Global reproductive, maternal, newborn, child and adolescent health policy survey: report for the Western Pacific Region 2020

Global Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey Report for the Western Pacific Region 2020 Global reproductive, maternal, newborn, child and adolescent health policy survey: Report for the Western Pacific Region 2020 © World Health Organization 2022 ISBN 978 92 9061 978 9 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Zak iii CONTENTS Abbreviations .................................................................................................................. vii Tables and figures ........................................................................................................... ix Foreword ......................................................................................................................... xv Executive summary ......................................................................................................xvii Summary of regional survey findings .............................................................................................xvii National-level coordination and target setting for RMNCAH .......................................xvii Maternal and newborn health.................................................................................................xviii Child health ...................................................................................................................................xviii Adolescent health ........................................................................................................................xviii Reproductive health ......................................................................................................................xix Gender-based violence ................................................................................................................xix The way forward ...................................................................................................................................... xx Introduction ......................................................................................................................1 Methods.... .........................................................................................................................3 Global RMNCAH Policy Reference Group (PRG) .............................................................................. 3 MCA Department policy survey ............................................................................................................. 3 Review of existing data sources ........................................................................................................... 3 Mapping the MCA survey and policy database to the Framework of Priority Policy Areas for RMNCAH ............................................................................ 4 Questionnaire development .................................................................................................................. 4 Questionnaire administration ............................................................................................................... 4 Data processing .......................................................................................................................................... 5 Data analysis ............................................................................................................................................... 5 Response ...........................................................................................................................6 Results......... ......................................................................................................................6 I. Cross-cutting RMNCAH ......................................................................................................... 6 National coordinating body on RMNCAH ................................................................................. 6 National targets for RMNCAH indicators.................................................................................. 9 National policy to ensure civil society engagement in RMNCAH national planning and review ....................................................................................................11 Quality of care for RMNCAH........................................................................................................14 Financial protection .......................................................................................................................18 iv G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Policies and legislation related to human right to health and health care ...............25 Policies on birth and death registration processes ............................................................28 Specifics on birth registration and as a precondition for accessing health and education services .................................................................................................................29 Specifics on death registration and routine audits.............................................................31 Survey and health management information system ........................................................33 Home-based records ......................................................................................................................40 II. Maternal and newborn health ..........................................................................................41 Antenatal care policy .....................................................................................................................41 Childbirth policy ..............................................................................................................................45 Postnatal care for mother and newborn policy .................................................................... 47 Management of premature/low-birthweight newborns ...................................................52 Management of sick newborns ..................................................................................................54 Lactation policy ...............................................................................................................................55 Human resources policy ...............................................................................................................56 Essential medicines and equipment ........................................................................................59 Maternal deaths ..............................................................................................................................61 Stillbirths ...........................................................................................................................................64 Neonatal deaths ..............................................................................................................................65 III. Child health .......................................................................................................................66 Overall strategy or plan for child health and development ............................................66 Prevention and management of pneumonia ........................................................................69 Prevention and management of diarrhoea ............................................................................71 Prevention and management of malaria ................................................................................72 Prevention and management of all forms of malnutrition ..............................................74 Paediatric hospital care for sick children ...............................................................................76 Essential medicines and equipment ........................................................................................76 Early childhood development ....................................................................................................79 Provision of integrated child health services .......................................................................81 IV. Adolescent health .............................................................................................................85 Overall plans/guidelines for adolescent health ..................................................................85 Cost for health services ................................................................................................................89 Infrastructure and training ..........................................................................................................91 Consent for services .......................................................................................................................93 Legislation .........................................................................................................................................95 vG LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y V. Reproductive health ........................................................................................................96 General reproductive health .......................................................................................................96 Family planning/contraception ..................................................................................................99 Clinical practice guidelines on family planning/contraception .................................. 103 Commodities for family planning and contraception ..................................................... 105 Sexually transmitted infections ...............................................................................................107 Cervical cancer .............................................................................................................................. 109 Infertility ......................................................................................................................................... 111 Sexual health ................................................................................................................................ 112 VI. Gender-based violence ...................................................................................................117 Specifics on national guidelines/protocols to address GBV by the health sector .................................................................................................................... 121 National clinical guideline/protocol for survivors of violence .................................... 122 vi G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y vii G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y ABBREVIATIONS ANC antenatal care BCG bacille Calmette–Guérin BFHI Baby-friendly Hospital Initiative CSE comprehensive sexuality education CHW community health worker ECD early childhood development EmOC emergency obstetric care services GBV gender-based violence GS 2030 Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) HIS health information system HMIS health management information system HPV human papillomavirus ICD-10 International Classification of Diseases, 10th revision ICM International Confederation of Midwives IMCI integrated management of childhood illness IMR infant mortality rate IUD intrauterine devices IVF in vitro fertilization KMC Kangaroo Mother Care MMR maternal mortality ratio NMR neonatal mortality rate PEP post-exposure prophylaxis PHC primary health care PNC postnatal care PPH postpartum haemorrhage PRG Policy Reference Group PSBI possible serious bacterial infection QOC quality of care RMNCAH reproductive, maternal, newborn, child and adolescent health SBA skilled birth attendant viii G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y SPA Service Provision Assessment STIs sexually transmitted infections TB tuberculosis TWG technical working group U5MR under-5 mortality rate UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund WASH water, sanitation and hygiene WHO World Health Organization ix GLOBAL REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH POLICY SURVEY Table 1. National coordinating body for RMNCAH and its components ........................................ 7 Table 2. Country-reported national target and year for RMNCAH indicators ........................... 10 Table 3. Country-reported national target and year for adolescent health indicators ......... 10 Table 4. Country-reported national target and year for SBA ........................................................... 11 Table 5. Countries/areas with a national policy in place to ensure civil society ......................... organizations’ engagement in planning and review of national RMNCAH programmes ....................................................................................................................................... 11 Table 6. Types of stakeholders that participated in national RMNCAH review ....................... 13 Table 7. Countries/areas having a national policy or guideline to improve quality of care in RMNCAH areas .............................................................................................. 14 Table 8. Countries/areas with a steering committee or TWG that looks at quality of care in RMNCAH areas ............................................................................................................. 15 Table 9. Countries/areas with national quality-of-care standards updated and community feedback solicited .....................................................................................................17 Table 10. Countries/areas with a national policy or guideline on free access to health services in the public sector .......................................................................................... 19 Table 11. Service free of charge at point of use in public sector for women of reproductive age .............................................................................................................................. 20 Table 12. Service free of charge at point of use in public sector for newborns ......................... 22 Table 13. Are children exempt from user fees for the following services in the public sector? ....................................................................................................................... 23 Table 14. Are adolescents exempt from user fees for the following health services in the public sector? ....................................................................................................................... 24 Table 15. Countries/areas having a dedicated law on following topics ........................................ 25 Table 16. Countries/areas having laws on primary health care and child welfare ...................27 Table 17. Countries/areas having laws or policies on birth registration, death registration and death audit........................................................................................... 29 Table 18. Specifics required by policy and law on birth registration.............................................. 30 Table 19. Countries/areas having a policy or law that requires proof of a birth certificate as a precondition for children’s access to health services and education ................ 31 Table 20. Countries/areas with a policy or law requiring death registration quality, audits and areas covered .............................................................................................................. 32 Table 21. Data being collected and reported by national health information system (HIS) .... 34 Table 22. Countries/areas having a national policy or guideline on ANC that contains specific recommendations ......................................................................................... 41 TABLES AND FIGURES xG LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 23. Countries/areas with national guideline or policies on ANC that included counselling and interventions ......................................................................................................... 42 Table 24. Countries/areas having national policy or guideline on improving preterm birth outcomes ........................................................................................................................44 Table 25. Countries/areas with national policies or guidelines on childbirth, on the right of access to skilled care and on recommendations on the place of childbirth ..............45 Table 26. Countries/areas with national policies or guideline on childbirth .....................................46 Table 27. Countries/areas with national policies or guidelines on postnatal care for mothers and newborns ...................................................................................................................47 Table 28. Countries/areas with national policies or guidelines on postnatal contacts ..................48 Table 29. Countries/areas with postnatal care policies or guidelines with specific ............................ recommendations ....................................................................................................................................50 Table 30. Countries/areas with recommendations on essential newborn care .................................52 Table 31. Management of preterm and low-birthweight newborns ......................................................53 Table 32. Countries/areas with national policies or guidelines on management of sick newborn babies ...............................................................................................................................54 Table 33. Countries/areas with national policy or guideline on lactation ...........................................55 Table 34. Countries/areas with human resource policy on maternal and newborn health care..................................................................................................................................................56 Table 35. Health professionals (nurse, midwife, nurse-midwife, medical assistant) other than a doctor that can independently perform specific maternal and newborn care interventions ........................................................................................................58 Table 36. Essential drugs indicated for use during pregnancy, childbirth and postpartum care .......................................................................................................................................60 Table 37. Supplies and equipment included in the national list of commodities indicated for use of pregnancy, childbirth and postpartum care ..........................................61 Table 38. Countries/areas with policy, guideline or law on maternal death reporting and review systems .................................................................................................................................62 Table 39. Countries/areas with a national panel or committee in place for maternal death .......63 Table 40. Countries/areas with a national policy, guideline or law on stillbirth review .................64 Table 41. Countries/areas with national policy or guideline on neonatal death reporting and review ..............................................................................................................................65 Table 42. Summary of strategy or plan for child health and development .........................................67 Table 43. Malaria approaches and treatment in countries/areas ............................................................73 Table 44. Child-specific malaria policy/guideline for preventive purposes in three countries ..........................................................................................................................................73 Table 45. Countries/areas with national policy or guideline on hospital care for sick children ...............................................................................................................................................76 Table 46. National essential drug list for management of childhood illness .....................................77 Table 47. Time periods addressed by ECD policy and guideline ..............................................................79 xi G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 48. Interventions recommended by national policy or guideline on ECD ................................80 Table 49. Sectors involved in national coordination mechanism for ECD ...........................................81 Table 50. Countries/areas with national policy or guideline for IMCI at PHC level, and by trained CHWs ....................................................................................................83 Table 51. Assessment and referral, or assessment and treatment activities that can be conducted by CHWs according to the national policy/guideline ...................................83 Table 52. Home-care practices by trained CHWs that are included in the national policy/guideline .....................................................................................................................84 Table 53. Summary table of key strategies/policies/laws/guidelines on adolescent health ........86 Table 54. Countries where adolescents are cited as a specific target group for interventions/activities in national policies/guidelines by each health issue ................87 Table 55. Summary of national standards for health service delivery for adolescents ...................89 Table 56. Summary of cost for health services – Are adolescents exempt from user fees for the following health services in the public sector? ..................................................90 Table 57. Health-promoting schools and adolescent health programmes .........................................91 Table 58. Summary of health worker competency, continuous education and pre-service training for adolescent-related service ...................................................................92 Table 59. Countries/areas that have legal age limits for unmarried adolescents to provide .......... consent, without parental/legal guardian consent for selected services .....................93 Table 60. Summary of legal age limit for married adolescents to provide consent to services without spousal consent ................................................................................................94 Table 61. Summary of laws and policies for protecting adolescent health .........................................95 Table 62. Coverage of reproductive health by national policies and guidelines ...............................97 Table 63. Countries/areas with a national policy or guideline on reproductive health care ..........98 Table 64. Prohibition of contraceptives from being made available in national policy/guidelines .....................................................................................................................................99 Table 65. Countries/areas that have a national policy or guideline on family planning or contraception that requires availability of data (survey or HMIS) disaggregated by population groups ............................................................................................. 101 Table 66. Countries/areas with a national policy or guideline on family planning or contraception .................................................................................................................................... 102 Table 67. Countries/areas with a national clinical practice guideline on family planning or contraception that include the following components ................................ 104 Table 68. Family planning and contraceptive commodities included in the national essential drug list ................................................................................................................................. 106 Table 69. Countries/areas with a national policy or guideline on STI that include the following specifics ................................................................................................................................ 108 Table 70. Countries/areas with policy or guideline on cervical cancer prevention and control that allows the provision of the following services ....................................... 110 Table 71. Assisted reproductive technology that is regulated by national policy or law ....................111 xii G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 72. Countries/areas reported having assisted reproductive technology or IVF services to groups of people specified ................................................................................. 112 Table 73. Countries/areas with a national policy or law on sexual health information and services that have provisions for non-discrimination for specified population groups ................................................................................................................................ 113 Table 74. Countries with law or policy decriminalizing male and female commercial sex workers.............................................................................................................................................. 113 Table 75. Countries/areas with a policy or law on sexual education and health worker’s training in counselling ...................................................................................................... 114 Table 76. Summary table on sexual health policies reported by countries/areas ......................... 115 Table 77. Summary table of key strategies, policies, laws or guidelines on gender-based violence .................................................................................................................................................... 117 Table 78. Countries/areas with national policy or guideline on gender-based violence contents .................................................................................................................................. 118 Table 79. Countries/areas with laws and policies on GBV specifics .................................................... 120 Table 80. Countries/areas with national guideline and protocol to address GBV by the health sector ............................................................................................................................. 122 Table 81. Countries/areas with national clinical guideline or protocol for survivors of violence ............................................................................................................................ 124 Fig. 1. Map of Global RMNCAH Policy Survey (2018), country participation in the Western Pacific Region ............................................................................................................... 6 Fig. 2. Stakeholders included in the national RMNCAH coordinating body .................................... 9 Fig. 3. Types of stakeholders that participated in national RMNCAH review ...............................12 Fig. 4. Proportion of countries/areas with a quality-of-care steering committee .......................15 Fig. 5. Types of stakeholders that participate in the national RMNCAH steering committee ........16 Fig. 6. Proportion of countries/areas with national quality-of-care standards and protocols for RMNCAH service delivery .................................................................................16 Fig. 7. Countries/areas with a national policy or guideline on free access to health services in the public sector ..................................................................................................18 Fig. 8. Countries/areas having laws on primary health care and child rights/welfare .............26 Fig. 9. Countries/areas with laws or policies on birth registration, death registration and death audits ......................................................................................................................................28 Fig. 10. Proportion of countries/areas conducting specific surveys or assessments ....................33 Fig. 11. Top three most common data sources used to compare country RMNCAH mortality rates and ratios .....................................................................................................................39 Fig. 12. Types of home-based records used ..................................................................................................40 Fig. 13. Proportion of countries with a national policy/guideline that recommends midwife-led care for pregnancy, childbirth and postnatal period ........................................57 xiii G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Fig. 14. Proportion of countries/areas with national policies/guidelines on the management of childhood pneumonia for children .................................................................69 Fig. 15. Percentage of level of health facilities that can treat pneumonia with chest in-drawing ......................................................................................................................................69 Fig. 16. Percentage of the first-line treatment for pneumonia with chest in-drawing ...............70 Fig. 17. Percentage of the first-line treatment for pneumonia with fast breathing .....................70 Fig. 18. Percentage of the recommended duration of treatment of pneumonia with fast breathing ..................................................................................................................................71 Fig. 19. Countries/areas having policy or guideline on management of childhood diarrhoea .....................................................................................................................................................71 Fig. 20. Malaria-endemic countries in the Western Pacific Region ......................................................72 Fig. 21. Countries/areas with national policy or guideline on management of acute malnutrition in children ...........................................................................................................74 Fig. 22. Recommended assessment of children for acute malnutrition ............................................75 Fig. 23. Countries/areas with national policy/guideline on routine assessment of children for overweight and obesity in health facilities ..........................................................75 Fig. 24. Conditions addressed by national IMCI guideline ......................................................................82 Fig. 25. Coverage of reproductive health contents covered by national policies and guidelines ..........................................................................................................................................97 Fig. 26. Prohibition of contraceptives from being made available in national policy/guidelines .....................................................................................................................................99 Fig. 27. Countries/areas having a national policy or guideline that prohibits access of family planning methods to specified population groups or requires availability of data disaggregated by population groups ..................................................... 