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WEST AND CENTRAL AFRICA REGIONAL GLOBAL ‘EVERY NEWBORN’ ACTION PLAN

CONSULTATION REPORT

DAKAR, SENEGAL – JULY 9-11, 2013

WEST AND CENTRAL AFRICA REGIONAL GLOBAL ‘EVERY NEWBORN’ ACTION PLAN CONSULTATION REPORT


TABLE OF CONTENTS

I. PURPOSE OF MEETING ............................................................................................................... 1

II. BACKGROUND ............................................................................................................................ 1

III. AGENDA ITEMS / SUMMARY OF THE CONFERENCE SESSIONS ............................................ 1

Agenda ........................................................................................................................................ 2

Day 1 ........................................................................................................................................... 4

Opening ................................................................................................................................... 4

Session 1 ................................................................................................................................. 4

Session 2 ................................................................................................................................. 4

Session 3 ................................................................................................................................. 4

Day 2 ........................................................................................................................................... 5

Session 3 (Continued) .............................................................................................................. 5

Day 3 ........................................................................................................................................... 6

Session 4 ................................................................................................................................. 6

Closing ..................................................................................................................................... 7

ANNEX 1: PARTICIPANTS LIST.......................................................................................................... 8

ANNEX 2: BOTTLENECK ANALYSIS TOOL - SECTION I (NEWBORN CARE IN GENERAL) COUNTRY

RESULTS ......................................................................................................................................... 11

Table 1. Degree of newborn programme improvement needed ............................................. 22

ANNEX 3: BOTTLENECK ANALYSIS TOOL - SECTION II (CRITICAL NEWBORN INTERVENTIONS)

COUNTRY RESULTS ........................................................................................................................ 23

Table 2. Country BNA tool group work ..................................................................................... 23

ANNEX 4: FOLLOW-UP ACTIONS / NEXT STEPS IN-COUNTRY ....................................................... 34

ANNEX 5: FEEDBACK ON EVERY NEWBORN DRAFT DOCUMENT ................................................. 39



Dakar Consultation Page 1

I. PURPOSE OF MEETING

The main purpose of this first regional consultation of Every Newborn: A Global Newborn Action Plan was to promote coordinated efforts among key country stakeholders focusing on newborn care to identify what needs to happen to scale-up evidence-based interventions to address preventable newborn deaths in the West and Central African region.

The consultation had three specific objectives: 1. To provide a forum for countries to identify their bottlenecks, challenges and identify

solutions and actions to accelerate the scale up of newborn programmes in national plans 2. To review and provide input to the Every Newborn draft document 3. To contribute to the advocacy movement around global, regional and national newborn

action and ensure country-level alignment with other key initiatives and political processes

II. BACKGROUND

A three-day regional consultation was organized in support of Every Newborn, a major new partner-based effort to accelerate national, regional and global progress towards reducing preventable newborn deaths. The consultation brought together about 70 participants including 8 country teams from Cameroon, Congo Brazzaville, DRC, Ghana, Niger, Nigeria, Senegal and Sierra Leone, as well as representatives from Burkina Faso and Mali, members of the Every Newborn Core Group as well as members on the global Every Newborn Advisory Group. Participants originated from their respective Ministries of Health, academic or professional associations, health centers and various national and international non-governmental organizations. Core and Advisory Group members facilitated the workshop. Please see the participants list in Annex 1. The meeting was hosted by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), supported by the U.S. Agency for International Development (USAID). This was the second consultation of Every Newborn following it’s introduction at the Global Newborn Health Conference in Johannesburg, South Africa in April 2013.

III. AGENDA ITEMS / SUMMARY OF THE CONFERENCE SESSIONS

Please find below a summary of the conference sessions as well as the conference agenda. Every Newborn meeting PowerPoint presentations as well as country consultation materials discussed below can be found at http://www.globalnewbornaction.org.

Participants were oriented on the Every Newborn development process and how it fits into the framework of existing reproductive, maternal, newborn, child and adolescent health (RMNCAH) initiatives. Facilitators highlighted the critical newborn interventions that require scale-up and shared the latest draft of Every Newborn with country participants, who in turn provided feedback. Country delegates also participated in groupwork to identify bottlenecks and solutions to the scale-up of newborn and maternal interventions necessary for improving newborn survival. Finally, each country team clearly outlined the immediate next steps that they would undertake to address and advance newborn health in their respective countries including the organization of a national, multi-stakeholder consultation on Every Newborn and newborn survival.

http://www.globalnewbornaction.org/




Agenda

Day 1: 09 July 2013

Time Sessions Facilitator/Presenter

07:30 – 08:30 08:30 – 09:00 09:00 – 09:15

Registration

Welcome, opening remarks, and introduction of participants Presentation of the objectives of the meeting and review of the agenda

UNICEF Regional Director Mariame Sylla

SESSION 1: GLOBAL INITIATIVES AND THE GLOBAL ‘EVERY NEWBORN’ ACTION PLAN Chairs: to be determined

09:15 – 09:30 09:30 – 09:45 09:45 – 09:55 09:55 – 10:10 10:10 – 10:20 10:20 – 10:30

Regional initiatives and situational analysis, (15 mins) Global initiatives to accelerate progress in RMNCH: how does this all fit together? (15 mins) Discussion The Global ‘Every Newborn’ Action Plan: Background, development process, timeline (15 mins) Overview of the Global Newborn Health Conference (10mins) Discussion

WHO Kim Eva Dickson Bernadette Daelmans Joseph de Graft Johnson

TEA BREAK (10:30 – 11:00)

SESSION 2: COUNTRY OVERVIEWS Chairs: to be determined

11:00 – 13:00 Country presentations (10 min per country)

Phase 1: 3 countries ( 30 min ) and discussion (10 min)

Phase 2: 3 countries (30 min) and discussion (10 min)

Phase 3: 3 countries (30 min) and discussion (10 min)

Countries

LUNCH (13:00 -14:00)

SESSION 3: BOTTLENECKS ANALYSIS AND IDENTIFICATION OF SOLUTIONS

14:00 – 14:10 14:10 – 14:20 14:20 – 14:35 14:35 – 15:00

‘Every Newborn’ Country Consultations (10 min) Discussion Introduction to the Maternal-Newborn Bottleneck Analysis Tool (15 mins) Discussion and explanation of Group Work

Kim Eva Dickson Aline Simen-Kapeu

15:00 – 17:30 (including tea/ coffee break)

Country Group work on the BNA Tool

Challenges and bottlenecks – Section I and Section II (2 interventions/country)

Identify solutions to address bottlenecks

Prepare presentations for feedback on each intervention

GENAP Core Group




Day 2: 10 July 2011

08:30 – 08:45 08:45 – 09:00

Plenary Recap of Day 1 Introduction to the ‘Every Newborn’ Toolkit (15 mins)

WHO Mary Kinney

09:00 – 11:30 (Including tea/coffee break)

Country Group work on the BNA Tool continues

Challenges and bottlenecks – Section II (2 interventions/country)

Identify solutions to address the bottlenecks

Prepare presentations for feedback on each intervention

GENAP Core Group

11:30 – 13:00 Plenary Feedback on bottlenecks and solutions Presentations on each intervention – bottlenecks and solutions (10 min presentation for each intervention) Discussion

Country Rapporteurs

LUNCH (13:00 – 14:00)

14:00 – 15:30 Plenary Feedback on bottlenecks and solutions Presentations on each intervention – bottlenecks and solutions (10 min presentation for each intervention) Discussion

