program Steering Committee, as a dashboard to measure progress in key areas of intervention. The selected indicators reflect essential interventions promoted through the MDG 4&5 program along the continuum of care; all of them have a focus in Zambezia province. All
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