100 Fig. 28. Coverage of key family planning components included in the national guideline ..........103 Fig. 29. Family planning and contraceptive commodities included in the national essential drug list ................................................................................................................................. 105 Fig. 30. Health professionals other than a specialist doctor that are allowed to independently perform family planning services .................................................................... 107 Fig. 31. National policy on provision of cervical cancer prevention and control ........................ 109 Fig. 32. Countries/areas with a national policy or law on sexual health information and services that have provisions for non-discrimination for specified population groups ................................................................................................................................ 112 Fig. 33. Countries/areas with laws and policies on GBV specifics .................................................... 120 Fig. 34. National guidelines or protocols addressing GBV by the health sector ......................... 121 Fig. 35. Countries/areas with national clinical guideline/protocol for survivors of violence ............................................................................................................................................... 123 xiv G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y xv FOREWORD FOREWORD Member States in the Western Pacific Region have repeatedly demonstrated their commitment to the provision of the best possible care for our women, children and families across the life course. This is seen in the dramatic improvements in access to reproductive, maternal, newborn, child and adolescent health (RMNCAH) services. For example, around 95% of births in our Region now take place in a health facility, attended by a skilled birth attendant. However, RMNCAH remains an unfinished business. Reaching the last few unreached with accessible RMNCAH services figures prominently in the health agenda of Member States in the Region. Moreover, more people around the globe die from poor-quality services than inaccessibility. Hence, we need a two-pronged approach towards reaching the unreached that also emphasizes quality of care. For the Future: Towards the Healthiest and Safest Region is a shared vision between Member States, WHO and partners in the Western Pacific and provides the framing to create more robust and efficient RMNCAH programmes through better integration into the broader health systems agenda, thematic priority setting and new operational shifts. This Global Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey, Report for the Western Pacific Region 2020 aims to assist Member States to review the alignment of policies, guidelines and laws against actions outlined in The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). We urge countries to use the detailed data breakdown and analysis in this report to drive progress in RMNCAH towards achieving the For the Future vision for all our women and children. We greatly appreciate the immense support of health ministries, national agencies and institutions, and other stakeholders who provided all the detailed information compiled in this report. Through our continued collaboration towards advancing universal health coverage, we strive to make health and development a reality for all women, children and families in the Western Pacific Region. Takeshi Kasai, MD, Ph.D. Regional Director xvi G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y xvii EXECUT IVE SUMMARY EXECUTIVE SUMMARY Reducing maternal, newborn, child, and adolescent morbidity and mortality remain key health priorities globally. Under the Sustainable Development Goals and the United Nations Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), all countries have committed to improving the health of women, children and adolescents via transformative multisectoral action to accelerate coverage of interventions, reduce gender and equity gaps, and improve the quality of services. Achieving these goals requires the adoption and implementation of strong, evidence-informed and equity-focused policies spanning the continuum of care for reproductive, maternal, newborn, child and adolescent health (RMNCAH) reaching beyond traditional health system boundaries. To track country progress in adopting World Health Organization (WHO) recommendations in national health legislation, policies, strategies and guidelines related to RMNCAH, WHO regularly conducts the Global Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey, with the previous four rounds conducted during 2009–2010, 2011–2012, 2013–2014 and 2016. All WHO Member States were invited to participate in the online global RMNCAH policy survey between July 2018 and April 2019. In the WHO Western Pacific Region, 14 (52%) countries and three (30%) areas completed the survey. Summary of regional survey findings National-level coordination and target setting for RMNCAH Half the participating countries and areas have a national coordinating body for RMNCAH-specific areas of work. National targets for skilled birth attendants (SBAs), the maternal mortality ratio (MMR), neonatal mortality rate (NMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR) are relatively well addressed, ranging from 72% to 100%, while only two countries reported having a national target for the stillbirth rate. Financial protection (free access) was addressed through national policies and laws. The highest was for immunization reported by 13 (76%) countries and areas, followed by 12 (71%) for growth monitoring and well-child visits, 11 (65%) for postnatal care, 10 (59%) for management of birth complications and adolescent HIV testing and treatment, and nine (53%) for antenatal care visits and services for sexually transmitted infections (STIs). Free rehabilitation service for adolescent substance abuse was only covered in three countries (18%). Among 13 countries, only three (23%) had policies and legislation in place for a human right to health and health care fully addressed across RMNCAH, six (46%) included coverage of maternal and newborn health, and five (38%) included coverage of sexual and reproductive health, as well as health rights, child health and adolescent health. Sixteen (94%) countries and areas had established processes for birth registration and 15 (88%) for death registration. However, only seven (41%) countries require routine audits by law for maternal, perinatal, newborn and child deaths. Birth registration is required for access to education in 11 (65%) countries, while only five (29%) countries use it for access to health services. xviii G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y According to the survey, assessments of emergency obstetric care services (EmOC) have been conducted in six (35%) countries, Service Availability and Readiness Assessments (SARAs) have been conducted in five (29%), while the Service Delivery Indicators Survey (SDI) and Service Provision Assessment (SPA) were conducted in four (24%) countries and areas. Less than one third of countries have conducted surveys since 2015. Maternal and newborn health Antenatal care (ANC) and postnatal care (PNC) counselling and interventions are well addressed through policies and guidelines. Nevertheless, only four countries included WHO recommendations on encouraging women to choose the birth position. All 13 countries that reported data on essential newborn care have a national policy or guideline in place on essential newborn care that recommends immediate skin-to-skin contact after birth (92%), delayed cord clamping (92%), early initiation of breastfeeding (100%), basic resuscitation (100%), hepatitis B vaccination (92%) and vaccination for bacille Calmette–Guérin (BCG) (92%). Six countries (60%, N=10) included Kangaroo Mother Care (KMC) (for clinically stable newborns of 2000 g or less) in national guidelines. Policies on lactation were covered by four countries (24%, N=17) on donor milk, three countries (18%) on the regulation of a human milk bank, and 11 countries (65%) on lactation support and the Baby-friendly Hospital Initiative (BFHI). Essential medicines and equipment for maternal and newborn care were well addressed. Child health Thirteen (76%) countries and areas reported having a national policy, guideline or law in place to provide free access to health services in the public sector for children under the age of 5 years, nine (53%) reported recognizing the need for universal access to essential health services and medicines for children up to 9 years of age, while five (29%) cover only up to age 5. Less than a third of countries reported having a national policy, guideline or law that addresses common childhood diseases covering the 0–9 years age group, with four countries (24%) covering pneumonia and diarrhoea, and three (18%) covering acute malnutrition. Nine countries (53%) reported having integrated management of childhood illness (IMCI) policies for prevention and case management of children 0–5 years of age. Ten countries (59%) reported having early childhood development (ECD) policies. Six countries (60%, N=10) reported that the national ECD policies cover care for children with developmental difficulties and disabilities. There was good representation from the health, nutrition, education, social welfare and child protection sectors involved in ECD national coordination mechanisms; however, only five countries (50%, N=10) reported that the national ECD policies involve environmental safety and security, including water, sanitation and hygiene (WASH) sectors. Adolescent health Nine countries (53%) reported having a policy on free access to health services for adolescents, with adolescent health programmes, and six (35%) reported having a professional education system for primary health workers to receive adolescent-specific training. Fourteen countries G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y xix EXECUT IVE SUMMARY (82%) reported having national guidelines that cited adolescents as a specific target group for sexual and reproductive interventions; 11 (65%) on tobacco, alcohol, substance use and mental health; and eight (47%) on injury and violence. As for the cost of health services in the public sector, 10 countries (59%) reported granting free access to HIV testing and counselling, nine (53%) countries granted free access to testing and treatment for STIs, seven (41%) provided counselling on contraceptives and mental health, and five (29%) on vaccination for human papillomavirus (HPV) and inpatient care, while free access to rehabilitation for substance abuse was covered by only three countries (18%). There was a lack of pre-service curriculum and continuing education and pre-service training for adolescent-related services across all cadres from clinicians, nurses and community health workers (CHWs). Consent from a parent or a legal guardian for contraceptive services (except sterilization) for unmarried adolescents was required by 11 countries (65%), and spousal approval was required by 10 countries (59%) for married adolescents. Reproductive health Fourteen (82%) countries reported having a national policy on reproductive health, including family planning, STIs, cervical cancer, infertility and sexual health. Nine countries (69%, N=13) reported having no prohibition on the availability of emergency contraceptives, and 10 (77%) had no prohibition on injectable implants and intrauterine devices (IUDs). Ten countries (77%, N=13) reported having a national policy requiring that a contraceptive commodity security plan be in place, six (46%, N=13) countries mandated a national body that monitors access to voluntary, non-discriminatory family planning services, and four (31%, N=13) included mechanisms that monitor denial of services on non-medical grounds or coercion. Key family planning commodities enjoyed good coverage in 10 reporting countries. Twelve countries (71%) reported having a national guideline on cervical cancer prevention and control policy, nine (75%, N=12) of which were consistent with WHO recommendations. Seven countries (41%) reported having national guidelines on infertility and assisted reproductive technology. There was a scarcity of data on whether laws or policies were in place to decriminalize male and female commercial sex workers in all countries and areas. Gender-based violence Ten countries (63%, N=16) reported having national guidelines or protocols to address violence against women and gender-based violence (GBV) by the health sector, and 10 countries (71%, N=14) reported criminalizing marital rape by national laws and policies. Confidentiality is covered by 10 countries (100%, N=10); nine countries (90%, N=10) cover privacy during consultations and the provision of referrals and strengthening linkages; eight countries (80%, N=10) have policies on non-judgemental and supportive responses to disclosure; and seven (70%, N=10) have policies on sexual assault services available 24/7. Australia, Cambodia, China, Cook Islands, Vanuatu, and Wallis and Futuna reported having covered GBV in the national guidelines and protocols. Nine countries (90%, N=10) reported that care for survivors of violence against women/GBV were included in national clinical guidelines or protocols. HIV post-exposure prophylaxis (PEP) is provided by nine countries (90%, N=10); eight countries (80%, N=10) provide STI prophylaxis, access to safe abortion and emergency contraception within 5 days of sexual assault, with sexual assault services available 24/7; seven xx G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y countries (70%) reported having mandatory reporting for domestic violence or intimate partner violence, and psychosocial support including first aid or first-line support; and six countries (60%, N=10) reported having selective or clinical enquiry for GBV or intimate partner violence as well as universal screening for domestic violence or intimate partner violence. The way forward This survey attained the highest regional participation in comparison to previous rounds, with data contributed by countries and areas across all income levels, including high-income countries and areas (Australia, Brunei Darussalam, French Polynesia, Guam, Palau and Singapore), upper- middle-income countries and areas (China, Cook Islands, the Marshall Islands, and Wallis and Futuna), and lower-middle-income countries and areas (Cambodia, the Lao People’s Democratic Republic, the Federated States of Micronesia, Mongolia, the Philippines, Vanuatu and Viet Nam). Data contributed by these countries – the majority of which participated for the first time – substantially enriched regional and global monitoring of country RMNCAH policy progress, with the potential for future interregional information exchange and learning. During and after the survey administration, countries reported that proactive discussions were inspired by the survey, triggering national-level reviews of RMNCAH policies, such as Cambodia and the Federated States of Micronesia. We hope this report presents a useful snapshot of RMNCAH policy coverage before 2019 and serves as a reference document for countries in the WHO Western Pacific Region to review current RMNCAH policy coverage, and identify potential areas for updates. G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 1 INTRODUCTION INTRODUCTION The Global Reproductive, Maternal, Newborn, Child, and Adolescent Health Policy Survey is undertaken by the World Health Organization (WHO) Department of Maternal, Newborn, Child and Adolescent Health (MCA) and Department of Reproductive Health and Research. The objective is to track country progress in adopting WHO recommendations in national health policies, strategies and guidelines related to reproductive, maternal, newborn, child and adolescent health (RMNCAH). The RMNCAH policy survey provides a mechanism for regular reporting against indicators outlined in the United Nations Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), and it offers a platform to monitor progress towards achieving its objectives. It also contributes towards measuring progress in achieving the Sustainable Development Goals and the Triple Billion targets of the WHO Thirteenth General Programme of Work. Previously, the WHO RMNCAH Policy Survey was conducted in four rounds: 2009–2010, 2011– 2012, 2013–2014, and 2016. Starting from 2018, WHO initiated an online survey platform for the RMNCAH survey, which allows for electronic submission of relevant RMNCAH policy documents. This allows all stakeholders to use the data for further analysis specific to priority areas for RMNCAH, to decide on the content and format of regional and country summary profiles, to monitor policy information within and across countries and regions, and to link to existing databases for wider analysis. All submitted documents will be stored in a searchable global database of policies relevant for RMNCAH and for sexual health and gender. Data for a selected set of indicators of the Global RMNCAH Policy Survey are now live on the WHO data portal: https://platform.who.int/data/maternal-newborn-child-adolescent-ageing This report was developed by Zhao Li, a consultant in the Maternal and Child Health, Hospital Quality and Patient Safety unit, Division of Health Systems and Services, WHO Regional Office for the Western Pacific. This report has received valuable input by Kannitha Cheang (WHO Cambodia), Sano Phal (WHO Cambodia), Daisuke Asai (WHO Lao People’s Democratic Republic), and Howard Sobel, John Murray, Priya Mannava and Mai Inada (WHO Regional Office for the Western Pacific). In addition to provision of a regional scope summary of RMNCAH policies, the report also serves as a data repository of country-level details, for country and regional RMNCAH stakeholders’ reference, and to continue a targeted policy dialogue and programme designed to address gaps and develop informed policy recommendations to improve RMNCAH in the WHO Western Pacific Region. We sincerely thank WHO country office colleagues who helped facilitate the administration of this survey (in alphabetical order): Daisuke Asai, Tsogzolmaa Bayandorj, Kannitha Cheang, Laura Davison, Benedicte Pascale Galichet, Lepaitai Blanche Hansell, Narwant Kaur, Jacqueline Kitong, Eunyoung Ko, Katri Maria Kontio, Outhevanh Kounnavongsa, Shogo Kubota, Pham Thi Quynh Nga, Sano Phal, Kumanan Rasanathan, Chun Paul Soo, Delgermaa Vanya and Tuohong Zhang. 2G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 3 METHODS METHODS Global RMNCAH Policy Reference Group (PRG) To optimize the approach for RMNCAH policy tracking, the Maternal, Newborn, Child, and Adolescent Health (MCA) Department, alongside the Department of Reproductive Health and Research, established a Global RMNCAH Policy Reference Group (PRG) to obtain expert advice on the content of the policy survey questionnaire and utilization of the related outputs. The first meeting was held in February 2017 to discuss which policy areas should be tracked. At this meeting, PRG members agreed to identify priority policy indicators to include in the policy survey and to exclude topics from the survey that are covered in other data sources. MCA Department policy survey In July and August 2017, the WHO MCA Department circulated a survey via Survey Monkey to the PRG, as well as a defined set of other RMNCAH experts. The online survey included questions about respondents’ identity, institutional affiliation and areas of expertise, followed by a series of questions in which respondents provided recommendations about whether to drop, consider retaining or keep tracking specific RMNCAH policy areas; a final section of the survey asked respondents to list policy areas they felt were missing from the list. Survey responses were compiled in an Excel spreadsheet at WHO headquarters in Geneva and analysed by an independent analyst in collaboration with WHO MCA staff in September 2017. Responses were analysed by reporting the number and percentage of respondents who said that WHO “must keep” tracking certain policy areas, categorized by respondent type. This decision was made as only small numbers of respondents recommended that specific policy areas could be dropped (range: 0–2 for PRG members, 0–3 for other respondents); slightly higher numbers of respondents selected “consider retaining” (range: 0–5 for PRG members, 0–9 for other respondents). Qualitative responses to open-ended questions were grouped in categories by policy area, edited for concision and tallied. The results from the PRG survey provided insight into expert prioritization of RMNCAH policies to be tracked. Review of existing data sources As the PRG recommended that the global policy tracking be streamlined by examining other potential data sources to extract key policies on an ongoing basis, a list of potential policies in RMNCAH was developed based on the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), or GS 2030, which grew out of the Every Woman Every Child movement, as well as key global initiatives and WHO priorities in the area of RMNCAH. In addition, the PRG mapped policy tracking for GS 2030 in February 2017, which resulted in the identification of 30 RMNCAH policy data sources. Starting with this list and adding additional sources identified by the MCA team, a critical review of potential data sources was undertaken to identify indicators from each source, select sources and indicators for inclusion in a database, and extract and compile the data into a single database. 4G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Mapping the MCA survey and policy database to the Framework of Priority Policy Areas for RMNCAH A mapping exercise was conducted to compare what is available in the newly created global policy database compared to the current MCA questionnaire. The results, in turn, laid out suggestions for what to include in the 2018 round of the Global Policy Survey taking into consideration what data could be pulled from existing sources. The aim was to reduce the reporting burden for countries. Questionnaire development A draft questionnaire based on the prioritization exercise, available data and past rounds of RMNCAH policy survey was created. Based on the mapping of data, questions where information was already available from other databases were excluded from the survey. The survey was shared with the PRG, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and regional WHO RMNCAH advisers for input. The questionnaire was revised based on their input, and a final questionnaire was created. The questionnaire can be found on https://platform.who.int/ docs/default-source/mca-documents/policy-documents/policy-survey-questionnaires/en-rmncah- policy-survey-final.pdf?sfvrsn=d91d9ec7_4 Questionnaire administration The RMNCAH policy survey questionnaire, consisting of six modules: 1) cross-cutting, 2) maternal and newborn health, 3) child health, 4) adolescent health, 5) reproductive health, and 6) gender- based violence – was programmed into an online platform. This online survey platform was developed to be administered in a modular approach to allow for specific respondents to complete the module(s) in their area of expertise. The tool also allowed respondents to upload the source documents used to complete the questionnaire. After the initial development, several WHO staff members from headquarters and the six regional offices tested the survey platform to identify necessary programming modifications. Regional staff were oriented on the survey platform through webinars led by WHO headquarters. Additionally, a training manual and video were provided to regional focal points. Regional focal points for the survey coordinated with assigned focal points in each country to collect information on the respondents in each country, including to which module(s) each individual respondent was assigned. These details were then relayed to WHO headquarters to configure each country team in the survey platform, including mapping respondents to modules and generating unique login keys. A WHO country officer or other assigned country focal point was then responsible for coordinating with the health ministry and/or other United Nations agencies to complete the survey. Country teams used various methods for completing the survey. In some countries, various respondents completed assigned modules directly on the platform; in others, the survey was completed offline and entered by one individual into the platform. Country teams reviewed the completed survey before submitting the final version. A training manual and video were provided as an aid for use of the survey platform. The survey and all training materials were translated into all United Nations official languages: Arabic, Chinese, English, French, Russian and Spanish, plus Portuguese. G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 5 METHODS Data processing Data were downloaded from the web-based platform into Excel. All data extraction and processing were conducted at WHO headquarters. A cleaning code was written in STATA software to rename variables from the question code used in the online survey platform to the question number from the RMNCAH policy survey questionnaire, to create and standardize value labels for response codes and to check for any validation errors that may have been missed in the survey platform programming. Data from the survey were split into two databases: one containing direct responses to questions and the other containing data stemming from information on source documents uploaded to the survey platform. Data analysis Statistical analyses were carried out using STATA 14.0 software and maps created using ArcGIS 10.7. The denominator used in analyses was the total number of respondent countries, either overall or by the subgroup of interest, such as skip-patterns. Non-positive responses (e.g. “No”, “Don’t know”, “Unknown”) were treated equally as negative. Empty entry and “NA” were treated as null and excluded from the denominator. In each table, country rows were deleted where answers were all “Unknown”, with footnotes inserted for details. Countries in each table were enlisted in alphabetical order based on ISO 3166-1 Alpha-3 code. In Australia, due to decentralization of the health system, survey questions on national-level policy and guidelines are reported as “Unknown”. The results were produced in relation to the objectives and key recommendations made to WHO Member States in the United Nations Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 6 Response Fourteen out of 27 (52%) countries in the Western Pacific Region have participated and completed the survey (Fig. 1), and these include Australia, Brunei Darussalam, Cambodia, China, Cook Islands, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Mongolia, Palau, the Philippines, Singapore, Vanuatu and Viet Nam. Three areas (or territories), which are not reflected in the above response rate, completed the survey. These include: French Polynesia, Guam, and Wallis and Futuna. Republic of Korea Japan China Mongolia Lao People's Democratic Republic Viet Nam Cambodia Singapore Brunei Darussalam Malaysia Philippines Palau Northern Mariana Islands Guam Australia Papua New Guinea Micronesia (Federated States of) Marshall Islands Nauru Kiribati Tuvalu Solomon Islands Vanuatu Fiji New Zealand Data Source: WHO Fig. 1. Map of Global RMNCAH Policy Survey (2018), country participation in the Western Pacific Region Results I. Cross-cutting RMNCAH National coordinating body for RMNCAH Half of the participating countries and areas in the Western Pacific Region have a national