Country Rapporteurs

TEA BREAK (15:30 – 16:00)

16:00 – 17:30 Country teams work on country action plans

Decide clear action plans (short and medium term) with roles and responsibilities

Day 3: 11 July, 2013

SESSION 4: THE GLOBAL NEWBORN ACTION PLAN Chairs: to be determined

08:30 – 08:45 08:45 – 09:00

Current guidelines for newborn health (15 mins) Discussion

Severin Ritter Von Xylander

09:00 – 09:30 The ‘Every Newborn’ Action Plan: Presentation of the draft document (15 mins) Introduction to Group Work

Lily Kak

09:00 – 13:00 (Including tea/coffee break)

Group work to review the ‘Every Newborn’ Action Plan GENAP Core Group

LUNCH (13:00 – 14:00)

14:00 – 15:30 Feedback on GNAP group work (10 min per Group ) Group Rapporteurs

TEA BREAK (15:30 – 16:00)

16:00 – 16:45 Country teams feedback on action plans and next steps in-country GNAP development process: Next steps

Countries GENAP Core/Advisory Group

16:45 – 17:00 Next steps, final remarks and closing WHO/UNICEF

CLOSING




Day 1: Tuesday, 9 July 2013 Opening:

The UNICEF Regional Director opened the meeting by welcoming participants and delivering introductory remarks.

Session 1: Regional and Global Initiatives

Regional initiatives and situational analysis: A brief overview of the status of newborn health in the West and Central African region, programming, regional initiatives as well as an introduction to Every Newborn was provided. This included a discussion of the major causes and risk factors for newborn deaths, the priority interventions that can avert these deaths at various levels of care, the strong link between maternal and newborn interventions across the continuum of care, and the importance of inter-sectoral linkages most relevant to the region and countries (e.g. WASH, HIV, nutrition) and their role in newborn health and survival.

Global initiatives to accelerate progress in RMNCAH: RMNCAH global initiatives (Commission for Women and Children, Commission for Information and Accountability, UN Commission on Life-Saving Commodities for Women and Children, A Promise Renewed and Family Planning 2020) were presented in order to demonstrate how all these initiatives are inter-related and form a common platform in countries to accelerate actions for newborns to achieve expected goals. Participants were also introduced to how Every Newborn fits in and it was emphasized that the newborn is an entry point for various initiatives.

Every Newborn Action Plan: The background, development process and timeline of Every Newborn were presented.

Overview of the Global Newborn Health Conference: The presentation provided an overview of the Global Newborn Health Conference held in Johannesburg in April 2013 including a brief discussion of the purpose and objectives, participants, conference activities and outcomes.

Session 2: Country Overviews

Country presentations: Eight countries (Burkina Faso, Cameroon, Congo Brazzaville, DRC, Ghana, Nigeria, Senegal and Sierra Leone) provided brief overviews. They shared information related to newborn epidemiology, demography and policy, health system infrastructure and access, existing initiatives and programmes implemented to address newborn survival and their challenges/bottlenecks.

Session 3: Bottlenecks Analysis (BNA) and Identification of Solutions

Current guidelines for newborn health: The current WHO guidelines related to priority interventions to end preventable newborn deaths were presented by level of care and with reference to materials and services.

Introduction to the maternal-newborn BNA tool: The background, layout and utility of the maternal-newborn BNA tool was presented. The tool is divided into two main sections. Section I includes questions related to newborn health programmes in general and is organized into 7 sub-sections according to health systems building blocks as follows:

1. Leadership and governance




2. Health financing 3. Health workforce 4. Essential medical products and technologies 5. Health services 6. Health information systems 7. Community ownership and partnership

At the end of each health system building block, respondents are asked to summarize the key bottlenecks and determine if the health system area is good (not a bottleneck to scale up), needs some improvements (minor bottleneck to scale up), needs major improvements (significant bottleneck to scale up) or is inadequate (very major bottleneck to scale up). Respondents are also asked to identify potential and successful strategies and solutions for each priority bottleneck under each health system building block. Section II is sub-divided into 9 sections representing the following critical newborn interventions:

1. Management of preterm birth (focus on antenatal corticosteroids) 2. Skilled care at birth (focus on use of the partograph) 3. Basic Emergency Obstetric Care (focus on assisted vaginal delivery) 4. Comprehensive Emergency Obstetric Care (focus on caesarean section) 5. Basic Newborn Care (focus on cleanliness/cord care, warmth and feeding) 6. Neonatal resuscitation 7. Kangaroo Mother Care (focus on skin-to-skin, breastfeeding and feeding support for

premature and small babies) 8. Treatment of severe infections (focus on using injectable antibiotics) 9. Inpatient supportive care for sick and small newborns (focus on IV fluids/feeding

support and safe oxygen)

Country group work on the BNA tool: With the guidance of a facilitator, each country team worked through Section I. By doing so, they became familiar with the questionnaire, analyzed challenges to the scale-up of newborn care, identified practical and realistic solutions to address the barriers, and provided feedback/inputs on how to improve the tool. Country results for Section I as well as Table 1 summarizing the degree of improvement needed by each building block for Section I are presented in Annex 2.

Day 2: Wednesday, 10 July 2013 Session 3 (Continued): Bottlenecks Analysis and Identification of Solutions

Country group work on the BNA tool (continued) and feedback on bottlenecks and solutions: During a plenary session, each country presented bottlenecks and strategies/solutions to address identified challenges related to one of the sections in the BNA tool. Please see Annex 3 for full summaries of the priority bottlenecks and solutions by health system building block and country for interventions in Section II (those completed). Table 2 in Annex 3 lists all the interventions in Section II and the corresponding countries that completed them.

Every Newborn Country Consultation: Participants were provided an overview of the Every Newborn country consultation process including its objectives, players/key participants, expected outputs, guiding principles and suggested agenda. The country consultation




concept note can be found at http://www.globalnewbornaction.org/Documents/Every-Newborn-country-consultation.pdf.

Introduction to the Every Newborn Toolkit: Participants were introduced to the Every Newborn toolkit and asked to explore its contents on the website (http://www.globalnewbornaction.org/every-newborn-toolkit/).

Country follow-up work plans / follow-up actions / next steps in-country: Country teams spent time to clearly define and outline in-country actions and next steps by the end of the year in relation to the following 3 areas:

1. To provide a forum for countries to identify their bottlenecks, challenges and solutions and actions to accelerate the scale up of newborn programmes in national plans

2. To review and provide input to the global Every Newborn action plan draft document

3. To contribute to the advocacy movement around global, regional and national newborn action and ensure country-level alignment with other key initiatives and political processes

They defined timelines, roles and responsibilities to hold a national consultation, completion of the BNA tool, sharing of results and using the results to facilitate integration of newborn interventions into national plans and implementation of selected interventions. Countries were asked to discuss the following 4 issues:

1. What are in-coming opportunities to facilitate a review of the national newborn action plan and sharpen it in light of the key messages of Every Newborn (annual review meeting, child survival planning meeting, etc.)?

2. How are newborn interventions promoted in maternal and child health programs in the country linked to maternal health? Explain the link and integration with other sectors including nutrition, HIV, WASH, child protection, etc. where applicable.

3. What are the roles and responsibilities of partners in facilitating and strengthening implementation of newborn programmes? How will the funding be secured?

4. How will the monitoring of future plans and activities be conducted (score card, key indicators, etc.)?

Formal feedback was provide by each country in a plenary session and is detailed in Annex 2.

