1. Sri Lanka Sharing the success story
1.Dr Deepthi Perera, Director MCH, Family Health Bureau, Ministry of Health
2.Dr Srilal de Silva, President of the Sri Lanka College of Paediatricians
3.Dr Dhammica Rowel, National Programme Manager Newborn Care, Family
Health Bureau, Ministry of Health
4.Dr Deepika Attygalle, Health Nutrition Specialist, UNICEF, Sri Lanka

2. < 5 Mortality Rate – 11.3 /1000 LB (2009 RG)
NNMR – 6.2 /1000 LB (2009 RG)
IMR – 9.0 /1000 LB (2009 RG)
< 5 Mortality Rate – 11.3 /1000 LB (2009 RG)
TFR – 2.3 (2006/2007 DHS)
CPR – 68%
MMR – / LB (2010, FHB)
Still Birth Rate – 8.8/1000 Births (2007, MSU)
LBW – 17.6% (2008, MSU)
Total Population 20.2 Million (2012)
Women (15-49 years) – 15%
Children <5 years – 2%
GNP per capita US$ 2866 (2012a)
Life Expectancy at Birth (2010)
Male – 70.3 y
Female – 77.9 y
Adult Literacy Rate (2010)
Male : 93.2 %
Female : 90.8 % 2

3. Trend in MMR (1911 – 1995) MD/100000LB (Registrar General’s Department Data)  

4. Trend in MMR (1995 – 2010) MD/100000LB (Family Health Bureau)

5. (Source; Registrar General)
Trends in IMR and NNMR
(Source; Registrar General)

6. Why do newborns die? Causes of Child Mortality in Sri Lanka- 2009
Source: Registrar General’s Office

7. KEY MNH Process Indicators : Sri Lanka (Family Health Report 2007 & DHS 2006)
AN TT coverage 100% (2010, FHB)
AN screened for syphilis 92% (2010, FHB)
At least 1 post natal visit by PHM during first 10 days 69.9% (2010, FHB)
Children ever breastfed of all children < 5 years – 99.3% (2006/7 DHS)
Breastfeeding initiation within 1 hr – 79.9% (2006/7, DHS)
Exclusive breastfeeding under 6 months – 76% (2006/7, DHS)
ANC: registered before 8 weeks – 70 % (2010, FHB)
ANC clinic more than 4 visits -92.5% (2006/7, DHS)
ANC clinic visits :avg– 7 (2010, FHB)
ANC home visits: av no of– 5 (2010, FHB)
Pregnant women visited at least once by PHM – 94.7% (2010, FHB)
Skilled Birth attendance – 98.6%
(2006/7 DHS)
95% Govt
3.6% Private
Pregnant mothers protected with rubella 91.4% (2010, FHB)

8. Provincial District National Preventive Care Curative Care
Level of Health system
Preventive Care
Curative Care
National
Secretary Health
DHGS
DDG- PHS
Provincial
CCP
District
MOMCH RE
SPHIDD
RSPHNO
Divisional (MOH) Unit
Tertiary Care Hospital
FHB
Provincial
General Hospital
Provincial Director
Regional
Director
District General Hospital
Base Hospital A/B
MOH
PHNS
SPHI
Divisional Hospital A/B/C
Primary Medical care Units
(CD &MH/CD/MH)
SP_HM
PHI
PHM
Field Clinic
Home

9. Curative Institutions

10. Organized and continued MCH care
Care for Eligible couples
Family unit with women yrs of age/ FU with under five child
Pre-pregnancy care
Antenatal care
Domiciliary/clinic
Family Planning and other RH services
Through integrated package at community/clinic and institutional level
Intra natal care
Post natal care
Institutional/Domiciliary

11. Implementation
1879 – Construction of First Maternity Hospital (De Zoysa Maternity Hospital) in Colombo
Organization of health unit system in 1926
1968–Family Health Bureau
1983 – Breastfeeding Code
1987- Safe motherhood concept
1992 – BFHI
MDG
External Review on MNH

12. Supportive national MNH Policies and Guidelines

13. Role of Development Partners
Government in the main driving seat works in collaboration with;
WHO
UNICEF
UNFPA
World Bank
SAARC Development Fund
In developing technical capacity, infrastructure, equipment, evaluation, operational research

