daelmans: framework for newborn health continuum of care package

7/28/2019 Daelmans: Framework for Newborn Health Continuum of Care Package

1/24

1|

Framework for newborn healthcontinuum of care package

Bernadette Daelmans,

Coordinator Policy, Planning and Programmes

Department of Maternal, Newborn, Child and Adolescent Health (MCA)


2/24

2|

The continuum of care


3/24

3|

Essential interventions


4/24

4|


Prevention of too early, unwanted, or

rapid successive pregnancies

Adequate nutrition, including iron and folic

acid supplementation, and treatment of

anaemia

Immunization (rubella, HepB, TT)

Prevention of HIV and STIs

Prevention and treatment of substance

use

Smoking cessation

Protection from harmful exposures and

from interpersonal violence

Tetanus toxoid immunization

Birth and emergency planning

Detection and management of problems

complicating pregnancy

Detection and treatment of syphilis

Intermittent preventive therapy for

malaria*

Information and counseling on self-care

Sleeping under an insecticide treated

bednet

Prevention of mother to child transmission

of HIV* (PMTCT)

Before pregnancy During pregnancy


5/24

5|


Monitoring of progress of labour, maternal

and foetal wellbeing with partograph

Social support (companion) during birth

Immediate newborn care (resuscitation if

required, thermal care, hygienic cord care,

skin-to-skin contact, early initiation of BF)

Emergency obstetric and newborn care for

complications

Antibiotics for pre-term premature rupture of

membranes (pPROM)

Antenatal corticosteroids for preterm labour

PMTCT

Exclusive breastfeeding

Thermal care

Hygienic cord care

Prompt care-seeking for illness

Extra care for low-birth-weight babies,

including kangaroo mother care

Immunization

Management of newborn illness

PMTCT

During child birth In the newborn period


6/24

6|

Family/

community

HOME VISITS

DURING

PREGNANCY

MANAGEMENT OF

NEWBORN PROBLEMS

SAFER HOME BIRTH

EARLY POSTNATAL HOME VISIT

CARING FOR THE

NEWBORN AT HOME

Newborn/postnatalPre-pregnancy Pregnancy

Outpatient

Clinical

ANTENATAL

CAREPOSTNATAL CARE

ESSENTIAL LABOUR AND

CHILDBIRTH CARE

MANAGEMENT OF

NEWBORN PROBLEMS

REPRODUCTIVE

CARE

AND

PRE-

PREGNANCY

CARE

Intersectoral: improved housing, water and sanitation, and nutrition; education and empowerment

Childbirth

Packages of care

TREATMENT

FOR

PREGNANCY

COMPLICATIONS

IMMEDIATENEWBORN CARE

MANAGEMENT OF

NEWBORN PROBLEMS


7/24

7|

The time AROUND childbirth:A window of opportunity for impact

Labour and childbirth care

Labour monitoring

Childbirth care

Essential newborn care

Birth: drying, skin-to-skin

First week: early/excl. BF,

warmth, cord care, hygiene

Obstruction/Fetal

distress: CS, vacuum

PT labour: corticosteroids,

antibiotics for PPROM

Preterm birth: Kangaroo

Mother Care, BF support,

immediate treatment ofsuspected infection

Suspected sepsis:Early antibiotic

treatment

Not breathing at

birth: Resuscitation


8/24

8|

Ending preventable newborn deaths

Labour and childbirth care

Labour monitoring

Childbirth care

Essential newborn care

Birth: drying, skin-to-skin

First week: early/excl. BF,

warmth, cord care, hygiene

Obstruction/Fetal distress: CS,

vacuum

PT labour: corticosteroids,

antibiotics for PPROM

Preterm/LBW: Kangaroo Mother

Care, BF support, immediate

treatment of suspected infectionSuspected sepsis: Early

antibiotic treatment

Not breathing at birth:

ResuscitationCARE DURING

PREGNANCY

TREATMENT

FOR

PREGNANCY

COMPLI-

CATIONS

PRE-

CONCEPTION

CARE

REPRODUCTIVE

CARE


9/24

9|

Quality of care: a barrier to progress

Quality of care has been recognized

as a neglected issue in the

international health agenda.

Global data show that quality of care

provided in referral facilities is often

poor.

Poor quality of care leads to

significant morbidity and mortality.

Existence of a quality gap is a mostlikely contributor to slow progress

towards MDG 4 and 5.


10/24

10|

Improving quality of care

practice guidelines, structural standards, trainingstandards

assessment and indicators

motivation, professional development, incentives,accreditation, etc.

champions, MoHs, local authorities, professionalassociation, NGOs & international agencies.