Day 3: Thursday, 11 July 2013 Session 4: The Global Newborn Action Plan

The Every Newborn Action Plan draft document: The Every Newborn draft document was presented and distributed to all participants for discussion. The document included questions to guide discussions. Participants were split up into self-selected groups and were guided by facilitators to discuss the draft:

http://www.globalnewbornaction.org/Documents/Every-Newborn-country-consultation.pdf

http://www.globalnewbornaction.org/Documents/Every-Newborn-country-consultation.pdf

http://www.globalnewbornaction.org/every-newborn-toolkit/




Group Discussion Area Facilitator Language

1 Vision, goal and targets Aline Simen Kapeu French

2 Vision, goal and targets Lily Kak English

3 Strategies 1-3 Seipati Mothebesoane-Anoh English

4 Strategies 1-3 Severin Ritter von Xylander French

5 Strategies 4- 6 Mariame Sylla French

6 Strategies 4-6 Assumpta Muriithi English

Formal feedback was provided in a plenary session after the group work and can be found in Annex 4. Core Group members will integrate feedback into the new Every Newborn draft document.

Closing

Remarks were made by representatives from UNICEF (Kim Dickson), WHO (Seipati Mothebesoane-Anoh) and USAID (Lily Kak). Kim Dickson thanked all of the organizers and participants for their active engagement and contribution to the development of Every Newborn and then formally closed the meeting.




ANNEX 1: PARTICIPANTS LIST

COUNTRY TEAMS

CAMEROON

Belyse Ngum Health Specialist UNICEF

Martina Baye Technical Advisor to the Ministry of Health Family Health Head Office

Moluh Seidou, Deputy Director, Maternal Health Family Health Head Office

Mah Evelyne Mungyeh, Deputy Secretary General SOCAPED SOCAPED

Francisca Monebenimp Pediatrician UTN Yaounde

CONGO BRAZZAVILLE

Richard Bileckot Director Research and Health Information Systems

Voumbo Matoumona Yolande

Director, Family Health Ministry of Health and Population

Jean Robert Mabiala Pediatrician University Hospital

Oko Aymar Pierre Gildy Pediatrician & Assistant University

Philomene Fouti Soungui Representative and Ambassador, CARMMA Parliament

Jean Kaseya Chief, CSD UNICEF

Assumpta Muriithi Medical Officer, Newborn Health WHO AFRO Congo

DRC

Celestin Nsibu Professor / President, Association of Pediatrics Department of Pediatrics, Faculty of Medicine

Lucie Zikudieka Senior Technical Advisor MSH / PROSANI

Jean Fidèle Ilunga National Coordinator, PECIME Ministry of Health

Luc Kamanga Pediatrician Ministry of Health

Brigitte Kini MPO MNCH WHO

Laurent Kambale Kapund Program Officer UNICEF

GHANA

Dr Patriack Aboagye Deputy Director, Reproductive and Child Health Ghana Health Service

Dr Lorna Renner Pediatrician Korle Bu Teaching Hospital, Pediatric Society of Ghana

Eric Quarshie Doctor Komfo Anokye Teaching Hospital

Daniel Yayemain Child Health Specialist UNICEF

Ernest Cudjoe Opoku MNH Specialist, UNICEF UNICEF

Juliana Ameh Pediatrician Ghana Health Service, Lekma Hospital

MALI

Attatier H. Toure NPO / CAH WHO

Tessougue Fatoumata Cisse NPO / MPS WHO

NIGER

Konaté /Tinni Aminata Chief, Division of Newborn and Child Health Ministry of Public Health

Abani Fassouma Technical Superviser, Community Health Ministry of Public Health

mailto:[email protected]




Kamaye Moumouni Chief, Neonatal Division in Central Maternity and Member of Pediatric Society

Ministry of Public Health

Fatima Hachimou Health Officer UNICEF

Adamou Balkissa FHP WHO

NIGERIA

Catherine Ojo Chief Nursing Officer Ahmadu Bello University Teaching Hosp, Zaria

Cecilia Abimbola Williams Snr MNH Manager Save the Children

Nnenna Ihebuzor Director, PHC Systems NPHCDA

Joy Ufere Head, Newborn Desk Federal Ministry Of Health

Oyinbo Olumuyiwa Manuel Senior Maternal & Newborn Health Adviser Save the Children

Garba Safiyanu Health Specialist, MNCH UNICEF

SENEGAL

Mariètou DIOP Chief, Department of Newborn health Ministry of Health

Gelaye Sall Professor, Pediatrics Makam University

Fatim Tall Thiam Head, Reproductive Health Programme WHO

Mariam Sylla Diene Health Specialist UNICEF

Fatou Ndiaye Maternal & Child Health / Family Planning Specialist

USAID

SIERRA LEONE

Sarian Kamara Acting Deputy CMO Ministry of Health and Sanitation

Fatmata Mansaray Deputy Chief Nursing Officer Ministry of Health and Sanitation

Joan Sherherd Head of the Midwives Association The Midwives Association

Kennedy Ongwae MNH Specialist UNICEF

Oyinbo Olumuyiwa Manuel Senior Maternal & Newborn Health Adviser SAVE THE CHILDREN

Garba Safiyanu Health Specialist, MNCH UNICEF

TOGO

Anjeoda Kodjovi NPO, FHPai WHO - TOGO

PARTNERS / INTERNATIONAL ORGANIZATIONS

CHILDREN’S INVESTMENT FUND FOUNDATION

Suzanne Fournier Investment Manager CIFF

GLOBAL ALLIANCE TO PREVENT PREMATURITY AND STILLBIRTHS

Eve Lackritz Senior Programme Officer GAPPS USA

MATERNAL AND CHILD HEALTH INTEGRATED PROGRAM

Joseph de Graft Johnson Team Leader, Newborn and Community Health MCHIP/SNL

Goldy Mazia Latin America & Caribbean Neonatal Alliance Coordinator

MCHIP/PATH

SAVE THE CHILDREN / SAVING NEWBORN LIVES

Mary Kinney Data and Communications Specialist Save the Children

Kate Kerber Africa Regional Specialist Saving Newborn Lives

UNICEF

Kim Dickson Senior Advisor, Maternal and Newborn Health Headquarters




Aline Simen Kapeu Maternal and Newborn Health Specialist Headquarters

Linda Vesel Maternal and Newborn Health Programme Specialist

Headquarters

Nuzhat Rafique Regional MNH Specialist ROSA Regional Office

Mariame Sylla Regional MNH Specialist WCARO Regional Office

Christophe Hodder Regional Health Advisor West and Central Africa – Programme Policy & Quality

WCARO Regional Office / Save the Children

USAID

Lily Kak Senior Maternal and Newborn Health Advisor Headquarters

WHO

Bernadette Daelmans Coordinator, Department of Maternal, Newborn, Child and Adolescent Health

Headquarters

Severin Ritter von Xylander Medical Officer, Department of Maternal, Newborn, Child and Adolescent Health

Headquarters

Seipati Mothebesoane-Anoh Regional Advisor, Making Pregnancy Safer, AFRO Regional Office

Olga Agbodjan-Prince Child Health Specialist AFRO Regional Office




ANNEX 2: BOTTLENECK ANALYSIS TOOL - SECTION I (NEWBORN CARE

IN GENERAL) COUNTRY RESULTS

CAMEROON

Summary of key bottlenecks by order of priority Strategies and solutions to address identified challenges and bottlenecks Building block Priority bottlenecks

