Al Bartlett, Saving Newborn Lives
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Al Bartlett, Saving Newborn Lives



Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015

Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
12 April 2013



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Al Bartlett, Saving Newborn Lives Al Bartlett, Saving Newborn Lives Presentation Transcript

  • 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 experienceIII. Where now? - Priorities and Opportunitiesfor Achieving Impact at Scale
  • High income countries~11 million birthsMiddle income countries~34 million births~40 million facility births~50 million births at home135millionlive birthsper year2010  One  in  4  newborns  is  African  2035    One  in  3  will  be  African  
  • Why are we focused on newborn survival?  Three killers –prematurity,asphyxia, andinfections -account for 81% ofall neonatal deaths3.1  million  Sources: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010. UNICEF,  State  of  the  Worlds  Children,  2011.    Causes of death in children under-five in developing countries –Newborn deaths are almost half of all deaths of children under five
  • 0204060801990 1995 2000 2005 2010 2015 2020 2025 2030 2035Source:  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  Rate  (deaths  /  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 2000Source: 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.org2165  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 onnewborn survival•  Supported key research on newborninterventions in developing country settings•  Raised global and national awarenessSNL 1 (2000-2005)
  • •  Large-scale research activities•  Programs in 18 countries•  Global advocacy and partnerships•  Establishedcommunicationplatforms including theHealthy Newborn NetworkSNL 2 (2006-2011)
  •      Outline  Getting on Global & National Agendas –SNL’s experience:•  Intention•  Evidence•  Exposure•  Engagement
  • InfectionManagementRCT in PakistanPostnatal CarePackage OR inBangladeshIntegration ofnewborn care RCTin UgandaNeonatal sepsismanagementthrough HEWs inEthiopiaSimplifiedAntibioticTrialTesting if simplifiedantibiotic regimensare effectivetreatment for sepsisTreatment failureTo modify globalpolicyPNC OperationsResearchTesting existing cadresproviding home visits toimprove practicesCoverage & PracticesTo inform MOH &partners how to deliverPNC in existing systemand scale upUNESTTesting community-basedpackage using volunteerslinked to the healthsystemCoverage & PracticesTo inform MOH how toscale up newborn carethrough health extensionvolunteersCOMBINETesting govrn’t HEW’sability to identify andtreat probable severebacterial infectionNMR, Case Detection &PracticesFirst study with NMRend point in Africa;providing input for GoEdecision on HEW rolein newborn careOutcomesDescriptionInfluenceEvidence  to  inform  policy  and  program  
  • Systematically Sharing Evidence
  • Exposure (beyond journal articles):Evidence Summaries
  • Engagement:Translating Research & Data for ActionRegionalOpportunities for Africa’s NewbornsASADI Science in ActionLAC AllianceGlobalCountdown to 2015CHERGLiSTUN Joint Statement on HomeVisitsNationalSituation 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 25BangladeshMalawiNepalPakistanUgandaTanzaniaEthiopiaMaliBoliviaAchievedPartially achievedNot achievedMissing0 5 10 15 20 25BangladeshMalawiNepalPakistanUgandaTanzaniaEthiopiaMaliBolivia2000 2010Source:  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 madeimportant progress1990-2010 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 forAchieving 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-seekingfor newborns•  Adequate indicators and monitoring2011-2 SNL Evaluation conclusions:What remains to be done
  • SNL 3•  Success (“3 + 1”) =Ø High impact newborn interventions are effectivelydelivered and used at national scale in selectedcountries;Ø Learning and evidence is documented, shared, andused within and outside SNL-assisted countries;Ø Partnerships committed to newborn survival & health areexpanded;•       5  years,  $40  million    +  Ø Newborn survival and health are institutionalized withincountries and key partners
  • Scaling up newborn interventions through health care systemsand 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 achievingimpact at scale (“Spheres of Influence”)
  • What the Evaluation taught us about achievingimpact at scale (“Spheres of Influence”)
  • What the Evaluation taught us about achievingimpact at scale (“Spheres of Influence”)
  • Opportunities for global & regional influence24•  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 deliveryapproaches•  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 newborncommodities
  • 2013 – A tipping point for newborns?25April May SeptemberGlobal Newborn Health Conference(UNICEF / USAID / SNL / WHO)State of theWorld’s Mothers report(Mother’s day)Women DeliverConferenceThe MDG 4 & 5Investment Framework(to be presented at UNGA)Global MomentsGlobal MovementsU.N. Commission on Life-SavingCommodities for Women’s & ChildrenThe “Promise Renewed” Call to Action forending preventable child deaths by 2035Post-MDG deliberations - an opportunity and a threatNovember (?)Launch Global NewbornAction Plan
  • Much to do…- We look forward toworking togetherto make it happen.- Thanks