National scale up o priority newborn interventions: curre status and way forwa By Joby George Bangladesh Neonatal Foru 5 th International Conferen (SYMPOSIUM 1) March 03, 2018
Bangladesh NMR R trend and targets 52 55 100% 48 50 90% 42 45 41 80% 37 40 70% 32 35 60% 28 30 50% 50% 22 22 25 40% 47% 20 57% 16 45% 42% 60% 61% 39% 30% 15 19 20% 10 12 10% 5 0 0% 1990 1995 2000 2005 2010 010 2015 2020 2025 2030 Year ear NMR Trend NMR Target % Newborn death % N Expon. (NMR Trend ) Bangladesh Demographic and Health Surv urvey 1993, 1997, 2000, 2004, 2007 2011, 2014
Bangladesh Declaration fo for Ending Preventable Child Deaths by 2035 35: Interventions Newborn hea ealth specific Child Health specific Maternal Health interventions interve ventions interventions 3. Essential new ewborn care with 7. Effective referral linkage to ensure newborn resu newborn resu suscitation & suscitation & continuum of care – from community c continuum of care – from community c to district /tertiary hospitals application o of Chlorhexidine 4. Antenatal ste steroids for premature lab labor and 8. IMCI at all levels Skilled birth attendance (CSBAs and Midwives) Kangaroo mo mother care Functional and 24/7 BEmONC and (KMC) for pre premature/low 9. Multi-sectoral approach to promote CEmONC at strategically located birth weight b t babies exclusive BF and IYCF facilities 5. Neonatal sep sepsis 10. Community based child drowning management nt at PHC level prevention activities 6. Specialized n d newborn care at 11. New vaccines: pneumococcal and district & sub sub-district level rotavirus
Pathway to effe ffective scale up Enabling Strength of High Effective Impact at Scale Environment Implementation Coverage nal readiness to support Standards of care re All newborns receive NBH interventions applied timely quality care Reduced Quality NBH Care Quality NBH Care re re neonatal neonatal available and accessi ssible mortality, still mproved sub-national Families and births and Systems functiona nal anagement capacity caregivers practice morbidity recommended behaviors Caregivers enables es to engthened systems and seek/ practice timel ely structures care
urrent Status of Priority Newbo born Interventions in angladesh Piloting in small Near universal Several districts or Consensus, policy tools & areas, learning coverage, institutionalizatio facilities covered guidelines development n HBB, 7.1% CHX ENC ACS
National Roll Out of He Helping Babies Breathe (October 2011 11 – March 2014) *Post training evaluation: -HBB logistics ( Bag-Mask and Capacity building : Sucker) available in 84% labor 28,189 SBA trained room/OT -81% Bag-mask and sucker we 17,530 found clean Resusc scitation equipment provided provided 1,649 Trainin ning equipment p provided Job aid : reprocessing of equipment
National roll-out of chlorhexi exidine for newborn cord care: (July 2015 – – June 2016) 85,849 service oviders, supervisors and anagers trained Orientation package Orientation package Capacity Building : 26,755 facility level ocacy and provider, 59,094 ization meeting community level provider trained st training evaluation: % providers received orientation X available in 52% facilities % providers could demonstrate lication procedure accurately % providers used CHX in the Logistic management week IEM/BCC material Job aid IM evaluation, Aug-Sep’16, 64 dist, 1044 facilities, 3400 provider
ENC, CHX and HBB: : Post-roll out Revisit (October 2016 – December 2017) Progress - 943 newborn focal perso evisit Package: identified and oriented on follow up package. efreshers orientation of - Advocacy meetings for u A in 64 districts of HBB and 7.1% CHX in erformance review of districts wborn interventions - Review meeting and - Review meeting and cluding CHX application cluding CHX application refresher training of 15,89 SBAs ogistics management - Quick assessment of 4,4 facilities regarding isit of all health facilities preparedness for newborn assess: interventions A workshop of Newbo born Focal Persons R, skill retention, (HR, training, facility cility readiness, logistic readiness, logistic availab anagement (CHX, HBB kit) ction plan development
Training status tus of providers Percentage of providers trained o d on 7.1% ENC, CHX & HBB (as reported on the he day of visit) 91 90 90 88 100 85 85 85 82 79 90 77 76 75 73 72 71 69 80 66 63 61 62 70 53 53 51 49 49 60 42 41 % 50 50 29 29 40 40 30 20 10 0 Gyn_Obs_Ped MO_Asst.Surgeon Nurse FWV_Para SACMO DH MCWC MCWC UHC UH&FWC-FP UH&FWC-H USC RD Others Total Provider type Facility type 7.1% CHX HX HBB Post roll out follow up visit ( Oct 2016- December 2017
Status of HBB and CHX X in facilities that provide deliver ery care 100 100 N= 4,469 100 91 90 89 87 90 84 77 77 77 80 74 73 69 69 69 65 70 56 60 54 50 48 48 47 47 46 46 50 50 41 40 30 30 30 16 15 20 13 10 0 Offer delivery service delivery service vice & HBB delivery service & 7.1% CHX Post roll out follow up visit ( Oct 2016- December 2017)
Institutionalization All newborn interventions incorporate ated into the National Newborn Health Program (N (NNHP) Dedicated budget for NNHP Procurement and distribution of comm mmodities: HBB equipment, CHX Indicators included in the MIS, dashb hboard created on DHIS 2 Monitoring and review of progress Capacity-building materials and job a b aids SBCC and newborn health campaign ign Engagement of partners and stakeho holders
Newborn Health Dashboard us used on DHIS 2 platform
Lessons learnt from nation ional scale up Reaching mothers who deliver at ho home remains a challenge: need alternativ tive delivery approaches mpact at scale” only as good as we weakest link National scale up requires commitme tment from all sectors – public, private, NGOs Community and local government of t offers potential local solutions to many of t f the bottlenecks Securing resources for all elements ts critical
Way Fo Forward Opportunities & Challenge ges Quality implementation of NNHP un under HPNSP Consistency across the service deliv elivery systems Sustainable support from partners Sustainable support from partners (technical and financial) Active engagement of all stakeholde lders Enhanced attention to quality of car are in the new sector program and new initiati iatives for MNH QoC
Thank you
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