Version Jan 2013 Why Every Newborn ? 44 percent of all under five - PowerPoint PPT Presentation

Version Jan 2013

Why Every Newborn ? 44 percent of all under five Country demand for guidance and deaths (2.9 million) are action to accelerate progress newborns , and another 2.6 towards MDGs 4 and 5, universal million babies are stillborn, yet health coverage, and towards huge potential for rapid change ending preventable deaths among with high impact, avoidable, women and children feasible interventions For greater effectiveness we must accelerate and harmonize global response and link to existing initiatives for reproductive, maternal, child and adolescent health care. Photo credit: Save the Children

We’ve made significant progress toward MDGs 4 & 5, but newborn survival is lagging behind Average annual rate reduction 1990-2012 Maternal mortality ratio* 4.2% At least 40% slower for Children aged 1- 59 months 3.4% newborn survival and slower still for stillbirths Neonatal mortality 2.1% (newborn, first 4 weeks after birth) Stillbirths 1.0% (last 3 months of pregnancy) (1995-2009) Source: Adapted from Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: UNICEF 2012 www.childinfo.org , UN MMR estimates 2012 * Maternal mortality ratio annual rate reduction 190-2010 3

We know the causes of newborn deaths Pneumonia 5% Pneumonia 13% 3 main killers to address: Prematurity 1. Preterm birth 14% 2. Birth complications Neonatal 3. Neonatal infections 44% Other conditions 13% Birth asphysia and birth trauma Two-thirds of neonatal 10% Non-communicable deaths diseases Neonatal sepsis 8% are preventable 5% Injuries 4% Congenital anomolies Data source: Cause of death - WHO. Global 4% Health Observatory Malaria HIV/AIDS http://www.who.int/gho/child_health/en/in Diarrhoea Neonatal tetanus dex.html); Child deaths - UN Inter-agency 7% 2% Group for Child Mortality Estimates. Levels 9% 1% Other conditions and Trends in Child Mortality. Report 2013; Diarrhoea 3% Stillbirths - Lawn et al The Lancet stillbirth Measles 1% series 2011. 377 (9775) p1448 – 1463 2% 4

We have the knowledge and tools to reduce the main causes of death • Preterm labor management including antenatal corticosteroids* 1 Preterm birth • Care including Kangaroo mother care, essential newborn care Birth • Prevention with obstetric care * complications 2 (and intrapartum • Essential newborn care, and resuscitation* stillbirths) • Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate* 3 Neonatal infections • Case management of neonatal sepsis * * 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

There are proven interventions within RMNCH continuum of care Clinical reproductive obstetric and childbirth care emergency emergency child health care including essential newborn care newborn care care Outreach/out patient reproductive antenatal care postnatal care child health care health care Family/community cleaner, adolescent early postnatal safer birth pregnancy ongoing care for health at home visits for home visits home and the child at home mother and school newborn intersectoral Improved living and working conditions including housing, water and sanitation, and nutrition Education and empowerment Pre-pregnancy Pregnancy Newborn/postnatal Childhood Birth Birth

Time around birth is critical window of opportunity to prevent and manage complications Care during labour, childbirth and the days following birth Labour and childbirth care Treatment for • Labour monitoring; childbirth care Reproductive pregnancy • Not breathing at birth: Resuscitation health care complications • Obstruction/Fetal distress: caesarean section, vacuum • Preterm labour: corticosteroids, antibiotics for PPROM Pre- Care during Essential newborn care conception pregnancy • Birth: drying, skin-to-skin; first week: early and care exclusive breastfeeding, warmth, cord care, hygiene • Suspected sepsis: Early antibiotic treatment • Preterm/LBW: Kangaroo Mother Care, breastfeeding support, immediate treatment of suspected infection

Care at birth gives a triple return on investments by also reducing stillbirths and maternal deaths Stillbirths Maternal deaths Neonatal deaths 2500000 If intervention in pregnancy and at birth reached all 2000000 Deaths averted families by 2015: 1500000  1.4 million newborn deaths averted (43%) 1000000  1.1 million stillbirths prevented (45%) 500000  201,000 maternal deaths 0 averted (54%) Basic antenatal Advanced Quality care at care antenatal care birth Source: Pattinson R, Kerber K, Buchmann E, et al, for The Lancet’s Stillbirths Series steering committee. Stillbirths: how ca n health systems deliver for mothers and babies? Lancet 2011; published online April 14. DOI:10.1016/S0140-6736(10)62306-9.