Leadership and Governance

Not recognizing newborn health as a specific issue

Advocacy and awareness: policy makers, gynecologists, pediatricians, all stakeholders in the newborn health field

Capacity strengthening Inclusion of neonatal health in the initial training

Health Financing

Existence of financial barriers to assess maternal and newborn care No specific mention of the newborn in new funding allocations for healthcare delivery

Subsidies/ free care for newborns in health facilities Scaling up of obstetric kits by including relevant newborn drugs Allocation of funding specific to the newborn for the supply of care services

Health Workforce

Insufficient staff trained for newborn care (pediatricians, obstetricians, midwives, nurses)

Recruitment of staff (pediatricians, obstetricians, midwives, nurses) Incentives for staff to stay in stations Staff training based on identified needs Health Service Delivery

Outdated documents on norms and standards for RMNCH

Revision of norms and RMNCH standards with an emphasis on newborn care Implementation of quality control systems

Essential Medical Products and Technologies

Absence of certain newborn drugs and supplies in national system of essential medicines and in facilities Frequent disruption of drug stocks and inputs

Drafting of the newborn essential drugs and equipment list by level of care Ensuring the availability of these inputs in health facilities Training / retraining providers / pharmacy personnel to handle inventory management




Health Information Systems

Lack of key information on newborn health Lack of adequate tools Multiplicity of tools

Update tools for data collection and data entry to include information on newborns Integrating newborn data into existing data collection tools Integration of collection tools taking into account the newborn Make data readily available

Community Ownership and

Partnership

Poor community involvement and participation

Recruit and train CHW elected by communities CHWs to provide services for newborn and maternal health

CONGO

Summary of key bottlenecks by order of priority Strategies and solutions to address

identified challenges and bottlenecks Building block Priority bottlenecks


Non-functional management team Weak coordination between sectors No technical work team

Health strengthening in districts Establishment of frameworks for cooperation between sectors for MNH Create a technical work team

Health Financing

Absence of pricing system for services Lack of sub-accounts Insufficient allocated funds

Develop a pricing system Create sub-accounts for MNH Advocate for an increased funds

Health Workforce

Development plan for HR not approved yet Inadequate human resources Basic training not adapted to current needs

Approval of HR development plan Increase human resources, Update current curriculum





No functionality of ‘COMEG’: low satisfaction rate

Failure to respect allocations of drug orders and payments

Absence of quantification committee

Decentralization (no storage mechanism, low staff qualifications, inadequate communication)

Strengthen ‘COMEG’ and the pharmacy department Develop a communication plan Strengthen the capacity of service providers to manage medical supplies

Health Service Delivery

Absence of quality control process

Develop a quality control process (standard referenced norms for certification and accreditation by maternities)


Weak health information system

Some available indicators not taken into account

Strengthening of HIS Update of materials and indicators Develop a quality control process on collected data

Community Ownership and Partnership

Weak policy/ strategy regarding taking into account the community approach

Weak enhancement of community interventions

Development of a community engagement strategy

Research

Lack of health policy and research.

Absence of data on the quality of MNH care services

Develop a health research strategy including newborn health Implement research projects

DRC



Weak high level involvement, worse than maternal health

Lobbying, i.e. through expert groups, women’s asssociations – channeling of efforts, support by First Lady International pressure, i.e. call for action

Health Financing

Little financing from the state Improve the channeling of funds towards priority tasks International pressure? COIA




Health Workforce Instability, mobility and distribution of healthcare workers

Implement the HR plan


Supply systems lacking efficient monitoring and inspections

Reinforce monitoring/inspections at all steps


Constantly changing guidelines and documents

Regular deadlines for completion/revision of documents including system for the provision of supplies


Delay in data sharing Invest in a data management system for RMNH


Lack of lasting commitments N/A

GHANA

Summary of key bottlenecks by order of priority Strategies and solutions to address identified challenges and bottlenecks

Building block Priority bottlenecks


Inadequate coordination especially at the regional and district level - absence of focal points for newborn care at the district Inadequate human resources Inadequate financial resources (some improvement at the national and regional level) Inadequate coordination of partners in newborn care

Identify and appoint/re-orient focal persons with clear job descriptions to coordinate newborn care interventions Develop/expand National Child Health Coordination Mechanism Provide office space, office equipment and vehicles for newborn focal points at the national level

Health Financing

Inadequate funds Delayed release of funds Poor claims management- delayed submission to and reimbursement of claims by National Health Insurance Scheme

Resources mobilization (seek other sources of funding – including engaging private sector/businesses) Advocate for adequate budgetary allocation and release of funds Advocate for improved funding for the NHIS and improved claims management

Health Workforce

Inadequate number (doctors,-paediatricians, midwives, anesthetist)

Increase intake into health training institutions (commenced, number of medical schools increased) In-service training programmes to




Inappropriate skill mix Disparities in distribution (mal-distribution) Failure to retain due to lack of social amenities for staff in rural areas

upgrade skills of staff e.g. CHNs and midwives Develop an in-service training module for newborn care Implement training programmes to train specialised nurses e.g. paediatric nursing Implement HR Policy (2 midwives/HC with back-up technical support)


Down time of equipment is long and challenges of preventive maintenance Cumbersome process sometimes creates delays in procurement of commodities

Develop MOUs with equipment suppliers for maintenance of equipment Implement minimum standard equipment package for all levels Engage industry to make local adaptation of equipment (PPP)


Competencies required for recertification not linked to service being provided by the staff Supervision is infrequent

Advocacy for the regulatory bodies to link requirement for recertification of health workers with the job of staff


No analysis and use of data at point of generation

Train technical staff on analysis and use of data


Weak partnership/no community ownership in peri-urban areas

Improve coordination with Ministry of local government and MMDA and traditional leadership/authorities

NIGER



N/A N/A

Health Financing

No specific budget line for newborn activities

Newborn activities are funded by partners and funds are derived from the overall health budget

Advocate for the allocation of a specific portion of the national health budget to go towards newborn activities




Health Work Force

Unequal distribution of health staff

Decentralize recruitment of health staff through the creation of budgetary posts in towns


Essential products for newborn care are not taken into account, in particular by the logistic management system

Clearly specify in the national list the 4 essential products that save newborn lives and include in the logistic management system


Poor monitoring of the effect of implementing policy on improved quality

Implementation of quality assurance committees in health facilities and quality control systems for deliveries Implementation of a performance-based funding system


EPI does not take into account vaccination against hepatitis at birth Delay in implementing perinatal death audits

Failure to gather information on the newborn in private institutions

Insert the vaccination against hepatitis at birth in the EPI Accelerate the implementation of perinatal death records Increase the transfer of data in private institutions

Raise awareness among leaders in private institutions


Ineffective community structures

Revitalize community structures

NIGERIA



No focal person or responsible person at district level Birth registration policy exists but not enforced. Birth certificates not always available - not implemented comprehensively

Integration and strengthening capacity of maternal health person to include newborn at the district level At state level, work with appropriate person in place Advocacy for newborn health National population commission and partners to strengthen registration including provision of certificates Training of health care providers on processes




Include vital registration as part of the national conditional cash transfer programmes

Health Financing

Very low coverage of health financing schemes No specific line item for tracking financial resources for newborn health at all levels

Get behind the signing of the health bill and get global backing High level advocacy Support MOH to create budget line for newborn health Appropriate legislative bodies to be able to support MOH to track money, to release money and strengthen accountability to report back on health expenditure Implement COIA framework Work with state government to expand community-based health insurance schemes

Health Workforce

Maldistribution and retention of health workers to remote and security challenged areas Poor numeration of health workers

Produce and deploy locally and get state level support Provide incentives for health workers working in remote and security challenged areas


Coordination is not effective yet because it is a new system it needs to be strengthened.