coordinating body to look at RMNCAH and its components. The committee meeting frequency varies from monthly (the Philippines) to annually (China). The majority of committee meetings were conducted in 2018 (Table 1). Participated Did not participate Outside of Region Member States in the Region The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on the maps represent approximate border lines for which there may not yet be full agreement Data Source: WHO Map production: WHO 7G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Co un tr y/ ar ea N at io na l co or di na tin g bo dy to lo ok a t RM N CA H a nd it s co m po ne nt s Th e na m e of th e co m m itt ee H ow o ft en th e co m m itt ee m ee ts D at e of th e la st c om m itt ee m ee tin g Au st ra lia N o Br un ei D ar us sa la m N o Ch in a Ye s N at io na l W or ki ng C om m itt ee o n Ch ild re n an d W om en un de r S ta te C ou nc il An nu al ly 11 /1 /2 01 6 Co ok Is la nd s U nk no w n Fe de ra te d St at es o f M ic ro ne si a U nk no w n Gu am N o Ca m bo di a Ye s 1 - T ec hn ic al W or ki ng G ro up fo r H ea lth 2 - T ec hn ic al W or ki ng S ub gr ou p fo r m at er na l a nd c hi ld h ea lth (M CH ) 3 - W or ki ng G ro up fo r N ew bo rn a nd in te gr at ed m an ag em en t o f ch ild ho od il ln es se s 4 - W or ki ng G ro up fo r N ut rit io n 5 - M in is tr y of H ea lth ’s G en de r M ai ns tr ea m in g Ac tio n G ro up 6 - C om m od ity S ec ur ity W or ki ng G ro up 7 - T ec hn ic al W or ki ng G ro up fo r G en de r 8 - V io le nc e ag ai ns t w om en c om m itt ee Bi m on th ly 9/ 1/ 20 18 La o Pe op le ’s D em oc ra tic Re pu bl ic Ye s RM N CH (r ep ro du ct iv e, m at er na l, ne w bo rn , a nd c hi ld h ea lth ) Se cr et ar ia t 8/ 1/ 20 18 M ar sh al l I sl an ds Ye s RH C om m itt ee Q ua rt er ly 8/ 1/ 20 18 M on go lia Ye s N at io na l b oa rd o n he al th , S te er in g co m m itt ee fo r r en ov at io n in m at er na l h ea lth c ar e se rv ic es in M on go lia , S te er in g co m m itt ee fo r in te rn at io na l p ro je ct s an d pr og ra m m es Se m i-a nn ua lly 10 /1 /2 01 8 Ta bl e 1. N at io na l c oo rd in at in g bo dy fo r R M N CA H a nd it s co m po ne nt s D at a So ur ce : W H O 8G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area N ational coordinating body to look at RM N CAH and its com ponents The nam e of the com m ittee H ow often the com m ittee m eets D ate of the last com m ittee m eeting Philippines Yes N ational Im plem entation Team for Responsible Parenthood and Reproductive H ealth M onthly 11/1/2018 Palau N o French Polynesia Yes H aut com ité pour la planification fam iliale a U nknow n 8/1/2016 Singapore N o Viet N am N o Vanuatu Yes N ational RM N CAH Com m ittee M onthly 9/1/2018 W allis and Futuna Yes Com ité de Pilotage de Convention Cadre 2016-2019 b Q uarterly 11/1/2018 Percentage of Yes 53% a H igh C om m ittee for Fam ily Planning b 2016–2019 Fram ew ork C onvention Steering C om m ittee D ata Source: W H O Table 1. (cont.) N ational coordinating body for RM N CAH and its com ponents 9RESULTSG LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Ministry of Professional associations Other implementing partners Other government organizations/sectors H6 partnership organizations Civil society Donors Academia Adolescents/young people Private sector Other 0% 22% 22% 44% 56% 56% 67% 78% 78% 78% 100% Among the stakeholders who are typically included in the RMNCAH coordinating body, the health ministry is involved in all countries as the leading participant, while professional associations, other implementing partners, and other government organizations and sectors are involved in 78% of the committees. H6 partnership organizations – comprising the Joint United Nations Programme on HIV/AIDS, UNFPA, UNICEF, WHO, UN Women, and the World Bank – are involved in 67% of the committees. Adolescents or young people are rarely involved (22%) (Fig. 2). Fig. 2. Stakeholders included in the national RMNCAH coordinating body National targets for RMNCAH indicators When asked about whether countries have developed national targets for the following RMNCAH indicators in alignment with Sustainable Development Goals, the maternal mortality ratio (MMR), the under-5 mortality rate (U5MR), the neonatal mortality rate (NMR), the presence of skilled birth attendants (SBAs) and stunting are relatively well developed with targets and years defined. The stillbirth rate target is clearly set by only one country (Vanuatu) and one area (Guam). The adolescent mortality rate target is seen only in Guam. Only China reports the target of 100% of women making their own informed decision regarding sexual and reproductive health issues by 2020 (Tables 2-4). health Data Source: WHO 10 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/ areaa Maternal mortality ratio (per 100 000 live births) Under-5 mortality ratio (per 1000 live births) Neonatal mortality rate (per 1000 live births) Stillbirth rate Stunting rate among children under 5 years Demand satisfied/ met for family planning (%) Total fertility rate (live births per woman) Brunei Darussalam 50 (2018) 8.5 (2018) - - -2025 - - China 12 (2030) 6 (2030) - - 7 (2020) - 1.8 (2020) Cook Islands 0 (1996) - - - - - - Guam 11.4 (2020) 26.5 (2020) 4.1 (2020) 5.9 (2020) - - - Cambodia 130 (2020) 30 (2020) 14 (2020) - 25 (2020) 62 (2020) 2.5 (2020) Lao People’s Democratic Republic 100 (2025) 30 (2025) 15 (2025) - 26 (2025) - 2.3 (2025) Marshall Islands 70 (2017) 25 (2017) 12 (2017) - 9 (2017) 21 (2017) - Mongolia 15 (2030) 9 (2030) 8 (2030) - - 80 (2020) - Philippines 90 (2022) 22 (2022) 10 (2022) - 22 (2022) 54 (2022) 2 (2022) Viet Nam 45 (2030) 15 (2030) 10 (2020) - 21.5 (2020) 70 (2020) 1.8 (2020) Vanuatu 86 (2017) 31 (2013) 12 (2013) 5 (2017) 29 (2013) 24.2 (2013) 4.2 (2013) Table 2. Country-reported national target and year for RMNCAH indicators a No data from Australia, French Polynesia, the Federated States of Micronesia, Palau, Singapore, and Wallis and Futuna. Data Source: WHO Country/areaa Adolescent mortality rate (%) Adolescent birth rate (per 1000 women of 15–19 years) Guam 54.3 (2020) 36.2 (2020) Cambodia - 51 (2020) Lao People’s Democratic Republic - 65 (2025) Mongolia - 30 (2020) Philippines - 10 (2022) Table 3. Country-reported national target and year for adolescent health indicators a No data from Australia, Brunei Darussalam, China, Cook Islands, French Polynesia, the Marshall Islands, the Federated States of Micronesia, Palau, Singapore, Vanuatu, Viet Nam, and Wallis and Futuna. Data Source: WHO 11 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/areaa Proportion of births attended by skilled health personnel Australia 98 (2020) Brunei Darussalam 100 (1996) Federated States of Micronesia 90 (2020) Guam 80 (2025) Cambodia 90 (2020) Marshall Islands 98 (2022) French Polynesia 80 (2020) Singapore 89.4 (2013) Table 4. Country-reported national target and year for SBA a No data from China, Cook Islands, the Lao People’s Democratic Republic, Mongolia, Palau, the Philippines, Vanuatu, Viet Nam, and Wallis and Futuna. Data Source: WHO National policy to ensure civil society engagement in RMNCAH national planning and review Less than one third of countries and areas have a national policy to ensure civil society’s engagement on national RMNCAH planning and review (Table 5). Professional associations and H6 partnership organizations are included in only half of the countries, while adolescents and young people are still under-represented. Fig. 3 is an overview of participating bodies; Table 6 is a country-level breakdown. Country/areaa National-level planning of RMNCAH programmes Periodic review of national programmes for RMNCAH Australia No No Brunei Darussalam No No Cambodia Yes Yes Lao People’s Democratic Republic Yes Yes Marshall Islands Yes No Philippines No No French Polynesia No Unknown Singapore No No Viet Nam Yes Yes Vanuatu Yes Yes Percentage of Yes 29% 24% Table 5. Countries and areas with a national policy in place to ensure civil society organizations’ engagement in planning and review of national RMNCAH programmes a China, Cook Islands, Guam, the Federated States of Micronesia, Mongolia, Palau, and Wallis and Futuna reported “Unknown” on both items. Data Source: WHO 12 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Ministry of health Fig. 3. Types of stakeholders that participated in national RMNCAH review Data Source: WHO 0% 25% 50% 75% 100% Others Adolescents/young people Private sector Civil society Professional associations Academia Donors Other implementing partners H6 partnership organizations Other government organizations/sectors 76% 65% 47% 59% 35% 29% 29% 47% 41% 24% 6% 13 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Co un tr y/ ar ea D oe s na tio na l re vi ew o f th e R M N CA H pl an (s ) i nc lu de st ak eh ol de r pa rt ic ip at io n M in is tr y of H ea lt h O th er g ov 't or ga ni za ti on s /s ec to rs H 6 pa rt ne rs hi p or ga ni za tio ns O th er im pl e- m en ti ng pa rt ne rs D on or s Ac ad em ia Pr of es si on al as so ci at io ns Ci vi l so ci et y Pr iv at e se ct or Ad ol es ce nt s /y ou ng pe op le Ch in a Ye s Ye s Ye s - Ye s - Ye s Ye s Ye s - - Co ok Is la nd s Ye s Ye s Ye s - Ye s - - - Ye s Ye s Ye s Ca m bo di a Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s La o Pe op le ’s D em oc ra ti c Re pu bl ic Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o N o M ar sh al l Is la nd s Ye s Ye s N o Ye s Ye s N o N o N o N o N o N o M on go lia Ye s Ye s Ye s Ye s Ye s Ye s - Ye s - - - Ph ili pp in es Ye s Ye s Ye s Ye s Ye s Ye s N o N o - N o N o Pa la u Ye s Ye s Ye s Ye s Ye s - - Ye s Ye s Ye s Ye s Fr en ch Po ly ne si a Ye s Ye s Ye s N o N o N o N o N o N o N o N o Si ng ap or e Ye s Ye s Ye s N o N o N o Ye s Ye s N o N o N o V ie t N am Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Va nu at u Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s W al lis a nd Fu tu na Ye s Ye s - - - - - - - - - Pe rc en ta ge of Y es 76 % 76 % 65 % 47 % 59 % 35 % 29 % 47 % 41 % 24 % 29 % Ta bl e 6. Ty pe s of s ta ke ho ld er s th at p ar ti ci pa te d in n at io na l R M N CA H r ev ie w D at a So ur ce : W H O 14 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/areaa Sexual and reproductive health Maternal health Newborn health Child health Adolescent health Brunei Darussalam No No No No No China Yes Yes Yes Yes No Federated States of Micronesia Yes Yes Unknown Yes Yes Cambodia Yes Yes Yes Yes Yes Lao People’s Democratic Republic No No No No No Mongolia Yes Yes Yes Yes Unknown Philippines Yes Yes Yes Yes Yes Palau Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes Singapore No No No No No Viet Nam Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Unknown Percentage of Yes 59% 59% 53% 59% 41% Quality of care for RMNCAH National policies and guidelines to improve quality of care (QOC) are in place in 76% of the countries and areas, but the specific content related to RMNCAH coverage varies from 41% to 59%. Only 24% of the national policies and guidelines cover all topics across RMNCAH (Table 7, Fig. 4). Seven countries (Brunei Darussalam, Cambodia, China, French Polynesia, Mongolia, the Philippines and Viet Nam) have a national steering committee for QOC in RMNCAH (Table 8). Fig. 5 lists the types of stakeholders participating in the national RMNCAH QOC steering committees and technical working groups (TWGs). Brunei Darussalam additionally includes “Patient representatives from the Board of Hospital Visitors” and Mongolia “nongovernmental organizations” into their national steering committee. Table 7. Countries/areas having a national policy or guideline to improve quality of care in RMNCAH areas a Australia, Cook Islands and the Marshall Islands reported not having a policy in place. Guam reported “Unknown”. Data Source: WHO 15 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Sexual and reproductive health Maternal health Newborn health Child health Adolescent health All areas 24% 57% 71% 86% 86% 100% Fig. 4. Proportion of countries/areas with a quality-of-care steering committee Table 8. Countries/areas with a steering committee or TWG that looks at quality of care in RMNCAH areas a Australia, Cook Islands, the Lao People’s Democratic Republic, the Marshall Islands, Palau and Vanuatu reported not having a policy in place; Guam, the Federated States of Micronesia, Singapore, and Wallis and Futuna reported “Unknown”. Country/ areaa Sexual and reproductive health Maternal health Newborn health Child health Adolescent health Committee /TWG meeting frequency Brunei Darussalam Unknown Yes Yes Yes No Quarterly China Yes Yes Yes Yes No Unknown Cambodia Yes Yes Yes Yes Yes Bimonthly Mongolia Yes Yes Yes Yes Yes Annually Philippines Unknown Unknown Yes Unknown Yes Unknown French Polynesia Yes Yes Yes Yes Yes Other Viet Nam Yes Yes Yes Yes Yes Other Percentage of countriesData Source: WHO Data Source: WHO 16 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Sexual and reproductive health Maternal health Newborn health Child health Early childhood development Adolescent health All areas 38% 67% 50% 58% 82% 85% 75% 0% 25% 50% 75% 100% Others Adolescents/young people Private sector Civil society Professional associations Academia Donors Other implementing partners H6 partnership organizations Other government organizations/sectors 100% 71% 71% 43% 29% 29% 43% 43% 14% 14% 57% Fig. 6. Proportion of countries/areas with national quality-of-care standards and protocols for RMNCAH service delivery Fig. 5. Types of stakeholders that participate in the national RMNCAH steering committee Percentage of countries Eighty-two per cent (14/17) of countries/areas have developed national QOC standards and protocols for delivery of services in health facilities. Brunei Darussalam reported “No”, while Guam and the Lao People’s Democratic Republic reported “Unknown”. Fig. 6 shows the proportion of countries with national QOC standards and protocols for delivery of services that covered RMNCAH topics. Data Source: WHO Data Source: WHO Ministry of health 17 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/area When were the national quality-of-care standards and protocols for RMNCAH health services last updated? Are there mechanisms in place at the facility level to solicit feedback on quality and access from community members (e.g. users, family)? Australia 2017 Yes Brunei Darussalam - Yes China 2018 Yes Cook Islands 2015 Yes Federated States of Micronesia 2018 Unknown Guam - Unknown Cambodia 2016 Yes Lao People’s Democratic Republic - No Marshall Islands 2016 No Mongolia 2012 Yes Philippines 2016 No Palau 2016 Yes French Polynesia 2017 No Singapore - Unknown Viet Nam 2016 No Vanuatu 2018 Yes Wallis and Futuna 2016 No Percentage of Yes 62% Table 9. Countries/areas with national quality-of-care standards updated and community feedback solicited The majority of participating countries reported that a recent update of national QOC standards and protocols for RMNCAH health services occurred between 2012 and 2018. More than half (62%) of the countries/areas have a mechanism in place at the facility level to solicit feedback on quality and access from community members (Table 9). Data Source: WHO 18 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Pregnant women Adolescents (10–19 years) Children 5–9 years Children under age of 5 years Newborns (0–4 weeks) 76% 76% 65% 53% 71% Fig 7. Countries/areas with a national policy or guideline on free access to health services in the public sector Percentage of countries Financial protection The majority of countries have a national policy/legislation to ensure free access to health service in the public sector for pregnant women (71%), newborn and children under age 5 years (76%), children aged 5–9 years (65%), and adolescents aged 10–19 years (53%) (Fig. 7). Table 10 contains the breakdown by country and population groups. Data Source: WHO 19 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Among services provided to women of reproductive age in public sectors, immunization services during pregnancy (59%), antenatal care (53%) and postnatal care for mothers (53%) are provided free of charge. Other services are provided free of charge in less than half of the countries and areas. Cook Islands and the Federated States of Micronesia have reported to having 100% of applicable services to women of reproductive age (Table 11). Table 10. Countries/areas with a national policy or guideline on free access to health services in the public sector Country/area Newborns (0–4 weeks) Children under age of 5 years Children 5–9 years Adolescents (10–19 years) Pregnant women Australia Yes Yes Yes Yes Yes Brunei Darussalam Yes Yes Yes No Yes China Yes Yes Yes No Yes Cook Islands Yes Yes Yes Yes Yes Federated States of Micronesia Yes Yes Yes Yes Yes Guam Yes Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yes No No Yes Marshall Islands No No No No No Mongolia Yes Yes Yes Yes Yes Philippines No No No No No French Polynesia Yes Yes Yes Yes Yes Singapore Yes Yes Yes Yes Yes Viet Nam Yes Yes No No No Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Yes Percentage of Yes 76% 76% 65% 53% 71% a Cambodia and Palau reported “Unknown” on all items. Data Source: WHO 20 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 11. Service free of charge at point of use in public sector for w om en of reproductive age Country/area Fam ily planning Antenatal care Childbirth (norm al delivery) Caesarean section M anagem ent of other birth com plications Postnatal care for m others Im m unization services during pregnancy Australia All All All All All All All Brunei D arussalam Partial Partial Partial Partial Partial Partial Partial China N o N o N o N o N o N o N o Cook Islands All All All All All All All Federated States of M icronesia All All All - - All All Guam Partial Partial N o N o N o Partial Partial Cam bodia Partial Partial Partial Partial Partial Partial All Lao People’s D em ocratic Republic All All All All All All All M arshall Islands All All N o N o N o All All M ongolia Partial All All All All All Partial Philippines Partial Partial Partial Partial Partial Partial Partial Palau All All N o N o N o All All French Polynesia All All All All All All All Singapore - Partial Partial Partial Partial Partial Partial Viet N am Partial Partial Partial N o N o All All Vanuatu N o N o N o N o N o N o N o W allis and Futuna All All All All All All All Percentage of Yes 47% 53% 41% 33% 35% 53% 59% D ata Source: W H O 21 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Co un tr y/ ar ea In se ct ic id e- tr ea te d be d ne ts Ph ar m ac eu ti ca l p ro du ct s an d/ or o th er m ed ic al su pp lie s if re qu ir ed fo r di ag no si s an d tr ea tm en t or c hi ld bi rt h Te st in g an d tr ea tm en t fo r se xu al ly tr an sm it te d in fe ct io ns Te st in g an d tr ea tm en t fo r sy ph ili s Te st in g an d tr ea tm en t fo r H IV In fe rt ili ty m an ag em en t Sc re en in g fo r ce rv ic al c an ce r A us tr al ia N o Al l Al l Al l Al l Al l Al l Br un ei D ar us sa la m N o Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Ch in a N o N o Pa rt ia l Pa rt ia l Pa rt ia l N o Pa rt ia l Co ok Is la nd s - Al l Al l Al l Al l Al l Al l Fe de ra te d St at es of M ic ro ne si a - - Al l Al l Al l Al l Al l G ua m - - Pa rt ia l Pa rt ia l Pa rt ia l N o Pa rt ia l Ca m bo di a Pa rt ia l Pa rt ia l Al l Al l Al l - Pa rt ia l La o Pe op le ’s D em oc ra ti c Re pu bl ic Al l Al l Pa rt ia l Pa rt ia l Al l N o N o M ar sh al l I sl an ds Al l N o Al l Al l Al l N o Al l M on go lia N o Al l N o N o Al l N o Al l Ph ili pp in es Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l N o Pa rt ia l Pa la u Al l N o Al l Al l Al l N o Al l Fr en ch P ol yn es ia N o Al l Al l Al l Al l Al l Al l Si ng ap or e N o Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l N o Pa rt ia l V ie t N am Pa rt ia l N o N o N o Pa rt ia l N o Pa rt ia l Va nu at u Al l Pa rt ia l N o N o N o N o N o W al lis a nd F ut un a N o Al l Al l Al l Al l - Al l Pe rc en ta ge o f Y es 20 % 35 % 38 % 47 % 45 % 24 % 35 % D at a So ur ce : W H O Ta bl e 11 . (c on t. ) Se rv ic e fr ee o f c ha rg e at p oi nt o f u se in p ub lic s ec to r fo r w om en o f r ep ro du ct iv e ag e 22 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Among services provided to newborns in the public sector, immunization is provided for free in a majority of countries (76%), followed by postnatal care (65%), management of birth complications (59%) and sick newborn care (53%). Cook Islands, the Federated States of Micronesia and Vanuatu have reported covering 100% of applicable services to newborns (Table 12). Table 12. Service free of charge at point of use in public sector for newborns Country/area Manage- ment of birth com- plicationsa Post- natal care Immu- nization Sick newborn care Insecticide- treated nets Pharmaceutical products and/ or other medical supplies if required for diagnosis and treatment Australia All All All All No All Brunei Darussalam Partial Partial Partial Partial No Partial China No No All No No No Cook Islands All All All All - All Federated States of Micronesia All All All All - - Guam Partial Partial Partial No No No Cambodia Partial Partial All Partial Partial Partial Lao People’s Democratic Republic All All All All All All Marshall Islands No All All No All No Mongolia All All All All No All Philippines Partial Partial Partial Partial Partial Partial Palau All All All No No No French Polynesia All All All All No All Singapore Partial Partial Partial Partial No Partial Viet Nam All All All All Partial Partial Vanuatu All All All All All All Wallis and Futuna All All All All No All Percentage of Yes 59% 65% 76% 53% 18% 41% a Including asphyxia, prematurity, sepsis and congenital anomalies. Data Source: WHO Among services provided to children in public sectors, immunization (76%), and well-child visits and growth monitoring (71%) are provided for free in the majority of countries. Cook Islands and the Federated States of Micronesia have reported covering 100% of applicable services to children (Table 13). 23 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/area Well-child visits and growth monitoring Immuni- zation Insecticide- treated bed nets Sick child outpatient care Paediatric inpatient care Pharmaceutical products and/or other medical supplies if required for diagnosis and treatment Australia All All No All All All Brunei Darussalam All Partial No Partial Partial Partial China All All No No No No Cook Islands All All - All All All Federated States of Micronesia All All - - All - Guam Partial Partial - - - - Cambodia Partial All Partial Partial Partial Partial Lao People’s Democratic Republica Partial Partial Partial Partial Partial Partial Marshall Islands All All All No No No Mongolia All All No All All All Philippines Partial Partial Partial Partial Partial Partial Palau All All All No No No French Polynesia All All No All All All Singapore Partial All No Partial Partial Partial Viet Nam All All Partial Partial Partial Partial Vanuatu All All All No No Partial Wallis and Futuna All All Partial All All All Percentage of Yes 71% 76% 18% 29% 35% 29% Table 13. Are children exempt from user fees for the following services in the public sector? a Following original submission, “Immunization” and “Insecticide-treated bed nets” became available for free in the Lao People’s Democratic Republic. Data Source: WHO Among services provided to adolescents in public sectors, HIV testing and counselling (59%) and testing and treatment of STIs (53%) are provided for free. Free contraceptive services are provided in less than half of countries (41%), with an even lower coverage in human papillomavirus (HPV) vaccination (29%). Cook Islands and Wallis and Futuna have reported having covered 100% of applicable services to adolescents (Table 14). 24 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area a O utpatient care visits Inpatient care visits H IV testing and counselling Contraceptive M ental health Rehabili- tation for substance abuse Pharm aceutical products and/or other m edical supplies if required for diagnosis and treatm ent Testing and treatm ent for sexually transm itted infections Vaccination for hum an papillom avirus (H PV) Australia All All All N o All - N o N o All Brunei D arussalam N o N o Partial Partial N o Partial Partial Partial Partial China N o N o N o N o N o N o N o N o N o Cook Islands All All All All All - All All All Federated States of M icronesia N o N o All All All - - All Partial Guam Partial N o Partial Partial N o N o N o Partial Partial Cam bodia Partial Partial All Partial Partial Partial Partial All - Lao People’s D em ocratic Republic N o N o All All - N o N o All Partial a M arshall Islands N o N o All All All All N o All All M ongolia All All All All All All All All N o Philippines Partial Partial Partial Partial - - Partial - Partial Palau N o N o All N o N o N o N o All All French Polynesia All All All All All All All All N o Singapore Partial Partial Partial N o Partial Partial Partial Partial Partial Viet N am N o N o Partial Partial Partial Partial N o N o N o Vanuatu N o N o N o N o N o N o N o N o Partial W allis and Futuna All All All All All - All All All Percentage of Yes 29% 29% 59% 41% 41% 18% 24% 53% 29% a Free for adolescents betw een 10 and 14 years old. D ata source: W H O country offi ce in the Lao People’s D em ocratic Republic. Table 14. Are adolescents exem pt from user fees for the follow ing health services in the public sector? 