Thinking Locally and Acting Globally to End Preventable Newborn Deaths_Joy Riggs-Perla_5.8.14
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Thinking Locally and Acting Globally to End Preventable Newborn Deaths_Joy Riggs-Perla_5.8.14
- 1. CORE Group Global Health Practitioner Conference May 8, 2014 Joy Riggs-Perla, Director, Saving Newborn Lives Program #EveryNewborn
- 2. Presentation Topics • What is ENAP and what are we trying to achieve? • ENAP targets for newborns, stillbirths and maternal mortality • Content of Action Plan • Process moving forward • Civil society contribution
- 3. A roadmap for change in countries… A platform for harmonized action by all partners…  Sets out a clear vision with mortality targets, strategic objectives, innovative actions within the continuum of care  Supported by new evidence to be published in The Lancet in May 2014  Plan to be launched at Partner’s Forum end of June 2014  A movement for greater action and accountability… The Every Newborn Action Plan: building a movement Photo credit: Save the Children
- 4. The vision for Every Newborn Action Plan A world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Vision statement in draft ENAP, March 2014
- 5. What are we aiming for? End preventable newborn deaths and stillbirths as well as maternal and child deaths Stillbirths and newborn deaths are not inevitable Women and babies deserve quality care around birth and small and sick newborns need special care Each year save the lives of 3 million newborns, stillbirths and women 1. Include newborns and stillbirths in post-2015 framework along with maternal & child health 2. Attention and funding for newborns and stillbirths within the RMNCH continuum 3. Sharpen national plans and improve demand and delivery of care at the time of birth 4. Develop and implement “Mother-Baby Friendly” package 5. Improve programmatic and impact data and use this for action in countries Long term Medium term NOW
- 6. 0 10 20 30 40 50 60 70 80 90 100 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 Mortalityrate(per1,000livebirths) 2000-2012 AAR = 2.7% 2000-2012 AAR = 3.8% Global U5MR Global NMR A Promise Renewed target: National U5MR of 20 or less [Global U5MR of 15] Current trends continue: U5MR AAR = 4.3% Target for ending preventable newborn deaths Current trends continue: NMR Scenario 2035 global neonatal mortality rate 2035 neonatal deaths If current trends are unchanged 13 1.8 million Every country to NMR <10 per 1000 7 0.9 million Similar to 2/3 reduction in NMR as if a continuation of MDG4 ENAP Neonatal Mortality target: National NMR of 10 or less [Global NMR of 7]
- 7. 0 5 10 15 20 25 1995 2000 2005 2010 2015 2020 2025 2030 2035 Globalaveragestillbirthrate (per1,000totalbirths) 2000-2009 ARR = 1.3% ARR required = 3.5% Scenario 2035 global stillbirth rate 2035 stillbirths If current trends are unchanged 15.9 2.2 million Every country reaches SBR of 10 per 1000 8.0 1.1 million Also similar to ≥2/3 reduction in stillbirth rate for every country With same time trends SBR Every Newborn target: for stillbirths National stillbirth rate of 10 or less [Global SBR of 8] Consistent with neonatal and under5 mortality targets Target for Stillbirths Country consultations requested a specific stillbirth target
- 8. Lancet GH Sept 2013 : The Lancet Global Health 2013; 1:e176-e177 (DOI:10.1016/S2214-109X(13)70059-7) Maternal mortality target in process of being set, coordinated by WHO and others Hope to include a target for MMR
- 9. Family/communityOutreach/out patient Clinical antenatal care postnatal care early postnatal home visits for mother and newborn cleaner, safer birth adolescent health at home and school child health care obstetric and childbirth care including essential newborn care emergency newborn care reproductive health care reproductive health care intersectoral Improved living and working conditions including housing, water and sanitation, and nutrition Education and empowerment emergency child care ongoing care for the child at home pregnancy home visits What to focus on? Packages within RMNCH continuum of care ChildhoodNewborn/postnatalBirthPregnancyPre-pregnancy Birth
- 10. What to focus on? Prevention & care for main causes of neonatal deaths (3 by 2) Preterm birth • Preterm labor management including antenatal corticosteroids* • Care including Kangaroo mother care, essential newborn care Birth complications (and intrapartum stillbirths) • Prevention with obstetric care * • Essential newborn care, and resuscitation* Neonatal infections • Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate* • Case management of neonatal sepsis * 1 2 * Prioritised by the UN Commission on Life Saving Commodities for Women and Children Over two-thirds of newborn deaths preventable – actionable now without intensive care 3
