National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) List of Acronyms ANC Ante Natal Care ANM Auxiliary Nurse Midwife BCC Behaviour Change Communication BEOC Basic Emergency Obstetric Care CAC Comprehensive Abortion Care CBO Community Based Organisation CBS Centre Bureau of Statistics CDP Community Drug Programme CEDAW Convention for the Elimination of Discrimination Against Women CEOC Comprehensive Emergency Obstetric Care CHD Child Health Division CTEVT Council for Technical Education and Vocational Training DACC District AIDS Coordination Committee DDA Department of Drug Administration DDC District Development Committee DHMC District Health Management Committee DHS Demographic and Health Survey DoHS Department of Health Services DUDBC Department of Urban Development and Building Construction EDP External Development Partner EHCS Essential Health Care Services ENC Essential Newborn Care EOC Emergency Obstetric Care FCHV Female Community Health Volunteer FHD Family Health Division FMIS Financial Management Information System HEFU Health Economics and Financing Unit HMIS Health Management Information System HP Health Post HURDEC Human Resource Development Centre HURIC Human Resource Information Centre IEC Information Education Communication IMCI Integrated Management of Childhood Illness IOM Institute of Medicine KAP Knowledge Attitudes and Practice LMD Logistics Management Division LMIS Logistics Management Information System LSGA Local Self Governance Act National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) LSI Livelihood and Social Inclusion MBBS Bachelor of Medicine Bachelor of Surgery MDG Millennium Development Goal MOF Ministry of Finance MOGA Ministry of General Administration MoHP Ministry of Health and Population MOLD Ministry of Local Development MPPW Ministry of Planning and Physical Works MRT Midwifery Refresher Training NAN Nursing Association of Nepal NNC Nepal Nursing Council NEPAS Nepal Paediatric Society NESOG Nepal Society of Obstetricians and Gynaecologists NGO Non Government Organisation NHEICC National Health Education Information Communication Centre NHTC National Health Training Centre NHSP-IP Nepal Health Sector Programme-Implementation Plan NLSS National Living Standard Survey NMC Nepal Medical Council NSMNH-LTP National Safe Motherhood Newborn Health -Long Term Plan PAC Post Abortion Care PCL Proficiency Certificate Level PESON Perinatal Society of Nepal PHCC Primary Health Care Centre PMTCT Prevention of Mother to Child Transmission PNC Post Natal Care PPP Public Private Partnership RH Reproductive Health RHCC Reproductive Health Coordination Committee RHD Regional Health Directorate RHTC Regional Health Training Centre SBA Skilled Birth Attendant SHP Sub Health Post SMNF Safe Motherhood Network Federation SMNH Safe Motherhood and Newborn Health SMNSC Safe Motherhood and Neonatal Sub Committee SN Staff Nurse SSMP Support to the Safe Motherhood Programme TMIS Training Management Information System TT Tetanus Toxoid UNFPA United National Fund for Population Activities UNICEF United Nations Children’s Fund USAID United States Agency for International Development VDC Village Development Committee WHO World Health Organisation National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) Executive Summary This revised National Safe Motherhood and Newborn Health Long Term Plan (NSMNH-LTP) 2006-2017 has been developed to be in line with the Second Long Term Plan Health Plan (1997-2017), the Nepal Health Sector Programme Implementation Plan and Millennium Development Goals (MDG). The revision takes into account recent developments such as the increased specific emphasis on neonatal health, recognition of the importance of skilled birth attendance in reducing maternal and neonatal mortalities, health sector reform initiatives, legalisation of abortion, recognition of the significant levels of mother to child transmission of HIV/AIDS and increased emphasis on equity issues in safe motherhood services. The overall goal of this plan is to improve maternal and neonatal health and survival especially among poor and socially excluded communities, with indicators drawn from the MDGs. These include a reduction in the maternal mortality ratio to 134 per 100,000 live births by 2017 and a reduction in the neonatal mortality ratio to 15 per 1,000 live births by 2017. The purpose is increased healthy practices and utilisation of quality maternal and neonatal health services, especially by the poor and excluded, delivered by a well-managed health sector. The indicators are an increase in the number of deliveries assisted by Skilled Birth Attendants (SBA) to 60 percent by 2017 and increase in the number of deliveries in a health facility to 40 percent by 2017. Met need for Emergency Obstetric Complication will be increased by 3 percent each year and the met need for Caesarean Section by 4 percent each year. Eight key outputs have been identified, with individual indicators and key activities: 1. Equity and Access The purpose is to ensure that individuals, groups and networks are socially empowered to practise desired Safe Motherhood and neonatal Health (SMNH) behaviours, leading to increased equity of and access to health services. The key activity areas are in advocacy, social mobilisation and behaviour change communication. 2. Services The purpose is to enhance equitable provision of quality SMNH services. These include: focused antenatal care, delivery and newborn care by skilled birth attendant, postnatal care, emergency obstetric care, comprehensive abortion care and referral services. Activity areas include strengthening and expansion of SMNH services, improvement in quality of services, reaching socially excluded groups, creating an enabling environment for services and developing appropriate linkages. National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) 3. Public Private Partnership The purpose is to increase participation of the private sector, NGOs, community based organisations and professional/academic institutions in SMNH related public services to ensure consumers have equitable access to affordable services. 4. Decentralisation The purpose is to enhance local government and partner capacity to plan and oversee SMNH services in line with the Local Self Governance Act (LSGA). 5. Human Resource Development: Skilled Birth Attendant Strategy The purpose is to develop and implement a strategy and plan for human resource development in safe motherhood and neonatal health, particularly skilled birth attendant training. 6. Information Management The purpose is to develop a comprehensive sector wide SMNH information base and to incorporate and utilise this within the Health Information System to support policy, planning, monitoring, evaluation and advocacy at national and local levels. Key activity areas include information management, data collection and quality, access to information and monitoring. 7. Physical Assets and Procurement The purpose is to ensure adequate physical resources for SMNH services along with year round availability of SMNH related drugs and supplies. Key activity areas include construction and maintenance, planning and quality assurance and distribution of drugs and commodities. 8. Finance The purpose is to ensure improved sustainable financing systems for SMNH services. Key activity areas include mobilisation of resources, alternative financing systems and formation of safety nets for the socially excluded. Seven cross cutting issues and approaches were identified, which are common to all the outputs. These are: social inclusion, gender, rights based approach, research and advocacy, enabling environment, public private partnership and decentralisation. National Safe Motherhood and Newborn Health-Long Term Plan (NSMNH-LTP) Contents Preface Acknowledgements List of Acronyms Executive Summary 1 Chapter: 1 Introduction and background 1 1.1 Introduction 1 1.2 Rationale for revision of the NSMNH-LTP 1 1.3 The revision process 2 1.4 Goal purpose and outputs 3 1.5 Definition of terms 4 1.6 Cross cutting issues and approaches 4 1.7 Risks and assumptions 6 2 Chapter: 2 Description of outputs 8 Output 1: Equity and access 8 Output 2: Services 9 Output 3: Public private partnerships 11 Output 4: Decentralisation 13 Output 5: Human resource development: Skilled Birth Attendant Strategy 14 Output 6: Information management 15 Output 7: Physical assets and procurementOutput 8: Finance 16 3 Chapter: 3 The logframe 20 Annexes