BuildingbridgesAJointUnitedNationsProgramme tosupport

RMNCAHinVanuatu

ApIsai Tokon, National Coordinator RMNCAH programme

12th PSRH Conference Port Vila

13-19 July, 2017

VanuatuArchipelago

83islands6provinces

“Somanycallit

paradise-

Wecallit

home”

Countryoverview- Vanuatu

…istheworld'smostat-riskcountryfornaturalhazards,withhighestvulnerabilityranking(WorldRiskIndexReports2014/2015)

…stillisinthelistofleastdevelopedcountries(UNDepartmentofEconomicandSocialAffairs,2016)

butinthevisiontobeupgradedtoMICstatusin2020

…

Countryoverview(TheStateoftheWorldChildrenReport2016)

• Totalpopulation:265,000• GNIpercapita- 3160(US$)• Lifeexpectancyatbirth,years– 72;• Annualnumberofbirths– 7000• Totaladultliteracyrate- 84%

• Lowbirthweightrate- 10%(2009-2013);• EarlyinitiationofBF– 85%• Exclusivebreastfeeding<6months- 73%• Introductionofsolid,semi-solidorsoftfoods(6-8m)-72%• Breastfeedingatage2- 49%

Countryoverview(TheStateoftheWorldChildrenReport2016)

• U5MR36(1990)– 28(2015)• IMR- 29(1990)23(2015)• NMR- 12(2015)

• Stunting- 29%• Underweight- 11%• Wasting4%• Overweight- 5%

Countryoverview- Keypoints

• Halfofpopulationisunderageof24;threequarterslivinginruralareas;

• Populationgrowthrateof2.2percent,fertilityrateis3.35birthperwoman(2014);

• 29%ofpregnanciesarereportedlyunplanned(17%mistimedand12%unwanted).

• oneofthehighestadolescentbirthratesinthePacificregion;womenaged15–19reportedthehighestproportionofunplannedbirthsat40%;

• Prevalenceofsexualabuseagainstyounggirlsisalsohigh;• Lowdensityoffrontlinehealthworkerstopopulationat1.7per

1,000population– wellbelowtheWHO’scurrentrecommendedrateof2.1;

• CountrymetMDG6relatedtargetonHIV/AIDS,malariaandotherdiseases,whilefailedtoprogressonMDG4(toreducechildmortality)andMDG5(toimprovematernalhealth).Similartoothercountriesintheregion,facesa“doubleburdenofdisease”situation

• 2.5-yearprogrammetoimprovereproductive,maternal,newborn,childandadolescenthealth(RMNCAH)systemsandoutcomes,withcorefundingprovidedbyAustralianDFAT;

• InVanuatu,theUNJPforRMNCAHwaslaunchedin2015;

• StartoftheprogrammecoincidedwithTCPamandpeakofpoliticalinstabilityandrelatedturmoilinseniorleadershippositionsinthecountry.

• Thoseconditionsdelayedrealonsetofimplementationprocesstillearly2016.

• FullimplementationofallthreecomponentsoftheUNJPstartedin2016.

UNJPonRMNCAH

UNJPonRMNCAHinVanuatu

Alignedwithglobalstrategiesandinitiatives

UNJPONRMNCAHSupportsnationalpriorities

Organizationalre-structuring:

•DelegationofplanningandmanagementofhealthservicestotheProvinciallevel(decentralisation)

• Strengthenedfinancialmanagementandhealthfinancing,transparencyandaccountabilityatalllevels.

Bettercoordinationwithpartners

Strengtheningofinternational,regionalandsub-regional partnerships

Developmentofoperationalandstrategicplanningprocesses

UNJPONRMNCAHThreeProgrammecomponents:

Component1:ImproveselectedRMNCAHservicesandoutcomes• supporttoaddresscriticalgapsinservicesbasedonneeds andgaps

analysisComponent2:HealthSystemsStrengtheningthroughRMNCAH

• Improvingpolicy,planning,budgetingandmonitoringsystemsbothatnationalanddecentralisedlevel

Component3:DevelopinganimprovedUNbusinessmodel•increaseefficiencyandeffectivenessofUNsupport;•IntegrateUN-supportedplansintogovernmentplansandbudgets

ComponentOne:ImproveselectedRMNCAHservicesandoutcomes

– Focusonaddressingcriticalgapsinservicesbasedonneedsandbottleneckanalysisconductedin4pilotprovinces,andnationwide.