25 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Policies and legislation related to human right to health and health care Less than half of the countries reported having a dedicated law on RMNCAH topics. The Philippines, Vanuatu and Viet Nam are the only countries with laws covering 100% of the RMNCAH topics mentioned below. Table 15 is a breakdown by topics. Table 15. Countries/areas having a dedicated law on following topics Country/ areaa Sexual health Repro- ductive health Repro- ductive rights Maternal health Newborn health Child health Adolescent health Australia No No No No No No No Brunei Darussalam No No No No No No No China No No No Yes Yes No No Federated States of Micronesia No No No No No No No Guam No Yes Yes Yes Yes Yes Yes Lao People’s Democratic Republic No No - No No No - Marshall Islands No No No No No No No Mongolia Yes No No No No No No Philippines Yes Yes Yes Yes Yes Yes Yes French Polynesia No Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Wallis and Futuna No No No No No No No Percentage of Yes 31% 38% 38% 46% 46% 38% 38% a No data from Cambodia, Cook Islands, Palau and Singapore. According to the WHO country office in Cambodia, the country has an abortion law and a juvenile protection law in place. Data Source: WHO 26 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% National law that guarantees universal access to primary health care Dedicated child rights law/child welfare act 65% More than half (65%) of the countries reported that they have a dedicated child rights law/ child welfare act, and nearly half (47%) reported having national law that guarantees universal access to primary health care (Fig. 8). Australia, Mongolia and Viet Nam are the three countries reported having 100% coverage on a human right to health and health care that is included in the national law. Table 16 is a breakdown with details. Fig. 8. Countries/areas having laws on primary health care and child rights/welfare Percentage of countriesData Source: WHO 47% 27 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Co un tr y/ ar ea a A na tio na l l aw th at g ua ra nt ee s un iv er sa l a cc es s to p rim ar y he al th ca re A de di ca te d ch ild ri gh ts / ch ild w el fa re ac t/ la w Th e ac t/ la w co nt ai ns p ro vi si on s th at p ro te ct th e rig ht to h ea lt h fo r al l c hi ld re n an d ad ol es ce nt s Th e ac t/ la w in cl ud es pr ov is io ns w hi ch gu ar an te e eq ua l ac ce ss to h ea lth c ar e fo r a ll ch ild re n an d ad ol es ce nt s A na tio na l c hi ld rig ht s in st itu tio nb m an da te d/ au th or iz ed to co ns id er m at te rs re la te d to R M N CA H A na tio na l h um an rig ht s in st itu tio nc m an da te d/ au th or iz ed to co ns id er m at te rs re la te d to R M N CA H Th e in fo rm at io n fr om th es e in st itu tio ns m ad e pu bl ic d Au st ra lia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Br un ei D ar us sa la m N o Ye s N o N o Ye s N o N o Ch in a N o Ye s Ye s Ye s Ye s U nk no w n Ye s Co ok Is la nd s U nk no w n Ye s Ye s Ye s Ye s Ye s Ye s Fe de ra te d St at es of M ic ro ne si a N o N o - - Ye s Ye s Ye s Gu am U nk no w n Ye s U nk no w n U nk no w n Ye s U nk no w n U nk no w n Ca m bo di a U nk no w n Ye s Ye s Ye s Ye s Ye s Ye s La o Pe op le ’s D em oc ra tic R ep ub lic U nk no w n Ye s Ye s Ye s Ye s Ye s N o M ar sh al l I sl an ds Ye s Ye s Ye s Ye s N o Ye s Ye s M on go lia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ph ili pp in es Ye s U nk no w n - - Ye s Ye s U nk no w n Fr en ch P ol yn es ia Ye s Ye s Ye s Ye s Ye s U nk no w n Ye s Si ng ap or e U nk no w n U nk no w n - - N o U nk no w n U nk no w n Vi et N am Ye s Ye s Ye s Ye s Ye s Ye s Ye s Va nu at u Ye s N o - - Ye s Ye s U nk no w n W al lis a nd F ut un a Ye s U nk no w n - - U nk no w n U nk no w n N o Pe rc en ta ge o f Y es 47 % 65 % 53 % 53 % 76 % 59 % 53 % Ta bl e 16 . Co un tr ie s/ ar ea s ha vi ng la w s on p ri m ar y he al th c ar e an d ch ild w el fa re a P al au re po rt ed “U nk no w n” . b F or ex am pl e, om bu ds pe rs on fo r c hi ld re n, n at io na l c hi ld ri gh ts co m m iss io ns /c om m itt ee . c F or ex am pl e, om bu ds pe rs on , n at io na l h um an ri gh ts co m m iss io n/ co m m itt ee . d F or ex am pl e, th ro ug h pe rio di c r ep or ts. D at a So ur ce : W H O 28 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% National policy/law requiring birth registration National policy/law requiring death registration All 41% 41% 88% 94% Policies on birth and death registration processes Nearly all countries have a national policy/law requiring birth registration (94%) and death registration (88%), while less than half (41%) of countries have a policy/law requiring a routine audit and/or review of death certification for maternal, perinatal, neonatal, and/or child deaths. China, Guam, the Marshall Islands, Mongolia, the Philippines, Vanuatu, Viet Nam, and Wallis and Futuna report 100% of the necessary laws and policies to cover birth registration, death registration and death audits (Fig. 9, Table 17). Fig. 9. Countries/areas with laws or policies on birth registration, death registration and death audits Data Source: WHO 29 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 17. Countries/areas having laws or policies on birth registration, death registration and death audit Country/area Birth registration Death registration Routine audit and/or review of death certification for maternal, perinatal, neonatal, and/or child deaths Australia Yes Yes Unknown Brunei Darussalam Yes Yes No China Yes Yes Yes Cook Islands Yes Yes Unknown Federated States of Micronesia Unknown No No Guam Yes Yes Yes Cambodia Yes Yes Unknown Lao People’s Democratic Republic Yes Unknown a Unknown Marshall Islands Yes Yes No Mongolia Yes Yes Yes Philippines Yes Yes Yes Palau Yes Yes Unknown French Polynesia Yes Yes Unknown Singapore Yes Yes No Viet Nam Yes Yes Yes Vanuatu Yes Yes Yes Wallis and Futuna Yes Yes Yes Percentage of Yes 94% 88% 41% Specifics on birth registration and as a precondition for accessing health and education services All countries have reported that the law/policy indicates who is authorized to register births, with the exception of the Federated States of Micronesia, which reported no data. Cook Islands, Mongolia and Vanuatu have national policies/laws that cover all topic areas (Table 18). Sixty- five per cent of countries reported that they require birth registration as the precondition for children’s access to education, and only 29% of countries require it for accessing health-care services. French Polynesia, Mongolia, Palau, Vanuatu and Viet Nam reported that birth certificates are required for children to access both health care and education services (Table 19). a At the time of this report publication, the Lao People’s Democratic Republic had issued a policy on death registration developed by the Ministry of Home Affairs. Data source: WHO country office in the Lao People’s Democratic Republic. Data Source: WHO 30 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area a Indicate w ho is authorized to register birth Require the recording of specific health inform ation on birth certificates Specify a required tim e fram e for registration Contain provisions for advancing birth registration am ong vulnerable groups of children b Specify restrictions on w hich caretaker of fam ily m em bers can register births Specify costs or fees for fam ilies or individual caretakers registering births Specify costs or fees for late or delayed registration of births A ustralia Yes Yes N o U nknow n U nknow n N o U nknow n Brunei D arussalam Yes Yes Yes U nknow n U nknow n N o Yes China Yes Yes Yes U nknow n U nknow n Yes N o Cook Islands Yes Yes Yes Yes Yes Yes Yes G uam Yes Yes Yes U nknow n U nknow n Yes Yes Cam bodia Yes N o Yes U nknow n U nknow n N o Yes Lao People’s D em ocratic Republic Yes N o Yes N o N o N o N o M arshall Islands Yes Yes Yes N o Yes N o Yes M ongolia Yes Yes Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes U nknow n N o Yes Palau Yes Yes Yes U nknow n N o Yes Yes French Polynesia Yes N o Yes N o N o N o N o Singapore Yes Yes Yes N o N o Yes N o V iet N am Yes Yes Yes Yes N o Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes W allis and Futuna Yes N o Yes U nknow n U nknow n U nknow n U nknow n Percentage of Yes 100% 75% 94% 31% 25% 50% 63% Table 18. Specifics required by policy and law on birth registration a N o data from the Federated States of M icronesia. b Such as orphans, illegal m igrants, refugees and internally displaced persons. D ata Source: W H O 31 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 19. Countries/areas having a policy or law that requires proof of a birth certificate as a precondition for children’s access to health services and education a Australia reported “Unknown” on both items. Data Source: WHO Country/areaa Access to health services Access to education Brunei Darussalam No No China No Unknown Cook Islands No Yes Federated States of Micronesia No No Guam Unknown Yes Cambodia No Yes Lao People’s Democratic Republic No No Marshall Islands No Yes Mongolia Yes Yes Philippines No No Palau Yes Yes French Polynesia Yes Yes Singapore No Yes Viet Nam Yes Yes Vanuatu Yes Yes Wallis and Futuna No Yes Percentage of Yes 29% 65% Specifics on death registration and routine audits There is a general lack of data on death registration and routine audits. China, Mongolia and Viet Nam have relatively complete information on national policy/law requirements on death registration quality, routine audits and specific contents required for death audits/reviews (Table 20). Ten participating countries have reported no data on death audits and reviews. 32 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y D oes the policy/law require routine audit and/or review of death certification to do any of the follow ing? Country/area Require cause of death registration to be in line w ith the International Classification of Diseases, 10th revision (ICD -10) Require routine audit and/or review of death certification for m aternal, perinatal, neonatal and/or child deaths Require the issuance of m edical certificates of cause of death Recom m end training health w orkers in filling out death certificates using the International Classification of D iseases Require death data recorded at health facilities or by com m unity health w orkers to be provided to the national statistics office, civil registration system or equivalent bodies Require sharing individual death records w ithin the health system and betw een central and district/ regional levels Recom m end verbal autopsy on com m unity deaths for determ ining cause of death Australia Yes U nknow n - - - - - Brunei D arussalam N o N o - - - - - China Yes Yes Yes Yes U nknow n Yes Yes Cook Islands Yes U nknow n - - - - - Federated States of M icronesia - N o - - - - - Guam Yes Yes U nknow n U nknow n U nknow n U nknow n U nknow n Cam bodia Yes U nknow n - - - - - Lao People’s D em ocratic Republic - U nknow n - - - - - M arshall Islands N o N o - - - - - M ongolia Yes Yes Yes U nknow n Yes Yes Yes Philippines N o Yes Yes N o Yes Yes Yes Palau Yes U nknow n - - - - - French Polynesia Yes U nknow n - - - - - Singapore Yes N o - - - - - Viet N am Yes Yes Yes Yes Yes Yes Yes Vanuatu U nknow n Yes Yes Yes Yes Yes Yes W allis and Futuna U nknow n Yes Yes Yes Yes U nknow n U nknow n Percentage of Yes 67% 41% 86% 57% 71% 71% 71% Table 20. Countries/areas w ith a policy or law requiring death registration quality, audits and areas covered D ata Source: W H O 33 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS EmOC Survey and health management information system Fig. 10 is an overview of health facility surveys conducted in 17 countries/areas. An emergency obstetric care services (EmOC) assessment has been conducted in 35% of the countries, a Service Availability and Readiness Assessment (SARA) in 29% of countries, a Service Delivery Indicators Survey (SDI) in 24% and a Service Provision Assessment (SPA) in 24%. Less than one third of countries have conducted surveys since 2015. Table 21 is a breakdown on whether a national health information system (HIS) collects and reports key RMNCAH indicators. The HIS in 82.4% (14/17) of countries is reported being able to present data disaggregated by age, except for French Polynesia, which reported “No”, and the Lao People’s Democratic Republic as well as Wallis and Futuna, which reported “Unknown”. Fig. 10. Proportion of countries/areas conducting specific surveys or assessments 0% 25% 50% 75% 100% Ever Since 2015 Ever Since 2015 SARA SPA SDI 24% 29% 35% 12% 12% 18% 24% 6% Data Source: WHO Percentage of countries 34 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 21. D ata being collected and reported by the national health inform ation system (H IS) Country/ area Percentage of Yes Australia Brunei Darussalam China Cook Islands Federated States of Micronesia Guam Cambodia Lao People’s Democratic Republica Marshall Islands Mongolia Philippines Palau French Polynesia Singapore Viet Nam Vanuatu Wallis and Futuna N um ber or ratio of m aternal deaths 100% Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Cause of m aternal death 94% Yes Yes Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes N um ber of antenatal care visits 82% Yes N o Yes Yes Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N o N um ber or rate of caesarean sections 94% Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N um ber or rate of live births 100% Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N um ber or rates of stillbirths 94% Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes - N um ber or rates of new born deaths 100% Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Causes of new born death 88% Yes Yes Yes Yes N o Yes Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes D ata Source: W H O 35 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/ area Percentage of Yes Australia Brunei Darussalam China Cook Islands Federated States of Micronesia Guam Cambodia Lao People’s Democratic Republic a Marshall Islands Mongolia Philippines Palau French Polynesia Singapore Viet Nam Vanuatu Wallis and Futuna N um be r o r pr op or tio n of n ew bo rn s br ea st fe d w ith in o ne ho ur o f b ir th 47 % N o N o N o Ye s - N o Ye s Ye s N o Ye s Ye s Ye s N o N o Ye s Ye s N o W ei gh t o f ne w bo rn s 94 % Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N um be r or p ro po r- tio n of lo w - bi rt hw ei gh t ne w bo rn s (< 2 50 0 g) 10 0% Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N um be r o r ra te o f p re - te rm n ew - bo rn s 94 % Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Pr op or tio n of p re m at ur e ne w bo rn s in iti at ed o n Ka ng ar oo M ot he r C ar e (s ki n- to -s ki n co nt ac t) 24 % N o N o N o Ye s - Ye s N o N o N o N o Ye s - N o N o Ye s - N o Ta bl e 21 . (c on t.) D at a be in g co lle ct ed a nd re po rt ed b y th e na tio na l h ea lt h in fo rm at io n sy st em (H IS ) D at a So ur ce : W H O 36 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area Percentage of Yes Australia Brunei Darussalam China Cook Islands Federated States of Micronesia Guam Cambodia Lao People’s Democratic Republica Marshall Islands Mongolia Philippines Palau French Polynesia Singapore Viet Nam Vanuatu Wallis and Futuna N um ber or rates of deaths am ong children under 5 100% Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Cause of death am ong children under 5 94% Yes Yes Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes N um ber or proportion of children w ho have a length/height for age < −2 SD of Z score 29% - N o Yes - N o N o N o N o N o Yes Yes - N o N o Yes Yes - N um ber or proportion of children w ho have w eight for height < −2 SD of Z score 29% - N o Yes - N o N o N o N o N o Yes Yes - N o N o Yes Yes - N um ber or proportion of children w ho have w eight for height > +2 SD of Z score (overw eight) 29% - N o Yes Yes N o N o N o N o N o N o Yes - N o N o Yes Yes - N um ber or proportion of children under 5 w ith pneum onia or sym ptom s of respiratory illness 65% - N o Yes Yes Yes N o Yes Yes Yes Yes Yes - N o Yes Yes Yes - Table 21. (cont.) D ata being collected and reported by the national health inform ation system (H IS) D ata Source: W H O 37 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/area Percentage of Yes Australia Brunei Darussalam China Cook Islands Federated States of Micronesia Guam Cambodia Lao People’s Democratic Republic a Marshall Islands Mongolia Philippines Palau French Polynesia Singapore Viet Nam Vanuatu Wallis and Futuna N um be r o r pr op or tio n of ch ild re n w ith pn eu m on ia o r sy m pt om s of re sp ir at or y ill ne ss th at re ce iv e an tib io tic s 35 % - N o N o Ye s Ye s N o Ye s N o N o N o Ye s - N o N o Ye s Ye s - N um be r o r pr op or tio n of ch ild re n un de r 5 w ith d ia rr ho ea 59 % - N o Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s - N o N o Ye s Ye s - N um be r o r pr op or tio n of ch ild re n w ith di ar rh oe a w ho re ce iv e or al re hy dr at io n so lu tio n an d zi nc 29 % - N o N o - Ye s N o Ye s N o N o N o Ye s - N o N o Ye s Ye s - N um be r o r pr op or tio n of ch ild re n un de r 5 w ith fe ve r 41 % - N o N o Ye s Ye s N o Ye s N o Ye s N o Ye s - N o - Ye s Ye s - Pr op or tio n of ch ild re n un de r 5 w ith fe ve r t es te d fo r m al ar ia 29 % - N o N o - Ye s N o Ye s Ye s N o N o Ye s N o N o N o - Ye s - Ta bl e 21 . (c on t.) D at a be in g co lle ct ed a nd re po rt ed b y th e na tio na l h ea lt h in fo rm at io n sy st em (H IS ) D at a So ur ce : W H O 38 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/ area Percentage of Yes Australia Brunei Darussalam China Cook Islands Federated States of Micronesia Guam Cambodia Lao People’s Democratic Republica Marshall Islands Mongolia Philippines Palau French Polynesia Singapore Viet Nam Vanuatu Wallis and Futuna Proportion of children w ho w ere tested for m alaria that tested positive 41% - N o Yes - Yes N o Yes Yes N o N o Yes N o N o N o - Yes Yes Proportion of children w ho w ere tested for tuberculosis that tested positive 59% - N o Yes - Yes N o Yes Yes Yes Yes Yes Yes N o N o - Yes Yes N um ber or rates of deaths am ong children 5– 9 years of age 82% Yes N o Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes N o Yes Yes N um ber or rates of deaths am ong children 10– 19 years of age 82% Yes N o Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes N o Yes Yes N um ber or proportion of pregnant w om en tested for syphilis 82% - N o Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N o Yes Yes Yes N um ber or proportion of pregnant w om en tested for H IV 88% - N o Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N um ber of cases of m ale urethral discharge 29% - N o N o - Yes N o Yes N o N o N o Yes - N o Yes - Yes - a Th e national health inform ation system , D H IS2, collects only aggregated data; therefore, there is no further breakdow n by age. D ata Source: W H O Table 21. (cont.) D ata being collected and reported by the national health inform ation system (H IS) 39 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS NHS of country CRVS of country WHO UNICEF UN SDG World Bank UNFPA IHME Countdown 2030 6% 6% 12% 12% 18% 35% 41% 41% 53% 0% 25% 50% 75% 100% Civil registration and vital statistics (CRVS), National Health Survey (NHS) and population surveys are the three most common data sources used to compare country RMNCAH mortality rates and ratios (Fig. 11). Fig. 11. Top ten most common data sources used to compare country RMNCAH mortality rates and ratios IHME – Institute for Health Metrics and Evaluation Data Source: WHO Percentage of countries Population survey of Country 40 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Home-based records Some 76.5% (13/17) of countries and areas reported the usage of home-based records, except for Cook Islands, Guam and Vanuatu. Cambodia reported “Unknown”. Fig. 12 shows the types of home-based records used in 2017. A child health card/booklet is used by 69% of countries, followed by a combined maternal and child health booklet (46%), a vaccination card (46%), and a vaccination card plus growth chart (46%). Fig. 12. Types of home-based records used Percentage of countriesData Source: WHO Child health card/booklet Maternal (pregnancy) health card/booklet Combined maternal, newborn and/or child health Family planning card/ booklet Vaccination and child health cards Maternal and child health cards Maternal and family planning cards Vaccination card Vaccination card plus 41 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 22. Countries/areas having a national policy or guideline on ANC that contains specific recommendations Country/ areaa Minimum number of ANC contacts during normal pregnancy Number of ANC visits during normal pregnancy Specifies when the first contact should occur, and if yes, when Includes a statement on counselling and inter- ventions Australia Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Brunei Darussalam No - Yes Within the first 12 weeks of pregnancy Yes China Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Cook Islands Yes At least 4 visits No - Yes Cambodia Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Lao People’s Democratic Republic Yes At least 8 visits Yes Within the first 12 weeks of pregnancy Yes Marshall Islands Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Mongolia Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Philippines Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Unknown Palau Yes At least 8 visits Yes Within the first 12 weeks of pregnancy Yes French Polynesia Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Viet Nam Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Vanuatu Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Wallis and Futuna Yes At least 4 visits Yes Within the first 12 weeks of pregnancy Yes Percentage of Yes 76% 76% 76% a Guam and the Federated States of Micronesia reported “Unknown”. No data were available from Singapore. Data Source: WHO II. Maternal and newborn health Antenatal care policy Thirteen out of seventeen (82%) countries and areas reported having a national policy or guideline on antenatal care (ANC), where 100% reported recommending at least four ANC visits, and 92% reported that the guideline specifies the first ANC contact should occur within the first 12 weeks of pregnancy. Table 22 provides breakdown details. 42 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Among the 13 countries and areas that reported a national policy or guideline on ANC, 100% included iron and folic acid during pregnancy, as well as the prevention and management of gestational diabetes, and 92% included birth preparedness and readiness, nutrition, and STI and HIV screening and treatment. Topics on immunization during pregnancy, tuberculosis (TB) treatment, tobacco, alcohol and substance abuse, and partner involvement in ANC visits are less covered, ranging from 46% to 77%. Malaria prevention and treatment is only mentioned by Australia, the Lao People’s Democratic Republic and Vanuatu. Table 23 provides the detailed breakdown on ANC counselling and intervention topics. Table 23. Countries/areas with national guideline or policies on ANC that included counselling and intervention Country/ areaa Birth pre- paredness and com- plication readiness Nutrition during preg- nancy Iron and folic acid during preg- nancy Immu- nization during preg- nancy Screening for sexu- ally trans- mitted infections Preven- tion and treatment of HIV in pregnancy Preven- tion and treatment of syphilis in pregnancy Australia Yes Yes Yes No Yes Yes Yes Brunei Darussalam Yes Yes Yes No No No No China Yes Yes Yes No Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Yes Cambodia Yes Yes Yes Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yes Yes Yes Yes Yes Yes Marshall Islands Yes No Yes Yes Yes Yes Yes Mongolia Yes Yes Yes No Yes Yes Yes Palau Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Wallis and Futuna No Yes Yes Yes Yes Yes Yes Percentage of Yes 92% 92% 100% 69% 92% 92% 92% a No data from Guam, the Federated States of Micronesia, the Philippines and Singapore. Data Source: WHO 43 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/areaa Prevention and treat- ment of TB in pregnancy Intermittent preventive treatment in pregnancy for malaria Prevention and manage- ment of gestational diabetes Counselling on tobacco, alcohol, and substance abuse during pregnancy Partner involvement /couple counselling Australia No Yes Yes Yes No Brunei Darussalam No No Yes No No China No No Yes Yes Yes Cook Islands No No Yes Yes Yes Cambodia Yes No Yes Yes Yes Lao People’s Democratic Republic Yes Yes Yes Yes Yes Marshall Islands No No Yes No No Mongolia Yes No Yes Yes Unknown Palau Yes No Yes Yes Yes French Polynesia Yes No Yes Yes Yes Viet Nam No No Yes No Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Unknown No Yes Yes Yes Percentage of Yes 46% 23% 100% 77% 69% a No data from Guam, the Federated States of Micronesia, the Philippines and Singapore. Data Source: WHO Table 23. (cont.) Countries/areas with national guideline or policies on ANC that included counselling and intervention 44 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Eleven out of 14 (79%) countries and areas have a national ANC policy recommending the use of ultrasound before 24 weeks of gestational age. The recommendation on improving preterm birth outcomes and the use of antenatal corticosteroids for prevention of preterm birth with clear criteria all have high coverage in the reporting countries (Table 24). Table 24. Countries/areas having national policy or guideline on improving preterm birth outcomes a No data from Guam, the Federated States of Micronesia and Singapore. Data Source: WHO Country/areaa Use of ultrasound before 24 weeks of gestation National policies/ guidelines exist on improving preterm birth outcomes Use of antenatal corticosteroids for prevention of preterm births Specifies clear criteria for when to use antenatal corticosteroids Australia Yes Yes No No Brunei Darussalam Yes Yes Yes Yes China Yes Yes Yes Yes Cook Islands No No - - Cambodia Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yes Yes Yes Marshall Islands Yes Yes Yes Yes Mongolia Yes Yes Yes Yes Philippines Yes Yes Yes Yes Palau Unknown Yes Yes No French Polynesia Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Vanuatu No Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Percentage of Yes 79% 93% 86% 79% 45 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/areaa Childbirth Right of every woman to have access to skilled care at childbirth Makes recommendations on the place of childbirth Australia No - - Brunei Darussalam Yes No - China Yes Yes Yes Cook Islands Yes Yes Yes Cambodia Yes Yes Yes Lao People’s Democratic Republic Yes Yes Yes Marshall Islands Yes Yes Yes Mongolia Yes Yes Yes Philippines Yes Yes Yes Palau Yes Unknown - French Polynesia Yes Yes Yes Singapore No - - Viet Nam Yes Yes Yes Vanuatu Yes Yes Yes Wallis and Futuna Yes Yes Yes Percentage of Yes 87% 73% 73% Childbirth policy Thirteen out of 15 (87%) countries/areas have a national policy or guideline on childbirth, except for Australia (due to decentralization); Singapore reported “No”. China, Cambodia, Cook Islands, French Polynesia, the Lao People’s Democratic Republic, the Marshall Islands, Mongolia, the Philippines, Vanuatu, Viet Nam, and Wallis and Futuna reported a national policy or guideline on childbirth that states the right of every woman to have access to skilled care at childbirth and makes recommendations on the place of childbirth (Table 25). Table 25. Countries/areas with national policies or guidelines on childbirth, on the right of access to skilled care and on recommendations on the place of childbirth a No data from Guam and the Federated States of Micronesia. Twelve out of 17 (71%) countries/areas reported data on national recommendations for childbirth, while no data were reported from Australia, Guam, the Federated States of Micronesia, Palau and Singapore. Among the 12 countries, 100% reported recommending oxytocin for prevention and treatment of postpartum haemorrhage (PPH), which is consistent with WHO recommendations, followed by 75% recommending ergometrine and 67% recommending misoprostol. Magnesium sulfate for the prevention and treatment of eclampsia is recommended by 92% of countries. Recommendations on safe childbirth and respectful delivery care are partially included, with 83% on facility delivery, 67% on companion of choice during labour, and 67% on water and sanitation in the health facility, yet only 33% recommended position of choice during the delivery (Table 26). Data Source: WHO 46 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Co un tr y/ ar ea a In di ca te s de si gn at ed he al th fa ci lit ie s as th e pr ef er re d pl ac e of ch ild bi rt h Re co m m en ds th e pr es en ce o f a co m pa ni on o f ch oi ce d ur in g la bo ur a nd bi rt h Re co m m en ds w om an ch oo se bi rt hi ng po si tio n Ad dr es se s av ai la bi lit y of c le an w at er a nd sa ni ta tio n in th e fa ci lit ie s w he re b ir th s ta ke p la ce Ad dr es se s av ai la bi lit y of e ss en ti al eq ui pm en t in fa ci lit ie s w he re b ir th s ta ke p la ce Re co m m en ds th e us e of m ag ne si um su lf at e fo r th e pr ev en tio n an d tr ea tm en t of e cl am ps ia Re co m m en ds ox yt oc in fo r pr ev en tio n an d tr ea tm en t of po st -p ar tu m ha em or rh ag e (P PH ) Re co m m en ds er go m et ri ne fo r pr ev en ti on an d tr ea tm en t of P PH Re co m m en ds m is op ro st ol fo r pr ev en - tio n an d tr ea tm en t of P PH Br un ei D ar us sa la m - - - N o N o Ye s Ye s N o N o Ch in a Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Co ok Is la nd s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s Ca m bo di a Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s La o Pe op le ’s D em oc ra ti c Re pu bl ic b N o N o N o U nk no w n U nk no w n Ye s Ye s Ye s Ye s M ar sh al l Is la nd s Ye s N o N o N o N o Ye s Ye s Ye s Ye s M on go lia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ph ili pp in es Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s N o Fr en ch Po ly ne si a Ye s Ye s N o Ye s Ye s U nk no w n Ye s N o N o V ie t N am Ye s N o N o Ye s Ye s Ye s Ye s Ye s Ye s Va nu at u Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s W al lis a nd Fu tu na Ye s Ye s U nk no w n Ye s Ye s Ye s Ye s U nk no w n U nk no w n Pe rc en ta ge of Y es 83 % 67 % 33 % 67 % 75 % 92 % 10 0% 75 % 67 % Ta bl e 26 . Co un tr ie s/ ar ea s w ith a n at io na l p ol ic y or g ui de lin e on c hi ld bi rt h a N o da ta fr om A us tr al ia , G ua m , t he F ed er at ed S ta te s o f M ic ro ne sia , P al au an d Si ng ap or e. b F ol lo w in g or ig in al su bm iss io n, th e L ao n at io na l g ui de lin e o n ch ild bi rt h in clu de s: “in di ca te s d es ig na te d he al th fa ci lit ie s a s th e p re fe rr ed p la ce o f c hi ld bi rt h” , “ re co m m en ds th e p re se nc e o f a co m pa ni on o f c ho ic e d ur in g la bo ur an d bi rt h” an d “r ec om m en ds fo r t he w om an to ch oo se th e b irt hi ng p os iti on ”. D at a So ur ce : W H O co un tr y offi ce in th e L ao P eo pl e’s D em oc ra tic R ep ub lic 47 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS a No data from Guam and the Federated States of Micronesia. b Following its original submission, Cambodia has updated the recommended length of stay under observation of a skilled attendant from 25-48 hours to 48-72 hours, in Safe Motherhood Protocol (2020). Data Source: WHO Postnatal care for mother and newborn policy Thirteen out of 17 (87%) countries and areas reported having a national policy or guideline on postnatal care, and 87% recommends a rooming-in policy for mother and baby during the entire hospital stay. The recommended length of postpartum stay varies between 12 to 24 hours and 24 to 48 hours, while WHO recommends healthy mothers and newborns should receive care in the facility for at least 24 hours after an uncomplicated vaginal birth in a health-care facility (Table 27). Country/ areaa Postnatal care for mothers and newborns Recommends the mother and baby rooming or being kept together until they are discharged from a facility Recommends length of stay under observation of skilled attendant for mother and baby, after normal childbirth, at facility Recommends postnatal follow-up contacts (visits/ reviews) by a skilled attendant for mother and newborn after discharge from the facility Australia No - - - - Brunei Darussalam Yes Yes No - Yes China Yes Yes Yes 25–48 hours Yes Cook Islands Yes Yes Yes 12–24 hours Yes Cambodia Yes Yes Yes 25–48 hoursb Yes Lao People’s Democratic Republic Yes Yes Yes 25–48 hours Yes Marshall Islands Yes Yes Yes 12–24 hours Yes Mongolia Yes Yes Yes Unknown Yes Philippines Yes Yes Yes 12–24 hours Yes Palau Yes Yes Unknown - Yes French Polynesia Yes Yes Yes Greater than 48 hours Yes Singapore No - - - - Viet Nam Yes Yes Yes Greater than 48 hours Yes Vanuatu Yes Yes Yes 12–24 hours Yes Wallis and Futuna Yes Yes Yes Greater than 48 hours Unknown Percentage of Yes 87% 87% 73% 80% Table 27. Countries/areas with national policies or guidelines on postnatal care for mothers and newborns 48 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y For postnatal care (PNC) contacts, 92% of countries specify in the national policy or guideline that the postnatal care contacts are for both mother and newborn, with the only exception for “mother only” as reported by the Marshall Islands. The minimum number of additional contacts, after 24 hours of birth within the first 6 weeks, is recommended by WHO as “at least three times”, yet only 