Integrate all existing procurement systems


Inadequate funding Supervision not regular at sub-national level

Funding for supervision. Ensure adequate number so ISS tools and funding for ISS implementation Need for annual review Information from ISS to link with PHC reviews


Poor engagement of the private sector

Weak reporting mechanisms

Incentive for private sector reporting Implementation of PPP policy Increase supervision of private sector




Socio-cultural issues around newborn deaths that prevent reporting Poor use of data for action Stillbirths and newborn deaths not counted

Link to annual reporting HMIS tools – to capture indicators at community level BCC strategies around making newborns counts


Sub-optimal engagement of community structures (ward development community committees, women’s group, CBAs, etc.)

Create sustainable support for existing structures

SENEGAL




Lack of coordination and multi-sectoral approach in integrating interventions

Establish a single framework for consultation Strengthen multisectoral approach (multisectoral committee to address the non-functional maternal and neonatal mortality)

Health Financing

Lack of financial resources allocated to MNH

Failure in the effectiveness of free care for childbirth and caesarean section with no consideration of newborns

No healthcare deductible

Advocacy for increased resource mobilization for MNCH Promoting premium-based health care coverage that includes the newborn package with support from the State

Health Work Force

National policy does not consider skill deployment for delivery care and newborn care at the community level

Validate and implement the National Policy on Community Health


Dysfunctional supply cycle for providers

Needs assessment often poorly done at the provider level

Strengthen the skills of all providers on medication management Improve communication between the different levels




Irregular commands at the operational level


National information system is weak and there are parallel circuits

Timing of annual reporting of the national system does not allow for national bodies to take appropriate/timely decisions

Private sector data are not taken into account

Strengthen the National Health Information System (in progress) Establish a partnership with the private sector for the regular updating of their skills and the integration of their data in the National Health Information System


Poor quality of service delivery Develop a national document to improve the quality of services

Implement an audit system for the quality of services at the national level


Absence of a nationally integrated reproductive, child and newborn health communication plan

Develop and implement an integrated communication plan for reproductive health and child survival integrating health of the newborn

Improved community empowerment through increased involvement




SIERRA LEONE



The Reproductive Child Health (RCHTCC) (Reproductive and Child Health Technical Coordinating Committee) not functioning effectively Absence of focal person at national and district level for newborn Lack of clear understanding the current situation of newborn health

Advocate to the Honourable Minister to revitalize the Health Sector Steering Committee meetings including the RCHTCC Review the ToR for RCHTCC and the composition Setting up working groups Have clear work plan Conduct an in-depth situation analysis of the newborn Identify a desk officer or key focal person for newborn health at national and district level

Health Financing

No specific funding for newborn health Disbursement of funds from national to district Stock out of commodities

Advocate for introduction of specific maternal and newborn budget in the RCH budget line Advocate for timely disbursement of funds Build capacity for quantification

Health Workforce

Inequitable distribution of skilled staff Irrational deployment of trained staff after training at facility Remote allowance not reaching the beneficiaries and PBF

Decentralise deployment of midwives and nurses and MCH aides to primary health units Strengthen the Posting Committee Advocate for additional allowance/incentive and enabling environment for staff Review existing human resource retention and policy for staff





National pharmaceutical procurement unit set up

Ongoing


Weak supervision Quality improvement process not harmonized No effective system for re-certification of key personnel

Define national quality improvement system taking into accounting already existing system (FIT, Facility Improvement Team, on the job training, mentoring, MDRs, Maternal Death Reviews, Infection Prevention and Control)


Health Information System currently not functioning

Lack of key personnel

Data reporting tools not disaggregating newborn data appropriately

Ongoing restructuring of HMIS Ongoing recruitment of Staff Restructuring is an opportunity for updating the reporting tools to appropriately disaggregate data on newborns, stillbirths and neonatal death within the first week


Lack of coordination among the existing community groups and actors Community Health Worker policy and strategy validated but not implemented Communication strategies not specially focusing on the newborn

Launch and implement the Community Health Workers policy and strategy




Table 1. Degree of newborn programme improvement needed

Cameroon Congo DRC Ghana Mali Niger Nigeria Senegal Sierra Leone

All Countries

ALL NEWBORN INTERVENTIONS (BNA SESSION I)

Leadership & Governance

Health Financing

Health Workforce

Essential Medical Products & Technology



Community Ownership & Partnership

Legend

Good Needs some improvement Needs major improvement Inadequate




ANNEX 3: BOTTLENECK ANALYSIS TOOL - SECTION II (CRITICAL

NEWBORN INTERVENTIONS) COUNTRY RESULTS

Table 2. Country BNA tool group work

Intervention Country Team

1) Management of preterm birth Cameroon

2) Skilled care at birth Congo

4) Comprehensive Emergency Obstetric Care Ghana

5) Basic Newborn Care 5a) Senegal 5b) Niger

6) Neonatal resuscitation Nigeria

7) Kangaroo Mother Care DR Congo

8) Treatment for severe infections Sierra Leone

9) Inpatient supportive care for sick and small newborns (partial) Nigeria

INTERVENTION 1: MANAGEMENT OF PRETERM BIRTH - Focus on antenatal corticosteroids



Lack of documents on norms and standards Staff not trained

Update RMNCH, a document on norms and standards, with a focus on newborns and disseminate at all levels Train and retain staff

Health Financing

Financial barriers to the access to care for mothers and newborns

Grant / free care for newborns in health facilities Scaling up obstetric kits and include new drugs

Health Workforce Weak supervision

Include newborn component in integrated supervision protocol and organize regular supervision at all levels


No guidelines for use of dexamethasone for lung maturation

Develop and disseminate guidelines


N/A

N/A


No awareness of reporting on the use of ACS

Update tools for collecting data on the administration of ACS


Partnership

Poor level of engagement for RMNCH

Sensitize leaders and communities




INTERVENTION 2: SKILLED CARE AT BIRTH - Focus on the use of the partograph



Lack of monitoring and evaluation of work

Decentralization of the production of partograph by health facility

Health Financing

Possibility of financial barriers for about 7% of women who give birth at home and need to investigate causes

Conduct a household survey to identify the causes of home birth

Health Work Force

Insufficient quantity (unequal distribution between rural and urban areas) Insufficient quality (profile of trainers is not appropriate) Lack of a plan for training and supervision

Develop a plan for continuing education and supervision for nurses and midwives Revise the core curriculum


Lack of leadership responsible for wards Poor stock management Lack of decentralization

Redefining the supply and distribution system tools (budget mechanism, role and responsibility of health facilities)


Geographical inaccessibility especially in rural areas Public private partnership Lack of access to water and electricity Inadequate basic training

Implement outreach Strengthen the health sector PPP


Poor performance of the information system (lack of timeliness and completeness, low quality data, data not available from the private for profit sector)

Refresh data collection tools Strengthen management teams


Partnership

Newborn community component – poorly defined and low community involvement

Design a policy/strategy taking into account community-based interventions




INTERVENTION 4: CEmOC - Focus on caesarean section



N/A

N/A

Health Financing

Funding is inadequate to improve existing facilities and to expand to districts that do not have CemOC facilities

