Improving neonatal health inSri Lanka:

The Way Forward

Prof Dulanie Gunasekera

University of Sri Jayawardenapura

NNMR – SE region

Trends in mortality in SL

Thank You

IMR>15IMR10-15IMR<10

District variation – IMR

Source FHB 2013

Global NN deaths – when?

SL situation

same

SL situation

• SL birth cohort – 385,000 births • 99.9% deliveries in Hospitals*-

90% with SCBU (59% with NICU)*

• Deaths - NOT due to coverage/access/ lack of infra structure

• These Babies die IN HOSPITALS after receiving care

NNMR – 6.8/1000 (LB 1950 deaths)

(Source FHB 2012)

Infant mortality in Sri Lanka

Asphyxia, 12%

Sepsis, 10%

Congenital abnormalities,

43%

Prematurity, 25%

Others, 10%Asphyxia

Sepsis

Congenitalabnormalities

Prematurity

Others

Source FHB 2012

Congenital defects

• Approx. 50% of birth defectsdeaths – due to complex CHD

(progress being made)• CNS malformations

• Lethal malformations – anencephaly?• Neural tube defects – do all eligible couples get

preconception Folic Acid?

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Way forward

WHO Health System Framework

Source: World Health Organization. Everybody’s Business:

Strengthening health systems to improve health outcomes—

WHO’s Framework for Action. Geneva: WHO, 2007, page 3.

Service Delivery I- Infrastructure

• LR

• NICU/SCBU

• MBC (18)

• LMC (33)

adequately equipped?

adequate staffing?

Service delivery - II

Standardize care (SOP/STP)

• Guidelines/STP/SOP

need to IMPLEMENT guidelines/SOP/STP

eg. hand washing, judicious use of AB

Service delivery – III

Skill Enhancement –

• NNR- mandatory skill for all HCW

• ENBC – essential knowledge for all HCW

• Sick NB – stabilization, retrieval/transfer

Maintain/improve levels of skills -

revalidate

Work force

• Adequate cover

• Adequately trained

• 24*7 cover of LR/ SCBU/NICU-MO/nurses/MW

• ADEQUATE numbers –per bed/shift

• Core skills training, certification – for LR/SCBU/NICU staff

Information

Quality control -

• monitoring & evaluation

• clinical audit -mortality/morbidity

• real time data base ( ICD- 10 classifications)

Drugs/ equipment/services

• Availability of essential drugs

• Other services

• dexa, antibiotics

• Surfactant

• CPAP/incubators

• In utero Transfer (high risk preg)

• NN retrieval services

• MBC- KMC

Financing

• Health expenditure - % of GNP – 1.2%• as % total govt. expenditure – 4.1%• Per Capita expenditure - Rs 4,392

• Disbursement • Utilization

(Source MoH 2012)

Legal framework

• Termination of Pregnancy

• Mandating core skills

• Revalidation

Advocacy/leadership Role

• SLCP – core group of experts – advocacy to MoH, governance

• Close collaboration/ partnership with MoH

• SLCP key partner

• Key issues – skills training

implementation

monitoring/evaluation/revalidation

decision making process

Thank you

Under-5 Mortality - SL

Source : Registrar Generals Office 2009