58% of countries have updated the policy. The recommended timing for the first to the fourth PNC contact in alignment with WHO recommendations ranges from 83% to 33%. Table 28 is the detailed breakdown data; no data were reported by Australia, Guam, the Federated States of Micronesia, Singapore, and Wallis and Futuna. Country/areaa Specifies if the postnatal care contacts (visits/reviews) are for mother and/or newborn Recommends a minimum number of additional contacts (visits/reviews) after 24 hours of birth within the first 6 weeksb Includes 1st contact within 24 hours from birth Brunei Darussalam Yes, both mother & newborn Yes, more than three Yes China Yes, both mother & newborn Yes, more than three Yes Cook Islands Yes, both mother & newborn Yes, more than three Unknown Cambodia Yes, both mother & newborn Yes, more than three Yes Lao People’s Democratic Republic Yes, both mother & newborn Yes, at least three Yes Marshall Islands Yes, mother only Yes, at least one No Mongolia Yes, both mother & newborn Yes, at least three Yes Philippines Yes, both mother & newborn Yes, at least two Yes Palau Yes, both mother & newborn Yes, at least two Yes French Polynesia Yes, both mother & newborn Yes, more than three Yes Viet Nam Yes, both mother & newborn Yes, at least two Yes Vanuatu Yes, both mother & newborn Yes, at least two Yes Percentage of Yes 92%c 58%d 83% Table 28. Countries/areas with national policy or guideline on postnatal contacts a No data from Australia, Guam, the Federated States of Micronesia, Singapore, and Wallis and Futuna. b At least three additional postnatal contacts are recommended for all mothers and newborns, on day 3 (48–72 hours), between days 7 and 14 after birth, and 6 weeks after birth. c “Yes, both mother & newborn” are deemed as positive. d “At least three” and “more than three” are deemed as positive. Data Source: WHO 49 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Postnatal care counselling at home was included in 77% of national policies and guidelines reported by 13 countries. All countries have reported that PNC counselling includes assessment of both the mother and the newborn. For health professionals who can conduct PNC visits at home, a skilled birth attendant (SBA) is mentioned by 77%, and community health worker (CHW) by 38%. Breastfeeding, nutrition, recognition and reporting of illness/sickness of the mother and the newborn, and well-being advice are recommended in 100% of country policies and guidelines, while exercise and rest (85%), family planning (92%) and early childhood development (54%) are partly covered. No data were reported from Australia, Guam, the Federated States of Micronesia and Singapore. Table 29 contains breakdown details. Country/areaa Includes 2nd contact within 72 hours Includes 3rd contact within 7 days Includes 4th contact within 28 days Recommends that first PNC should be as early as possible within 24 hours of birth for home delivery Brunei Darussalam No No No Yes China Yes Yes Yes Yes Cook Islands Unknown Unknown Unknown Yes Cambodia Yes No No Yes Lao People’s Democratic Republic Yes Yes No Yes Marshall Islands No No No Unknown Mongolia Yes Yes No Yes Philippines Yes Yes Yes Yes Palau Unknown Unknown Yes Unknown French Polynesia Yes Yes Yes Yes Viet Nam Unknown Unknown Unknown Yes Vanuatu Unknown Yes Unknown Yes Percentage of Yes 50% 50% 33% 83% a No data from Australia, Guam, the Federated States of Micronesia, Singapore, and Wallis and Futuna. Data Source: WHO Table 28. (cont.) Countries/areas with national policy or guideline on postnatal contacts 50 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Th e na ti on al p ol ic y/ gu id el in e re co m m en ds c ou ns el lin g fo r th e m ot he r on : Co un tr y/ ar ea a D es cr ib es w ho c ou ld pr ov id e ca re du ri ng th e PN C co nt ac t( s) at h om e Sk ill ed at te nd an t i s sp ec ifi ed to pr ov id e ca re du ri ng p os t- na ta l f ol lo w up c on ta ct s at h om e CH W is sp ec ifi ed to p ro vi de ca re d ur in g po st na ta l fo llo w u p co nt ac ts a t ho m e D oe s th e na tio na l po lic y/ gu id el in e re co m m en d as se ss m en t of t he m ot he r an d ne w bo rn Br ea st - fe ed in g N ut ri ti on Ex er ci se an d re st Fa m ily pl an ni ng Re co g- ni tio n an d re po rt in g of il ln es s/ si ck ne ss fo r th e m ot he r an d th e ne w bo rn W el l- be in g ad vi ce fo r th e m ot he r an d th e ne w bo rn Ea rl y ch ild ho od de ve lo p- m en t Br un ei D ar us sa la m Ye s Ye s Ye s Ye s, bo th m ot he r & ne w bo rn Ye s Ye s N o N o Ye s Ye s N o Ch in a Ye s Ye s Ye s Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s Ye s Co ok Is la nd s Ye s Ye s Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s U nk no w n Ca m bo di a N o - - Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s U nk no w nb La o Pe op le ’s D em oc ra ti c Re pu bl ic Ye s Ye s Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s N o M ar sh al l Is la nd s N o - - Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s Ye s M on go lia Ye s Ye s Ye s, bo th m ot he r & ne w bo rn Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ta bl e 29 . Co un tr ie s/ ar ea s w ith p os tn at al c ar e po lic ie s or g ui de lin es w ith s pe ci fic re co m m en da tio ns a N o da ta fr om A us tr al ia , G ua m , t he F ed er at ed S ta te s o f M ic ro ne sia an d Si ng ap or e. b F ol lo w in g or ig in al su bm iss io n, C am bo di a h as is su ed a 10 00 -d ay p ac ka ge w he re E CD w as re co m m en de d fo r a p os tn at al v isi t f ro m th ird P N C vi sit (c ov er in g ne w bo rn 1 .5 m on th s u p to 2 y ea rs o ld ). D at a So ur ce : W H O 51 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 29. (cont.) Countries/areas w ith postnatal care policies or guidelines w ith specific recom m endations a N o data from Australia, G uam , the Federated States of M icronesia and Singapore. b Follow ing original subm ission, Cam bodia has issued a 1000-day package w here ECD w as recom m ended for a postnatal visit from the third PN C visit (covering new borns 1.5 m onths up to 2 years old). D ata Source: W H O The national policy/guideline recom m ends counselling for the m other on: Country/ area a D escribes w ho could provide care during the PN C contact(s) at hom e Skilled attendant is specified to provide care during post- natal follow - up contacts at hom e CH W is specified to provide care during postnatal follow - up contacts at hom e D oes the national policy/guideline recom m end assessm ent of the m other and new born N utrition Exercise and rest Fam ily planning Recognition and reporting of illness/ sickness for the m other and the new born W ell- being advice for the m other and the new born Early childhood Palau U nknow n - - Yes, both m other & new born Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes, both m other & new born Yes Yes Yes Yes Yes Yes Yes Viet N am Yes Yes Yes Yes, both m other & new born Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes, both m other & new born Yes Yes Yes Yes Yes Yes Yes W allis and Futuna Yes Yes Yes, both m other & new born Yes Yes Yes Yes Yes Yes U nknow n Percentage of Yes 77% 77% 38% 100% 100% 100% 85% 92% 100% 100% 54% 52 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y All 13 countries that reported data on essential newborn care have a national policy or guideline in place on essential newborn care, which recommends immediate skin-to-skin care after birth (92%), delayed cord clamping (92%), early initiation of breastfeeding (100%), basic resuscitation (100%), hepatitis B vaccination (92%) and bacille Calmette-Guérin (BCG) vaccination (92%) (Table 30). Country/ areaa Immediate skin-to- skin care after birth Delayed cord clamping Early initiation of breast- feeding Basic re- suscitation Hepatitis B vaccination BCG vaccination China No Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Cambodia Yes Yes Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yes Yes Yes Yes Yes Marshall Islands Yes Yes Yes Yes Yes Yes Mongolia Yes Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes Yes Yes Palau Yes Yes Yes Yes Unknown Unknown French Polynesia Yes Yes Yes Yes Yes Yes Singapore Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Wallis and Futuna Yes Unknown Yes Yes Yes Yes Percentage of Yes 92% 92% 100% 100% 92% 92% a No data from Australia, Brunei Darussalam, Guam and the Federated States of Micronesia. Data Source: WHO Table 30. Countries/areas with recommendations on essential newborn care Management of premature/low-birthweight newborns Ten out of 14 (71%) countries have reported having a national policy or guideline on management of preterm and low-birthweight newborns, with a specification recommending breastmilk feeding for very-low-birthweight (100%), skilled personnel to be present to assist mothers who have difficulties breastfeeding (100%), providing Kangaroo Mother Care (KMC) for clinically stable newborns weighing 2000 g and less at birth (60%), and indicating the level of facility where KMC should be provided (67%) (Table 31). 53 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/ areaa National policy/ guideline on management of low- birthweight and preterm newborns Recommends preterm/low- birthweight including very-low- birthweight should be fed breastmilk Specifies the presence of skilled personnel to assist mothers who have difficulties breastfeeding Recommends Kangaroo Mother Care for clinically stable newborns weighing 2000 g or less at birth at health facilities Indicates the level of facility where KMC should be provided Australia No - - - - Brunei Darussalam No - - - - China Yes Yes Yes No - Cambodia Yes Yes Yes Yes Yes, both first-level and referral- level facilities Lao People’s Democratic Republic Yes Yes Yes Yes No Marshall Islands No - - - - Mongolia Yes Yes Yes No - Philippines Yes Yes Yes Yes Yes, but not specified in the survey Palau Yes Yes Yes Yes Unknown French Polynesia Yes Yes Yes Yes Yes, first- level facilities Singapore No - - - - Viet Nam Yes Yes Yes Yes Yes, first- level facilities Vanuatu Yes Yes Yes No - Wallis and Futuna Yes Yes Yes Unknown - Percentage of Yes 71% 100% 100% 60% 67% Table 31. Management of preterm and low-birthweight newborns a No data from Cook Islands, Guam and the Federated States of Micronesia. Data Source: WHO 54 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Management of sick newborns Nine out of 13 (69%) countries reported having a national standard for the management of newborn infants with severe illness, with 54% specifying the availability of special newborn care units and 69% neonatal intensive care units. Routine haemoculture of suspected sepsis before starting antibiotics treatment is required by 54% countries, and treatment of sick newborns with possible serious bacterial infection (PSBI) at the primary health care level when referral is not feasible is recommended by 23% countries (Table 32). No data were reported from Australia, Guam, the Federated States of Micronesia and Mongolia. Country/ areaa Manage- ment of newborn infants with severe illness Specifies availability of special newborn care unitsb Specifies availability of neonatal intensive care unit Recommends routine haemoculture before starting on antibiotics in case of suspected sepsis Treatment of sick newborns with possible serious bacterial infection at primary health care facility when referral is not feasible Brunei Darussalam No No No Yes No China Yes No Yes Unknown No Cook Islands Yes Yes Yes Yes No Cambodia Yes Unknown Unknown Yes No Lao People’s Democratic Republic Yes Yes Yes Yes No Marshall Islands No No No No No Philippines Yes Yes Yes No No Palau Yes No No Unknown Unknown French Polynesia Yes Yes Yes Yes Yes Singapore No No Yes No No Viet Nam Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes No Yes Wallis and Futuna Unknown Yes Yes Yes Unknown Percentage of Yes 69% 54% 69% 54% 23% Table 32. Countries/areas with national policies or guidelines on management of sick newborn babies a No data from Australia, Guam, the Federates States of Micronesia and Mongolia. b Special newborn care units. Data Source: WHO 55 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Lactation policy More than half of the countries/areas (65%) have policies on the Baby-friendly Hospital Initiative (BFHI) and for the provision of lactation management support to mothers and infants during the hospital stay (65%). Less than one third (24%) have a policy for the provision of human donor milk, and 18% have set regulations for human milk banks. Mongolia and the Philippines are the two countries that have 100% coverage of lactation policies (Table 33). Table 33. Countries/areas with national policy or guideline on lactation Country/area Provision of human donor milk for babies whose mothers cannot produce sufficient breastmilk Sets regulations for human milk banking Provides lactation management support to mothers of newborns and infants in inpatient care On BFHIa Australia No - No Yes Brunei Darussalam No - Yes Yes China No - Yes Yes Cook Islands No - No No Federated States of Micronesia Unknown - Unknown Yes Guam No - Unknown No Cambodia No - Yes Yes Lao People’s Democratic Republic No - Yes Yes Marshall Islands No - No No Mongolia Yes Yes Yes Yes Philippines Yes Yes Yes Yes Palau Unknown - Yes Unknown French Polynesia Yes Yes Yes No Singapore Yes Unknown Yes Yes Viet Nam No - No Yes Vanuatu No - Yes Yes Wallis and Futuna No - Yes No Percentage of Yes 24% 18% 65% 65% a Baby-friendly Hospital Initiative Data Source: WHO 56 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Human resources policy Ten out of 15 countries have a national policy or guideline that set forth a competency framework for maternal and/or newborn health care, 53% have a continuous professional education system in place for primary health care (PHC) clinicians and nurses to receive maternal and/ or newborn-specific training, 40% on education of midwifery providers based on International Confederation of Midwives (ICM) competencies, and 53% on regulation of midwifery care providers (doctors, nurses and midwives) based on ICM competencies (Table 34). Fig. 13 shows the proportion of countries with a national policy or guideline that recommends midwife-led care for services during pregnancy, childbirth and the postnatal period. Table 35 is a breakdown on health professionals other than a doctor (nurse, midwife, nurse-midwife, medical assistant) that are allowed to independently perform specific maternal and newborn care interventions. Table 34. Countries/areas with human resource policy on maternal and newborn health care a No data from Guam and the Federated States of Micronesia. b International Confederation of Midwives Data Source: WHO Country/ areaa Sets forth a competency framework for maternal and/ or newborn health care A continuous profes- sional education system in place for primary health-care clinicians and/or nurses to receive maternal and/or new- born-specific training Education of midwifery care providers based on ICMb competencies A national policy/ guideline on regulation of mid- wifery care providers (doctors, nurses and midwives) based on ICM competencies Australia Yes Yes Yes Yes Brunei Darussalam No Yes No No China Yes No Yes Yes Cook Islands No Yes No No Cambodia Yes Yes Yes Yes Lao People’s Democratic Republic Unknown Yes Unknown Unknown Marshall Islands No No No No Mongolia Yes Unknown Unknown Yes Philippines Yes Unknown Unknown Yes Palau No No No No French Polynesia Yes Unknown No No Singapore Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Wallis and Futuna Yes Unknown Unknown Unknown Percentage of Yes 67% 53% 40% 53% 57 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Mother only Mother and newborn Pregnancy Childbirth Postnatal period 59% 0% 0% 65% 29% 29% Fig. 13. Proportion of countries with a national policy/guideline that recommends midwife- led care for pregnancy, childbirth and postnatal period Data Source: WHO Percentage of countries 58 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/ areaa Assist normal child- birth Admin- ister parenteral antibiotics Adminis- ter intra- venous oxytocin Adminis- ter miso- prostol tablets Admin- ister parenteral anticon- vulsants Manually remove the pla- centa Remove retained products of concep- tion Brunei Darussalam Cook Islands Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Cambodia Nurse Marshall Islands Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Mongolia Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Philippines Nurse, Midwife Nurse, Midwife Nurse, Midwife Nurse, Midwife Nurse, Midwife Palau Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse- midwife French Polynesia Midwife Midwife Midwife Midwife Midwife Midwife Midwife Viet Nam Nurse, Midwife, Nurse- midwife, Medical assistant Medical assistant Midwife Midwife Medical assistant Midwife, Medical assistant Midwife Vanuatu Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Wallis and Futuna Midwife Nurse, Midwife Midwife Midwife Midwife Midwife Table 35. Health professionals (nurse, midwife, nurse-midwife, medical assistant) other than a doctor that can independently perform specific maternal and newborn care interventions a No data from Australia, China, Guam, the Lao People’s Democratic Republic, the Federated States of Micronesia, and Singapore. Data Source: WHO 59 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/ areaa Assist normal child- birth Admin- ister parenteral antibiotics Adminis- ter intra- venous oxytocin Adminis- ter miso- prostol tablets Admin- ister parenteral anticon- vulsants Manually remove the pla- centa Remove retained products of concep- tion Brunei Darussalam Cook Islands Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Cambodia Nurse Marshall Islands Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Mongolia Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Midwife, Nurse- midwife Philippines Nurse, Midwife Nurse, Midwife Nurse, Midwife Nurse, Midwife Nurse, Midwife Palau Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse, Nurse- midwife Nurse- midwife Nurse- midwife French Polynesia Midwife Midwife Midwife Midwife Midwife Midwife Midwife Viet Nam Nurse, Midwife, Nurse- midwife, Medical assistant Medical assistant Midwife Midwife Medical assistant Midwife, Medical assistant Midwife Vanuatu Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Wallis and Futuna Midwife Nurse, Midwife Midwife Midwife Midwife Midwife Country/ areaa Perform assisted vaginal birth Blood trans- fusion Perform newborn resusci- tation Support Kangaroo Mother Care Provide lactation management support to moth- ers who have breastfeeding difficulties Support caregivers of very small or sick babies to participate in the care of their hospitalized infant Brunei Darussalam Nurse Cook Islands Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse-midwife Nurse, Midwife, Nurse-midwife Cambodia Medical assistant Medical assistant Medical assistant Medical assistant Marshall Islands Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse-midwife Nurse Mongolia Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse-midwife Midwife, Nurse- midwife Philippines Nurse, Midwife Nurse Nurse, Midwife Nurse, Midwife Nurse, Midwife Nurse Palau Nurse-midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife Nurse, Nurse- midwife French Polynesia Midwife Midwife Nurse, Midwife Nurse, Midwife Nurse Viet Nam Midwife, Medical assistant Midwife Nurse, Midwife, Nurse- midwife, Medical assistant Nurse, Midwife, Nurse-midwife, Medical assistant Midwife, Medical assistant Vanuatu Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse- midwife Nurse, Midwife, Nurse-midwife, Medical assistant Nurse, Midwife, Nurse-midwife Wallis and Futuna Nurse, Midwife Midwife Nurse, Midwife Nurse, Midwife Nurse, Midwife Essential medicines and equipment The majority of countries (82%) have a national policy or guideline on essential medicines and equipment. Tables 36 and 37 provide country details on essential drugs and equipment indicated for use during pregnancy, childbirth and postpartum care. a No data from Australia, China, Guam, the Lao People’s Democratic Republic, the Federated States of Micronesia, and Singapore. Data Source: WHO Table 35. (cont.) Health professionals (nurse, midwife, nurse-midwife, medical assistant) other than a doctor that can independently perform specific maternal and newborn care interventions 60 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Co un tr y/ ar ea a M ag ne siu m su lfa te Ox yt oc in Am pi ci lli n or am ox ic ill in in je ct io ns In je ct io n Pr oc ai ne pe ni ci lli n in je ct io n Ch lo r- he xi di ne Ce ft ria xo ne In tr av en ou s tr an ex am ic ac id Br un ei D ar us sa la m Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ch in a Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s N o Ye s Ye s Co ok Is la nd s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ca m bo di a Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s La o Pe op le ’s D em oc ra tic Re pu bl ic Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s U nk no w nb M ar sh al l I sl an ds Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s M on go lia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ph ili pp in es Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Pa la u Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Fr en ch P ol yn es ia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Si ng ap or e Ye s Ye s N o Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s Vi et N am Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s Ye s Ye s Ye s N o Va nu at u Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s U nk no w n W al lis a nd Fu tu na Ye s Ye s Ye s Ye s Ye s Ye s U nk no w n U nk no w n Ye s Ye s Ye s Ye s Pe rc en ta ge o f Y es 10 0% 10 0% 79 % 10 0% 10 0% 93 % 79 % 93 % 10 0% 79 % 10 0% 71 % Ta bl e 36 . Es se nt ia l d ru gs in di ca te d fo r u se d ur in g pr eg na nc y, ch ild bi rt h an d po st pa rt um c ar e a N o da ta fr om A us tr al ia , G ua m an d th e F ed er at ed S ta te s o f M ic ro ne sia . b E ss en tia l m ed ic in e l ist in th e L ao P eo pl e’s D em oc ra tic R ep ub lic in clu de s “ in tr av en ou s t ra ne xa m ic ac id ”. D at a So ur ce : W H O 61 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 37. Supplies and equipment included in the national list of commodities indicated for use of pregnancy, childbirth and postpartum care a No data from Australia, Guam and the Federated States of Micronesia. Data Source: WHO Country/areaa Obstetric ultrasound machine Self-inflating bag with neonatal and paediatric masks of different size and valve Oxygen supply Pulse oxi- meter Blood and blood products Vacuum aspiration Brunei Darussalam Yes Yes Yes Yes Yes Yes China Yes Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Cambodia Yes Yes Yes Yes Yes Yes Lao People’s Democratic Republic Unknown Yes Yes Yes Yes Yes Marshall Islands Yes Yes Yes Yes Yes Yes Mongolia Yes Yes Yes Yes Yes Yes Philippines Unknown Yes Yes Yes Yes No Palau Yes Yes Yes Yes Yes No French Polynesia Yes Yes Yes Yes Yes Yes Singapore Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Yes Yes Percentage of Yes 86% 100% 100% 100% 100% 86% Maternal deaths Eleven out of 16 countries have a national policy, guideline or law requiring all maternal deaths to be notified within 24 hours to a central authority, 63% requiring all maternal deaths to be reviewed, and 44% requiring developing a national action plan to implement recommendations identified in the maternal death review process. Eleven (69%) countries require classification of cause of death according to ICD-10, and 81% reported having maternal death review and response process in place. Brunei Darussalam, Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines and Vanuatu reported “Yes” on all items (Table 38). 62 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 38. Countries/areas with policy, guideline or law on maternal death reporting and review systems a No data from Australia. b WHO application of ICD-10 to deaths during pregnancy, childbirth and postpartum period. c Maternal death review systems currently only review maternal deaths in health facilities. Thus, “Required all maternal deaths to be reviewed” is “No”. Data Source: WHO Country/areaa Requires all maternal deaths to be notified within 24 hours to a central authority Requires all maternal deaths to be reviewed Includes development of a national action plan to implement recommendations identified in the maternal death review process Requires classification of the causes of maternal deaths according to the ICD-MMb A facility maternal death review and response process in place Brunei Darussalam Yes Yes Yes Yes Yes China Yes Yes Yes Yes Yes Cook Islands Yes No - Yes Yes Federated States of Micronesia Unknown Unknown - No Yes Guam Yes No - Yes No Cambodia Yes Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yesc Yes Yes Yes Marshall Islands No No - No No Mongolia Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes Yes Palau No No - No Yes French Polynesia Yes Yes Unknown No Yes Singapore Yes Yes No Yes Yes Viet Nam No Yes No No Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Unknown Unknown - Yes Unknown Percentage of Yes 69% 63% 44% 69% 81% Forty-one per cent of countries have a national panel (committee) in place to review maternal deaths, but only 6% includes women’s groups or other civil society groups. There is a mechanism in place in 35% of countries to provide feedback to the community on results and recommendations from national panel. A small proportion (18%) of panels will also review stillbirth or neonatal deaths. Nearly half (47%) of countries have a subnational committee to review maternal deaths (Table 39). 63 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 39. Countries/areas w ith a national panel or com m ittee in place for m aternal deaths Country/area M aternal death review s in place Includes w om en’s groups or other civil society representatives H as a m echanism in place to provide feedback to the com m unity on results and recom m endations Includes stillbirth or neonatal death review s Frequency of national panel m eetings W hen did the panel m eet last? H as a subnational panel or com m ittee in place to review m aternal deaths Australia U nknow n - - - - U nknow n Brunei D arussalam Yes N o Yes Yes U nknow n 2015 Yes China Yes U nknow n Yes Yes Sem i-annually 2018 Yes Cook Islands N o - - - - N o Federated States of M icronesia U nknow n - - - - Yes Guam N o - - - - N o Cam bodia Yes N o Yes N o Q uarterly 2018 Yes Lao People’s D em ocratic Republic Yes N o N o N o Sem i-annually 2016 Yes M arshall Islands N o - - - - N o M ongolia Yes N o Yes N o Sem i-annually 2018 Yes Philippines N o - - - - Yes Palau N o - - - - N o French Polynesia N o - - - - N o Singapore N o - - - - N o Viet N am Yes N o Yes N o Annually 2017 Yes Vanuatu Yes Yes Yes Yes U nknow n 2017 N o W allis and Futuna U nknow n - - - - U nknow n Percentage of Yes 41% 6% 35% 18% 47% D ata Source: W H O 64 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 40. Countries/areas with a national policy, guideline or law on stillbirth review a No data from Australia. Data Source: WHO Stillbirths Less than half (44%) of the countries reported having a national policy, guideline or law that requires stillbirth (fresh or macerated) to be reviewed, and only 50% have a facility stillbirth review process in place. China, Cook Islands, French Polynesia, Mongolia, Palau, Vanuatu, and Wallis and Futuna have both policy and facility review processes on stillbirth (Table 40). Country/areaa Requires stillbirths (fresh or macerated) to be reviewed Has a facility stillbirth review process in place Brunei Darussalam No Yes China Yes Yes Cook Islands Yes Yes Federated States of Micronesia No No Guam No No Cambodia No No Lao People’s Democratic Republic No No Marshall Islands No No Mongolia Yes Yes Philippines No No Palau Yes Yes French Polynesia Yes Yes Singapore No No Viet Nam No No Vanuatu Yes Yes Wallis and Futuna Yes Yes Percentage of Yes 44% 50% 65 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 41. Countries/areas with national policy or guideline on neonatal death reporting and review Neonatal deaths More than two thirds (69%) of countries reported having a national policy, guideline or law that requires neonatal deaths (0–28 days) to be reviewed and have a facility neonatal death review process in place (69%), with 56% requiring classification of cause of death using the ICD-10 standard. China, Cook Islands, French Polynesia, Guam, Mongolia, Singapore, Vanuatu, and Wallis and Futuna have policies for 100% coverage, ICD classification and facility review processes on neonatal deaths (Table 41). Country/areaa A national policy/ guideline/law that requires neonatal deaths (0–28 days) to be reviewed A national policy requiring classification of the causes of stillbirths and neonatal deaths according to the ICD-PM classificationb A facility neonatal death review process in place Brunei Darussalam Yes No Yes China Yes Yes Yes Cook Islands Yes Yes Yes Federated States of Micronesia No No Yes Guam Yes Yes Yes Cambodia No No Noc Lao People’s Democratic Republic No No No Marshall Islands No No No Mongolia Yes Yes Yes Philippines Yes Yes No Palau Yes Unknown Yes French Polynesia Yes Yes Yes Singapore Yes Yes Yes Viet Nam No No No Vanuatu Yes Yes Yes Wallis and Futuna Yes Yes Yes Percentage of Yes 69% 56% 69% a No data from Australia. b WHO application of ICD-10 to deaths during the perinatal period. c Neonatal death review process is put in place in three demonstration provinces. Data Source: WHO 66 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y III. Child health Overall strategy or plan for child health and development In the 17 participating countries in the Western Pacific Region, 76% reported having a national policy, guideline or law in place to provide free access to health services in the public sector for children under the age of 5 years, 53% reported recognizing the need for universal access to essential health services and medicines for children aged 0–9 years, while 29% covered only age 0–5 years. Less than one third of countries reported having a national policy, guideline or law that addresses common childhood diseases such as pneumonia (24%), diarrhoea (24%) and acute malnutrition (18%), even though half (59%) reported having integrated management of childhood illness (IMCI) policies. Early childhood development policies are reported by 59% of countries. Table 42 provides a breakdown on coverage of child health and development and specific age groups. 