Advocacy for fund to upgrade existing HC to hospitals

Health Workforce

Insufficient skilled workers Mal-distribution of skilled staff

Revise staffing norms Scale up LSS training Train all newly qualified midwives in LSS


Centralization of blood processing Weak management of logistics for blood processing (62% of District hospitals have refrigerators, 38% of hospitals blood bags had blood bags, 51% hospitals had hepatitis screening kits)

Advocate for review of the blood transfusion Build capacity of the District hospital to screen, process and store blood


No quality of clinical audit Maternal death audit Infection Prevention and Control Referral system

Develop guidelines and benchmarks for clinical audit Retrain facility based clinical teams Intensive monitoring on infection prevention measures in facilities


Non-capture of data from private sector No Routine assessment of EmOC IT Challenges

Engage the Private Sector through association- provide guidelines, provide training Develop guidelines and orientate facility managers to institutionalize routine EmOC assessment


Partnership

Inadequate capacity of health managers to engage communities and traditional authorities Non-standardization of messages in the local languages

Develop partnership with other sectors e.g. Local Government to engage communities through tradition Use network of community radios to provide messages to communities in local languages High illiteracy levels - Develop pictorial




materials

INTERVENTION 5a: BASIC NEWBORN CARE FOR ALL NEWBORNS - Focus on

cleanliness/cord care, warmth, and feeding support




Implementation of policies and procedures is not always effective: lack of equipment, training, supervision at all levels (especially hygiene)

Home care for infants not yet introduced in policy documents, norms and procedures.

Memory aids are often not displayed

Division of tasks is not done leading to an overload of work in the delivery room

Job descriptions are not always detailed/written

Lack of support to “AME (fr)”

Improve service organization and leadership at the district level

Create and follow job descriptions

Make memory aids available

Strengthen capacity for providers on infection prevention

Advocate with local authorities and health committees for the acquisition and maintenance of equipment

Training manuals were adapted and training and post-training follow-up is in progress (scaling up by the end of 2014)

Strengthen support for “AME (fr)”

Integrate home care in the next revision of national plan but in the meantime, send technical notes to regions

Accelerate the scale up of home care

Find a system for recovery and systematization of supervision at all levels

Health Financing

Not enough funding for equipment

Not enough funding for care: the care is expensive, families cannot support direct payment

Ensure the operationalization of the initiative of free care for children under 5 years as part of current strategy/policy

Seize the opportunity of public-private partnerships to increase funding

Health Work Force

Lack of health workers to provide neonatal care Job descriptions not followed

Scaling up of neonatal care through the use of community health workers

Mandatory use of job descriptions at




the supervisory level and display organogram


Use of chlorhexidine is not included in the protocols of care for the newborn

Evaluate the policy of dry cord care to decide whether to adopt the use of chlorhexidine for cord care


Full service delivery package is not always provided/available Deliveries don’t always happen in facilities because the environment does not allow for it Hygiene rules are not followed (deficient equipment and inadequate training / skills of providers, lack of motivation, no source of water in some delivery rooms)

Inadequate patient admission procedures/conditions

Not enough funding for public-private partnership

Irregular supervision

Improve and strengthen the system of accreditation of health facilities to improve the quality of services


Perinatal deaths not sufficiently taken into account in death audits

Death audits not performed systematically

Empower audit committees to be more systematic


Partnership

The postnatal visits are not always attended because of geographical or affordability problems, cultural beliefs, lack of quality of services

Postnatal visits are often made for mothers but not for newborns (if baby is doing well it is thought that a check-up is not needed) Patients are referred to health centers, but the referral system is dysfunctional

Scale-up home care for mothers and newborns Encourage local authorities to work with community leaders and health workers to strengthen referral system Improve communication with the general population through men’s groups, social mobilization, etc. Community health workers must be literate in national languages and tools should be translated into local languages for better understanding of




Tools are in French, but communication is in the national language and functional literacy (national language) is very low in Senegal Poor involvement of men

the target

INTERVENTION 5b: BASIC NEWBORN CARE FOR ALL NEWBORNS - Focus on

cleanliness/cord care, warmth, and feeding support



High quality hygienic standards are not properly followed Poor coordination with private facilities

Develop a plan for repayment and equipment monitoring Apply hygienic standards in accordance with facility strategic plan Create a coordination system for public and private structures

Health Financing

Insufficient funding to acquire appropriate equipment

Identification, by level, of specific needs Fundraising Develop a financial plan Identify specific needs and seek funding

Health Work Force

Lack of training that takes into account all the skills needed to take care of newborns

Develop a training plan

Promote training monitoring


N/A N/A


Lack of supervisors to oversee postnatal check-ups

Lack of qualitative data analysis / surveys

Prenatal and postnatal care training Monitor deliveries and prenatal care Revise/review supervision structure Conduct a qualitative study to analyze




customer satisfaction

Monitor activities and delivery of prenatal care Conduct a qualitative study to analyze customer satisfaction


Lack of data collection on postnatal care Lack of clinical journals related to newborn care from which data can be extracted

Take into account postnatal care data when revising materials Conduct regular reviews of newborn management and report on it


Partnership

Lack of social mobilization Lack of effective strategies to improve access to newborn care services in rural areas

Strengthening BCC for key family practices (KFP) Community involvement including micro planning Support joint health actions

INTERVENTION 6: NEONATAL RESUSCITATION



Packing of the guidelines Referral prioritizes the mother - doesn’t always focus on the newborn

Divide training documents into modules for ease of use and reference Emphasize in the guidelines that newborns should be prioritized

Health Financing

Financial barriers and insufficient funds at national and district levels

The government has recognized this as a gap at national level and is making provisions to procure bag and masks, but not for all Need more advocacy to get state level and LGAs procurement and funds. Discussions at national level to explore supply side issues / opportunities with private sector Expand health insurance coverage and include newborn health in the scheme

Health Work Force Not enough competent health workers across all levels

Training (pre- and in-service) and re-training of health workers to improve




Job aids exist but not enough There is mentoring and supervision but only exist in pockets Numbers and distribution

competence Provision of adequate job aids across board Strengthen supervision at all levels Recruitment, deployment, equitable distribution and incentives


Equipment not available Equipment not appropriate size for the newborn Quality

Funding Standardization for procurement including quality


Funding for quality improvement Enforcement and supervision Rotation of trained health workers in newborn health Poor arrangement/ organization of service delivery points

Funding for regular supervision PHC review Keeping workers where they are trained Re-organize service delivery points to ensure integration along the continuum of care and better quality of care

Health Information System

Information not being collected and measured so data is not being used for action

Include neonatal resuscitation indicators in HMIS and make data collection a requirement


Partnership

Low awareness and knowledge Socio-economic barriers Limited engagement of community

Improve community engagement through involvement in planning and implementation using existing structures such as women’s groups and Ward Development Committees Community groups should support fundraising Community groups to create awareness and peer pressure / positive deviance for newborn health

INTERVENTION 7: KMC



Requires improvements in health structures

Advocacy for inclusion of KMC spaces for new construction of facilities and




redevelopment of existing structures

Health Financing Dependence on external funding

Advocacy for increased health budget line for maternal and newborn evaluation

Health Work Force Shortage of health workers

Introduction of KMC in intitial training course


N/A N/A


Availability of space for KMC units

N/A


N/A

N/A


Partnership

Low involvement of men

N/A

Intervention 8: MANAGEMENT OF SEVERE NEWBORN INFECTIONS - Focus on the use of

injectable antibiotics



The Guidelines are available but are limited to the District Hospital and 65 of the BEmONC facilities Inadequate funds to disseminate and Print the documents Commitment of staff

Systematically disseminate guidelines and protocols to all health facilities.

