The World Health Report 2005: Make every mother and child

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243
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4806
ID World Health Organization

2005
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contents

Message from the Director-General xi

Overview xiii

Patchy progress and widening gaps – what went wrong? xiv

Making the right technical and strategic choices xiv

Moving towards universal coverage: access for all,

with financial protection xvi

Chapter summaries xix

Chapter 1

Mothers and children matter – so does their health 1

The early years of maternal and child health 2

Where we are now: a moral and political imperative 3

Mothers, children and the Millennium Development Goals 7

Uneven gains in child health 8

The newborn deaths that went unnoticed 9

Few signs of improvement in maternal health 10

A patchwork of progress, stagnation and reversal 12

The numbers remain high 13

Chapter 2

Obstacles to progress: context or policy? 21

Context matters 22

Poverty undermines progress 22

The direct and indirect effects of HIV/AIDS 23

Conflicts and emergencies set systems back 24

The many faces of exclusion from care 25

Sources of exclusion 26

Patterns of exclusion 29

Different exclusion patterns, different challenges 30

Are districts the right strategy for moving towards universal coverage? 32

A strategy without resources 32

Have districts failed the test? 33

Chapter 3

Great expectations: making pregnancy safer 41

Realizing the potential of antenatal care 42

Meeting expectations in pregnancy 42

Pregnancy – a time with its own dangers 44

Seizing the opportunities 46

Critical directions for the future 47

Not every pregnancy is welcome 48

Planning pregnancies before they even happen 48

Unsafe abortion: a major public health problem 50

Dealing with the complications of abortion 51

Valuing pregnancy: a matter of legal protection 52

Chapter 4

Attending to 136 million births, every year 61

Risking death to give life 61

Skilled professional care: at birth and afterwards 65

Successes and reversals: a matter of building health systems 65

Skilled care: rethinking the division of labour 68

Care that is close to women – and safe 69

A back-up in case of complications 72

Rolling out services simultaneously 73

Postpartum care is just as important 73

Chapter 5

Newborns: no longer going unnoticed 79

The greatest risks to life are in its beginning 79

Progress and some reversals 82

No longer falling between the cracks 85

Care during pregnancy 86

Professional care at birth 86

Caring for the baby at home 88

Ensuring continuity of care 89

Planning for universal access 90

Benchmarks for supply-side needs 90

Room for optimism, reasons for caution 91

Closing the human resource and infrastructure gap 93

Scenarios for scaling up 93

Costing the scale up 98

Chapter 6

Redesigning child care:

survival, growth and development 103

Improving the chances of survival 103

The ambitions of the primary health care movement 103

The successes of vertical programmes 103

Time for a change of strategy 105

Combining a wider range of interventions 105

Dealing with children, not just with diseases 107

Organizing integrated child care 108

The World Health Report 2005

Households and health workers 109

Referring sick children 111

Bringing care closer to children 112

Rolling out child health interventions 112

The cost of scaling up coverage 115

From cost projections to scaling up 117

Chapter 7

Reconciling maternal, newborn and child health

with health system development 125

Repositioning MNCH 125

Different constituencies, different languages 128

Sustaining political momentum 130

Rehabilitating the workforce 132

Not just a question of numbers 132

Recovering from the legacy of past neglect 134

Destabilization with the best of intentions 136

Tackling the salary problem 136

Financial protection to ensure universal access 137

Replacing user fees by prepayment, pooling and a refinancing of the sector 138

Making the most of transitory financial protection mechanisms 139

Generalizing financial protection 140

Channelling funds effectively 140

Statistical annex 149

Explanatory notes 149