67 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 42. Summary of strategy or plan for child health and development a Following the original submission, it was suggested the correct age coverage should be 0–5 years old in abovementioned strategies in the Lao People’s Democratic Republic. Data Source: WHO country office in the Lao People’s Democratic Republic. Data discrepancies from original submission and review suggestions are kept for Member State’s reference and consideration. Country/area Free access to health services in the public sector for children under 5 years of age Universal access to essential health services and medicines for children Child health and development of children Competency framework for child health care Management of childhood pneumonia Australia Yes No Yes, 0–9 Yes Unknown Brunei Darussalam Yes Yes, 0–5 Yes, 0–5 Unknown No China Yes Yes, 0–9 Yes, 0–9 Yes Yes, 0–9 Cook Islands Yes Yes, 0–9 Yes, 0–9 Yes Yes, 0–9 Federated States of Micronesia Yes Yes, 5–9 Unknown Unknown No Guam Yes Unknown Unknown Unknown Unknown Cambodia Unknown Unknown Yes, 0–5 Unknown Yes, 0–5 Lao People’s Democratic Republica Yes Yes, 5–9 Yes, 5–9 Unknown Yes, 5–9 Marshall Islands No Yes, 0–9 No No No Mongolia Yes Yes, 0–9 Yes, 0–5 Yes Yes, 0–5 Philippines No Yes, 0–5 Yes, 0–5 Yes Yes, 0–5 Palau Unknown Yes, 0–9 Yes, 0–9 No No French Polynesia Yes Yes, 0–9 Yes, 0–9 Yes Yes, 0–9 Singapore Yes Yes, 0–9 Yes, 0–9 No No Viet Nam Yes Yes, 0–9 Yes, 0–9 Yes Yes, 0–9 Vanuatu Yes Yes, 0–5 Yes, 0–5 Yes Yes, 0–5 Wallis and Futuna Yes Yes, 0–9 No Unknown Unknown Percentage of Yes 76% - - 47% - Percentage of policies covering entire 0–9 age group - 53% 41% - 24% Percentage of partial age group coverage (0–5 or 5–9) - 29% 35% - 29% 68 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y a Following the original submission, it was suggested the correct age coverage should be 0–5 years old in abovementioned strategies in the Lao People’s Democratic Republic. Data Source: WHO country office in the Lao People’s Democratic Republic. Data discrepancies from original submission and review suggestions are kept for Member State’s reference and consideration. Country/area Manage- ment of childhood diarrhoea Manage- ment of acute malnutri- tion Management of hospitalized children (from 1 month to 9 years) Early childhood develop- ment Integrated manage- ment of childhood illness Management of childhood illness by trained com- munity health workers Australia Unknown No Unknown Yes Yes Unknown Brunei Darussalam Yes, 0–9 No No Yes Unknown No China Yes, 0–9 Yes, 0–9 Unknown Yes Yes No Cook Islands No No No No No No Federated States of Micronesia Unknown Unknown Unknown No Unknown Unknown Guam Unknown Unknown Unknown Yes Unknown Unknown Cambodia Yes, 0–5 Yes, 0–5 Yes No Yes No Lao People’s Democratic Republica Yes, 5–9 Yes, 5–9 Yes Yes Yes Yes Marshall Islands No No No No Yes Yes Mongolia Yes, 0–5 Yes, 0–5 Yes Yes Yes Yes Philippines Yes, 0–5 Yes, 0–5 Unknown Yes Yes Yes Palau No No Unknown No No No French Polynesia Yes, 0–9 No Yes Yes Yes Yes Singapore No Yes, 0–9 No Yes No No Viet Nam Yes, 0–9 Yes, 0–5 Yes Yes Yes Yes Vanuatu Yes, 0–5 Yes, 0–5 Yes Unknown No Yes Wallis and Futuna Unknown Yes, 0–9 Yes No Unknown Unknown Percentage of Yes - - 41% 59% 53% 41% Percentage of policies covering entire 0–9 age group 24% 18% - - - - Percentage of partial age group coverage (0–5 or 5–9) 29% 35% - - - - Table 42. (cont.) Summary of strategy or plan for child health and development 69 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% First-level health facility Referral-level health facility Other 11% 56% 33% Among 17 countries and areas, nine have responded to the question on the level of health facilities and first-line treatment for pneumonia with chest in-drawing. Referral-level health facility accounts for 56% of the level designated, and amoxicillin was reported by 78% and co-trimoxazole by 11% as the first-line treatment for pneumonia with chest in-drawing (Fig. 15, Fig. 16). Fig. 14. Proportion of countries/areas with national policies/guidelines on the management of childhood pneumonia for children Fig. 15. Percentage of level of health facilities that can treat pneumonia with chest in-drawing National policy/guideline exists on the management of childhood pneumonia for children Prevention and management of pneumonia Eight (47%) countries have national policies or guidelines on the management of childhood pneumonia for children aged 0–5 years, five (29%) countries have these for children aged 5–9 years, four (24%) countries and areas (China, Cook Islands, French Polynesia and Viet Nam) have these for both ages, groups from 0–9 (Fig. 14). Data Source: WHO Data Source: WHO Percentage of countries 0% 25% 50% 75% 100% Ages 0–5 Ages 5–9 Ages 0–9 24% 29% 47% 70 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Amoxicillin Co-trimoxazole Other 11% 11% 78% Similarly, nine countries have responded to the question on the treatment of pneumonia with fast breathing (Figs. 17 and 18). Amoxicillin was reported by 78% and co-trimoxazole by 11% as the first-line treatment for pneumonia with fast breathing, and the recommended treatment duration varied: 5 days (44%), 3 days (33%) and other (22%). Fig. 17. Percentage of the first-line treatment for pneumonia with fast breathing Fig. 16. Percentage of the first-line treatment for pneumonia with chest in-drawing Data Source: WHO Data Source: WHO 0% 25% 50% 75% 100% Amoxicillin Co-trimoxazole Other 11% 11% 78% 71 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% 3 days 5 days Other 22% 44% 33% Fig. 18 Percentage of the recommended duration of treatment of pneumonia with fast breathing Fig. 19. Countries/areas having policy or guideline on management of childhood diarrhoea 1 Pocket book of hospital care for children: Guidelines for the management of common childhood illnesses (second edition), World Health Organization. Prevention and management of diarrhoea Eight (47%) countries have national policies/guidelines on the management of childhood diarrhoea for children aged 0–5 years; five (29%) countries have these for children aged 5–9 years; four (24%) countries (Brunei Darussalam, China, French Polynesia and Viet Nam) have these for both age groups, from 0–9 years (Fig. 19). All countries have listed oral rehydration solution, zinc and fluid as the recommended treatment for diarrhoea with dehydration. The three essential elements in managing children with diarrhoea are rehydration therapy, zinc supplementation, and counselling for continued feeding and prevention, as per WHO recommendations.1 Percentage of countries National policy/guideline exists on management of childhood diarrhoea including children Data Source: WHO Data Source: WHO Percentage of countries 0% 25% 50% 75% 100% Ages 0–5 Ages 5–9 Ages 0–9 24% 29% 47% 72 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Republic of Korea Japan China Mongolia Lao People's Democratic Republic Viet Nam Cambodia Singapore Brunei Darussalam Malaysia Philippines Palau Northern Mariana Islands Guam Australia Papua New Guinea Micronesia (Federated States of) Marshall Islands Nauru Kiribati Tuvalu Solomon Islands Vanuatu Fiji New Zealand Fig. 20. Malaria-endemic countries in the Western Pacific Region Prevention and management of malaria Malaria is endemic in 10 countries in the Western Pacific Region, six of which have participated in this survey: Cambodia, China, Lao People’s Democratic Republic, the Philippines, Vanuatu and Viet Nam. The other four countries are Malaysia, Papua New Guinea, the Republic of Korea and Solomon Islands (Fig. 20). Only three countries, the Lao People’s Democratic Republic, the Philippines and Vanuatu, completed the malaria general survey questions (Table 43). Given the limited survey participation on this section, the percentage is not deemed representative, and therefore was not calculated. Non-WPR countries Malaria-endemic countries Countries in the Western Pacific Region Non-endemic WPR countries The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on the maps represent approximate border lines for which there may not yet be full agreement Data Source: WHO Map production: WHO 73 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 44. Child-specific malaria policy/guideline for preventive purposes in three countries Table 43. Malaria approaches and treatment in countries/areas Country/ area Policy/guideline recommends parasitological (i.e. microscopy or a rapid diagnostic test) confirmation of malaria before treatment Which approach is used for confirmation of malaria? What is the first-line treatment for malaria? What is the pre- referral treatment for severe malaria? What is the first-line treatment for severe malaria? Lao People’s Democratic Republic Noa No datab Artemether plus lumefantrine Other Parenteral artesunate Philippines Yes Rapid diag-nostic test Artemether plus lumefantrine Parenteral quinine Parenteral quinine Vanuatu Yes Rapid diag-nostic test Artesunate plus sulfadoxine- pyrimethamine Rectal artesunate Parenteral artesunate a Following original submission, the Lao People’s Democratic Republic has updated its policy as “Yes”. b Following original submission, the Lao People’s Democratic Republic has updated its policy as “rapid diagnostic test and microscopic test”. Data Source: WHO Country/area Is there a national policy/guideline on prevention of malaria in children? Does the policy/ guideline recommend intermittent preventive treatment in infants? Does the policy/guideline recommend seasonal malaria chemoprevention for children? Lao People’s Democratic Republic Yes, 5–9 years No No Philippines Yes, 0–5 years Yes Yes Vanuatu Yes, 0–9 years No No Vanuatu is the only country among the reported endemic countries with a national policy or guideline on the management of malaria with appropriate recommendations for children, covering ages 0–9 years (Table 44). Data Source: WHO 74 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Fig. 21. Countries/areas with national policy or guideline on management of acute malnutrition in children Prevention and management of all forms of malnutrition Less than half of the countries (47%) have a national policy or guideline on the management of acute malnutrition in children aged 0–5 years, and the coverage decreases further on children aged 5–9 years (24%) and 0–9 years (18%) (Fig. 21). Among the nine countries responding, 100% reported recommending the assessment of children for acute malnutrition by measuring weight for height, while 67% on mid-upper arm circumference, 44% on weight for age, and 33% on oedema of both feet (Fig. 22). National policy/guideline exists on management of acute malnutrition including children Data Source: WHO 0% 25% 50% 75% 100% Ages 0–5 Ages 5–9 Ages 0–9 18% 24% 47% 75 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Fig. 22. Recommended assessment of children for acute malnutrition MUAC - mid-upper arm circumference Fig. 23. Countries/areas with national policy/guideline on routine assessment of children for overweight and obesity in health facilities As for overweight or obesity assessments, 53% countries reported having a national policy or guideline recommending routine assessment for children aged 0–5 years, and 35% for children aged 5–9 years and 0–9 years (Fig. 23). Data Source: WHO Data Source: WHO 0% 25% 50% 75% 100% Ages 0–5 Ages 5–9 Ages 0–9 Policy/guideline recommendation for routine assessment of children for overweight or obesity in health facilities Percentage of countries 35% 35% 53% 0% 25% 50% 75% 100% MUAC Weight for height Weight for age Oedema of both feet Percentage of countries recommending assessment of children for acute malnutrition 33% 44% 100% 67% 76 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Paediatric hospital care for sick children Less than half (41%) of countries reported having a national policy or guideline on the management of hospitalized children from 1 month to 9 years old; 47% reported having clinical standards for the management of children with severe illness in hospitals (Table 45). Table 45. Countries/areas with national policy or guideline on hospital care for sick children Essential medicines and equipment For a country’s national essential drug list coverage of drugs for management of childhood illness (Table 46), Vanuatu (94%), the Philippines (94%), the Lao People’s Democratic Republic (94%) and Cambodia (94%) reported having the highest coverage among all 17 countries and areas, followed by Cook Islands (88%), the Federated States of Micronesia (88%), Palau (88%) and French Polynesia (88%). a Australia, China, Guam, the Federated States of Micronesia, the Philippines and Palau reported “Unknown.” Data Source: WHO Country/areaa Management of hospitalized children (from 1 month to 9 years) Clinical standards for the management of children with severe illness in hospitals Brunei Darussalam No Yes Cook Islands No No Cambodia Yes Yes Lao People’s Democratic Republic Yes Yes Marshall Islands No No Mongolia Yes Yes French Polynesia Yes Yes Singapore No No Viet Nam Yes Yes Vanuatu Yes Yes Wallis and Futuna Yes Yes Percentage of Yes 41% 47% 77 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS a No data from Guam. Data Source: WHO Table 46. National essential drug list for management of childhood illness National essential drug list includes any of the below drugs indicated for management of childhood illnessa Au st ra lia Br un ei D ar us sa la m Ch in a Co ok Is la nd s Fe de ra te d St at es of M ic ro ne si a Ca m bo di a La o Pe op le ’s D em oc ra tic Re pu bl ic M ar sh al l I sl an ds Amoxicillin dispersible tablet (250 mg) No Yes Yes Yes Yes Yes Yes No Amoxicillin syrup (125 mg per 5 mL) No Yes No Yes Yes Yes Yes No Co-trimoxazole paediatric tablet (20 mg trimethoprim + 100 mg sulfamethoxazole) No Yes No No Yes Yes Yes No Co-trimoxazole Syrup (40 mg trimethoprim + 200 mg sulfamethoxazole) No Yes No Yes Yes Yes Yes Yes Ciprofloxacine tablets (250 mg OR 500 mg) No Yes Yes Yes Yes Yes Yes Yes Oral rehydration salts No Yes Yes Yes Yes Yes Yes Yes Zinc sulfate tablets (10 mg or 20 mg) No Yes No Yes Yes Yes Yes Yes Rectal artesunate (50 mg or 100 mg) No No No No Yes Yes No No Salbutamol inhaler No Yes Yes Yes Unknown Yes Yes Yes Ampicillin injectable (250-mg vial) No Yes No Yes Yes Yes Yes No Gentamicin injectable (2-mL vial containing 20 mg) No Unknown No Yes Yes No Yes No Gentamicin injectable (2-mL vial containing 80 mg) No Yes Yes Yes Yes Yes Yes Yes Ceftriaxone No Yes Yes Yes Yes Yes Yes Yes Procaine penicillin (50 000 U) No Yes No Yes Yes Yes Yes Yes Aqueous benzyl penicillin (100 000–150 000 U) No Yes Yes Yes Yes Yes Yes Yes Child-friendly tubercu- losis formulations (RHZ, RH) and isoniazid No No Yes Yes Unknown Yes Yes Yes Percentage of Yes by country/area 0% 81% 50% 88% 88% 94% 94% 63% 78 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y National essential drug list includes any of the below drugs indicated for management of childhood illnessa M on go lia Ph ili pp in es Pa la u Fr en ch P ol yn es ia Si ng ap or e Vi et N am Va nu at u W al lis a nd F ut un a Amoxicillin dispersible tablet (250 mg) No No Yes Yes No Yes Yes Unknown Amoxicillin syrup (125 mg per 5 mL) Yes Yes Yes Yes Yes Yes Yes Yes Co-trimoxazole paediatric tablet (20 mg trimethoprim + 100 mg sulfamwethoxazole) No Yes Yes Yes Yes Yes Yes Unknown Co-trimoxazole Syrup (40 mg trimethoprim + 200 mg sulfamethoxazole) No Yes Yes Yes Yes Yes Yes Unknown Ciprofloxacine tablets (250 mg OR 500 mg) Yes Yes Yes Yes Yes Yes Yes Unknown Oral rehydration salts Yes Yes Yes Yes Yes Yes Yes Yes Zinc sulfate tablets (10 mg or 20 mg) Yes Yes No Unknown No Yes Yes Unknown Rectal artesunate (50 mg or 100 mg) No Yes No No No Yes Yes Unknown Salbutamol inhaler Yes Yes Yes Yes Yes Yes Yes Yes Ampicillin injectable (250-mg vial) No Yes Yes Yes No Yes Yes Yes Gentamicin injectable (2-mL vial containing 20 mg) No Yes Yes Yes No Yes Yes Yes Gentamicin injectable (2-mL vial containing 80 mg) Yes Yes Yes Yes Yes No Yes Yes Ceftriaxone Yes Yes Yes Yes Yes Yes Yes Yes Procaine penicillin (50 000 U) No Yes Yes Yes No Unknown Yes Yes Aqueous benzyl penicillin (100 000–150 000 U) No Yes Yes Yes Yes Unknown Yes Yes Child-friendly tubercu- losis formulations (RHZ, RH) and isoniazid No Yes Yes Yes No Unknown Un- known Unknown Percentage of Yes by country/area 44% 94% 88% 88% 56% 75% 94% 56% a No data from Guam. Data Source: WHO Table 46. (cont.) National essential drug list for management of childhood illness 79 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 47. Time periods addressed by ECD policy and guideline Early childhood development Ten out of 17 (59%) countries and areas have a national policy or guideline on early childhood development (ECD); they are Australia, Brunei Darussalam, China, French Polynesia, Guam, the Lao People’s Democratic Republic, Mongolia, the Philippines, Singapore and Viet Nam. All 10 countries and areas reported that the national policy on ECD covers ages 0–4 years, while 50% covers ages 5–9 years in addition. Pregnancy is covered by 90% and preconception 40%. Singapore is the only country that reported having covered all time periods from preconception to ages 5–9 years (Table 47). a Cambodia, Cook Islands, the Marshall Islands, the Federated States of Micronesia, Palau, Vanuatu, and Wallis and Futuna did not report having a national policy or guideline on early childhood development and were, therefore, not included in the denominator. Data Source: WHO Country/areasa Preconception Pregnancy 0–4 years 5–9 years Australia Yes Yes Yes Yes Brunei Darussalam No Yes Yes No China Yes Yes Yes No Guam No No Yes No Lao People’s Democratic Republic No Yes Yes Yes Mongolia No Yes Yes No Philippines Unknown Yes Yes Yes French Polynesia No Yes Yes No Singapore Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Percentage of Yes 40% 90% 100% 50% Six countries and areas (China, French Polynesia, the Lao People’s Democratic Republic, the Philippines, Singapore and Viet Nam) reported having a national policy or guideline on ECD that recommends responsive care and early learning, infant and young child nutrition, and care for children with developmental difficulties and disabilities. Overall, the responsive care and early learning is well addressed (100%), followed by nutrition (90%). However, care for children with developmental difficulties and disabilities is only covered in a policy or guideline in 60% countries (Table 48). 80 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 48. Interventions recommended by national policy or guideline on ECD Country/areasa Responsive care and early learning (e.g. care for child development) Infant and young child nutrition Care for children with developmental difficulties and disabilities Australia Yes Yes No Brunei Darussalam Yes Yes No China Yes Yes Yes Guam Yes No No Lao People’s Democratic Republic Yes Yes Yes Mongolia Yes Yes No Philippines Yes Yes Yes French Polynesia Yes Yes Yes Singapore Yes Yes Yes Viet Nam Yes Yes Yes Percentage of Yes 100% 90% 60% a Cambodia, Cook Islands, the Marshall Islands, the Federated States of Micronesia, Palau, Vanuatu, and Wallis and Futuna did not report having a national policy or guideline on early childhood development and were, therefore, not included in the denominator. Data Source: WHO A national coordination mechanism for ECD exists in 59% of the countries and areas; they are Australia, Brunei Darussalam, China, French Polynesia, Guam, the Lao People’s Democratic Republic, Palau, the Philippines, Singapore and Viet Nam. High rates of participation from the health, nutrition, education, social welfare/protection and child protection sectors are reported (80–100%), while the participation of the environmental safety and security sector, including water (WASH), sanitation and hygiene, is only reported by 50% of the countries and areas (Table 49). 81 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 49. Sectors involved in national coordination mechanism for ECD a Cambodia, Cook Islands, the Marshall Islands, the Federated States of Micronesia, Palau, Vanuatu, and Wallis and Futuna did not report having a national policy or guideline on early childhood development and were, therefore, not included in the denominator. Data Source: WHO Country/ areaa Health Nutrition Education Social welfare or social protection Child protection Environmental safety and security, including WASH Australia Yes Yes Yes Yes Yes Yes Brunei Darussalam Yes Yes Yes Yes Unknown Unknown China Yes Yes Yes Yes Yes Yes Guam Yes No Yes Yes Yes No Lao People’s Democratic Republic Unknown Unknown Yes Yes Unknown Yes Philippines Yes Yes Yes Yes Yes Unknown Palau Yes Yes Yes Yes Yes No French Polynesia Yes Yes Yes Yes Yes Yes Singapore Yes Yes Yes Yes Yes Unknown Viet Nam Yes Yes Yes Yes Yes Yes Percentage of Yes 90% 80% 100% 100% 80% 50% Provision of integrated child health services Nine countries and areas (53%) reported having a national policy or guideline on the integrated management of childhood illness (IMCI); they are Australia, Cambodia, China, French Polynesia, the Lao People’s Democratic Republic, the Marshall Islands, Mongolia, the Philippines and Viet Nam. Fig. 24 lists the detailed conditions that the national IMCI guidelines address. 82 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Less than one third of countries and areas (29%) have a policy or guideline for treatment of young infants with PSBI at the PHC level, and six countries and areas (41%) reported having a policy on the management of childhood illness by trained CHWs. Tables 50 and 51 show detailed activities that can be conducted by CHWs according to the national policy or guideline, where assessment and referral of diarrhoea and pneumonia are fully covered, followed by 83% with a policy or guideline on acute malnutrition, 67% on assessment and referral of syphilis, HIV and TB. Congenital syphilis Fig. 24. Conditions addressed by national IMCI guideline Data Source: WHO 0% 25% 50% 75% 100% Diarrhoea Pneumonia Throat infection/sore throat Wheezing Tuberculosis Malaria Measles Dengue Acute malnutrition Anaemia Sickle cell anaemia Ear infection HIV Essential newborn care Early childhood development Infant and young child feeding Skin conditions Other 100% 100% 100% 63% 63% 63% 63% 63% 25% 88% 88% 88% 88% 88% 88% 88% 75% 75% 75% Percentage of countries with a national IMCI guideline that addresses the conditions listed 83 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 50. Countries/areas with national policy or guideline for IMCI at PHC level, and by trained CHWs Country/areaa National policy/guideline exists for treatment of young infants with possible serious bacterial infection at primary health care facility when referral is not feasible National policy /guideline exists for management of childhood illness by trained community health workers Brunei Darussalam Unknown No China No No Cook Islands No No Cambodia No No Lao People’s Democratic Republic Yes Yes Marshall Islands Yes Yes Mongolia Yes Yes Philippines No Yes Palau No No French Polynesia Yes Yes Singapore No No Viet Nam Unknown Yes Vanuatu Yes Yes Percentage of Yes 29% 41% a Australia, Guam, the Federated States of Micronesia, and Wallis and Futuna reported "Unknown" on both items. Table 51. Assessment and referral, or assessment and treatment activities that can be conducted by CHWs according to the national policy/guideline a Among seven countries/areas with a national policy in place for management of childhood illness by trained CHWs, Mongolia did not submit data and was therefore, was not included in the denominator. Country/ areaa Pneumonia Diarrhoea Malaria Severe acute malnutri- tion TB HIV Con- genital syphilis Refer Treat Refer Treat Refer severe ma- laria Treat uncom- plicated malaria Refer Treat Re-fer Refer Refer Lao People’s Democratic Republic Yes No Yes No Yes Yes Yes No No Yes Yes Marshall Islands Yes Yes Yes Yes No No Yes No Yes Yes Yes Philippines Yes No Yes No Yes No Yes No Yes No No French Polynesia Yes No Yes No No No No No No No No Viet Nam Yes Yes Yes Yes No No Yes No Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Percentage of Yes 100% 50% 100% 50% 50% 33% 83% 17% 67% 67% 67% Data Source: WHO Data Source: WHO 84 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y The Lao People’s Democratic Republic and Viet Nam are the only two countries reported having a national policy or guideline on integrated community case management. Brunei Darussalam, China, Mongolia, Vanuatu and Viet Nam are the five countries that reported having a national policy or guideline on supporting home-care practices by trained CHWs. Table 52 lists detailed home-care practices that can be provided by CHWs, reported by four countries. Table 52. Home-care practices by trained CHWs that are included in the national policy/ guideline Country/ areaa Essential newborn care Infant and young child nutrition Early child- hood devel- opment Preven- tion of child- hood illness Signs of illness and timely care- seeking from a qualified provider House- hold contact scree- ning for TB Index case testing for HIV Treat- ment of pre- sumed neonatal infection Brunei Darus- salam Yes No No No Yes No No No China Yes Yes Yes Yes Yes Un-known Un- known Unknown Viet Nam Yes Yes Yes Yes Yes No No No Vanuatu Yes Yes Yes Yes Yes Yes Yes Un-known Percentage of Yes 100% 75% 75% 75% 100% 25% 25% 0% a Five countries reported having national policy or guideline on supporting home care practices by trained CHWs. Among the five, Mongolia did not submit answers to detailed questions and was, therefore, not included in the denominator. Data Source: WHO 85 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS IV. Adolescent health In the Western Pacific Region, 13 out of 17 (76%) participating countries and areas have national policies or guidelines that specifically address adolescent (10–19 years) health issues. The composition of the responding team in most countries are comprised of health ministry officials, with some participation from UNICEF and UNFPA. More than half of the countries did not specify the team composition. Overall plans or guidelines for adolescent health Table 53 provides an overview of key adolescent health strategies, policies, laws and guidelines. Vanuatu is the only country that possesses all aforementioned documents targeted for adolescent health. 