The views expressed in this presentation are the views of the author and do not necessarily reflect the

views or policies of the

Asian Development Bank Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments
they represent. ADBI does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequences of their use. Terminology used may not necessarily be consistent with ADB official terms.

ADBI-Ewha IDHS Policy Workshop:

Gender Dimension in Health and
Sustainable Development Goals (SDGs)

Global Strategies for Women’s Sexual and

Reproductive Health and Sustainable Development
Goals in Asia and Pacific:
JICA’s strategic focus on Reproductive, Maternal
Newborn and Child Health (RMNCH) toward SDGs
25-26 March 2019
Ewha Women’s University
Republic of Korea
Akiko HAGIWARA, Ph.D.
Hagiwara.Akiko@jica.go.jp
Senior Advisor (Health)
Japan International Cooperation Agency
 Outline of the Presentation
1. JICA’s Strategic Focus on Reproductive, Maternal
Newborn and Child Health (RMNCH)
2. JICA’s Health Sector Cooperation in Asian
countries
3. Maternal and Child Health Handbook as a tool for
Women’s and Children’s Health, Empowerment
and Equity

2
 Women’s Empowerment and Health

• Women need to be well informed about their

reproductive health options and available services for
them and for their children.
• Empowered women can gain greater control over their
health and their children’s health by making informed
decision.
• Health is also a driving force for empowerment

Health
Decision Seek Health Good
Information
Making Service Health Empowerment
& Service

3
 JICA’s cooperation in Health sector

• JICA’s cooperation in Health sector focuses on the

achievement and Universal Health Coverage (UHC) and
SDGs with human security approach.

• Universal health coverage (UHC):

ensuring all people and communities can use the
promotive, preventive, curative, rehabilitative and
palliative health services they need, of sufficient
quality to be effective, while also ensuring that the use
of these services does not expose the user to financial
hardship. (WHO, 2017)

4
https://www.jica.go.jp/english/publications/j-world/c8h0vm0000e2ebnn-att/1901_02.pdf
 Human Security and
Quality Growth
• “The Maternal and Child Health handbook (MCH
handbook) provides the strength to live”
• The book is not just a record.
• “The book is designed for mothers and family
members to understand what they can do to take
care of woman and a child at home.”
• Mothers and family members can take active roles
and make decisions on ways to improve their own
health.

https://www.jica.go.jp/english/publications/j-world/c8h0vm0000e2ebnn-att/1901_02.pdf 6
 JICA's Strategy for Reproductive Maternal,
Newborn and Child Health (RMNCH) toward SDGs

UHC COC
Universal Health Coverage Continuum of Care

Multi-
Partnership
sector And sharing knowledge
For Impact

7
 CoC : Continuum of Care

Pregnancy Delivery Postnatal

care care care

Newborn Infant Child

care care care

MNCH services should be

provided on time
wherever they are.

8
 Characteristics of
JICA’s Cooperation in the fields MNCH and RH

1) capacity development of
health administration Health system
2) quality MNCH services to (Provider side)
ensure continuum of
care (COC) Health
3) empowerment of Administration
women and community
4) strengthening linkages
among health Community
administration, MNCH
services and community (Demand Side)
 JICA’s Strategies for RMNCH

• Reproductive, Maternal, Newborn and Child Health

(RMNCH) is a priority in Health Sector
• Health System Strengthening and Capacity
Development to promote continuous Reproductive and
MCH services to all women and children
• Empowerment of women as service provides and
service recipient
• Policy and Regulation to protect women’s health
• Improvement of women’s knowledge, the
strengthening of women’s decision-making to use the
health services to protect themselves and their
children, and the promotion of men’s and
communities’ understanding
10
 JICA’s Strategies for RMNCH

• Preventing unwanted pregnancies and unsafe

abortions, STIs and STDs (HIV/AIDS), and malnutrition
during adolescence.
• Increase awareness of family planning and
reproductive health (RH) (through education programs)
increase use of contraception (through health services).

