al bartlett, saving newborn lives
DESCRIPTION
Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015 12 April 2013TRANSCRIPT
Save the Children –
Saving Newborn Lives
What we’ve learned, where we’re going
Australia April 2013
Outline
I. Background – Why Newborn Health? II. Getting on Global & National Agendas –
SNL’s experience III. Where now? - Priorities and Opportunities
for Achieving Impact at Scale
High income countries ~11 million births
Middle income countries ~34 million births
~40 million facility births ~50 million births at home
135 million
live births per year
2010 One in 4
newborns is African
2035 One in 3 will be
African
Why are we focused on newborn survival?
Three killers – prematurity, asphyxia, and infections -
account for 81% of all neonatal deaths 3.1 million
Sources: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010. UNICEF, State of the World's Children, 2011.
Causes of death in children under-five in developing countries – Newborn deaths are almost half of all deaths of children under five
0
20
40
60
80
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
Source: UN Inter-‐agency Group for Child Mortality Es>ma>on, Levels and Trends in Child Mortality: Report 2011; UNICEF, Required Accelera>on for Child Mortality Reduc>on beyond 2015, 2012; team analysis SNL/Save the Children team analysis for NMR projec>on for Call for Ac>on mee>ng
Mortality Ra
te (d
eaths / 1000 births)
20
35
Accelerated U5MR ARR = 5.1% Current U5MR ARR = 2.2%
* ARR = annual rate of reduc>on
MDG 4 target = 34 U5MR
Global Progress for child survival U5MR and NMR decline 1990-‐2010, projected to 2035
15
Current NMR ARR = 1.8%
If 1-‐59 month mortality accelerates further but neonatal mortality conKnues on same trend then with
2 million child deaths in 2035, 1.5 million may be neonatal.
REGION
Neonatal mortality rate Average annual change 1990-‐2010
Africa 1.3% East Med 1.6% Southeast Asia 2.2% Western Pacific 4.2% Americas 3.6% Europe 3.6%
Maternal mortality ratio = 4.2% 1- 59 month mortality rate = 3% Neonatal mortality rate = 1.8%
All 3 measures show increased progress since 2000
Source: 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: Oestergaard et al 2011 PLoS, UNICEF 2012 www.childinfo.org
2165
2085
2040
Mortality average annual rate of reducKon
WHEN WILL REGIONS REDUCE NMR TO CURRENT RATE OF HIGH INCOME
COUNTRIES (3 per 1000)?
• First major international program to focus on newborn survival
• Supported key research on newborn interventions in developing country settings
• Raised global and national awareness
SNL 1 (2000-2005)
• Large-scale research activities
• Programs in 18 countries
• Global advocacy and partnerships
• Established communication platforms including the Healthy Newborn Network
SNL 2 (2006-2011)
Outline
Getting on Global & National Agendas – SNL’s experience:
• Intention • Evidence • Exposure • Engagement
Infection Management
RCT in Pakistan
Postnatal Care Package OR in
Bangladesh
Integration of newborn care RCT
in Uganda
Neonatal sepsis management
through HEWs in Ethiopia
Simplified Antibiotic Trial
Testing if simplified antibiotic regimens
are effective treatment for sepsis
Treatment failure
To modify global policy
PNC Operations Research
Testing existing cadres providing home visits to
improve practices
Coverage & Practices
To inform MOH & partners how to deliver PNC in existing system
and scale up
UNEST Testing community-based package using volunteers
linked to the health system
Coverage & Practices
To inform MOH how to scale up newborn care
through health extension volunteers
COMBINE Testing govrn’t HEW’s ability to identify and treat probable severe
bacterial infection
NMR, Case Detection & Practices
First study with NMR end point in Africa;
providing input for GoE decision on HEW role
in newborn care
Out
com
es
Des
crip
tion
In
fluen
ce Evidence to inform policy and program
Systematically Sharing Evidence
Exposure (beyond journal articles): Evidence Summaries
Engagement: Translating Research & Data for Action
Regional Opportunities for Africa’s Newborns
ASADI Science in Action
LAC Alliance
Global Countdown to 2015
CHERG
LiST
UN Joint Statement on Home Visits
National Situation Analysis (15)
Data Profiles
Engagement at Country Level (Nepal): Catalysing naKonal policy change through partnership
Source: Pradhan YV et al. 2012. Newborn survival in Nepal: a decade of change and future implica>ons. Health Policy and Planning 27(Suppl. 3):iii57–iii71.