– Supportprovidedmostlyatthedecentralizedlevel,through channelingDCTtothePHMofficeandusinggovernmentimplementationmodalitiesinlinewithPFMsystem.

– Priorityinterventionareas:ASRH,FP,MNH,Childhealthandnutrition;• ASRH– 5prongedapproach;• FP- TOTonupdatedFPpackageandintroductionoflong-lastingmodernmethods;

• MNC- deathauditsinpriorityprovincesandestablishmentofMCDSRcommitteeatMOH;

• Childhealthandnutrition- EPIandlinkingWASH,health andnutritionprioritiesatthecommunitylevel.

Measuringprogress:ComponentOne

• 2outof4performanceindicatorsexceededannualtargets–onnumberofusersofmodernFPmethodsandonEPI(81%measlescoverage);

• Adolescentfertilityrate-relatedindicatorhasshowngoodprogressin4th quarterofyear,whenactualimpactofUNJPactivities,whichstartedin2016,couldbemeasured(49againstannualtargetof57).

• Theannualtarget onnumberofANCvisitswerenotmet,whiletheconcernwasnotonlythenumbers,butalsoqualityofservicesprovidedduringthosevisitswhichtheUNJP/Governmentcollaborationattemptedtoresolvethroughcomponent2interventions.

Sanma

ComponentTwo:ImprovingRMNCAHpolicy,planning,budgetingandmonitoring

systemsatnationalandprovinciallevels

RMNCAH/healthcoordinationhavebeenstrengthenedatthenationallevelandprovincialcommitteesestablishedinthefourpilotprovinces;

• RMNCAHstrategyfor2017–2020finalizedandapprovedwithwith four-yearimplementationplan,aligningwiththeNationalStrategicDevelopmentPlanforVanuatufor2017–2030andSDGs2030.

• MajorprioritiesoftheRMNCAHstrategyincorporatedintothe2016healthsectorbusinessplan.

• FPnationalguidelinesdevelopedfollowedbydeliveryofnationalToT inpreparationforscale-upin2017.

• nationalYFHSguidelinesdevelopedandToT capacitybuiltinlinewithnewguidelinesatthenationallevelandcoveringallsixprovincesinpartnershipwiththeUNDPMillenniumDevelopmentGoal(MDG)AccelerationFrameworkproject.

• Developmentofcomprehensivenationalmaternalandnewbornhealthguidelines isunderwaythatincorporateANC,intrapartumcare,includingemergencyobstetricandneonatalcare(EmONC), postpartumcare,preventionofmother-to-childtransmission(PMTCT)andmaternalandchildnutrition,aswellasrelatedwaitinghomespolicy.

ComponentTwo(cont’d):ImprovingRMNCAHpolicy,planning,budgetingandmonitoring

systemsatnationalandprovinciallevels

• Nationalmaternalandchilddeathsurveillanceandresponse(MCDSR)committeeestablishedatMoH toimprovesystematicanalysisofandreportingoncausesofmaternal,newbornandchilddeaths.

• Nutritionpolicyfinalizedandapproved;maternalnutritionandIYCFguidelinesdevelopedandvalidated,TOTconductedonthisbasisforfurthercapacitybuildling atprovincial levels;IMAMguidelinesareunderrevisionforprovincialrolloutaswell.

• NationalRMNCAH coordinationcommittee meetsmonthlytodiscuss criticalissuesrelatedtohealthsystembottlenecksandservicequalitywiththeinvolvementofkeygovernmentofficialsfromthePrimeMinisterOffice,DepartmentofStrategicPlanningPolicyandAidCoordinationanddevelopmentpartnersthatincludedUNagenciesandNGOs.Provincialcoordinationcommitteesestablishedinpilotprovinces bridgingcommunityneedswithprovincialandnationalhealthmanagement.