• JICA’s technical/financial support to projects to

strengthen RH
– India (2007-2011), Jordan (1997-2011), Afghanistan (2004-
2015), Palestine (2005-2012), Syria (2007-2013), Sudan
(2008-2014), for Syrian Refugees in Jordan (2016-2018)
and more.
11
 Universal Access of FP at rural Muslim communities

JICA assisted the Jordan to improve RH/FP 1997-2011

•Community health workers (CHW) were recruited from the target

villages, trained and employed by the Ministry of Health.
•CHW provided RH education, home visit counseling and services
at rural communities.
•CPR significantly improved among the women at intervention
villages. (CPR from 43.7 to 55.6 from 2008 to 2011.)
•Women who have received home-visit program increased their
utilization of postnatal from 2008 to 2011 (25.0% vs. 36.6%)
 JICA’s Health Sector Cooperation
in Asian Countries
1. Long term cooperation history for top
referral hospitals (Facility and Human
Laos: Sethathirath Myanmar: New Yangon
Resources). Hospital Since General Hospital
Since
1998
2. Capacity Development of Health Human 1984

Resources
3. Sharing Japan’s experiences
4. Active relationship with Japanese Since
2007

academics and business, etc.

5. Global Learning among countries with
Japan, beyond bilateral cooperation by
Japan. Thailand: Long term care system

13
 Hospital Hardware & Management
Since Tertiary Hospital Cooperation in Vietnam
1998
Case of Bach Mai Hospital in Hanoi

Japan’s Cooperation
as a driving force, the
Government of Vietnam
further develop the
Hospital sustainably,
in line with the
development of the
country

Vietnam Government
constructed and opened new
building completed in 2016

Central Building by Grant Aid Project

completed in 2001
Technical Cooperation
Projects implemented.
14
 Since
1966
Cho Ray Hospital,
Ho Chi Minh City,
Vietnam

Cho Ray Hospital, built by Japan's

Cooperation in 1970's

PET-CT

Crowded Patient Ward 15

 Hospital Management
Nosocomial Infection Control System Development
at Cho Ray Hospital, Vietnam 2000-2005
(1) Training of Infection Control Practitioner（ICP)
(2) Organize & Operate Infection Control Committee (ICC) and Infection
Control Team(ICT) as a lead body
(3) Hospital Round by the member of ICC/ICT based on the activity plan
(4) Enhancement of Inter-Professional Work

16
 Hospital/Medical Cooperation for Myanmar

• Regional General Hospitals:

Loikaw in Kayah, Magway,
Dawei, Lashio in Shan State
• Management Improvement for
Community to Regional Hospital
• Tertiary Hospital： Construction of （Image）

New Yangon Specialist Hospital

• Health Human Resource Development:
Medical Education, Medical Engineers,
Health Information System Trainings
• Public-Private Partnership Projects：
Medical Oxygen Supply, Blood Transfusion Equipment
17
 Maternal and Child Health and
Health System Strengthening
in Philippine
Cordillera-wide strengthening of
the local health system
for effective and efficient delivery of
maternal and child health services
2012-2017
Birthing Facility in Rural
Areas Training on Basic Emergency
Obstetric and Newborn Care
(BEmONC)

Community Campaign

Health Facility accreditation by health insurance agency

19
Source: Dr. Makoto Tobe, JICA
 MCH and Health System Strengthening
in Philippine

Health National Health

Upgrading Birth
Worker’s Insurance policy
facility with basic facility accreditation,
emergency obstetric skill
supportive
care training supervision

Maternal
Organize Community
and
Strengthening of Health Team to
Newborn
Local Health System support mothers,
Death
children and families
Review