- 11. What to do differently? Every Newborn’s Five strategic objectives 1. Strengthen and invest in care during labour, birth and the first day and week of life 2. Improve the quality of maternal and newborn care 3. Reach every woman and every newborn; reduce inequities 4. Harness the power of parents, families and communities 5. Count every newborn – measurement, tracking and accountability
- 12. Every Newborn’s guiding principles Country leadership Good governance, community participation, partner alignment Integration Integrated service delivery, continuum of care, programme coordination Equity Universal coverage, closing the equity gap Human rights Principles, standards Accountability Transparency, oversig ht Innovation Interventions, delivery approaches, technologies
- 13. Health Sector Strategic & Investment Plan Integrated National RMNCH Plan Increasing access and use of Family Planning Ending preventable newborn deaths Ending preventable deaths from pneumonia and diarrhoea (GAPPD) Ending preventable maternal deaths Sharpen focus within existing national RMNCH and health strategies and plans; not a new stand alone plan
- 14. UMBRELLA MESSAGE In next decade, 3 million babies and women saved every year with quality care at birth Every Newborn main events 2014 February NovemberJune September LAUNCH! May Every Newborn 2014 UNGA ICM Problem identification Burden of problem Progress for newborns has fallen behind Lives saved and investment case Cost-effective and feasible solutions available Lives saved and cost Triple return on investment Post-2015 action for newborn & stillbirths Actions by all at country and global level Parent and civil society voice * Developing detailed matrix of events for more details WHA SOWM Countdown
- 15. Unique Civil Society Contribution • Household Level Essential Newborn Care: Drying, wrapping, delayed bathing, clean cord care including CHX, immediate/exclusive breastfeeding. • Demand and Care Seeking: Preventive care around birth, sustained demand for services and timely care seeking for mothers and newborns • Community leadership and accountability: Solve practical problems, hold health providers accountable to providing quality services, strengthen links between community and facilities, promote incentives for community health workers.
- 16. Unique Civil Society Contribution • Champions: Develop local champions, including parliamentarians, parent groups, professionals, community health volunteers and community leaders; engage and link champions for RMNCH+A • Adolescents: Give special attention to adolescent girls; help prevent early and unwanted pregnancies • Quality and accountability: Be a voice for change. Demand quality, affordable, accessible services. Report poor services. Change social norms regarding preventable maternal and newborn death.
Editor's Notes
- Concentric circles
- The action plan sets out a vision, and proposes a goal and targets for neonatal mortality reduction by 2035, with intermediate mortality targets for 2020 and 2025. This slide shows the current trajectory for under-five and neonatal mortality, along with the targets for under-five mortality reduction as proposed by A Promise Renewed and matching targets for newborn mortality reduction as proposed by the Every Newborn action plan. AnalysisIndividual country unit of analyses, using UN-IGME neonatal mortality rates 1990-2012. Business as usual based on ARR 2000-2012 so more optimistic than 1990-2012. All analyses weighted by lives births per country by year using UN Pop Div live births projectionsVarious NMR reduction scenarios applied with baseline of 2012 NMR to predict 2035 NMRs and number of neonatal deaths based on the scenarios for 195 countries.1. Business as usual (2000-2012 ARR)2. Other countries comparisonBest regional ratesHistoric US/UK ARR3. Target scenariosRelative (66% or 75% reduction)Absolute NMR (5, 7, 10, 12) Global target of ending preventable newborn deaths: All countries have less than 10 neonatal deaths/1000 live births by 2035, with a resultant global neonatal mortality rate of 7 deaths/1000 live births, with interim global targets as shown below. This target is consistent with and supports that in Committing to child survival: A Promise Renewed for ending preventable child deaths and with proposed targets for ending preventable maternal deaths. To achieve aglobal neonatal mortality rate of 7 deaths/1000 live births, all countries will have to reduce neonatal mortality by at least two-thirds from a baseline in 2012, which may be considered a continuation of Millennium Development Goal 4 applied to the unfinished agenda for the reduction in the number of newborn deaths.
