This presentation by JSI's Nosa Orobaton, "March of Care for Newborn Umbilical Cord in Nigeria" was part of a dynamic panel moderated by JSI's Dr. Penny Dawson on February 13, 2015 at the 14th World Congress on Public Health in Kolkata, India. Four speakers summarized evidence for interventions proven to reduce newborn mortality (e.g., chlorhexidine) and shared important policy and programmatic experiences in prevention and treatment of neonatal infections. JSI's Leela Khanal and Dr. Nosa Orobaton spoke about experiences from Nepal and Nigeria in scaling up chlorhexidine use in those countries. Another speaker shared results from the COMBINE trial in Ethiopia, implemented primarily by JSI with support from SAVE/SNL, which evaluated the impact on neonatal mortality of health extension worker-led management of bacterial infections.

1. THE MARCH OF CARE FOR
NEWBORN UMBILICAL CORD
IN NIGERIA
Using Advocacy to Launch and Move of Chlorhexidine
7.1% Digluconate Gel Use for Newborn Cord Care to
Scale: 2012-2014
Nosa Orobaton MD, DrPH, MBA
Olayinka Umar-Farouk, MD, MBA
February 11 2015

2. REMEMBER
THIS
Chlorhexidine, powerful,
impactful, for health
system improvements
Government role across value
chain is critical
Public-private partnerships
matter
Trust-based community
demand is foundation for
local market
Proactive, comprehensive
forecasting is key to prevent
shortages

3. NIGERIA:
CONTEXT
Second highest newborn deaths
globally at 276,000 in 2014*
Infections cause 1 in 3 newborn
deaths
Nationally, two in three babies delivered at
home without skilled assistance
In some states, over four in five babies
delivered at home
1 in 4 non-institutional births apply
potentially harmful substances to umbilical
cord
* Lancet Newborn Series, 2014

4. STRATEGIC
CONSIDERATIONS
Multi-pronged, co-
reinforcing, organic
approach
Clear national
leadership &
Commitment
Direct implementation in 2
States generates local
experience
Network of Public-Private Actors to
Fast-track LocalManufacture
Study Tour of 30 States to Sokoto
State for firsthand view of community-
based program
Chlorxy-G Brand, Manufactured in Nigeria. Launched in March
2014

5. AT
NATIONAL
LEVEL
Strong national leadership
Nigeria co-chair of UNCoLSC
Strong, proactive drug
regulatory agency
Open innovation space to test
program approaches
Chlorhexidine 7.1% Digluconate
included in Essential Drug List

6. AT STATE &
COMMUNITY LEVEL
Launched in Sokoto &
and Bauchi States
CHX & misoprostol
twinned
Govt used own funds to
buy both commodities
CHX and misoprostol added to
work of community-based health
volunteer system
Both states decide to implement
metrics-based program at scale

7. Newborns as Percent of Expected Births Reached with
Chlorhexidine Gel in Sokoto State, Nigeria April-Dec 2013
N=36,404

8. ​99.7% survivedthe
neonatal period.
​More than 3 in 4
newborns had died
prior to or around
birth.
Source: http://office.microsoft.com/en-us/excel-help/present-your-data-in-a-column-chart-HA010218663.aspx
Newborn Deaths By Reported Timing in Cohort of 36,404
Who Rcvd CHX in Sokoto State, Nigeria, April-December
2013 (N=124)

9. SPREADING
THE MESSAGE

10. PROGRESS:
MARKET
FORMATION
Pace of growth reflect national
commitment and the use of an
integrated community-
manufacturer-regulator-buyer
platform.
Activity January
2014
January
2015
National Policy No Yes
Number of States at
Sokoto CHX Study
Tour
0/37 30/37*
Approved Local
CHX Producing
Firms
0 2
CHX Locally
Manufactured
No Yes
Number of CHX
Tubes Annual
Production Capacity
0 20 million
(one firm
only)
Number of States
with CHX in Use
0 8

11. LOCAL
MANUFACTURE
10
6
3
2
1
PRIVATE NIGERIAN
PHARMACEUTICAL FIRMS
THAT ENTERED IN
CHLORHEXIDINE 7.1%
DIGLUCONATE GEL
MANUFACTURE AS OF
DECEMBER 2014

12. ONE
MILLION
UNIT MARK
MET IN
DECEMBER
2014
Source: http://office.microsoft.com/en-us/excel-help/present-your-data-in-a-column-chart-HA010218663.aspx
0
200000
400000
600000
800000
1000000
1200000
Cumulative Trends in the Known Quantities of
Chlorhexidine 7.1 Digluconate Gel Ordered
by/for 8 Nigerian State Governments and Fed
Govt 2012-2014

13. LESSONS:
DEMAND SIDE

14. LESSONS:
SUPPLY SIDE
Proactive, responsive
National Drug
Regulatory Agency
Public-Private Partners
Network as Incubator
accelerated drug
development process
Integrated community-to-
manufacturer-buyer learning
platform
Federal system created open
innovation space for early
movers to adopt

15. LOOKING AHEAD Government role across value
chain is critical
Think sustainability upfront
Proactive, comprehensive
forecasting by government is
key to prevent shortages
Public-private partnerships
matter
Align entry into OTC market with
demand creation process to increase
commodity security, availability

16. Short, 10 minutes Film: Watch it on
Youtube
Introduction of CHX-Miso in Nigeria:
https://www.youtube.com/watch?v=ts1-9soXbZ8