20
 NCDs Maternal health HSS & Prevention
Bangladesh: THE PROJECT FOR STRENGTHENING HEALTH
SYSTEMS THROUGH ORGANIZING COMMUNITIES
2017-2022
• Objective: Improve both Non-
Communicable Diseases (NCDs) and
Maternal Health services in an
integrated manner with a
community based approach through
mobilizing Community Group (CG)
and Community Support Group
(CSG).
 Delivering integrated NCDs and Maternal Health
services
 Strengthening Hospital Management for Service
Quality Improvement
 Promoting NCD Prevention Activities in the Pilot
Sites through Working with Community Support
Groups 21
 Promoting Mutual Learning
Indonesia-JICA Training course on MCH Handbook
2007-2018
In INDONESIA by Ministry of Health Indonesia
Participated by Afghanistan(28), Laos(27), Vietnam(18),
Since Kenya(16), East Timor(13), Uganda(8), Morocco(8),
2007
Bangladesh(6), Palestine(6), Philippine(5), Thailand(3),
Tajikistan(3), Myanmar(1), Cameroon(1).
Total 143 participants from 15 countries

Based on the Indonesia

and JICA cooperation
On MCH Handbook Since
1993

Photo: 2018 International Training Program

Lampung Province- Indonesia Oct.28th -Nov 2nd, 2018 22
 Promoting Mutual Learning
Thailand-Japan
The Partnership Project for Global Health and
Universal Health Coverage)
2016-2020

• Global learning for UHC

• to improve Access to health services and
financial risk in Thailand and participating
countries. (in and out of ASEAN countries)
MAIN THEMES:
Achievement of UHC, Sustainable Health
Finance, Health System for Ageing Society
23
 Promoting Mutual Learning
• Knowledge Co-creation
Program in Japan JFY2017,
2018
• “Continuum of Care for
Maternal, Newborn and Child
Health(MNCH)and Universal
Health Coverage(UHC) ”

• THEME “What are the UHC gaps and how to promote CoC ad
UHC in your country?”
Participants:
Afghanistan (3）Cambodia(2) Myanmar (2) Tadzhikistan (2) Laos (1)
Ghana(6) Kenya (1) 24
 Promoting Mutual Learning
• Knowledge Co-creation
Program in Japan JFY2015,
2016, 2017, 2018,
• “Improvement of Maternal
Health Through the CoC at
Community Level”

Themes:
• Client Friendly Services
• Creating Supportive
Environment
• Action Plan to
Strengthen COC at
Community level
• Afghanistan(6), Pakistan(5)
Philippine(5) Myanmar(5)
India(3), Tajikistan (3),
Bhutan(2)…. total of 62
participants from 25 countries
(up to 2017)
25
 JICA’s Assistance on MCH and MCH
handbook in the world

• 9 million MCH handbook / years

• More than 20 countries
• With their local languages
• In line with their National RMNCH and Nutrition
standards
26
Contribute to International Standards Creation
‘WHO recommendations on home based
records for maternal, newborn and child
health’ (Published, Sep.18, 2018)
JICA proposed and cooperated WHO for creating
new international guidelines.

Evidences from Research by JICA Senior Advisors ANGOLA:

・Keiko Osaki (20015) Factors affecting the utilization of maternal, Cluster Randomized Controlled
newborn, and child health services in Indonesia: the role of the
Trial, to verify the effects to
Maternal and Child Health Handbook
Continuum of Care between
(2017) Maternal and Child Health Handbook use for maternal and
child care: a cluster randomized controlled study in rural Java,
MCH Handbook and existing
Indonesia Home Based Records.
・Akiko Hagiwara (2013) Is the Maternal and Child Health (MCH)
handbook effective in improving health-related behavior?
Evidence from Palestine
・Hirotsugu Aiga (2016) Fragmented implementations of
maternal and child health home-based records in Vietnam: Need
for an integration. , etc. 27
 What is MCH handbook?

• The Maternal and Child Health Handbook is

a comprehensive tool designed to be kept
by the family that may contain health
records and information on pregnancy,
delivery and child health.

