MATERNAL, NEWBORN AND CHILD HEALTH IN THE AMERICAS A REPORT ON THE COMMITMENTS TO Women’s And children’s heALTH This work was co-authored by The Canadian Red Cross Society with the International Federation of Red Cross and Red Crescent Societies. The Canadian Red Cross reserves its right, title and interest in and to this work and any rights not expressly granted are reserved by the Canadian Red Cross. Without limiting the rights under copyright reserved above, any part of this publication may be cited, copied, translated into other languages or adapted to meet local needs without prior permission from the Canadian Red Cross provided that the source is clearly stated. In consideration of this, such use shall be at the sole discretion and liability of the user and the said user shall be solely responsible, and shall indemnify the Canadian Red Cross, for any damage or loss resulting from such use. ISBN 978-1-55104-595-5 (c) International Federation of Red Cross and Red Crescent Societies & Canadian Red Cross Society, Geneva, 2013 Requests for commercial reproduction should be directed to the IFRC at [email protected] and the Canadian Red Cross Society located at 170 Metcalfe St., Ottawa, ON, K2P 2P2, Canada, Tel: (613) 740-1900 or by email at [email protected]. Cover photo: Sonia Komenda/CRC ACKnowledGements The IFRC Americas Zone Health Team would like to thank the Canadian Red Cross for funding the MNCH Research Delegate position in the Americas Zone Office to conduct this project and for the extensive efforts of the Americas Team in the overall production of the report. We would also like to recognize Dr. Salim Sohani, Senior Health Advisor at the Canadian Red Cross for the technical expertise he contributed to this report. His insights and knowledge enabled the exploration of different angles on the issues of MNCH and health equity. We would also like to thank Christopher Drasbek, Regional Advisor, Integrated Child Health, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC, for his technical review of the report. His suggestions and input were valuable. CONTRIBUtors Sonia Komenda – Main Researcher, CRC Julie Hoare – Americas Zone Health Coordinator/Project Manager, IFRC Dr. Salim Sohani – MNCH and Technical Advisor, CRC This report is made possible through the support of the International Federation of Red Cross and Red Crescent Societies (IFRC), in co-operation with the Canadian Red Cross and the Pan American Health Organization (PAHO). International Federation OF RED CROSS AND RED Crescent Societies Strategy 2020 voices the collective determination of the International Federation of Red Cross and Red Crescent Societies (IFRC) to move forward in tackling the major challenges that confront humanity in the next decade. Informed by the needs and vulnerabilities of the diverse communities with whom we work, as well as the basic rights and freedoms to which all are entitled, this strategy seeks to benefit all who look to Red Cross Red Crescent to help to build a more humane, dignified, and peaceful world. www.ifrc.org Saving lives, changing minds. Over the next ten years, the collective focus of the IFRC will be on achieving the following strategic aims: 1. Save lives, protect livelihoods, and strengthen recovery from disasters and crises 2. Enable healthy and safe living 3. Promote social inclusion and a culture of non-violence and peace CANADIAN RED CROSS The Canadian Red Cross works with partner Red Cross and Red Crescent Societies around the world to meet the Millennium Development Goals of reducing preventable deaths of children under the age of five, and to improve maternal health. The Canadian Red Cross has been active in maternal, newborn and child health (MNCH) since 1997, and supports programs in some 20 countries. Since 2005, Canadian Red Cross supported MNCH programs have reached more than 12 million people directly, and have indirectly benefited another 40 million. Forty thousand trained Red Cross volunteers have contributed to the achievement of health program objectives. www.redcross.ca PAN American Health ORGANIZation/WORLD Health ORGANIZation (PAHO/WHO) The Pan American Health Organization (PAHO), founded in 1902, is the world’s oldest international public health agency. It provides technical cooperation and mobilizes partnerships to improve health and quality of life in the countries of the Americas. PAHO is the specialized health agency of the Inter-American System and serves as the Regional Office for the Americas of the World Health Organization (WHO). Together with WHO, PAHO is a member of the United Nations system. www.paho.org 4 MNCH in the Americas | A report on the commitments to women’s and children’s health Contents Executive Summary ......................................................................................................... 6 Key Findings and Recommendations .............................................................................. 8 Methods ........................................................................................................................ 10 RESULTS ........................................................................................................................ 11 The Current MNCH Situation .......................................................................................... 11 Survey to National Societies ........................................................................................... 16 Questions 1, 2 and 3 ........................................................................................................ 16 Questions 4, 5 and 6 ........................................................................................................ 17 Questions 7 and 11 ......................................................................................................... 20 Question 8 ....................................................................................................................... 23 Questions 9, 10 and 12 .................................................................................................... 24 Partner National Societies Priorities and Commitments ................................................ 25 External Partners: Priorities and MNCH Activities .......................................................... 27 DISCUSSION .................................................................................................................. 29 Gaps Based on Current Need .......................................................................................... 29 Gaps Within the Movement ............................................................................................ 31 Gap Analysis of Top Five Countries in Need of MNCH Programming ............................... 33 Case Study: Haiti ............................................................................................................ 35 Gaps Outside the Movement .......................................................................................... 36 Coordination Within the Top Five Countries in which External Partners Implement MNCH ................................................................ 38 Case Study: Bolivia ......................................................................................................... 40 Case Study: Honduras .................................................................................................... 42 Disparities in MNCH ....................................................................................................... 44 Case Study: Guatemala .................................................................................................. 46 Case Study: Colombia .................................................................................................... 52 Case Study: Health Disparities in Panama ..................................................................... 54 Next Steps ..................................................................................................................... 55 Annexes ............................................................................................................................. ANNEX A – Scale and Results of Statistical Analysis of MNCH Indicators ..................... 56 ANNEX B – HDI Value ...................................................................................................... 58 ANNEX C – MNCH Survey to National Societies ............................................................. 59 ANNEX D – List of National Societies that Answered the Survey ................................... 64 ANNEX E – Partner National Societies: MNCH-related Projects .................................... 65 ANNEX F – List of Current Government Strategies or Projects ....................................... 66 ANNEX G - External Partners List per Country ................................................................ 67 ANNEX H - Government Priorities and Commitments .................................................... 68 ANNEX I - Acronyms and Definitions .............................................................................. 73 References .................................................................................................................... 74 MNCH in the Americas | A report on the commitments to women’s and children’s health 5 TABLE OF FIGUres AND Tables TABLE 1. Top five countries in the Americas in need based on under-five, neonatal and maternal mortality.. .............................................................