Health Financing

Indirect Cost Stock out leading to the woman buying the drugs Unofficial Costs

Civil society involvements Conditional Cash Transfers being explored

Health Workforce

Inadequate and inequitable distribution of Skilled Personnel (Rural

Training of more staff- Midwives Incentives and living environment, retention package in remote areas In-service training Rational and equitable posting of staff

Essential Medical Products and

Only occasional stock out of injectable antibiotic

Build MoHS capacity on quantification and forecasting using the current




Technologies restructuring of PSM.


Weak referral system from community to PHU to district hospital Delays in the referral chain Low skills and knowledge among the staff on emergency newborn care.

Strengthen referral system, provide ambulance system and community involvement In-service training to improve skills.


Lack of newborn care infection data in HMIS. No perinatal audits.

Use current HMIS restructuring to include appropriate data collection on newborns Include some perinatal audits into on-going MDRs


Participation

Direct and indirect financial barriers to access Staff attitude Social cultural barriers

Social protection policy drafted that is proposing Cash Transfers Supportive supervision and monitoring of staff performance Staff motivation Community involvement and awareness

Intervention 9: INPATIENT SUPPORTIVE CARE FOR SICK AND SMALL NEWBORNS - Focus on IV fluids, feeding support, and safe oxygen



Enforcement (supervision and monitoring) Bringing recommendations into practice at service delivery level Availability of guidelines

Making guidelines widely available in secondary and tertiary facilities Strengthening quality assurance teams to monitor and supervise

Health Financing

Forecasting Funds to procure and distribute Out of pocket payments Maintenance

insurance for out-of-pocket payment Appropriate forecasting for estimation based on need Strengthen logistics system




Health Workforce Incomplete Incomplete


Incomplete Incomplete






Participation





ANNEX 4: FOLLOW-UP ACTIONS / NEXT STEPS IN-COUNTRY

CAMEROON

Activities

July August September Oct Nov Dec

Responsible Observations 1 2 3 4 1 2 3 4 1 2 3 4 S1

S2

S3

S4

S1

S2

S3

S4

S1

S2

S3

S4

Share with country colleagues

Drs Baye, Moluh, Ngum, Monebenimp

Submit at central level and share draft Every Newborn document

DSF

July 25, 2013

Organize a preparatory meeting to create an advocacy plan

DSF

Implement the plan

Relevant personnel

2013 - 2014

Send country feedback on Every Newborn document

MINSANTE

Review strategy documents and include newborn issues

Relevant personnel




Identify a newborn focal point at the central level

MINSANTE

Convene a national consultation on newborn health

DSF

Create a newborn sub-group as part of the mother/ child technical work team.

MoH

Share the RMNCH strategic plan of Cameroon 2013-2014

MoH

CONGO

Activities Responsible Timeframe

There is a draft of the plan on child survival

(Technical submission to DGS on 18/07, then to Diracab)

DSF

July 23rd, 2013

Integrate newborn into child survival docs DSF July 26th, 2013

Workshop for validation of technical aspects with all stakeholders

DSF August 2-3, 2013

Prepare budget DEP August 20th, 2013

Final validation MoH Office August 28th, 2013

Disseminate plan DSF September

Define operational plans at department level DEP/DSF October




DR CONGO


Feedback on meeting to Task force for MNH made up of major stakeholders

Dr Ilunga/Team July 22-25, 2013

Hire 2 consultants (1 national and 1 international) to prepare national forum for newborn health

Unicef August /2013

Organize the national forum for the newborn (situation analysis; identification of bottlenecks, challenges and solutions)

Department of Family and specific groups

September 16-21, 2013

Elaborate the GENAP as part of the acceleration timeframe of MDGs 4 and 5

Technical team October 30th, 2013

Integrate the GENAP interventions in operational health action plans.

Investigation and Planning Department

November-December 2013

GHANA

Activity Responsible Timeframe

Hold newborn stakeholders meeting FHD/RCH July 2013

Newborn Care Steering Committee to meet Minister of Health

DG/DFHD Aug 2013

Develop Advocacy materials for Newborn Health FHD/HP September 2013

Newborn care steering committee to meet Female Caucus of Parliament

GHS/MOH October 2013

Newborn Care Steering Committee to meet Minister of Gender, Children and Social Protection

GHS/MOH October 2013

Develop new born care strategic plan DFHD August – December 2013

NIGER


Debrief Top Management (MSP, UNICEF,OMS) Dakar Team July 16, 2013




Convene national committee on reduction of maternal and child mortality to give them necessary input for national plan (information and identification of specific sub-committee)

MSP July 22-26, 2013

Prepare documentation for info and advocacy DGSR September – October 2013

National workshop for feedback and consensus building for care of newborn

DGRS October 2013

National advocacy and workshop result sharing forum. DGSR October 2013

Integrate strategies in annual action plans at all levels MSP/DRSP/DS November

Implementation MSP From 2014

NIGERIA


Write a report of the GENAP meeting and submit to the Hon Minister of Health for approval

Dr Joy Ufere/Team

3rd

wk of July

Present report and recommendations to the CTC Team Last wk of July

Convene a meeting of an expanded neonatal subcommittee of the UNCoLSC – to plan for National Consultation meeting on NBH

FMOH & partners

Last wk of July

Conduct a comprehensive BNA on NBH in preparation for a national consultation meeting - Link NBH processes into the already existing APR, and SOML initiatives

Team lead by FMOH

1st

wk Sept

Convene a national consultation meeting on NENBAP FMOH 2

nd

wk Sept

SENEGAL


Finalize consultation document Senegal Team By July 16

Feedback on national consultation to operational and steering committee for child survival

Mariètou

July 18

Increase newborn target visibility in current on-going national plans.

Operational Group

End of July




Meet with operational group to contribute to GENAP Operational Group

By July 25

National consultation with stakeholders to contribute to the GENAP

DSRSE Week of September 2nd, 2013

Elaborate newborn advocacy plan DSRSE October 2013

Implement advocacy plan DSRSE Nov 2013-Nov 2014

SIERRA LEONE


Debrief Top Management Deputy CMO

15th, July 2013

Debrief RCH TCC on Newborn Global Health Action Plan and UN Commission on Life Saving Commodities - Set up working groups to finalize country bottlenecks - Propose consultation - Identify and recruit consultant to populate bottleneck tool and finalize report

Deputy CMO/Director RCH

18th, July 2013

Convene 2 days country consultation to discuss and agree on the bottlenecks, and provide input to the Global Every Newborn Draft Action Plan - One day working session - Follow-up meetings for the next one month

Deputy CMO/Director RCH

24th -25th,

July 2013

Complete UN Commission on Life Saving Commodities Proposal and submit

Deputy CMO /Director RCH/H4+

By 15th, August 2013

Finalize and complete bottleneck analysis tool DCMO /Director RCH/ Consultant

By August 22nd, 2013

Prepare, finalize and submit report of consultation process to the Global Action Group on newborn and give feedback on Global Newborn Action Plan

DCMO/Director RCH/Consultant

By August 22nd, 2013

Follow up on actions from the recently concluded National Newborn Advocacy Forum held on 12th June 2013

DCMO/Director RCH




ANNEX 5: FEEDBACK ON EVERY NEWBORN DRAFT DOCUMENT

VISION, GOAL & TARGETS: Group 1 (French)

Vision

The group liked option 1 best as it was positive and accurate. The quality of life taken into account. It is consistent with the principle of CARMMA “no woman should die while giving life” and A Promise Renewed Other options are defeatists and stillbirths is inevitable.