NEW NEONATAL MORTALITY TARGET Unless we greatly accelerate newborn survival efforts, goal to end preventable child deaths by 2035 unreachable 100 APR target: 90 Mortality rate (per 1,000 live births) National U5MR of 20 or less Global U5MR of 15 80 2000-2012 Global U5MR AAR = 3.8% Proposed NMR target: 70 National NMR of 10 or less Business as 60 usual: U5MR Global NMR of 7 50 40 Business as 30 usual: NMR Global NMR 2000-2012 20 AAR = 2.7% 10 AAR = 4.3% 0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 Scenario 2035 global NMR 2035 neonatal deaths If current trends are unchanged 13 1.8 million Every country to NMR of 10 per 1000 7 0.9 million Similar to 2/3 reduction in NMR as if a continuation of MDG4

NEW target for stillbirths and a maternal mortality target is in process 25 Business as usual: SBR Proposed SBR target: National SBR of 10 or less 20 Global average stillbirth rate Global SBR of 8 2000-2009 (per 1,000 total births) ARR = 1.3% 15 ARR = 3.5% 10 5 0 1995 2000 2005 2010 2015 2020 2025 2030 2035 Scenario 2035 global SBR 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 SBR for every country

We can bend the curve: proof of impact at scale even in low income countries Over the last decade, 77 countries reduced NMR by >25% , including at least 13 low income countries: Bangladesh, Bolivia, Eritrea, Guatemala, Indonesia, Nepal, Madagascar, Malawi, Morocco, Senegal, Rwanda, Tanzania, Vietnam Neonatal mortality rate MDG 4 MDG 5 Av annual change 2000-2010  Rwanda Progressing 6.2%   Bangladesh 4.0%   Nepal 3.6%  Malawi Progressing 3.5% Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7

The Every Newborn Action Plan: building a movement A global roadmap for change… A movement for greater action and accountability… A platform for harmonized action by all partners…  Sets out a clear vision with mortality target, strategic directions, and innovative actions within the continuum of care  Supported by new evidence to be Photo credit: Save the Children published in The Lancet in May 2014

Every Newborn’s strategic framework

Every Newborn’s guiding principles Country leadership Integration Equity Good governance, Integrated service delivery, Universal coverage, closing community participation, continuum of care, the equity gap partner alignment programme coordination Innovation Accountability Interventions, delivery Transparency, approaches, technologies oversight

Every Newborn’s strategic objectives  Strengthen and invest in care during labour, child birth and the first day and week of life  Improve the quality of maternal and newborn care  Reach every woman and every newborn ; reduce inequities  Harness the power of parents, families and communities  Count every newborn – measurement, tracking and accountability

Every Newborn supports the Global Strategy Country leadership & Implementation Key catalytic initiatives in support of Every Woman Every Child Family Planning A Promise UN Commission on Life 2020 Saving Commodities Renewed Global action plans: Every Newborn , scaling up nutrition, global action plan for pneumonia & diarrhea, vaccines, WASH for all, and others Who? Global mechanisms for coordinated action and advocacy Some examples: Commission on Information and Accountability and independent Expert Review Group Visit www.everywomaneverychild.org

Every Newborn prioritizes focus on birth within existing national strategies and plans; not a new stand alone plan Health Sector Strategic & Investment Plan Integrated National RMNCH Plan Increasing Ending preventable Ending Ending access and deaths from pneumonia preventable preventable use of FP and diarrhoea (GAPPD) maternal deaths newborn deaths

All stakeholders have a role to play  Countries, donors, civil society groups, professionals, and businesses are leading this effort in support of Every Woman Every Child . Every Newborn builds on key platforms like FP2020, A Promise Renewed, the Commodities Commission, and Commission on Information and Accountability.  A comprehensive consultation process Photo credit: Save the Children whereby all stakeholders are given an opportunity to feed into the plan and countries identify specific bottlenecks and solutions