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Neonatal Health and         Sur vivalGenerating Evidence and Translating            into Practice             Abdullah Baq...
Baqui Newborn Research Activities• Develop and test feasible, context-specific, and cost-effective interventions• Use evid...
A Research Partnership toGenerate EvidencePROJAHNMO inBangladesh                     3
PROJAHNMO in Bangladesh: Context• Partnership of Bangladesh MOHFW,  ICDDR,B, Shimantik, CHRF, and Johns  Hopkins Universit...
Projahnmo-1: Interventions• Between 2001-2006, developed, implemented and  evaluated a package of community-based MNH  int...
Projahnmo-1: ServiceDelivery Strategies• One CHW/ 4,000 population• 2-monthly home visits to identify pregnant women• 2 an...
Projahnmo-1: Key Findings• Home based delivery of a community-based package of  MNH interventions reduced NMR by 34% (Baqu...
Projahnmo: Policy and ProgramImpact• MOHFW/Bangladesh developed a national  neonatal health strategy• USAID/Bangladesh sup...
Evaluation/ImplementationResearch to Improve Program      Performance and        Effectiveness Evaluation of RACHNA Progra...
RACHNA Evaluation: Overview• A program at scale, covered ~100 million people in 8 states of  India• Integrated program add...
JHU/IIP’S STEPWISEEVALUATION DESIGNS                                                    To what extent can the impact     ...
RACHNA Evaluation – Results andinterpretation • No reduction in neonatal mortality – why? • Modest increase in coverage • ...
Optimizing integrated MNCH         services in Tanzania• MOHSW/ Tanzania implementing an integrated MNCH  program emphasiz...
Evaluation objectives• To monitor and document the implementation of the  MNCH intervention package• To provide feedback t...
Year -1 Evaluation Activities• Conducted baselines assessments using mixed  methods:   – Household Survey   – CHW surveys ...
Utilization of maternal healthservices16
Barriers to care seeking• Supply side:   – Inadequate human resources, supervision, supplies   – Inadequate quality of car...
Recommendations• Continued focus on improving quality• Develop strategies for overcoming barriers to care  seeking e.g, ad...
Concluding Thoughts• The burden of newborn and maternal mortality is still very  high• More than half of these deaths can ...
Concluding Thoughts• Many lives are at stake• We know what needs to be done• Deliver evidenced-based  interventions at sca...
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Dory Storms_Baqui_10.11.12