Goal

Group proposed “Achieve universal quality coverage of essential interventions in maternal, newborn and child health by strengthening the health system and health promotion”

Target

Group preferred absolute target of NMR in 2035 at 9/1000 live births with intermediate targets every 5 years Suggested sub-national equity targets and quality targets of key intervention coverage

VISION, GOAL & TARGETS: Group 2 (English)

Vision

Group wanted to include stillbirths but like the positive language of celebration in the second option. Also agreed to use similar language as A Promise Renewed and CARMMA targets. Proposed vision: “A world in which preventable maternal and newborn deaths and stillbirths are averted, childbirth is celebrated and babies thrive”

Goal

Group wanted to specifically include social determinants of health but thought the goal needed to recognize that this is a cross-sector issue and more than just the role of MoH. Also context specific. Agreement to include “address related social determinants of health in partnership with other sectors” Goal is bigger than the vision by including “women and children health” – propose removing women’s and children’s response

Target

Most of the group wanted an absolute target Discussion about needing to do costing analysis to determine what is achievable realistically and feasible in a country. Identified that the OneHealth Tool is available to do costing. Suggest adding “or less” after the absolute target as some are already on target.




STRATEGIES 1-3: Group 1 (French)

Focus on the time of birth

and high-impact, cost-

effective interventions

Strategies addressed the contiuum of care All countries apply the strategies listed but scaling up is an issue Suggestion to add strategies for poverty eradication There is a problem of prematurity induced by physicians through early c-section Coverage of prenatal care needs to be improved Treatment of severe infection should be expanded to any infections Postnatal care: mothers and newborns should be cared for 24 hrs after delivery and on 3rd and 7th day. In some countries there is a baby shower/baptism on the 7th day. Need better communication action to link event with PNC. Later consultations should be carried out for mother and newborn eg days 7-14.

Quality of care

QoC is important: training, infrastructure, equipment. Disseminate implementation of standards and ensure that commodities are available. On the job training and regular supervision. Perinatal and maternal death review – should include “near misses” including newborns. Focus on patients’ rights and strengthen mechanisms for monitoring quality of reviews. Strengthen regular monitoring of QoC Performance incentives/funding including user involvement in assessments of quality. Proposal to group normative functions separate to competency building of HR

Proposed new order

Develop laws, regulations, norms and standards related to support universal coverage of newborn health interventions as well as mechanisms for enforcement of those; this includes effective legislation on marketing of breastmilk substitutes, health commodities, service standards, standards for education of health professionals etc. Strengthen competencies of health professionals, including midwifery personnel, through curriculum development for pre- and in- service training, continuous education and supportive supervision Ensure the availability of essential commodities at all levels, identify bottlenecks




STRATEGIES 1-3: Group 2 (English)

Terminology: ENC vs BNC

ENC (spotlight PLUS) or BNC (interventions)? This terminology is confusing. Needs to be harmonized. Countries are used to ENC. If we use BNC then we have to be very clear as to what this means. Core group said (Bernadette): Essential = Basic (warmth, feeding, etc.) + others (resuscitations, care for preterm birth, care for sepsis etc.) Want to keep ENC – what countries are currently using

Terminology: Childbirth care

Specify what is childbirth care (3rd stage of labor - when the baby comes out). Proposal to organize in the following way: Just before labor, labor, delivery and postnatal

“Spotlight PLUS slide”

slide / conceptual framework

diagram

Diagram needs to be clarified The circles and boxes should be aligned so they follow the continuum of care (colors or legends). Monitoring, actions and outcomes. Highlight the ones that are pertinent to the newborns

Definitions

Give operational definitions for all terms as to avoid confusion and where possible harmonize with terminology that is being used in country. Community vs. facility: Community based? What community package is going to be promoted/addressed? Skilled care at birth – everything necessary to provide skilled care not just skilled birth attendant Infections / Inpatient Care: Treatment of any infections (not just severe). Add severe infections to inpatient supportive care? Inpatient supportive care special/inpatient care for sick and small babies. Inpatient (to include community) management for very sick and small newborns. What is meant by special care for small babies? Management of preterm labor and delivery (goes beyond birth) Does resuscitation include stimulation and drying? (i.e. HBB)

Postnatal care

Highlight postnatal care as separate activity– 24 hrs, day 3, day 7

Order Should re-order interventions and avoid duplication and overlap

Quality of care

Recommend including midwifery, nursing, CHWs – “skilled attendant” instead of “midwifery” (this is adapted/defined in the country context) Does the 3rd bullet address access to care? Access in that the drugs are in the facility and close to where they need to be administered.




STRATEGIES 4-6: Group 1 (French)

General Comments

Practical inputs to actions provided in PPT Filling in gap for skilled staff: fair posting of staff Institutionalize and promote birth registration (5) Spell out indicators and deadlines (better to understand than benchmarks) Strengthen monitoring of health services Strategy 6: encourage community leadership and develop champions Incentives re CCT: CCT and universal health coverage Adopt/strengthen policies to promote access

STRATEGIES 4-6: Group 2 (English)

General Comments

Practical inputs to the actions under themes 4-6 detailed in PPT Group suggested adding a crosscutting principle or theme “harnessing use of appropriate technologies (e.g. mobile phones) Consider the point of adding “based on evidence” to other themes esp where interventions are prioritized

Coverage and equity

Add “Fill critical gaps in numbers and distribution of skilled personnel, in particular midwifery personnel, for maternal and newborn health through accelerated production, retention, and motivation approaches” Add “Define and make available the delivery of the priority interventions packages by level of health service provision, at community, primary and referral levels with the- appropriate skills mix (and based on evidence) Reduce financial barriers out-of-pocket payments for maternal and newborn health services and institute financial protection mechanisms (for example: reduce out of pocket…) Reduce inequities in coverage of effective interventions, giving special attention to social determinants of health (including hard to reach, vulnerable popns). Also discussed male power dynamic) Give special attention to adolescent girls and implement approaches to help prevent early and unwanted pregnancies (we discussed use of the term ‘early’ given different country definitions of adolescents)

Count every newborn

Institutionalize VITAL registration Implement maternal and perinatal death surveillance and response (ensure consistency as quality of care theme mentions death ‘review’)




Conduct periodic household surveys in order to obtain objective and verifiable data on mortality and intervention and demand coverage

Harness power of parents,

families and communities

Foster community leadership and accountability and develop local champions Consider strategies to generate and sustain demand for services using community owned actions (e.g. incentives, such as conditional cash transfers, sanctions, insurance, transport) Create awareness and increase optimal household practices including care seeking Empower communities to solve practical problems such as transport and incentive for CHWs

OTHER ISSUES & COMMENTS Precision, language and consistency There is a lot of work that is going to underpin and feed into this document We will look at accelerators of change that may be generalized and other countries can take on – task shifting, financial mechanisms, etc. This evidence will be in the action plan. All feedback will be incorporated into the document and continue to send comments.




Senegal delegation

Nigerian delegation

Participants at the regional consultation