86 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area Free access to health services for adolescent A dedicated law on adolescent health A dedicated law that addresses adolescent (10– 19 years) health Standards for delivery of health services to adolescents Standards for health- prom oting schools N ational adolescent health program m e N ational policies/ guidelines that specify com petencies of health w orkers in adolescent health Continuous professional education system for prim ary health w orkers to receive adolescent- specific training A ustralia Yes N o Yes U nknow n N o U nknow n U nknow n U nknow n Brunei D arussalam N o N o N o N o N o N o N o N o China N o N o Yes N o Yes N o N o N o Cook Islands Yes U nknow n Yes U nknow n U nknow n U nknow n U nknow n Yes Federated States of M icronesia Yes N o U nknow n U nknow n U nknow n Yes U nknow n U nknow n G uam Yes Yes N o U nknow n U nknow n N o N o N o Cam bodia U nknow n U nknow n Yes Yes U nknow n U nknow n Yes Yes Lao People’s D em ocratic Republic N o U nknow n Yes U nknow n U nknow n Yes U nknow n N o M arshall Islands N o N o Yes N o Yes Yes N o N o M ongolia Yes N o Yes Yes Yes Yes Yes N o Philippines N o Yes Yes Yes U nknow n Yes Yes Yes Palau U nknow n U nknow n Yes U nknow n U nknow n Yes Yes N o French Polynesia Yes Yes Yes Yes Yes N o Yes N o Singapore Yes U nknow n Yes N o Yes Yes N o Yes V iet N am N o Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes W allis and Futuna Yes N o N o U nknow n U nknow n U nknow n U nknow n N o Percentage of Yes 53% 29% 76% 35% 41% 53% 41% 35% Table 53. Sum m ary table of key national strategies/policies/law s/guidelines on adolescent health D ata Source: W H O 87 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/ area Sexual and reproductive health includ- ing adolescent pregnancy prevention Sexually transmit- ted infec- tions HIV/AIDS Nutrition Diet Physical activity Tobacco Australia Yes Unknown Unknown Yes Yes Yes Unknown Brunei Darussalam No No No Yes Unknown Yes No China Yes Unknown Yes Yes Yes Yes No Cook Islands Yes Yes Yes Yes Yes Yes Yes Federated States of Micronesia Yes Yes Yes Unknown Unknown Yes Yes Guam Yes Yes Yes No No Unknown Yes Cambodia Yes Yes Yes Yes No Yes Yes Lao People’s Democratic Republic Unknown Unknown Unknown Unknown Unknown Unknown Unknown Marshall Islands Yes Yes Yes No No No No Mongolia Yes Yes Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes Yes Yes Yes Palau Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes Yes Yes Singapore Unknown Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Unknown Unknown Unknown Unknown Percentage of Yes 82% 76% 82% 71% 59% 76% 65% Table 54 is a summary table of the countries and areas where adolescents were cited as a specific target group for interventions or activities in national policies or guidelines by health issue: sexual and reproductive health (including adolescent pregnancy prevention), STIs, HIV/AIDS, nutrition, diet, physical activity, tobacco, alcohol, substance use, mental health, injury prevention, violence, TB, and other communicable diseases (e.g. lower respiratory tract infections, meningitis, diarrhoea). Mongolia, Palau, the Philippines and Vanuatu have 100% coverage of the abovementioned health issue for adolescents. Sexual and reproductive health, adolescent pregnancy prevention and HIV/ AIDS have the highest coverage of 82%, followed by STIs and physical activity with a coverage of 76%. Comparatively, only around half of the countries have mentioned adolescents in issues such as tobacco, alcohol, substance abuse, mental health, injury prevention and violence. Table 54. Countries/areas where adolescents are cited as a specific target group for interventions/activities in national policies/guidelines by each health issue Data Source: WHO 88 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 54. (cont.) Countries/areas where adolescents are cited as specific target group for interventions/activities in national policies/guidelines by each health issue Country/ area Alcohol Sub- stance use Mental health Injury preven- tion Violence Tubercu-losis Other communicable diseases (e.g. lower respiratory tract infections, meningitis, diarrhoea) Australia Unknown Un-known Unknown Un- known Un- known Unknown Unknown Brunei Darussalam No No No No No No No China No No Yes No No Yes No Cook Islands Yes No Yes No Yes Yes Yes Federated States of Micronesia Yes Yes Yes Un-known Un- known Unknown Unknown Guam Yes Yes Unknown Yes Un-known Unknown Unknown Cambodia Yes Yes Yes Yes Yes Unknown Unknown Lao People’s Democratic Republic Unknown Un-known Unknown Un- known Un- known Unknown Unknown Marshall Islands No No No No Yes No No Mongolia Yes Yes Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes Yes Yes Yes Palau Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes No No Singapore Yes Yes Yes No No No No Viet Nam Yes Yes Yes Yes Yes Yes No Vanuatu Yes Yes Yes Yes Yes Yes Yes Wallis and Futuna Unknown Un- known Unknown Un- known Un- known Unknown Unknown Percentage of Yes 65% 59% 65% 47% 53% 41% 29% Data Source: WHO 89 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 55 is a summary of national standards for health service delivery for adolescents. The Philippines, Vanuatu and Viet Nam reported “Yes” on all three items, while the majority of the other countries and areas do not have standards at all. Table 55. Summary of national standards for health service delivery for adolescents Country/areaa Country has national standards for delivery of health services to adolescents Activities are being carried out to monitor the implementation of these standards for delivery Standards include a clearly defined comprehensive package of health services for adolescents Brunei Darussalam No - - China No - - Cambodia Yes Unknown Yes Marshall Islands No - - Mongolia Yes Unknown Yes Philippines Yes Yes Yes French Polynesia Yes Yes No Singapore No - - Viet Nam Yes Yes Yes Vanuatu Yes Yes Yes Percentage of Yes 60% 40% 50% a Countries that reported “Unknown”: Australia, Cook Islands, Guam, the Lao People’s Democratic Republic, the Federated States of Micronesia, Palau, and Wallis and Futuna. Data Source: WHO Cost for health services Table 56 provides a summary of cost for health services provided to adolescents. Cook Islands, Mongolia, French Polynesia, and Wallis and Futuna have the highest rate (89%) of user-fee exemptions for all adolescents in accessing health services. Singapore’s 89% of the listed health services are provided to select population groups and not all adolescents, followed by 67% for Brunei Darussalam, Cambodia and the Philippines. The highest free-access health services provided for adolescents are HIV testing and counselling (59%) and STI testing and treatment (53%); free access to the other services for all adolescents is all below 50%. 90 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Co un tr y/ ar ea O ut pa tie nt ca re v is its In pa tie nt ca re v is its H IV te st in g an d co un se lli ng Co nt ra ce p- tiv es M en ta l he al th Re ha b fo r su bs ta nc e ab us e Ph ar m ac eu tic al p ro du ct s an d/ or o th er m ed ic al su pp lie s if re qu ire d fo r di ag no si s an d tr ea tm en t Te st in g an d tr ea tm en t f or se xu al ly tr an s- m itt ed in fe ct io ns Va cc in at io n fo r h um an pa pi llo m a- vi ru s Au st ra lia Ye s Ye s Ye s N o Ye s U nk no w n N o N o Ye s Br un ei D ar us sa la m N o N o Pa rt ia l Pa rt ia l N o Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Ch in a N o N o N o N o N o N o N o N o N o Co ok Is la nd s Ye s Ye s Ye s Ye s Ye s U nk no w n Ye s Ye s Ye s Fe de ra te d St at es of M ic ro ne si a N o N o Ye s Ye s Ye s U nk no w n U nk no w n Ye s Pa rt ia l Gu am Pa rt ia l N o Pa rt ia l Pa rt ia l N o N o N o Pa rt ia l Pa rt ia l Ca m bo di a Pa rt ia l Pa rt ia l Ye s Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Ye s U nk no w n La o Pe op le ’s D em oc ra tic Re pu bl ic N o N o Ye s Ye s U nk no w n N o N o Ye s Pa rt ia la M ar sh al l I sl an ds N o N o Ye s Ye s Ye s Ye s N o Ye s Ye s M on go lia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Ph ili pp in es Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l U nk no w n U nk no w n Pa rt ia l U nk no w n Pa rt ia l Pa la u N o N o Ye s N o N o N o N o Ye s Ye s Fr en ch P ol yn es ia Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Si ng ap or e Pa rt ia l Pa rt ia l Pa rt ia l N o Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l Vi et N am N o N o Pa rt ia l Pa rt ia l Pa rt ia l Pa rt ia l N o N o N o Va nu at u N o N o N o N o N o N o N o N o Pa rt ia l W al lis a nd F ut un a Ye s Ye s Ye s Ye s Ye s U nk no w n Ye s Ye s Ye s Pe rc en ta ge o f Y es fo r a ll ad ol es ce nt s 29 % 29 % 59 % 41 % 41 % 18 % 24 % 53 % 29 % Pe rc en ta ge o f Y es fo r s el ec te d gr ou ps (P ar tia l) 24 % 18 % 29 % 29 % 18 % 24 % 24 % 18 % 41 % Pe rc en ta ge o f N o 47 % 53 % 12 % 29 % 29 % 29 % 47 % 24 % 24 % Ta bl e 56 . Su m m ar y of c os t f or h ea lt h se rv ic es – Ar e ad ol es ce nt s ex em pt fr om u se r f ee s fo r t he fo llo w in g he al th s er vi ce s in th e pu bl ic s ec to r? a F re e f or ad ol es ce nt s b et w ee n 10 an d 14 y ea rs o ld . D at a so ur ce : W H O co un tr y offi ce in th e L ao P eo pl e’s D em oc ra tic R ep ub lic . D at a So ur ce : W H O 91 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Infrastructure and training Table 57 is a summary of health-promoting schools and health programmes targeted for adolescents. Singapore and Viet Nam reported having 100% coverage of health-promoting school and adolescent health programmes, including national standards, designated personnel and budgets, and monitoring of the implementation of these standards. Health-promoting schools Adolescent health programme Country/area National standard for health- promoting schools Activities are carried out to monitor the implemen- tation of these standards for delivery National adolescent health programme At least one designated full- time person for the national adolescent health programme Regular government budget allocation to support the national adolescent health programme Australia No - Unknown - - Brunei Darussalam No - No - - China Yes No No - - Cook Islands Unknown - Unknown - - Federated States of Micronesia Unknown - Yes Unknown Unknown Guam Unknown - No - - Cambodia Unknown - Unknown - - Lao People’s Democratic Republic Unknown - Yes No No Marshall Islands Yes Yes Yes Yes No Mongolia Yes Yes Yes Yes No Philippines Unknown - Yes Yes Yes Palau Unknown - Yes Yes Yes French Polynesia Yes Yes No - - Singapore Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes No Yes Wallis and Futuna Unknown - Unknown - - Percentage of Yes 41% 35% 53% 35% 29% Table 57. Health-promoting schools and adolescent health programmes Table 58 is a summary of whether adolescent-related topics are included in health worker competencies, continuous education systems, and pre-service training for clinicians, nurses and CHWs. Viet Nam is the only country that has included adolescent health in the entire spectrum of the health worker education system, followed by the Philippines (90%), Palau (80%) and French Polynesia (80%). Data Source: WHO 92 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Co un tr y/ ar ea N at io na l p ol ic ie s/ gu id el in es th at s pe ci fy co m pe te nc ie s of he al th w or ke rs in ad ol es ce nt h ea lth Ba si c co nc ep ts in ad ol es ce nt he al th a nd de ve lo pm en t Ef fe ct iv e co m m un i- ca tio n w ith ad ol es - ce nt s La w , po lic ie s Q ua lit y st an da rd s Cl in ic al ca re o f ad ol es ce nt s w ith sp e- ci fic c on di - tio ns A co nt in uo us pr of es si on al ed uc at io n sy st em fo r pr im ar y he al th w or ke rs to re ce iv e ad ol es ce nt - sp ec ifi c tr ai ni ng Cl in ic ia ns N ur se s CH W s Au st ra lia U nk no w n - - - - - U nk no w n U nk no w n U nk no w n U nk no w n Br un ei D ar us sa la m N o - - - - - N o N o N o N o Ch in a N o - - - - - N o N o N o N o Co ok Is la nd s U nk no w n - - - - - Ye s Ye s Ye s U nk no w n Fe de ra te d St at es of M ic ro ne si a U nk no w n - - - - - U nk no w n U nk no w n U nk no w n U nk no w n Gu am N o - - - - - N o U nk no w n U nk no w n U nk no w n Ca m bo di a Ye s Ye s Ye s Ye s Ye s U nk no w n Ye s N o N o N o La o Pe op le ’s D em oc ra tic Re pu bl ic U nk no w n - - - - - N o U nk no w n U nk no w n U nk no w n M ar sh al l I sl an ds N o - - - - - N o N o N o N o M on go lia Ye s Ye s U nk no w n Ye s Ye s Ye s N o Ye s N o Ye s Ph ili pp in es Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s N o Pa la u Ye s Ye s Ye s Ye s Ye s U nk no w n N o Ye s Ye s Ye s Fr en ch P ol yn es ia Ye s Ye s Ye s Ye s Ye s Ye s N o Ye s Ye s N o Si ng ap or e N o - - - - - Ye s Ye s Ye s Ye s Vi et N am Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Ye s Va nu at u Ye s N o Ye s Ye s N o N o Ye s Ye s Ye s Ye s W al lis a nd F ut un a U nk no w n - - - - - N o U nk no w n U nk no w n U nk no w n Pe rc en ta ge o f Y es 41 % 35 % 35 % 41 % 35 % 24 % 35 % 47 % 41 % 29 % Ta bl e 58 . Su m m ar y of h ea lt h w or ke r c om pe te nc y, co nt in uo us e du ca tio n an d pr e- se rv ic e tr ai ni ng fo r a do le sc en t- re la te d se rv ic e D at a So ur ce : W H O 93 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Consent for services Table 59 is a summary of legal age limits for unmarried adolescents to access health services without consent from a parent or legal guardian. The Federated States of Micronesia, the Philippines and Viet Nam defined a clear age limit of 18, while the rest of the countries and areas have no age limit for accessing services for adolescents or do not have data. Country/ area Contracep- tive services except sterilization Emergency contracep- tion HIV testing |and coun- selling services Harm reduction interventions for injecting drug usersa Mental health services HIV care and treatment Australia Yes Unknown Unknown Unknown Unknown Unknown Brunei Darussalam No No No No No No China No No No Unknown No No Cook Islands Unknown No No Unknown No No Federated States of Micronesia Yes (18) Yes (18) Yes (18) Unknown Yes (18) Unknown Guam No No No Unknown Unknown No Cambodia No No No No Unknown No Lao People’s Democratic Republic No No No No No No Marshall Islands Yes (15) No No No No No Mongolia No No No No No No Philippines Yes (18) No Yes (18) No No Yes (18) Palau No No No Unknown Unknown No French Polynesia No No No Unknown No No Singapore No Unknown Unknown Unknown No Unknown Viet Nam Yes (18) No Yes (18) Yes (18) Yes (18) Yes (18) Vanuatu No No No No No No Wallis and Futuna Yes (15) Unknown Unknown No No Unknown Total Percentage of No (no age limit) 65% 76% 65% 47% 65% 65% Table 59. Countries/areas that have legal age limits for unmarried adolescents to provide consent, without parental/legal guardian consent, for selected services a Including needle exchange, opiate substitution and therapy. Data Source: WHO 94 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 60 is the summary of legal age limits for married adolescents to access health services without spousal consent. The survey did not ask for a specific age in this section. Overall, there is lack of a clear definition of legal age limits for the access by married adolescents to health service, except for Vanuatu (100%). Table 60. Summary of legal age limit for married adolescents to provide consent to services without spousal consent Country/ areaa Contracep- tive services except sterilization Emergency contracep- tion HIV testing and counselling services HIV care and treatment Harm reduction interven- tions for injecting drug usersb Mental health services Brunei Darussalam No No No No No No China No No No No No No Cook Islands No No No No Unknown No Cambodia No No No No No Unknown Lao People’s Democratic Republic No No No No No No Marshall Islands No No No No No No Mongolia No Yes Yes Yes Yes Yes Philippines Yes No Yes Yes No No Palau No No No No Unknown Unknown French Polynesia No No No No Unknown No Singapore No No No No No No Viet Nam Yes No Yes Yes Yes No Vanuatu Yes Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Unknown Unknown Total Per- centage of No (no age limit) 59% 65% 53% 53% 41% 53% a Australia, Guam and the Federated States of Micronesia reported “Unknown” on all items. b Including needle exchange, opiate substitution and therapy. Data Source: WHO 95 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 61. Summary of laws and policies for protecting adolescent health Legislation Table 61 summarizes laws and policies on protecting adolescents from coerced sex; the provision of driver licences; and prohibiting and regulating sales of tobacco, alcohol, alcoholic beverages, and unhealthy foods and beverages. All countries and areas have laws and policies in place for punishing perpetrators of coerced sex involving adolescent girls, and prohibiting sales to minors of tobacco products, except for the Lao People’s Democratic Republic. Alcohol regulations and control for sales are in place in 82% of countries and areas, and a minimum age is designated in 76% of countries and areas. A lack of laws and policies is prevalent in areas of driving licensure and the marketing and sales of unhealthy foods and beverages. Country/areaa Punish perpetrators of coerced sex involving adolescent girls Provide graduated licensing for novice drivers Prohibit sales to minors of tobacco products Regulate the marketing of alcohol to adolescents Australia Yes Yes Yes Yes Brunei Darussalam Yes No Yes No China Yes Yes Yes Yes Cook Islands Yes Unknown Yes Yes Federated States of Micronesia Yes Unknown Yes Yes Guam Yes Yes Yes Yes Cambodia Yes Unknown Yes No Marshall Islands Yes No Yes Yes Mongolia Yes Yes Yes Yes Philippines Yes No Yes Yes Palau Yes No Yes Yes French Polynesia Yes No Yes Yes Singapore Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Vanuatu Yes Unknown Yes Yes Wallis and Futuna Yes Unknown Yes Yes Percentage of Yes 94% 35% 94% 82% a The Lao People’s Democratic Republic reported “Unknown” on all items. Data Source: WHO 96 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 61. (cont.) Summary of laws and policies for protecting adolescent health V. Reproductive health General reproductive health Fourteen out of 17 (82%) countries and areas have a national policy on reproductive health; they are Brunei Darussalam, Cambodia, China, Cook Islands, French Polynesia, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Mongolia, the Philippines, Palau, Vanuatu, Viet Nam, and Wallis and Futuna. Fig. 25 shows coverage for reproductive health reported by the 14 countries and areas, and Table 62 is a detailed breakdown. Country/areaa Designate an appropriate minimum age for purchase or consumption of alcoholic beverages Prohibit selling unhealthy foods and sweetened non- alcoholic beverages in or close to schools Regulate marketing of foods and beverages high in sugar, salt and fat to children Australia Yes No No Brunei Darussalam No No No China No No No Cook Islands Yes Yes Yes Federated States of Micronesia Yes No No Guam Yes No No Cambodia No No No Marshall Islands Yes No No Mongolia Yes Yes Yes Philippines Yes Yes Yes Palau Yes Unknown No French Polynesia Yes No No Singapore Yes Yes Yes Viet Nam Yes Yes Yes Vanuatu Yes Yes Yes Wallis and Futuna Yes Yes No Percentage of Yes 76% 41% 35% Data Source: WHO 97 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Percentage of national policies/guidelines including items listed 0% 25% 50% 75% 100% Family planning/contraception Abortion Infertility/Fertility care Preconception care Menopause Cervical cancer Violence against women 100% 100% 86% 86% 79% 79% 93% China, French Polynesia, the Federated States of Micronesia, Mongolia, Palau, the Philippines, Viet Nam, Vanuatu, and Wallis and Futuna reported having national policy covering all topics of reproductive health (Table 62). Table 62. Coverage of reproductive health by national policies and guidelines Country/ areaa Family planning/ contraception Abortion Infertility/ fertility care Precon- ception care Meno- pause Cervical cancer Violence against women Brunei Darussalam Yes No Yes No Yes Yes No China Yes Yes Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes - Federated States of Micronesia Yes Yes Yes Yes Yes Yes Yes Cambodia Yes Yes Yes No No Yes Yes Lao People’s Democratic Republic Yes Yes No No - Yes Yes Marshall Islands Yes Yes No Yes No Yes Yes Mongolia Yes Yes Yes Yes Yes Yes Yes Philippines Yes Yes Yes Yes Yes Yes Yes Palau Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Yes Yes Yes Percentage of Yes 100% 93% 86% 79% 79% 100% 86% a No data from Australia, Guam and Singapore. Data Source: WHO Fig. 25. Coverage of reproductive health contents covered by national policies and guidelines Data Source: WHO 98 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Thirteen countries and areas (76%) reported having a national policy or guideline on reproductive health that promotes universal access, followed by 65% that set forth a competency framework, 65% that have a continuous professional education system in place for PHC clinicians and nurses to receive specific training for reproductive health. More than one third (35%) of these policies or guidelines are informed by the WHO's global Reproductive Health Strategy or Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). Cambodia, China, Vanuatu and Viet Nam reported “Yes” on all items. Table 63 is a detailed breakdown. Table 63. Countries/areas with a national policy or guideline on reproductive health care Country/ area Promotes universal access to re- productive health care Informed by the WHO global Reproduc- tive Health Strategy Informed by the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) Sets forth a competency framework for repro- ductive health care Continuous professional education system is in place for primary health care clinicians and/or nurses to receive reproductive health- specific training Australia - - - Unknown Unknown Brunei Darussalam No No No No Yes China Yes Yes Yes Yes Yes Cook Islands Yes Unknown Unknown Yes Yes Federated States of Micronesia Yes Yes Yes Yes Unknown Guam - - - Unknown Unknown Cambodia Yes Yes Yes Yes Yes Lao People’s Democratic Republic Yes Unknown Unknown No Unknown Marshall Islands Yes Unknown Unknown No Yes Mongolia Yes Yes Yes Yes Yes Philippines Yes Unknown No No No Palau Yes Unknown Unknown Yes Yes French Polynesia Yes No No Yes Yes Singapore - - - Yes Yes Viet Nam Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Yes Unknown Unknown Yes Unknown Percentage of Yes 76% 35% 35% 65% 65% Data Source: WHO 99 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Injectables Implants Intrauterine device (IUD) Emergency contraceptives Other 23% 23% 23% 23% 31% Fig. 26. Prohibition of contraceptives from being made available in national policy/guidelines Family planning/contraception Thirteen out of 17 (76%) countries and areas reported having a national policy or guideline on family planning or contraception; they are Cambodia, China, Cook Islands, French Polynesia, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Mongolia, Palau, the Philippines, Vanuatu, Viet Nam, and Wallis and Futuna. One third (31%) of national policies or guidelines on family planning and contraception prohibits emergency contraceptive pills from being made available, and 23% on intrauterine devices, implants and injectables (Fig. 26, Table 64). Table 64. Prohibition of contraceptives from being made available in national policy/guidelines Country/areaa Injectables Implants Intrauterine device Emergency contraceptives China No No No No Cook Islands No No No No Federated States of Micronesia No No No No Cambodia No No No No Lao People’s Democratic Republic No No No No Marshall Islands Yes Yes Yes Yes Mongolia Yes Yes Yes Yes Philippines No No No Yes Palau No No No No French Polynesia No No No No Viet Nam Yes Yes Yes Yes Vanuatu No No No No Wallis and Futuna No No No No Percentage of no prohibition 77% 77% 77% 69% a No data from Australia, Brunei Darussalam, Guam and Singapore. a No data from Australia, Brunei Darussalam, Guam and Singapore. Data Source: WHO Data Source: WHO 100 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Among 13 countries and areas that have a national policy or guideline in place, Fig. 27 shows the proportion that prohibit access to specified population groups or require availability of data disaggregated by specified population groups. Table 65 presents a breakdown of requirements for data availability – survey or health management information systems (HMIS) – disaggregated by population subgroups. Fig. 27. Countries/areas having a national policy or guideline that prohibits access of family planning methods to specified population groups or requires availability of data disaggregated by population groups Data Source: WHO Requires availability of data Percentage of countries 0% 25% 50% 75% 100% Adolescents -partum women Post-abortion women Unmarried individuals Couples in humanitarian Urban poor Rural population groups Migrant workers Others Prohibits access 0% 8% 8% 23% 23% 46% 46% 46% 15% 15% 31% 31% 15% 15% 15% 15% 23% 38% Post or crisis settings 101 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 65. Countries/areas that have a national policy or guideline on family planning or contraception that requires availability of data (survey or HMIS) disaggregated by population groups a Australia, Brunei Darussalam, Guam and Singapore did not report data and were, therefore, excluded from the denominator. Cambodia, as well as Wallis and Futuna, reported “Unknown”. Data Source: WHO Country/ areaa Ado- les- cents Unmarried women Unmar- ried ado- lescents Post- partum women Income status Rural popula- tions Post- abor- tion clients HIV status China No No No No No No No No Cook Islands No No No No No No No No Federated States of Micronesia Yes Yes Yes Yes Yes Yes Yes Un-known Lao People’s Democratic Republic Yes Yes No Yes Yes Yes No No Marshall Islands No No No No No No No No Mongolia Un-known Yes Unknown Yes Un- known Yes Un- known Yes Philippines No No No No No No No No Palau Yes Yes Yes Yes Yes Yes No Yes French Polynesia No No No No No No No No Viet Nam Yes Yes Yes Yes No Yes Yes Un-known Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes Percentage of Yes 38% 46% 31% 46% 31% 46% 23% 23% 102 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 66. Countries/areas with a national policy or guideline on family planning or contraception Country/areaa Mandates a national body that monitors access to voluntary, non-discriminatory family planning services Includes mechanisms that monitor denial of services on non- medical groundsb or coercionc Requires a contraceptive commodity security plan China No No Yes Cook Islands No Unknown Yes Federated States of Micronesia Unknown No Yes Cambodia Yes No Yes Lao People’s Democratic Republic Yes No Yes Marshall Islands No Yes No Mongolia Yes Yes Yes Philippines Yes Yes Yes Palau No No No French Polynesia No No No Viet Nam Yes No Yes Vanuatu Yes Yes Yes Wallis and Futuna No No Yes Percentage of Yes 46% 31% 77% a No data from Australia, Brunei Darussalam, Guam and Singapore. b For example, age, marital status and ability to pay. c Such as inappropriate use of incentives to clients or providers. Data Source: WHO Ten countries and areas (77%) reported that they have a national policy requiring a contraceptive commodity security plan; 46% mandate a national body that monitors access to voluntary, non-discriminatory family planning services; and 31% includes mechanisms that monitor denial of services on non-medical grounds or coercion. Table 66 contains a detailed breakdown; Mongolia, the Philippines and Vanuatu met all three criteria. 103 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Counselling Male condoms Female condoms Pills Injectables Vaginal rings Implants IUDs Male sterilization Female sterilization Lactational amenorrhea method Standard days method Two-day method Sympto-thermal method Calendar method Emergency contraceptives 90% 70% 40% 30% 60% 100% 80% 80% 100% 100% 100% 100% 100% 100% 40% 90% Clinical practice guidelines on family planning/contraception More than half (59%) of the countries and areas that reported have a national clinical practice guideline on family planning and contraception; they are Cambodia, China, French Polynesia, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Mongolia, the Philippines, Vanuatu and Viet Nam. Fig. 28 shows coverage of key components included in the national guidelines, and Table 67 provides a detailed breakdown. Fig. 28. Coverage of key family planning components included in the national guideline Percentage of countriesData Source: WHO 104 GLOBAL REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH POLICY SURVEY Country/ area a C o u n s e l l i n g M a l e c o n d o m s F e m a l e c o n d o m s P i l l s I n j e c t a b l e s V a g i n a l r i n g s I m p l a n t s I U D s M a l e s t e r i l i z a t i o n F e m a l e s t e r i l i z a t i o n L a c t a t i o n a l a m e n o r r h e a m e t h o d S t a n d a r d d a y s m e t h o d Tw o - d a y m e t h o d S y m p t o - t h e r m a l m e t h o d C a l e n d a r m e t h o d E m e r g e n c y c o n t r a c e p t i v e s China Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes U n- know n Yes U n- know n Yes Yes Federated States of M icronesia Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Cam bodia Yes Yes N o Yes Yes N o Yes Yes Yes Yes Yes N o N o N o Yes Yes Lao People’s D em ocratic Republic Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes N o Yes Yes Yes M arshall Islands Yes Yes Yes Yes Yes N o Yes Yes N o Yes Yes N o N o Yes Yes Yes M ongolia Yes Yes Yes Yes Yes Yes Yes Yes N o Yes Yes Yes U n- know n U n- know n U n- know n Yes Philippines Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes N o Yes Yes N o French Polynesia Yes Yes N o Yes Yes Yes Yes Yes Yes Yes N o N o N o N o N o Yes V iet N am Yes Yes Yes Yes Yes N o Yes Yes Yes Yes Yes Yes N o N o N o Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes U n- know n Yes Yes Percentage of Yes 100% 100% 80% 100% 100% 40% 100% 100% 80% 100% 90% 60% 30% 40% 70% 90% a N o data from Australia, Brunei D arussalam , C ook Islands, G uam , Palau, Singapore, and W allis and Futuna. D ata Source: W H O Table 67. Countries/areas w ith a national clinical practice guideline on fam ily planning or contraception that include the follow ing com ponents 105 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Male condoms Female condoms Pills Injectables Vaginal rings Implants IUDs Emergency contraceptives 59% 76% 65% 82% 82% 35% 65% Commodities for family planning and contraception Injectables and pills are included in 82% of national essential drug lists, followed by IUDs (76%), male condoms (65%), implants (65%), emergency contraceptives (59%) and female condoms (35%). No country has reported the inclusion of vaginal rings in the national essential drug list (Fig. 29, Table 68). Fig. 29. Family planning and contraceptive commodities included in the national essential drug list Data Source: WHO Percentage of countries 106 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 68. Family planning and contraceptive commodities included in the national essential drug list a No data from Australia and Wallis and Futuna. b Following original submission, the Lao People’s Democratic Republic has updated its essential medicine list to include emergency contraceptives. Data Source: WHO Country/ areaa Male con- doms Female con- doms Pills Injectables Vaginal rings Implants IUDs Emergency contracep- tives Brunei Darus- salam No No Yes Yes No No Yes Yes China No No Yes Yes No Yes Yes No Cook Islands Yes Yes Yes Yes Un- known Yes Yes Yes Federated States of Micronesia Yes Yes Yes Yes No Yes Yes Yes Guam Yes Yes Yes Yes No Yes Yes Yes Cambodia Yes Yes Yes Yes No Yes Yes Yes Lao People’s Democratic Republic Yes No Yes Yes No Yes Yes Nob Marshall Islands No No No No No No No No Mongolia Yes Yes Yes Yes No No Yes Yes Philippines Yes No Yes Yes No Yes Yes No Palau Yes No Yes Yes No Yes Yes Yes French Polynesia Yes No Yes Yes No Yes Yes Yes Singapore No No Yes Yes No No No No Viet Nam Yes No Yes Yes No Yes Yes Yes Vanuatu Yes Yes Yes Yes Un-known Yes Yes Yes Percentage of Yes 73% 40% 93% 93% 0% 73% 87% 67% Cambodia, China, French Polynesia, the Lao People’s Democratic Republic, the Federated States of Micronesia, Mongolia, Palau, the Philippines, Vanuatu and Viet Nam reported having a national policy guideline on task sharing of family planning services. Brunei Darussalam reported “No”, while the rest of countries reported unknown. Fig. 30 lists the health professionals other than a specialist doctor that are allowed to independently perform family planning services. 