11/24

11|

Evidence based newborn guidelines (2009 13)

Care of the newbornimmediately after birth

Newborn resuscitation

Newborn immunization

Postnatal care

Care of the preterm and low

birth weight baby

Management of neonatalsepsis

Management of neonatal

seizures

Management of neonatal

jaundice

Management of necrotizing

enterocolitis

Care of the HIV-exposed

newborn

http://www.who.int/maternal_child_adolescent/documents/en


12/24

12|

Monitoring quality

WHO Safe Childbirth Checklistcontains 29 items addressing:

the major causes of maternal

death - haemorrhage, infection,

obstructed labour and

hypertensive disorders

intrapartum-related stillbirths -

inadequate intrapartum care

neonatal deaths - birth asphyxia,

infection and complications relatedto prematurity

http://www.who.int/patientsafety/implementation/checklists/childbirth/en/index.html


13/24

13|

Context matters: Health workforce

WHO Global Health Workforce Statistics. Countdown countries affected by a severe health workforce shortagein 2012, by UNICEF region.al Health Workforce Statistics.


14/24

14|

Midwifery: the dual gap

Quantity Not enough midwives, 38

countries have severe

shortages

Quality Many existing facilities are

poorly equipped, with

inadequate staffing levels

Competencies of staff may

be insufficient Motivation and respect are

compromised


15/24

15|

A call for bold steps

Governments:

Recognize midwifery and engage midwives at national policy decisions

Include midwifery in costed MNH plans, and align human resources for health plans.

Invest in active monitoring of the practising midwifery/MNH workforce.

Regulatory bodies

Educational standards and practice competencies.

License and relicense midwives.

By schools and training institutions

Improve and maintain competencies in midwifery and transformative education.

Support development of midwifery leadership

By professional associations

Establish solid governance, strengthen administrative capacity and improve financialmanagement

By partners:

Support programmes to scale up midwifery services enabling country commitments to

the Global Strategy


16/24

16|

Community health workers: a critical link

Pregnancy visits to promote:

Antenatal care

Birth with skilled birth attendant

Newborn care at birth: immediate

drying and skin-to-skin contact, early

initiation of breastfeeding, clean cordcare

Postnatal visits to support:

Early and exclusive breastfeeding

Keeping the newborn warm, hygienic

cord care

Extra care for LBW babies

Timely recognition of danger signs

Uptake of family planning


17/24

17|

Adolescence: a time for investment

Preventing early pregnancy Prevent early marriage

Prevent early pregnancy

Increase use of contraception

Combat coerced sex

Reduce unsafe abortions

Increase access to skilled care

Reaching out before conception Provide folic acid supplementation

Reduce harmful behaviors (tobacco, alcohol)

Pay attention to mental health

Providing extra care for mother and baby

During pregnancy and childbirth

In the postnatal period


18/24

18|

Conducive policies are essential


19/24

19|

Surveillance to save lives

Surveillance

Response

Identify

deaths

Report

deaths

Response

action

Review

deaths

MMR trackingQoC measurement

Vital registrationQoC improvement


20/24

20|

Life-saving commodities: a new impetus

13 life-saving commodities

10 recommendations Shaping global markets

Shaping local delivery markets

Putting in place innovative financing

Strengthening quality

Making regulation more efficient

Increasing supply and awareness

Increasing demand and utilization

Reaching the poorest women and children

Improving performance and accountability

Prioritizing and funding product innovation


21/24

21|

Closing the equity gap

:Source:2015Barros AJ D et al., Equity in maternal, newborn and child health interventions in Countdown toa retrospective review of survey data from 54 countries. Lancet 2012; 379: 1225-33.

Cove

rage


22/24

22|

Family Planning

SummitBorn too soon

A Promise

Renewed

Country leadership & Implementation

Decade of Vaccines

Global action plans: nutrition, pneumonia & diarrhea, newborn

Visit www.everywomaneverychild.org

Key advocacy events and catalytic initiatives in support of

Every Woman Every Child

Commission on Live-saving Commodities

CoIA Independent Expert Review Group

Innovations working group

Bringing it all together


23/24

23|

HOME: She and her family were visited by a

CHW during pregnancy, who encouraged ANC

and early care-seeking for danger signs

HOSPITAL: When the mother went into

premature labour, her husband urged her to go

to the hospital, and she delivered a LBW infant

weighting 1.5 kg

HOME:When discharged from the hospital on

day 5, the CHW visited to assist with feeding,

ensuring warmth and screen for danger signs

This young mother lives in an area covered by a home-based

newborn care program

The continuum in action


24/24

24|

Thank you

daelmans: framework for newborn health continuum of care package

Documents