• Comprehensive Health Record

• It is a complete health record for both a mother and a baby.
• Health Education Messages
• Helps mothers make informed health decisions
• Continuous health care practices
• Promote Continuity of maternal and child care (continuum of care)
• Effective integration between primary and secondary health care.
28
Platform to Link all stakeholders

MCH

Family
EPI
Planning

Growth
IMCI
Monitoring

Nutrition ECD
A. Hagiwara (2016)
29
 Promoting CoC for
the 1st 1000 days
Health system
(Provider side)
Hospital/Clinic

Health center

Community
Outreach
Community
(Demand Side)
Home visit
A. Hagiwara (2016) 30
 MCH handbook as a tool for
Women Empowerment

• MCH handbook promotes equity

• It ensures the rights and entitlements of women,
children and minorities, particularly during
vulnerable stages of the life course.
• It provides information and encourage a woman
to seek health services.
• It provides a chance for a woman to make
decision by herself on her health and on her
child’s health.
31
 MCH handbooks
as Global Standards with Global Networking

11th international conference on MCH handbook was held in

Bangkok, Thailand, 12-14 Dec. 2018. More than 400
participants from 31 countries participated in the conference,
including Afghanistan, Cambodia, Indonesia, Lao PDR,
Myanmar, Philippines , Tajikistan, Vietnam, Kenya Angola, ….
32
Technical Brief for Global Promotion of MCH HB
 Technical Brief
MCH Handbook Technical Brief (English)
http://libopac.jica.go.jp/images/report/
P1000030133.html
MCH Handbook Technical Brief (French)
http://libopac.jica.go.jp/images/report/
P1000030143.html
 “The health and nutrition of
women during pregnancy has
a lifelong impact on their
children’s wellbeing. That is
why we started training health
care providers in nutrition
counseling for women
through sessions that are easy
to understand, utilizing the
personal health data kept in
the maternal and child health
handbook”, said Hagiwara.
https://www.newsweek.com/sponsored/how-japan-applying-its-knowledge-and-
experience-ensure-health-and-well-being-all
35
36
 Related Links
Home-based records for maternal, newborn and child health-Guideline in
development
http://www.who.int/maternal_child_adolescent/guidelines/development/hom
e-based-records/en/
Protecting Precious Lives - Mother and Child Health Handbooks for the Future
https://www.youtube.com/watch?v=1r53JHmhSGk
(Introduction of Digital Application of MCH Handbook in Japan and in Jordan)
“Fortifying Parent-and-Child Healthcare in Palestine” (Gov. of Japan)
https://www.youtube.com/watch?v=1YqpiW2y7mw
“What is MCH handbook ” (Gov. of Japan)
https://www.youtube.com/watch?v=jsime57JTXA

Hagiwara A, Ueyama M, Ramlawi A, Sawada Y. Is the maternal and child health (MCH)
handbook effective in improving health-related behavior? Evidence from Palestine. J
Public Health Policy. 2013;34:31–45. doi: 10.1057/jphp.2012.56.

37
VietHealth (2013) End-line survey for assessing the intervention of Project for
Implementing Maternal and Child Health Handbook for Scaling-Up Nationwide.
Hanoi: JICA

Osaki K, Hattori T, Kosen S, Singgih B. (2009), Investment in home-based maternal,

newborn an child records improves immunization coverage in Indonesia, Trans R
Soc Trop Med Hyg. 103 (8) 846-848 .27 (2): .121-127.

Mori R, Yonemoto N, Noma H, Ochirbat T,Barber E, Soyolgerel G, et al. (2015) The

Maternal and Child Health (MCH) Handbook in Mongolia: A Cluster-Randomized,
Controlled Trial. PLoS ONE 10(4): e0119772. doi:10.1371/journal.pone.0119772

Osaki K, Hattori T, Kosen S. Factors affecting the utilisation of maternal, newborn,

and child health services in Indonesia: the role of the Maternal and Child Health
Handbook. Public Health. 2015;129(5):582–6.

Aiga H, Nguyen VD, Nguyen CD, Nguyen TTT, Nguyen LTP. (2016) Knowledge,
attitude and practices: assessing maternal and child health care handbook
intervention in Vietnam. BMC Public Health 16: 129.
38