107 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Fig. 30. Health professionals other than a specialist doctor that are allowed to independently perform family planning services Sexually transmitted infections All 17 countries and areas reported having a national policy or guideline on sexually transmitted infections (STI) diagnoses, treatment and counselling. Table 69 provides a breakdown of STI guideline specifics. Percentage of countriesData Source: WHO Unknown Family Doctor Nurse Midwife Auxiliary nurse Auxiliary midwife CHWs/lay workers 29% 29% 29% 29% 29% 29% 6% 6% 6% 6% 6% 24% 24% Sterilization IUDsImplants Injectable contraceptives 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 50% 25% 75% 100% 108 GLOBAL REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH POLICY SURVEY Table 69. Countries/areas w ith a national policy or guideline on STI that includes the follow ing specifics Country/area a Requires the use of STI surveillance system to m onitor the progress to global STI targets A ligned w ith the G lobal H ealth Sector Strategy on STIs (2016– 2021) or latest W H O guidelines on STIs Includes a target for the reduction of Treponem a pallidum (syphilis) infection Includes a target that contributes to the reduction of congenital syphilis Includes a target that contributes to the reduction in N. gonorrhoeae incidence Includes a recom m endation on integrated H IV and STI testing Addresses screening for or reporting of congenital syphilis during A N C A ustralia Yes Yes Yes Yes Yes Yes Yes Brunei D arussalam N o N o N o N o N o N o Yes China Yes Yes Yes Yes N o Yes Yes Cook Islands U nknow n Yes U nknow n U nknow n U nknow n Yes Yes Federated States of M icronesia Yes U nknow n U nknow n U nknow n U nknow n U nknow n U nknow n G uam U nknow n U nknow n Yes Yes Yes Yes Yes Cam bodia Yes Yes Yes Yes Yes Yes Yes M arshall Islands U nknow n Yes Yes Yes Yes Yes Yes M ongolia Yes Yes Yes Yes Yes Yes Yes Philippines Yes U nknow n Yes Yes Yes Yes Yes Palau Yes U nknow n U nknow n U nknow n U nknow n Yes Yes French Polynesia Yes N o Yes Yes Yes Yes Yes Singapore Yes Yes Yes Yes Yes Yes Yes V iet N am Yes Yes Yes Yes U nknow n Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes W allis and Futuna Yes Yes Yes Yes Yes Yes Yes Percentage of Yes 71% 59% 71% 71% 59% 82% 88% a Th e Lao People’s D em ocratic Republic reported “U nknow n” on all item s. D ata Source: W H O 109 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Percentage of countries 0% 25% 50% 75% 100% Yes, and free for target population Yes, but not free Screen for cervical pre-cancer lesions Treat cervical pre-cancer lesions Diagnosis of cervical cancer Treatment of cervical cancer Palliative care of cervical cancer 17% 50% 58% 58% 83% 67% 75% 25% 25% 25% 17% 17% Fourteen out of 17 countries and areas (82%) reported having a national policy on elimination of mother-to-child transmission of HIV and syphilis, while Palau reported “No”, and the Federated States of Micronesia and the Lao People’s Democratic Republic reported “Unknown”.2 Ten countries and areas reported having policy to ensure the availability of benzathine penicillin in the service delivery points for use in the treatment of syphilis, except Australia and Singapore reported “No”; Guam, the Lao People’s Democratic Republic, the Federated States of Micronesia, Palau, and Wallis and Futuna reported “Unknown”.3 Cervical cancer Twelve countries (71%) have a comprehensive national cervical cancer prevention and control policy and guideline in place, nine of which are consistent with WHO Comprehensive Cervical Cancer Control guidelines (2014). The nine countries or areas are Cambodia, China, Cook Islands, the Marshall Islands, the Federated States of Micronesia, Mongolia, Singapore, Vanuatu and Viet Nam. Fig. 31 and Table 70 provide the specifics covered by national policies on provision of cervical cancer prevention and control services broken down by country or area. Fig. 31. National policy on provision of cervical cancer prevention and control 2 The Lao People’s Democratic Republic does not have a specific national policy on elimination of mother-to-child transmission of HIV/syphilis, but it is included in the national policy on HIV and ANC standards (2019). 3 The Lao People’s Democratic Republic has benzathine benzyl penicillin on the essential medicines list. Data Source: WHO HPV vaccination programme 110 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/ areaa HPV vaccination programme Screen for cervical pre-cancer lesions Treat cervical pre-cancer lesions Diagnosis of cervical cancer Treatment of cervical cancer Palliative care of cervical cancer Australia Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Unknown Brunei Darussalam Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population China Yes, but not free Yes, and free for target population Yes, but not free Yes, and free for target population Yes, but not free Yes, and free for target population Cook Islands Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Federated States of Micronesia Yes, and free for target population Yes, and free for target population Unknown Yes, and free for target population Unknown Unknown Cambodia Unknown Yes, but not free Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Marshall Islands Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population No Yes, and free for target population Mongolia No Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Philippines Unknown Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Unknown Singapore Yes, and free for target population Yes, but not free Yes, but not free Yes, but not free Yes, but not free Yes, but not free Viet Nam Yes, but not free Yes, but not free Yes, but not free Yes, but not free Yes, but not free Yes, but not free Vanuatu Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Yes, and free for target population Unknown % of free service provision for target population 58% 75% 67% 83% 58% 50% Table 70. Countries/areas with policy or guideline on cervical cancer prevention and control that allows the provision of the following services a No data from French Polynesia, Guam, the Lao People’s Democratic Republic and Palau. Data Source: WHO 111 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Infertility Less than half (41%) of the countries have a national policy or law on infertility management. Countries and areas that reported having such a policy/law are Brunei Darussalam, China, French Polynesia, Mongolia, Palau, Singapore and Viet Nam. Among seven countries that have a policy or law on infertility management, five reported having a policy or law that regulates access to the application or practice of assisted reproductive technology. Brunei Darussalam and Palau reported “No”. Table 71 contains data from five countries on which assisted reproductive technology is regulated by national policy or laws. Table 71. Assisted reproductive technology that is regulated by national policy or law Country/ areaa Post- humous repro- duction Gamete donation Fetal re- duction In-vitro fertiliza- tion Sex selection Same sex/single parenting Cross- border reproduction China Yes Yes Yes Yes Yes Yes No Mongolia No No No Yes No No No French Polynesia No No Yes Yes No No No Singapore Yes Yes Yes Yes Yes Yes No Viet Nam No Yes Yes Yes No No No Percentage of Yes 40% 60% 80% 100% 40% 40% 0% a No data from Australia, Brunei Darussalam, Cambodia, Cook Islands, Guam, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Palau, the Philippines, Vanuatu, and Wallis and Futuna. Data Source: WHO French Polynesia and Singapore are the only two that reported having penalties for the violation of the governance, licensing and credentials certification for the practice of assisted reproductive technology, and having national programmes that provide financial support for the individual use of assisted fertility services. As for accessibility to assisted reproductive technology or in vitro fertilization (IVF) services provided to groups of people, no country has yet provided access to all the groups listed below. Heterosexual couples in recognized relationships have the highest access to the services. Only six countries and areas reported data on this section (Table 72). 112 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Age Sex Sexual orientation Gender identity Disability Race/ethnicity Marital status HIV status Involvement in sex work Others 33% 56% 89% 89% 78% 78% 89% 89% 89% 89% Country/area Heterosexual couples in recognized relationships Heterosexual couples not in a recognized relationship (unmarried) Same sex couples in a recognized relationship Same sex couples not in a recognized relationship (unmarried) Brunei Darussalam Yes Unknown Unknown Unknown China Yes No No No Mongolia Yes No No No French Polynesia Yes Yes No No Singapore Yes No No No Viet Nam Yes No No No Percentage of Yes 100% 17% 0% 0% Table 72. Countries/areas reported having assisted reproductive technology or IVF services to groups of people specified Sexual health Nine out of 17 countries/areas (53%) reported having a national policy or law on sexual health information and services. The majority (89%) of the national policies or laws have covered provisions for non-discrimination for groups of people regardless of their HIV status, marital status, disability, gender identity, sex and age (Fig. 32, Table 73). Fig. 32. Countries/areas with a national policy or law on sexual health information and services that have provisions for non-discrimination for specified population groups Data Source: WHO Data Source: WHO 113 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Country/ areaa Age Sex Sexual orienta- tion Gender iden- tity Disabil- ity Race/ ethnicity Mari- tal status HIV sta- tus Involve- ment in sex work Brunei Darussalam No No No No No No No No No China Yes Yes Yes Yes Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Yes Yes Un- known Marshall Islands Yes Yes Yes Yes Yes Yes Yes Yes Yes Mongolia Yes Yes Un-known Yes Yes Un- known Yes Yes Un- known Palau Yes Yes Yes Yes Yes Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Yes Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes Un-known Percentage of Yes 89% 89% 78% 89% 89% 78% 89% 89% 56% Table 73. Countries/areas with a national policy or law on sexual health information and services that have provisions for non-discrimination for specified population groups a No data from Australia, Cambodia, Guam, the Lao People’s Democratic Republic, the Federated States of Micronesia, the Philippines, Singapore, and Wallis and Futuna. Data are scarce on whether laws or policies decriminalize male and female commercial sex workers. French Polynesia reported regulating sex work through regular medical check-ups. China and Viet Nam prohibit harmful practices related to sexual health (Table 74). Table 74. Countries with law or policy decriminalizing male and female commercial sex workers a Eight countries did not report data and were, therefore, not included in the denominator. Cook Islands, Palau and Vanuatu reported “Unknown” on all items. Country/areaa Decriminalizes male commercial sex workers Decriminalizes female commercial sex workers Regulates sex work through regular medical check-ups Prohibits harmful practices related to sexual health Brunei Darussalam No No No No China No No No Yes Marshall Islands No No No No Mongolia No No Unknown Unknown French Polynesia No No Yes No Viet Nam Unknown Unknown Unknown Yes Percentage of Yes 0% 0% 11% 22% Data Source: WHO Data Source: WHO 114 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/areaa Establishes mandatory CSE as part of the regular educational curriculum Exists on standard curricula for the training of health providers in sexuality counselling Exists on a strategy to provide sexuality counselling through public services Brunei Darussalam No No No China Unknown Unknown Yes Marshall Islands No No No Mongolia Yes Unknown Yes Palau Unknown Yes Unknown French Polynesia Yes Yes Yes Viet Nam Unknown Yes Yes Vanuatu Yes Yes Yes Percentage of Yes 33% 44% 56% Table 75. Countries/areas with a policy or law on sexual education and health worker’s training in counselling a Eight countries did not report data and were, therefore, not included in the denominator. Cook Islands reported “Unknown” on all items. Data Source: WHO French Polynesia and Vanuatu reported having national policies or laws that establish mandatory comprehensive sexuality education (CSE) as part of the regular education curriculum, as well as the standard curricula for the training of health providers in sexuality counselling and strategies to provide sexuality counselling (as defined by WHO) through public services. Brunei Darussalam and the Marshall Islands reported “No” on all items. Only nine countries and areas reported data as listed below in Table 75 (see also Table 76 for a summary of sexual health policy/guideline/law). 115 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Table 76. Summary table on sexual health policies reported by countries/areas Summary of sexual health policy, guideline or law Country/area National policy/ guideline on reproductive health care to promote universal access to reproductive health care Countries that have a dedicated reproductive health law National policies/ guidelines that specifically address reproductive health issues National policy/ guidelines on family planning/ contraception Country/area National policies/ guidelines on STIs diagnoses, treatment and counselling National cervical cancer prevention and control policy/ guidelines Policies/ laws on infertility management National policies/laws on sexual health information and services Australia - No No No Australia Yes Yes No Unknown Brunei Darussalam No No Yes No Brunei Darussalam Yes Yes Yes Yes China Yes No Yes Yes China Yes Yes Yes Yes Cook Islands Yes Unknown Yes Yes Cook Islands Yes Yes No Yes Federated States of Micronesia Yes No Yes Yes Federated States of Micronesia Yes Yes Unknown Unknown Guam - Yes Unknown Unknown Guam Yes Unknown Unknown No Cambodia Yes Unknown Yes Yes Cambodia Yes Yes No Unknown Lao People’s Democratic Republic Yes Unknown Yes Yes Lao People’s Democratic Republic Yes Unknown No Unknown Marshall Islands Yes No Yes Yes Marshall Islands Yes Yes No Yes Mongolia Yes No Yes Yes Mongolia Yes Yes Yes Yes Philippines Yes Yes Yes Yes Philippines Yes Yes Unknown No Palau Yes Unknown Yes Yes Palau Yes No Yes Yes French Polynesia Yes Yes Yes Yes French Polynesia Yes No Yes Yes Singapore - Unknown No No Singapore Yes Yes Yes Unknown Viet Nam Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Vanuatu Yes Yes Unknown Yes Wallis and Futuna Yes No Yes Yes Wallis and Futuna Yes Unknown No No Percentage of Yes 76% 29% 82% 76% Percentage of Yes 100% 71% 41% 53% Data Source: WHO 116 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Country/area National policy/ guideline on reproductive health care promote universal access to reproductive health care Countries that have a dedicated reproductive health law National policies/ guidelines that specifically address reproductive health issues National policy/ guidelines on family planning/ contraception Country/area National policies/ guidelines on STI diagnoses, treatment and counselling National cervical cancer prevention and control policy/ guidelines Policies/laws on infertility management National policies/laws on sexual health information and services Australia - No No No Australia Yes Yes No Unknown Brunei Darussalam No No Yes No Brunei Darussalam Yes Yes Yes Yes China Yes No Yes Yes China Yes Yes Yes Yes Cook Islands Yes Unknown Yes Yes Cook Islands Yes Yes No Yes Federated States of Micronesia Yes No Yes Yes Federated States of Micronesia Yes Yes Unknown Unknown Guam - Yes Unknown Unknown Guam Yes Unknown Unknown No Cambodia Yes Unknown Yes Yes Cambodia Yes Yes No Unknown Lao People’s Democratic Republic Yes Unknown Yes Yes Lao People’s Democratic Republic Yes Unknown No Unknown Marshall Islands Yes No Yes Yes Marshall Islands Yes Yes No Yes Mongolia Yes No Yes Yes Mongolia Yes Yes Yes Yes Philippines Yes Yes Yes Yes Philippines Yes Yes Unknown No Palau Yes Unknown Yes Yes Palau Yes No Yes Yes French Polynesia Yes Yes Yes Yes French Polynesia Yes No Yes Yes Singapore - Unknown No No Singapore Yes Yes Yes Unknown Viet Nam Yes Yes Yes Yes Viet Nam Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Vanuatu Yes Yes Unknown Yes Wallis and Futuna Yes No Yes Yes Wallis and Futuna Yes Unknown No No Percentage of Yes 76% 29% 82% 76% Percentage of Yes 100% 71% 41% 53% Table 76. (cont.) Summary table on sexual health policies reported by countries/areas Data Source: WHO 117 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS VI. Gender-based violence Sixteen countries and areas responded to this section of the survey, and 14 (88%) have a national policy or guidelines that reference gender-based violence (GBV). Multisectoral plans of action for GBV exist in 69% of countries, followed by national guidelines/protocol to address violence against women and GBV by the health sector (63%), and 56% have a national training programme to strengthen the capacity of health-care providers to respond to violence against women and GBV (Table 77). Country/areaa References gender- based violence Multisectoral plan of action for gender- based violence Addresses violence against women/gender- based violence by the health sector Country has a training programme to strengthen the capacity of health-care providers to respond to violence against women/gender- based violence Australia Yes Yes Yes Yes Brunei Darussalam Yes Yes No No China Yes Yes Yes Yes Cook Islands Yes No Yes No Guam Yes Yes Unknown Unknown Cambodia Yes Yes Yes Yes Lao People’s Democratic Republic Yes Yes No Yes Mongolia Yes Yes Yes Yes Philippines Yes Yes Yes Yes Palau Yes Unknown Unknown Yes French Polynesia Yes No Yes No Viet Nam Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes No Percentage of Yes 88% b 69% 63% 56% Table 77. Summary table of key strategies, policies, laws or guidelines on gender-based violence a No data from the Marshall Islands. b The Federated States of Micronesia and Singapore reported “Unknown” on all items and were deleted from the table, while the answers were still regarded as negative in the numerator. Data Source: WHO 118 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 78 provides a breakdown on contents covered by the national policy or guideline on GBV. Capacity-building and skills training for service providers are included in 93% of national policies or guidelines, followed by legal and police service for survivors (86%), mass media campaign or awareness-raising initiatives (86%), healthy relationship skills to manage conflicts (79%), perpetrator programmes or interventions (79%), minimum age of consensual sexual activity (79%), and promoting or enforcing laws and policies on gender equality (71%). Around half of the countries and areas also reported having policies or laws to address social or gender norm change strategies, interventions addressing alcohol or other substance misuse, monitoring and evaluation of GBV programmes, and standardizing data collection, research and documentation. Country/ areaa Social or gender norm change strate- gies Legal and police services for survivors Perpetra- tor pro- grammes/ interven- tions Mass me- dia cam- paigns/ awareness- raising initiatives Healthy relation- ship skills to manage conflicts Parenting programmes to prevent child abuse or to improve parent–child communica- tion Australia Yes Yes Yes Yes Yes Yes Brunei Darussalam Unknown Yes Unknown No Unknown Unknown China Unknown Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Guam Yes Yes Yes Yes Yes Yes Cambodia Yes Yes Yes Yes Yes Yes Lao People’s Democratic Republic No Yes Yes Yes Yes Yes Mongolia Yes Yes Yes Yes Yes Yes Philippines Yes Yes No Yes Unknown No Palau Unknown Yes Yes Yes Yes Yes French Polynesia No Yes Yes Yes Yes Yes Viet Nam Yes Unknown Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Percentage of Yes 57% 86% 79% 86% 79% 79% Table 78. Countries/areas with national policy or guideline that includes gender-based violence contents a No data from the Marshall Islands, the Federated States of Micronesia and Singapore. Wallis and Futuna reported “Unknown” on all items. Data Source: WHO 119 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Nearly four fifths of the countries and areas have a multisectoral GBV plan of action, and 63% have guidelines or protocols to address GBV by the health sector and recognize marital rape as a crime (63%). Less than half (44%) reported having a budget line item for provision of health services for GBV in the government budget (Fig. 33, Table 79). Country/ areaa Minimum age of consensu- al sexual activity Interven- tions address- ing al- cohol or other substance misuse Promot- ing/en- forcing laws and policies on “gender equality”b Capacity- building/ skills train- ing for service providers Monitoring and evaluation of GBV pro- grammes Standardizing data collection, conducting research and documentation of GBV Australia Yes Unknown Yes Yes Yes Yes Brunei Darussalam Yes Unknown Unknown Yes Unknown Yes China Yes Yes Yes Yes Unknown Yes Cook Islands Yes Yes Yes Yes Yes Yes Guam Yes Yes Yes Yes Yes Yes Cambodia Unknown Yes Yes Yes Yes Unknown Lao People’s Democratic Republic Yes No No Yes No No Mongolia Yes Yes Yes Yes Yes Yes Philippines Yes Unknown Unknown Yes Unknown No Palau Yes Yes Yes Yes Unknown Unknown French Polynesia No Yes Yes Yes Yes Yes Viet Nam Yes Unknown Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Percentage of Yes 79% 57% 71% 93% 57% 64% Table 78. (cont.) Countries/areas with national policy or guideline that includes gender-based violence contents a No data from the Marshall Islands, the Federated States of Micronesia and Singapore. Wallis and Futuna reported “Unknown” on all items. b For example, improving women’s employment and education, improving equality for women in marriage, custody and divorce laws. Data Source: WHO 120 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y 0% 25% 50% 75% 100% Country has a multisectoral plan of action for gender-based violence Marital rape is criminalized in the country There is a budget line item for provision of health services for violence against women/gender-based violence in the government budget National guidelines or protocols address violence against women/gender-based violence by the health sector the capacity of health care providers to respond to violence against women/gender-based violence 79% 71% 64% 71% 50% Fig. 33. Countries/areas with laws and policies on GBV specifics Country/ areaa A multi- sectoral plan of action for gender- based violence Marital rape is crimi- nalized in the country A budget line item for provision of health services for violence against women/gender- based violence in the government budget Violence against women/ gender-based violence by the health sector A training programme to strengthen the capacity of health- care providers to respond to violence against women/ gender-based violence Australia Yes Yes Unknown Yes Yes Brunei Darussalam Yes Unknown No No No China Yes Yes Unknown Yes Yes Cook Islands No No No Yes No Guam Yes Yes Unknown Unknown Unknown Cambodia Yes Yes No Yes Yes Lao People’s Democratic Republic Yes Yes Yes No Yes Mongolia Yes Unknown Unknown Yes Yes Philippines Yes No Yes Yes Yes Palau Unknown Yes Yes Unknown Yes French Polynesia No Yes Yes Yes No Viet Nam Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes No Percentage of Yes 79% 71% 50% 71% 64% Table 79. Countries/areas with laws and policies on GBV specifics a No data from the Marshall Islands, the Federated States of Micronesia and Singapore. Data Source: WHO Data Source: WHO Percentage of countries Country has a training programme to strengthen 121 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS Specifics on national guidelines/protocols to address GBV by the health sector Ten countries and areas have reported data on the specifics of the health sector’s guideline/ protocols to address GBV. Confidentiality is covered by 100% of countries, followed by privacy during consultation (90%), provision of referrals and strengthening linkages (90%), non-judgemental and supportive response to disclosure (80%), and sexual assault services available 24/7 (70%). Australia, Cambodia, China, Cook Islands, Vanuatu, and Wallis and Futuna reported having 100% coverage in the national guidelines and protocols (Fig. 34, Table 80). Fig. 34. National guidelines and protocols addressing GBV by the health sector Data Source: WHO Percentage of countries 0% 25% 50% 75% 100% Sexual assault services available 24/7 Privacy during consultation Non-judgemental, supportive response to disclosure Providing referrals and strengthening linkages 90% 90% 80% 70% 100% 122 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y Table 80. Countries/areas with national guideline and protocols to address GBV by the health sector Country/ areaa Sexual assault services available 24/7 Privacy during consultation Confidentialityb Non- judgemental, supportive response to disclosure Providing referrals and strengthening linkages Australia Yes Yes Yes Yes Yes China Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Cambodia Yes Yes Yes Yes Yes Mongolia Unknown Yes Yes Unknown Yes Philippines Unknown Yes Yes Yes Yes French Polynesia Yes Yes Yes Yes Unknown Viet Nam Unknown Unknown Yes Unknown Yes Vanuatu Yes Yes Yes Yes Yes Wallis and Futuna Yes Yes Yes Yes Yes Percentage of Yes 70% 90% 100% 80% 90% a No data from Brunei Darussalam, Guam, the Lao People’s Democratic Republic, the Marshall Islands, the Federated States of Micronesia, Palau and Singapore. b For example, in providing care and documenting. Data Source: WHO National clinical guideline/protocol for survivors of violence Nine countries and areas reported national clinical guidelines or protocols for the care for survivors of violence against women and GBV. HIV post-exposure prophylaxis (PEP) is provided by 100% of countries, followed by STI prophylaxis (89%), access to safe abortion (89%), emergency contraception within 5 days of sexual assault (89%), sexual assault services available 24/7 (89%), mandatory reporting (78%), psychosocial support including first aid or first-line support (78%), selective or clinical enquiry for GBV or intimate partner violence (67%), and universal screening for domestic violence or intimate partner violence (67%) (Fig. 35, Table 81). 123 G LO B A L R E P RO D U CT I V E, M AT E R N A L, N E W B O R N, C H I L D A N D A D O L E S C E N T H E A LT H PO L I CY S U RV E Y RESULTS 0% 25% 50% 75% 100% Universal screening for domestic violence/intimate partner violence Selective or clinical enquiry for domestic violence/intimate partner violence Mandatory reporting for domestic violence/intimate partner violence Sexual assault services available 24/7 Emergency contraception within 5 days of sexual assault Access to safe abortion in cases of rape or incest STI prophylaxis for survivors of sexual assault HIV post-exposure prophylaxis (PEP) for survivors of sexual assault 90% 80% 80% 80% 80% 70% 70% 60% 60% Fig. 35. Countries/areas with national clinical guidelines/protocols for survivors of violence Data Source: WHO Percentage of countries 124 GLOBAL REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH POLICY SURVEY Country/ area a Universal screening for dom estic violence/ intim ate partner violence Selective or clinical enquiry for dom estic violence/ intim ate partner violence Psychosocial support including psychological first aid/ first-line support M andatory reporting for dom estic violence/ intim ate partner violence Sexual assault services available 24/7 Em ergency contraception w ithin 5 days of sexual assault Access to safe abortion in cases of rape or incest STI prophylaxis for survivors of sexual assault H IV post- exposure prophylaxis (PEP) for survivors of sexual assault China Yes Yes Yes Yes Yes Yes Yes Yes Yes Cook Islands Yes Yes Yes Yes Yes Yes Yes Yes Yes Cam bodia N o Yes Yes Yes Yes Yes Yes N o Yes M ongolia Yes Yes Yes Yes Yes Yes Yes Yes Yes Philippines N o N o U nknow n N o U nknow n N o N o Yes Yes French Polynesia N o N o Yes N o Yes Yes Yes Yes Yes V iet N am Yes Yes Yes Yes Yes Yes Yes Yes Yes Vanuatu Yes Yes Yes Yes Yes Yes Yes Yes Yes W allis and Futuna Yes U nknow n N o Yes Yes Yes Yes Yes Yes Percentage of Yes 60% 60% 70% 70% 80% 80% 80% 80% 90% Table 81. Countries/areas w ith national clinical guidelines/protocols for survivors of violence a N o data from Brunei D arussalam , G uam , the Lao People’s D em ocratic Republic, the M arshall Islands, the Federated States of M icronesia, Palau and Singapore. Australia reported “U nknow n” on all item s D ata Source: W H O