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Nepal Safe Motherhood and Newborn Health Road Map 2030

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Nepal Safe Motherhood and Newborn Health Road Map 2030 NEPAL SAFE MOTHERHOOD AND NEWBORN HEALTH ROAD MAP 2030 Family Welfare Division Ministry of Health and Population Government of Nepal September 2019 0 Nepal Safe Motherhood and Newborn Health Road Map 2030 1 CONTENTS List of Abbreviations .............................................................................................................. 4 Executive Summary .............................................................................................................. 7 2 Introduction ................................................................................................................... 17 2.1 Background ............................................................................................................ 17 2.2 Key Policies, Strategies and Programmes for Maternal and Newborn Health ......... 17 2.3 Rationale for Safe Motherhood and Newborn Road Map 2030 ............................... 19 2.4 Process for Developing Safe Motherhood and Newborn Health Road Map 2030.... 21 3 Situation Analysis .......................................................................................................... 23 3.1 Population............................................................................................................... 23 3.2 Progress on Universal Health Coverage ................................................................. 23 3.3 Health Service Structure ......................................................................................... 24 3.4 Trends, Levels and Targets of Maternal and Neonatal Mortality ............................. 25 3.5 Causes and Timing of Maternal Deaths .................................................................. 26 3.6 Causes of and Timing of Neonatal Deaths .............................................................. 27 3.7 Progress across the Continuum of Care: Antenatal Care, Delivery and PNC .......... 28 3.8 Social barriers to Accessing Services ..................................................................... 31 3.9 Stages of the Obstetric Transition ........................................................................... 35 4 Vision, Mission and Goal ............................................................................................... 37 4.1 Vision, Mission and Goal ........................................................................................ 37 4.2 Strategic Approaches ............................................................................................. 38 4.3 Quality as a Key Principle ....................................................................................... 38 5 Delivering the Road Map - Outcomes and Outputs ....................................................... 40 5.1 Outcome One: The availability of high-quality maternal and newborn health services increased, leaving no one behind .................................................................................... 40 5.1.1 Output 1.1 Reproductive, maternal and newborn health services are available, and health facilities that comply with the standards are located in strategically accessible areas, with functional referral linkages ........................................................ 40 5.1.2 Output 1.2 Readiness of health facilities (public and private) to provide services is ensured .................................................................................................................... 53 5.2 Outcome Two: The demand for and utilisation of equitable maternal and newborn health services increased ................................................................................................ 61 5.2.1 Output 2.1 Mothers and families have appropriate and accurate information and knowledge to seek care in a timely manner .................................................................. 61 5.2.2 Output 2.2 Health managers have adequate capacity and address users’ needs 63 5.2.3 Output 2.3 More effective and equitable outreach services are ensured ........... 64 5.2.4 Output 2.4 Parliamentarians and locally elected leaders are empowered to demand adequate investment in maternal and newborn health .................................... 66 1 Nepal Safe Motherhood and Newborn Health Road Map 2030 5.3 Outcome Three: The governance of maternal and newborn health services is improved, and accountability is ensured .......................................................................... 67 5.3.1 Output 3.1 Adequate financing is ensured for maternal and newborn health services ....................................................................................................................... 67 5.3.2 Output 3. 2 Effective and sustainable partnerships are ensured for maternal and newborn health services .............................................................................................. 69 5.3.3 Output 3.3 Accountability for maternal and newborn health services is enhanced at all levels ................................................................................................................... 70 5.4 Outcome Four: Monitoring and evaluation of maternal and newborn health improved 72 5.4.1 Output 4.1 Monitoring of maternal and newborn health is improved ................. 72 5.4.2 Output 4.2 Evaluation of maternal and newborn health and health services is planned during the programme design and is effectively carried out ............................ 74 5.5 Outcome Five: Emergency preparedness and response for maternal and newborn health strengthened ......................................................................................................... 75 5.5.1 Output 5.1 Preparedness of maternal and newborn health services to address emergencies is improved ............................................................................................. 75 5.5.2 Output 5.2 Response to maternal and newborn health care in emergencies is strengthened ................................................................................................................ 76 6 Appendices ................................................................................................................... 78 6.1 Annex 1: Progress across the Continuum of Care: ................................................. 78 6.1.1 Family Planning ................................................................................................ 78 6.1.2 Abortion ............................................................................................................ 80 6.1.3 High-quality Antenatal Care .............................................................................. 81 6.1.4 Delivery and Postnatal Care ............................................................................. 84 6.1.5 Maternal Malnutrition ........................................................................................ 91 6.1.6 Reproductive Morbidity ..................................................................................... 92 6.1.7 Financial Resources for Maternal and Newborn Health .................................... 92 6.1.8 Readiness of Maternal Health Services ............................................................ 93 6.2 Annex 2: Family Planning Services ......................................................................... 88 6.3 Annex 3: Abortion Services in Nepal ....................................................................... 90 6.4 Annex 4: Obstetric and Newborn Care .................................................................... 92 6.5 Annex 5: Goal, Outcome and Output Indicators, Definition and Targets ................. 95 2 Nepal Safe Motherhood and Newborn Health Road Map 2030 Table of Figures Figure 1: Selection of Policies and Programmes for Safe Motherhood and Newborn Health25 Figure 2: Maternal Mortality Decline, 1996–2016, with Projected Targets to 2030 .............. 25 Figure 3: Causes of Maternal Deaths in Hospitals (%) ........................................................ 26 Figure 4: Causes of Maternal Deaths at Community Level (%) ........................................... 27 Figure 5: Timing of Maternal Death (%) .............................................................................. 27 Figure 6: Causes of Newborn Deaths (%) ........................................................................... 28 Figure 7: Timing of Newborn Deaths (%) ............................................................................ 28 Figure 8: Continuum of Care for Safe Motherhood .............................................................. 30 Figure 9: Trends in Percentage of Women having ANC, Institutional Delivery and PNC by Income Group ..................................................................................................................... 32 Figure 10: Trends in Percentage of Women Giving Birth in a Health Facility by Caste, Ethnic and Religious Group ........................................................................................................... 34 Figure 11: High-quality Health System Framework ............................................................. 39 Figure 12: Map of Nepal's Health Facilities’ Concentration across Districts ......................... 45 Table of Tables Table 1: Service Coverage and Financial Protection for Countries in South Asia ................ 23 Table 2: Dimensions and Barriers to Accessing High-quality Health Services ..................... 33 Table 3: GoN and WHO 2016 ANC Models .......................................................................
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