• RMNCAHUNJPsupportedhumanresourcesgapsassessmentfollowedbythesubmissiontoMOHrecommendationsforshort- andlong-termsolutions.

• Needs- andgaps-basedRMNCAHsupplyinventoryconductedinpartnershipwithbilateralDFATsupporttoMoH.

Penama

Measuringprogress:ComponentTwo

Allthreeindicatorsmetandexceededannualtargets:• Onenationalandfourprovincialplanscomparedwithatargetoftwoprovincialplansweredeveloped,costedandbudgetsreflectedinthehealthsectorbusinessplanfor2016–2017.

• Morethan50percentofgapanalysisactions,comparedwithatargetof30percent,wereprioritizedandactionedinhealthsectorbusinessplan.

• TheRMNCAHcoordinationcommitteechairedbygovernment/MOHmetmorefrequentlythanplanned(10timescomparedwithatargetof4 meetings),tosetthenationalstrategicdirectionforRMNCAH.

ComponentThree:DevelopinganimprovedUNbusinessmodel

• JointworkaroundthesharedRMNCAHagendaamongthethreeUNagencieswasstrengthenedusingjointprogramme funding,planningand implementationandmonitoring;

• “Oneplan,onebudget,onesystem”principleappliedincreasingeffectivenessofMOHworkwithUNpartners;

• Nationalanddecentralizedplanningandmicro-budgetingonRMNCAHimproved;• Regularconsultationsthroughface-to-faceandvirtualmeetingswereheldbetween

UNJPpartnersandRMNCAHcoordinatorsatthenationalandprovinciallevelstoaddresssystembottlenecksandsupporttoprogramme implementation;

• QualityassurancestandardswereestablishedthatalignedwithUNandGoV planning,reportingandfinancingprocedures.

• LinkageswithinMOHandwithrelatedgovernmentinstitutionsstrengthenedaroundRMNCAHagenda.AnnualreviewmeetingonRMNCAHUNJPtodefinestrategicdirections heldinDec2016thewasagoodexampleofthatbeingchairedbyPMOrepresentativesandMoH directors,representedbyprovincialtamsfromallsixprovinces,includingmanagers,RHfocalpoints,hospitalstaffandRMNCAHcoordinators,aswellasnursingschool;NGOs,UNagenciesanddonoragencies.

Shefa

Measuringprogress:ComponentThree

All2016targetsforComponent3aremet:• AllUNJPforRMNCAHactivitiesfor2017wereincorporatedintothehealthsectorbusinessplan;

• Adhocactivitiesnot-reflectedinhealthsectorbusinessplanminimized(onlyonein2016);

• AllTAagreementsrelatedtotheUNJPforRMNCAHwereprocessed asplannedwhile67percentcompletedand33%(long-termassignments)arecurrentlyongoing.

Malampa

SowhatisbeingbridgedbyRMNCAHUNJP?

• ….generations/targetgroups- applyinglifecycleapproachtoprogramming;

• …differentlevelsofhealthsystem- ensuringcontinuumofcare;• ….nationallevelwithprovinces;provinceswithareacouncilsand

communities;• ….UNagencieswithgovernment–bringingtogethercomparative

advantagesofeachtomeetthecountryneeds;• ….UNagenciesamongthemselves- aroundthesharedagenda–

avoidingduplicationsandgapsinsupport;• …DifferentsectorsoftheMOH- RH,Childhealth,EPI,Nutrition,

WASH,NCDs– talkingtoeachothertohavestrongerimpact;• …MOHwithothergovernmentsectorsresponsibleforsocial

determinantsofhealth/RMNCAH(geographicandfinancialaccess,safedrinkingwaterandsanitationfacilities,foodsecurity,communityresiliencetoemergenciesetc)

• …andNGOsreachingthehardtoreachcommunities…

AnnualReviewMeetingRMNCAH2016

ANNUALREVIEWMEETINGRMNCAH2016

ACKNOWLEDGEMENTTOTHERMNCAHTEAMOFVANUATUNATIONALGOVERNMENT/SECTORS/PROVINCES/COMMUNITIES

UNJOINT&PARTNERS

TANKYU

TUMAS