Al Bartlett, Saving Newborn Lives

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Al Bartlett, Saving Newborn Lives

  1. 1. Save the Children – Saving Newborn Lives What  we’ve  learned,  where  we’re  going     Australia   April  2013  
  2. 2.      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
  3. 3. 135 million live births per yearHigh income countries Middle income countries~11 million births ~34 million births 2010   One  in  4   newborns  is   African   2035     One  in  3  will  be   African  ~50 million births at home ~40 million facility births
  4. 4. Why are we focused on newborn survival?   Causes of death in children under-five in developing countries – Newborn deaths are almost half of all deaths of children under five Three killers – prematurity, asphyxia, and infections - account for 81% of 3.1  million   all neonatal deaths .    Sources: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010. UNICEF,  State  of  the  Worlds  Children,  2011
  5. 5. Global  Progress  for  child  survival   U5MR  and  NMR  decline  1990-­‐2010,  projected  to  2035   Current  U5MR    ARR  =  2.2%   80 Accelerated  U5MR  ARR  =  5.1%     Mortality  Rate  (deaths  /  1000  births) Current  NMR  ARR  =  1.8%   60 40 MDG  4  target  =  34   35   U5MR   20 20   15   0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 *    ARR  =  annual  rate  of  reduc>on  Source:  UN  Inter-­‐agency  Group  for  Child  Mortality  Es>ma>on,  Levels  and  Trends  in  Child  Mortality:  Report  2011;     If  1-­‐59  month  mortality  accelerates  further  but  neonatal  mortality  conKnues  on  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   same  trend  then  with     2  million  child  deaths  in  2035,  1.5  million  may  be  neonatal.    
  6. 6. Mortality  average  annual  rate  of  reducKon   Maternal mortality ratio = 4.2% 1- 59 month mortality rate = 3% Neonatal mortality rate = 1.8% All 3 measures show increased progress since 2000REGION   Neonatal  mortality  rate   WHEN  WILL  REGIONS  REDUCE  NMR       TO  CURRENT  RATE  OF  HIGH  INCOME   Average  annual  change     COUNTRIES       1990-­‐2010     (3  per  1000)?  Africa   1.3%   2165  East  Med   1.6%  Southeast  Asia   2.2%   2085  Western  Pacific   4.2%  Americas   3.6%   2040  Europe   3.6%   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
  7. 7. SNL 1 (2000-2005)•  First major international program to focus on newborn survival•  Supported key research on newborn interventions in developing country settings•  Raised global and national awareness
  8. 8. SNL 2 (2006-2011)•  Large-scale research activities•  Programs in 18 countries•  Global advocacy and partnerships•  Established communication platforms including the Healthy Newborn Network
  9. 9.      Outline   Getting on Global & National Agendas – SNL’s experience: •  Intention •  Evidence •  Exposure •  Engagement
  10. 10. Evidence  to  inform  policy  and  program   Infection Postnatal Care Integration of Neonatal sepsis Management Package OR in newborn care RCT management RCT in Pakistan Bangladesh in Uganda through HEWs in Ethiopia Simplified PNC Operations UNEST COMBINEDescription Antibiotic Trial Research Testing community-based Testing govrn’t HEW’s Testing if simplified Testing existing cadres package using volunteers ability to identify and antibiotic regimens providing home visits to linked to the health treat probable severe are effective improve practices system bacterial infection treatment for sepsisOutcomes Treatment failure Coverage & Practices Coverage & Practices NMR, Case Detection & Practices To modify global To inform MOH & To inform MOH how to First study with NMRInfluence policy partners how to deliver scale up newborn care end point in Africa; PNC in existing system through health extension providing input for GoE and scale up volunteers decision on HEW role in newborn care
  11. 11. Systematically Sharing Evidence
  12. 12. Exposure (beyond journal articles): Evidence Summaries
  13. 13. Engagement:Translating Research & Data for Action Global Countdown to 2015 CHERG LiST UN Joint Statement on Home Visits Regional Opportunities for Africa’s Newborns ASADI Science in Action LAC Alliance National Situation Analysis (15) Data Profiles
  14. 14. Engagement  at  Country  Level  (Nepal):   Catalysing  naKonal  policy  change  through  partnership   Saving  Newborn  Lives  1   Saving  Newborn  Lives  2  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.  
  15. 15.    Engagement  –  Catalyzing  Change  in  Countries:   27  Benchmarks  of  scale-­‐up  readiness  for  newborn  care    2000 2010 Bolivia Bolivia Mali Mali Ethiopia Ethiopia Tanzania Tanzania Uganda Uganda Pakistan Pakistan Nepal Nepal Malawi Malawi Bangladesh Bangladesh 0 5 10 15 20 25 0 5 10 15 20 25 Achieved Partially achieved Not achieved Source:  Moran  AC  et  al.  2012.  Benchmarks  to  measure  readiness  to  integrate  and  scale  up  newborn  survival  interven>ons.  Health   Missing Policy  and  Planning.  27(Suppl.  3):  iii29-­‐ii39.    
  16. 16. Some SNL-assisted countries have made important 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  
  17. 17.      Outline   Where now? - Priorities and Opportunities for Achieving Impact at Scale
  18. 18. 2011-2 SNL Evaluation conclusions: What remains to be doneAt 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
  19. 19. SNL 3•       5  years,  $40  million    •  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;+   Ø Newborn survival and health are institutionalized within countries and key partners
  20. 20. Scaling up newborn interventions through health care systems and programs - a systematic & measurable approach   Government   Health  Sector   Civil  Society   Community     Officials  &   Managers  &  Health   OrganizaKons     Leaders  Champions   Parliamentarians   Workers   Capacity  to  implement:   Strength  of   -­‐  Trained  workers   implementaKon:     Scale-­‐up  readiness   -­‐  CommodiKes     -­‐   Availability   -­‐  Guidelines  &  standards   -­‐   Quality   “EffecKve  coverage”   -­‐  Accessibility     Social  &   Community  &  home  care:   Community  &  home  care:   behavioral   -­‐  PrevenKve  pracKces   -­‐  Problem  recogniKon     -­‐  Appropriate  care-­‐seeking   change    
  21. 21. What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
  22. 22. What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
  23. 23. What the Evaluation taught us about achieving impact at scale (“Spheres of Influence”)
  24. 24. Opportunities for global & regional influence•  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 newborn24 commodities
  25. 25. 2013 – A tipping point for newborns?Global Moments April May September November (?) Global Newborn Health Conference Women Deliver Launch Global Newborn (UNICEF / USAID / SNL / WHO) Conference Action Plan The MDG 4 & 5 State of the World’s Mothers report Investment Framework (Mother’s day) (to be presented at UNGA)Global Movements U.N. Commission on Life-Saving The “Promise Renewed” Call to Action for Commodities for Women’s & Children ending preventable child deaths by 2035 Post-MDG deliberations - an opportunity and a threat 25
  26. 26. Much to do… - We look forward to working together to make it happen. - Thanks www.healthynewbornnetwork.org  

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