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Postnatal Care

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Updated with MICS 2006 data (Joy Lawn) ... the continuum of care in Malawi ... Advocacy to prompt national commitment and focus on newborn health care issues ... – PowerPoint PPT presentation

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Title: Postnatal Care


1
Postnatal Care Kangaroo Mother Care Scale-up
Malawi
  • Evelyn Zimba
  • Malawi Country OfficeWomen Deliver Conference
    London
  • 19th October 2007

2
Outline
  • Related health indicators
  • SNL 1 in Malawi
  • Community maternal and newborn care package
  • KMC scale-up

3
Related Health Indicators(DHS 2004 MICS 2006)
4
National progress to MDG 4
Updated with MICS 2006 data (Joy Lawn)
5

Where in Malawi is the risk highest for newborn
deaths?
Mean NMR for rural and urban populations in
Malawi DHS survey 2000
Average Neonatal mortality rate per 1000 live
births
DHS data for Malawi 2000, provided by Shea
Rustein, analysis Lawn 2004.
6
Coverage along the continuum of care in Malawi
Based on non institutional deliveries
Source Opportunities for Africas Newborns
based on DHS 2005 preliminary results
7
Malawi 20,000 neonatal deaths Why?Estimated
direct causes of neonatal death for 2000
Source Estimates for Malawi for the year 2000
from Lawn JE, et al Lancet 2005. based on cause
specific mortality data and estimates for 192
countries as used in WHO World Health Report 2005
8
Saving Newborn Lives Malawi
  • Was launched in 2002
  • To improve neonatal health and survival, hence
    reduce neonatal morbidity and mortality

9
Principal Strategies for SNL Malawi Program
  • Use of an Essential Newborn Care (ENC) Package to
    improve the quality of care for newborns
  • Capacity building of central and district teams
    through competence-based training for ENC,
    resuscitation and Kangaroo Mother Care (KMC)
  • Influencing behavior change at household,
    community and health facility levels towards
    improved neonatal care and survival
  • Advocacy to prompt national commitment and focus
    on newborn health care issues

10
Key Accomplishments
  • A newborn care training unit was established -
    through Kamuzu College of Nursing and trained 22
    TOTs and 311 ENC service providers
  • Established a KMC training unit at Zomba Central
    Hospital, trained 18 TOTs and 274 service
    providers
  • ENC/KMC BCC materials were developed
  • KMC National guidelines were developed
  • ENC/KMC content was incorporated into the
    pre-service Midwifery training

11
KMC Background in Malawi
  • KMC was started at Kamuzu Central Hospital in the
    early 1990s, but was stopped after two deaths
    occurred as it was then associated with
    mortality.
  • KMC was re-introduced at Zomba Central Hospital
    in 1999. Proposals were submitted to several
    organizations to renovate the nursery to include
    a KMC unit.
  • The EU responded favorably and the proposed
    renovations were done. However KMC was not well
    coordinated and there was very little
    documentation

12
SNL Support on KMC
  • Supported the establishment of a KMC learning
    center at Zomba, with the view of expanding KMC
    services beyond Zomba.
  • For advocacy (to influence buy in by national
    staff) and TA purposes organized orientation and
    training trips for staff to Zimbabwe, Cape Town
    and Columbia
  • Partnered with MOH/RHU, DHOs, CHAM, PVOs and KCN
    to implement KMC services

13
Benefits of KMC
  • KMC is
  • Useful for stable LBW babies
  • Involves mother in care
  • Facilitates breastfeeding
  • Helps prevent and treats hypothermia
  • Reduces work strain on few nursing staff
  • Believed to be cost effective

14
KMC accomplishments
  • KMC training manual developed
  • 18 TOTs and 274 H/W trained
  • BCC materials developed
  • Established KMC Task Force
  • National KMC guidelines developed
  • KMC Register monitoring sheet were developed
  • Established a total of 6 KMC sites
  • Introduced grandparents strategy

15
Challenges
  • How to provide adequate follow-up especially for
    those who do not return for follow-up care
  • Continued mentoring and supervision of trained
    KMC providers

16
Way Forward
  • MOH in partnership with Save the Children,
    UNICEF, WHO, UNFPA, ACCESS and other partners
    are
  • Piloting a community maternal and newborn care
    package
  • Scaling-up KMC in all district hospitals with
    guidance from results of retrospective KMC study
  • Scaling-up ENC/KMC practice to all district
    hospitals

17
Community Maternal and Newborn Care Package
  • Malawi is piloting a 3 year program to develop,
    implement and evaluate the feasibility, cost and
    outcomes of a scaleable strategy of high impact
    interventions to improve key maternal and
    neonatal practices and health care coverage in 3
    districts.
  • The package will be delivered by Health
    Surveillance Assistants (HSAs) in the context of
    ACSD/IMCI framework
  • This programme will be managed and implemented
    within the prevailing structures and staffing of
    the MOH in the three district.
  • UNICEF, Save the Children, and others will
    provide technical and financial support where
    mutually agreed to support the planning,
    implementation, capacity building and monitoring
    and evaluation.

18
Progress
  • A design workshop was conducted in February 2007
  • A task force comprising of representatives from
    different key partners and terms of reference
    developed in May 2007
  • A proposal written and approved by the Ethics
    Review Board
  • Conducted a formative research and final report
    submitted Oct.
  • Process underway to conduct HFA by end of October
    and baseline survey by mid-November 2007
  • Adaptation of the HSAs TOTs training manual
    scheduled for mid-November 2007
  • Sepsis management component to be added later

19
Scale-up of KMC
  • KMC retrospective study done, final report to be
    out soon
  • KMC Coordinator to be recruited through ACCESS to
    provide TA in the scale-up of KMC
  • Dissemination of the KMC retrospective study
    results to be conducted in January 2008
  • Community KMC to be included in the pilot of the
    community maternal and newborn care package

20
THANK YOU
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