s The World Health report 2005 b Make every mother and child count ssss World Health Organization ss Policy briet one Integrating maternal ssss newborn and child health programes sss This year's World Health Report comes at a time when only a decade is left to achieve the MDGs. Poverty, inequality, war and civil unrest, and the destructive influence of HIV/AIDS have all played their part in the lack of progress towards better health for mothers and children but the key obstacle is exclusion from good quality care. TACKLING EXCLUSION born. Progress in tackling this situation is too slow and too patchy. In a Rising demand and expectations Families in poor communities, few countries great improvements have been made, but in many others and women in particular, know all too well that access to health care is mortality rates have stagnated or taken a turn for the worse. Currently important. They are increasingly demanding better care for their babies almost no measurable progress is being made in maternal health, and and children, and for themselves as well. They rightfully expect their newborn health has until recently gone unnoticed as an important com- governments to guarantee their access to care. These expectations ponent of child health. The irony behind this lack of progress is that now constitute a political reality and there are political costs for those most of the deaths could be avoided since the life saving interventions ho ignore the call are well known and can be implemented on a large scale, including in resource poor settings. The main problems are not technical, but Too many remain excluded b The reasons for exclusion from access operational: choosing the right strategies for programmes to go to scale to care are multiple Services may simply be unavailable, or women with and overcome the constraints that hamper the development of may find it difficult to access them because of their gender or because effective health systems of barriers generated by poverty, race, language and culture, uncer- tainty about what care will cost them, or the awareness that it will be CHOOSING THE RIGHT PROGRAMME STRATEGIES too expensive, deters many from accessing care that may prove vital. Building the continuum of care p The core principle underlying the Even for people who do manage to use services, what is offered can strategies to develop MNCH programmes is the"continuum of care be untimely, ineffective, unresponsive or discriminatory -and is often Confusingly, this expression has two meanings. First, it means care has catastrophically expensive to be provided as a continuum throughout the life cycle, including ado- lescence, pregnancy, childbirth and childhood. Second, it indicates that Too little progress> The results are often fatal. Every year 529 000 care has to be provided in a seamless continuum that spans the home, women die from pregnancy-related causes, including a staggering the community, the health centre and the hospital. Understanding these their fifth birthday. This number includes 4 million babies who die be. two dimensions of the continuum of care has profound consequences 68 000 from unsafe abortion alone. 10.6 million children do not reach for the way programmes are organized fore they are one month old, but not the 3. 3 million babies that are still-Policy brief one Integrating maternal, newborn and child health programmes born. Progress in tackling this situation is too slow and too patchy. In a few countries great improvements have been made, but in many others mortality rates have stagnated or taken a turn for the worse. Currently almost no measurable progress is being made in maternal health, and newborn health has until recently gone unnoticed as an important com￾ponent of child health. The irony behind this lack of progress is that most of the deaths could be avoided since the life saving interventions are well known and can be implemented on a large scale, including in resource poor settings. The main problems are not technical, but operational: choosing the right strategies for programmes to go to scale with and overcome the constraints that hamper the development of effective health systems. CHOOSING THE RIGHT PROGRAMME STRATEGIES Building the continuum of care ► The core principle underlying the strategies to develop MNCH programmes is the “continuum of care”. Confusingly, this expression has two meanings. First, it means care has to be provided as a continuum throughout the life cycle, including ado￾lescence, pregnancy, childbirth and childhood. Second, it indicates that care has to be provided in a seamless continuum that spans the home, the community, the health centre and the hospital. Understanding these two dimensions of the continuum of care has profound consequences for the way programmes are organized. This year’s World Health Report comes at a time when only a decade is left to achieve the MDGs. Poverty, inequality, war and civil unrest, and the destructive influence of HIV/AIDS have all played their part in the lack of progress towards better health for mothers and children, but the key obstacle is exclusion from good quality care. TACKLING EXCLUSION Rising demand and expectations ► Families in poor communities, and women in particular, know all too well that access to health care is important. They are increasingly demanding better care for their babies and children, and for themselves as well. They rightfully expect their governments to guarantee their access to care. These expectations now constitute a political reality and there are political costs for those who ignore the call. Too many remain excluded ► The reasons for exclusion from access to care are multiple. Services may simply be unavailable, or women may find it difficult to access them because of their gender or because of barriers generated by poverty, race, language and culture, uncer￾tainty about what care will cost them, or the awareness that it will be too expensive, deters many from accessing care that may prove vital. Even for people who do manage to use services, what is offered can be untimely, ineffective, unresponsive or discriminatory – and is often catastrophically expensive. Too little progress ► The results are often fatal. Every year 529 000 women die from pregnancy-related causes, including a staggering 68 000 from unsafe abortion alone. 10.6 million children do not reach their fifth birthday. This number includes 4 million babies who die be￾fore they are one month old, but not the 3.3 million babies that are still￾The World Health Report 2005 Make every mother and child count 1 World Health Organization