- Country consultations voiced demand for a stillbirth targetFor international comparison purposes, a stillbirth is defined as a baby born with no signs of life, weighing more than 1000 g or at least 28 weeks gestation. ANALYSISUsing estimated ARR % for stillbirths 2000 – 2009 to estimate stillbirth rates for 2012. Various SBR reduction scenarios applied to 2012 SBR to predict 2025 and 2035 SBRs and number of stillbirths based on the scenarios for 195 countries. National scenario 1. Business as usual (2000-2009 ARR) 2. Relative target(66% reduction)3. Absolute targetsStillbirth rate of 5 by 2035Stillbirth rate of 10 by 2035TARGETA new target for stillbirths is proposed whereby all countries reduce their stillbirth rate to less than 10/1000 total births by 2035, with a resultant global stillbirth rate of 8/1000 total births. Those countries with a stillbirth rate under 10/1000 total births should focus on addressing inequalities and using audit data to track and prevent all avoidable stillbirths. Â
- The Every Newborn Action Plan proposes five strategic objectives. Strategic objective 1: Strengthen and invest in care during labour, childbirth, and the first day and week of life. More than one-third of stillbirths (1.2 million), 75% of newborn deaths (2 million) and 72% of maternal deaths (206 250) occur within this period. Many deaths and complications can be prevented by ensuring provision of high-quality, essential care for every pregnant woman and every baby around the time of labour, childbirth and in the first 24 hours and week after birth. Strategic objective 2: Improve the quality of maternal and newborn care. Substantial gaps in the quality of care exist across the continuum of care for women and children’s health. In many settings women and newborns do not receive the care that they need even when they have a contact with the health system whether before, during or after pregnancy. The key to success is introducing high-quality care with high-impact, cost-effective interventions for mother and baby together – in most cases, by the same health providers at the same time. Strategic objective 3: Reach every woman and every newborn to reduce inequities. Access to high-quality health care that people need without suffering financial hardship when paying for them is a human right. There is increasingly robust evidence of approaches for ending preventable newborn deaths that effectively accelerate the coverage of essential interventions, through innovations that include task sharing, improved access to life-saving commodities, health insurance and financing mechanisms, and use of information technology and social and knowledge networks. Strategic objective 4: Harness the power of parents, families and communities. Education and information are crucial for empowering parents, families and their communities to demand quality care. Evidence has shown the power of engaged community leaders, women’s groups, and community workers in turning the tide for better health outcomes for newborns. Participatory learning and action in poor rural communities is a core intervention that requires investment and expansion. Strategic objective 5: Count every newborn - measurement, programme tracking and accountability. Measurement enables managers to improve performance and adapt actions as needed. Assessing outcomes and financial flows with standardized indicators improves accountability. There is an urgent need to improve the metrics globally and nationally, especially for birth outcomes and quality of care. Every newborn needs to be registered and newborn deaths need to be counted. Counting every maternal death and stillbirth is of equal importance.
- The action plan relies on five guiding principles: Country leadership: Countries have the primary ownership and responsibility for establishing good governance and providing effective and good-quality reproductive, maternal and newborn health services. Community participation is a key feature of such leadership as it is one of the most effective transformational mechanisms for action and accountability for newborn health. Development partners should align their contributions and harmonize action. Integration: Providing every woman and every newborn with good-quality care requires integrated service delivery with coordinated health system approaches between multiple programmes, stakeholders and initiatives across the continuum of reproductive, maternal, newborn and child health are essential, without losing visibility for newborn specific content.Equity: Equitable and universal coverage of high-impact interventions, and a focus on reaching the most vulnerable and poorest population groups are central to realizing the right of every woman and every newborn, girl and boy, to health. Accountability: Transparency, oversight and accountability are prerequisites for equitable coverage, quality of care and optimal use of resources.Innovation: Evidence has been accumulating over the past decade of strategies that broaden the coverage of interventions for newborns and reduce mortality. Nevertheless, innovative thinking is needed about ways to reach the poorest and most underserved populations. Optimizing the application of knowledge of which interventions and strategies are most effective still needs more research and development.