14. Coordinating Mechanisms
Central level –
National Nutrition Council and Presidential Task Force
National Committee on Family Health
National Nutrition Steering Committee
Breastfeeding code monitoring committee
Food Advisory Committee
Technical Advisory Committees - Newborn and Maternal Health
Maternal & Child Nutrition Sub committee

15. Coordinating Mechanisms
Central – Provincial Dialogue
- Planning meetings
Monitoring meetings,
MOMCH reviews,
MCH reviews at the districts
Regional – MOH monthly meetings with the RDHS, Monthly conference at the MOH, Supervision visits of RDHS, MOMCH, MOH, RSPHNO, PHNS, SPHM SPHI etc
Government and Private – Through Directorate of Private Sector Development

16. Health Financing Free health service
Government health expenditure is 1.3 % of GDP
Invest in training skilled health staff – doctors, nurses, midwives
Sustain funding for the key areas and increasing the
budget allocation for curative and preventive health
Ensure fund allocation for priority implementations and to scale up
Funds are identified for activities at the national and district levels

17. Human Resource
Cadre positions for Institutions and field deployment of officers on a routine basis
Pre and In service training for the staff caring for newborns organized (MOs, NOs, Mid wives in institutions and field)
All major hospitals include Neonatologists and/or Pediatricians
Medical officer and Nursing Officer cadre positions to the SCBUs and NICUs identified

18. Health Service Delivery
Service delivery model
Widely dispersed network of NICUs and SCBUs
Establishment of MBC and LMC for cost effective delivery of services
Reduce disparities - Estate health sector was absorbed to government service, government staff eg; MOs, PHMs appointed for duties
Remote areas – recruiting PHMs for training from the underserved areas, early transfer possibilities to doctors working the N and E during the war

19. Technology, Medicines and Equipment
Guideline for NICU, SCBU, MBC, LMC and for LR on standard infrastructure, equipment, drugs at each level
NALS, CPAP ventilation, Surfactant was introduced in 2008
Essential medicines and supply needs assessment conducted annually – gaps and reasons for gaps identified and rectify at routine planning

20. Community Ownership and Participation
Public Health Midwife is the key worker –
Provide domiciliary MCH care
One PHM for population
Every house hold in Sri Lanka is identified under PHM area
BCC planning within the MCH/FP programme at National , Provincial, Divisional and Health worker (PHM) levels

21. Monitoring and Evaluation
Well defined MIS system for monitoring and evaluation of MCH FP program
Situation analysis completed; National
EmONC survey completed in 2011/2012
In built system of auditing and monitoring and evaluation - Monthly Perinatal audits
Infant death investigations, Maternal death
audits

22. Success factors/ Tipping points
Policies – Free health, free education - female literacy
Policy to non training TBAs and invest in professional training of health staff
Keeping up with the innovative global developments – ANC, BF code, BFHI, Planning
Incorporation the concepts of good governance – Accountability - Formats
Health Financing – successive governments have ensured
Human Resource – focus on developments according to needs
Over all socio-economic development over the years and after the end of the war
Infrastructure development through government and donor funding

23. Remaining challenges
To provide high quality MNH services across the country
Sustaining the current status of care while focusing on new developments
Inter district disparities in MMR, IMR, NMR and other MCH related indicators
Timely availability of funds
Parallel developments of newborn care with other relevant medical specialties eg; ROP services, Pediatric surgery, Pediatric Cardiac surgery etc.

24. Present status of critical interventions
Preparatory
Early
Mature
 1.Management of pre-term birth                            √
 2. Skilled care at birth                          
3. Basic Emergency Obstetric Care                           
4. Comprehensive Emergency Obstetric Care           
5. Basic Newborn Care                                       
6. Neonatal resuscitation
7. Kangaroo mother care                                       
8. Treatment of severe infections                             
9. Inpatient supportive care for sick and small newborns

25. Acknowledgments
Hon Minister and Deputy Minister of Health Ministry of Health and Provincial Ministries of Health Family Health Bureau Sri Lanka College of Community Physicians Sri Lanka College of Pediatricians Sri Lanka College of Obstetricians Perinatal Society of Sri Lanka WHO UNICEF UNFPA World Bank SAARC Development Fund

26. Thank
you!!