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Dory Storms_Baqui_10.11.12

  1. 1. Neonatal Health and Sur vivalGenerating Evidence and Translating into Practice Abdullah Baqui Pr ofessor Depar tment of Inter national HealthJohns Hopkins Bloomber g School of Public Health Cor e g roup meeting, 11 October 2012
  2. 2. Baqui Newborn Research Activities• Develop and test feasible, context-specific, and cost-effective interventions• Use evidence to influence policies and programs• Assist ministries, NGOs, and development partners to scale up tested interventions through real time monitoring, evaluation and implementation research
  3. 3. A Research Partnership toGenerate EvidencePROJAHNMO inBangladesh 3
  4. 4. PROJAHNMO in Bangladesh: Context• Partnership of Bangladesh MOHFW, ICDDR,B, Shimantik, CHRF, and Johns Hopkins University• Established in 2001 to improve new-born and maternal health• Study Site: Sylhet district in about 560,000 population• Facility delivery rate = 9%• Skilled attendance at delivery = 13%• NMR ~ 50/ 1,000; 50% attributed to infections. Funded by USAID, SNL/Save the Children, Gates Foundation, NIH
  5. 5. Projahnmo-1: Interventions• Between 2001-2006, developed, implemented and evaluated a package of community-based MNH interventions• Package components included promotion of • ANC, TT, IFA supplementation • Birth preparedness including promotion of facility delivery or skilled attendance at delivery • Recognition of maternal danger signs, and care seeking • Essential newborn care • Recognition of newborn danger sign, care seeking
  6. 6. Projahnmo-1: ServiceDelivery Strategies• One CHW/ 4,000 population• 2-monthly home visits to identify pregnant women• 2 antenatal home visits to promote the interventions• 3 postnatal home visits (days 1,3,7 of births) to promote newborn care, assess babies and manage sick babies• CHWs were trained to treat suspected infections if referral was not feasible
  7. 7. Projahnmo-1: Key Findings• Home based delivery of a community-based package of MNH interventions reduced NMR by 34% (Baqui et al., Lancet, 2008)• Early postnatal home visits on day 1 or 2 of life by a trained CHW was associated with 2/3rd lower NMR (Baqui et al, BMJ, 2009)• Early identification and management of new-born infection, either at first level health facility or at home, had additional impact on neonatal mortality (Baqui et al, PIDJ, 2009)
  8. 8. Projahnmo: Policy and ProgramImpact• MOHFW/Bangladesh developed a national neonatal health strategy• USAID/Bangladesh supported scale up in two districts• UNICEF/Bangladesh supported implementation through local NGOs in 6 additional districts• WHO/UNICEF issued a joint statement recommending home visits for the newborn child as a strategy to improve survival
  9. 9. Evaluation/ImplementationResearch to Improve Program Performance and Effectiveness Evaluation of RACHNA Program in India (2002- 2006)
  10. 10. RACHNA Evaluation: Overview• A program at scale, covered ~100 million people in 8 states of India• Integrated program addressed: – Maternal health – Child health and nutrition including community-based newborn care – Family Planning, HIV/AIDS• A facilitation program, implemented through two existing government programs: ICDS and MoHFW• Newborn package was similar to Projahnmo• Used a quasi-experimental design• Conducted annual assessments to provide feedback to implementers so that program strategies can be adjusted
  11. 11. JHU/IIP’S STEPWISEEVALUATION DESIGNS To what extent can the impact To what extent can the impact be attributed toto the program? be attributed the program? for program improvement IsIs there an impact on health and there an impact on health? for program improvement nutrition? Systematic feedback Systematic feedback Have adequate levels ofof effective coverage Have adequate levels effective coverage been reached inin the population? been reached the population? Are these services being used by the population? Are these services being used by the population? Is there continuity of care? Are adequate quality services being provided? Are adequate quality services being provided? atat health facility level?  health facility level? atat community level?  community level? Are the interventions and plans for delivery technically sound and Are the interventions and plans for delivery technically sound and appropriate for the epidemiological and health system context? appropriate for the epidemiological and health system context?
  12. 12. RACHNA Evaluation – Results andinterpretation • No reduction in neonatal mortality – why? • Modest increase in coverage • A postnatal home visit within 3 days of delivery was associated with significantly lower neonatal mortality • Modelling of data suggested that increasing coverage of postnatal home visit to 90% could reduce neonatal mortality rate by 30% • Increasing coverage, sustaining quality, and achieving health impact in large programs remain a challenge
  13. 13. Optimizing integrated MNCH services in Tanzania• MOHSW/ Tanzania implementing an integrated MNCH program emphasizing postpartum care with support from JHPIEGO• The program components include:  Development of a CHW program to provide behavior change communication and selected services  Capacity building of selected district hospitals and health centers• Conducting evaluation in partnership with MoHSW, Tanzania, Jhpiego, and Muhimbili UniversityFunded by USAID through HRCI cooperative agreement
  14. 14. Evaluation objectives• To monitor and document the implementation of the MNCH intervention package• To provide feedback to program managers on barriers to access, coverage, and quality of essential MNCH interventions to facilitate adjustment of program strategies• To assess effectiveness and cost of the final intervention package; and• To disseminate lessons learned and provide policy support to facilitate scale up to other Regions of Tanzania
  15. 15. Year -1 Evaluation Activities• Conducted baselines assessments using mixed methods: – Household Survey – CHW surveys – Facility assessments – In-depth interviews• Synthesized data and lessons learned• Shared in a participatory workshop and developed recommendations for the program
  16. 16. Utilization of maternal healthservices16
  17. 17. Barriers to care seeking• Supply side: – Inadequate human resources, supervision, supplies – Inadequate quality of care, both technical quality as well as disrespectful behavior by providers• Demand side – No systematic community-based program – Distance to facility, lack of transport, cost
  18. 18. Recommendations• Continued focus on improving quality• Develop strategies for overcoming barriers to care seeking e.g, address transport and other costs• Build linkages between the community and facility• Formalize the CHW cadre, including recruitment criteria, training, and service packages• Develop sustainable support systems for CHWs, with a focus on supportive supervision and create incentives for CHWs work
  19. 19. Concluding Thoughts• The burden of newborn and maternal mortality is still very high• More than half of these deaths can be prevented by scaling up evidenced based interventions• Successful implementation requires strengthening health system including real time monitoring/ evaluation and real time use of data to adjust program strategies• Close partnership between program managers and researchers and use of implementation/evaluation research can help us quickly attain the MDG goals
  20. 20. Concluding Thoughts• Many lives are at stake• We know what needs to be done• Deliver evidenced-based interventions at scale with high coverage and quality to reduce stagnated neonatal mortality Thank you

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