Saving Newborn Lives 1 Saving Newborn Lives 2
0 5 10 15 20 25
Bangladesh
Malawi
Nepal
Pakistan
Uganda
Tanzania
Ethiopia
Mali
Bolivia
AchievedPartially achievedNot achievedMissing
0 5 10 15 20 25
Bangladesh
Malawi
Nepal
Pakistan
Uganda
Tanzania
Ethiopia
Mali
Bolivia
2000 2010
Source: Moran AC et al. 2012. Benchmarks to measure readiness to integrate and scale up newborn survival interven>ons. Health Policy and Planning. 27(Suppl. 3): iii29-‐ii39.
Engagement – Catalyzing Change in Countries: 27 Benchmarks of scale-‐up readiness for newborn care
Some SNL-assisted countries have made important progress
1990-2010 Changes in Newborn Mortality
• Bangladesh: 51% decline • Bolivia: 41% decline • Indonesia: 45% decline • Malawi: 39% decline • Tanzania: 35% decline
Levels & Trends in Child Mortality – Report 2010 UN Inter-‐agency Group for Child Mortality EsJmaJon
Outline
Where now? - Priorities and Opportunities for Achieving Impact at Scale
At Global Level – • Increased political commitment and resources
• Increased participation by key organizations
• “Need to see it actually done at scale”
At Country Level – • Newborn programs taken to scale through health systems • Increased resources • Responding to increasing rates of facility births • Improving families’ expectations, care, & care-seeking
for newborns • Adequate indicators and monitoring
2011-2 SNL Evaluation conclusions: What remains to be done
SNL 3
• Success (“3 + 1”) =
Ø High impact newborn interventions are effectively delivered and used at national scale in selected countries;
Ø Learning and evidence is documented, shared, and used within and outside SNL-assisted countries;
Ø Partnerships committed to newborn survival & health are expanded;
• 5 years, $40 million
+
Ø Newborn survival and health are institutionalized within countries and key partners
Scaling up newborn interventions through health care systems and programs - a systematic & measurable approach
“EffecKve coverage” Scale-‐up readiness
Capacity to implement: -‐ Trained workers -‐ CommodiKes -‐ Guidelines & standards
Strength of implementaKon:
-‐ Availability -‐ Quality -‐ Accessibility
Social & behavioral change
Community & home care: -‐ PrevenKve pracKces
Community & home care: -‐ Problem recogniKon -‐ Appropriate care-‐seeking
Champions
Government Officials &
Parliamentarians
Health Sector Managers & Health
Workers
Civil Society OrganizaKons
Community Leaders
What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
Opportunities for global & regional influence
24
• Research priority setting and tracking (with WHO) - Identify opportunities from WHO priority list
- Connect with the community – “Sign up” for topics
• Participate in knowledge exchange / communities of practice • Promote evidence-based interventions and effective delivery
approaches • Participate in regional / global movements for newborn health
– Child Survival Call to Action (“Promise Renewed”)
– “Global Newborn Action Plan”
• UN Commission on Life-Saving Commodities
– Participate in situation analyses and/or national planning for newborn commodities
2013 – A tipping point for newborns?
25
April May September
Global Newborn Health Conference (UNICEF / USAID / SNL / WHO)
State of the World’s Mothers report (Mother’s day)
Women Deliver Conference
The MDG 4 & 5 Investment Framework
(to be presented at UNGA)
Global Moments
Global Movements U.N. Commission on Life-Saving Commodities for Women’s & Children
The “Promise Renewed” Call to Action for ending preventable child deaths by 2035
Post-MDG deliberations - an opportunity and a threat
November (?)
Launch Global Newborn Action Plan
Much to do…
- We look forward to working together to make it happen.
- Thanks
www.healthynewbornnetwork.org