Reaching Newborns Through Integration

1
Reaching Newborns Through Integration

• Uzma Syed
• Saving Newborn lives (SNL)
• Save the Children
• Women Deliver Conference
• London
• Oct 18-20, 2007

2
Outline

• Integration Why
• Opportunities for integration
• Lessons from
• Bangladesh
• Nepal

3
Integration - Why

• To maximize care
• To maximize use of available resources
• To sustain
• To take interventions to scale

4
Opportunities to Reach Newborns

• Programs
• - Antenatal care
• Skilled attendance
• Postnatal care
• Emergency Obstetric care
• IMCI
• Immunization
• Family planning
• Hospital/referral care
• PMTCT of HIV
• Malaria control
• Training pre-service and in-service
• Behaviour Change and community mobilization

5
Key Interventions

• ANTENATAL
• Tetanus toxoid
• Nutrition iron/folate
• Maternal infections
• Birth preparedness
• Breastfeeding counseling
• Danger signs

• IMMEDIATE
• Drying warming
• Immediate exclusive breastfeeding
• Prophylactic eye care

Postpartum Care for Newborn Mother
Labor Delivery Care
Immediate Newborn Care
Antenatal Care

• POSTPARTUM
• Exclusive breastfeeding
• Clean cord care
• Maintenance of temperature
• Early postpartum visit
• Danger signs
• Maternal nutrition

• INTRAPARTUM
• Skilled birth attendant
• Clean delivery
• Danger signs

6
Content Focus of Integrated Approach
Baby
Mother

• First day blood loss, pain, BP, danger signs,
  advice
• Early breast care, infection, lochia, mood,
  family planning (LAM)
• Late recovery, anemia, contraception, birth
  spacing

• First day breathing, warmth,
• feeding, cord, danger signs, immunization
• Early feeding, cord, infection,
• danger signs
• Late weight, feeding, danger signs,
  immunizations

Adapted from MotherNewBorNews, 2005.
7
Integrated Approaches Examples from Bangladesh
and Nepal
8
Maternal and Neonatal Intervention Coverage along
the Continuum of Care - Bangladesh
Source DHS, 2004
9
Maternal and Neonatal Intervention Coverage along
the continuum of Care - Nepal
Source DHS, 2006
10
Steps Takenin Bangladesh and Nepal

• Reviewed policies
• Identified opportunities
• Clarified roles and responsibilities among
  partners
• Reviewed operational plans jointly

11
Steps Taken (contd)

• Developed integrated curriculum
• Planned integrated service delivery and logistic
  supplies
• Developed integrated job aids
• Ensured everyone agrees about what should be done

12
Key Strategies

• Counseling on
• Antenatal Visits
• Tetanus Toxoid
• Birth and Postanatal Care Preparedness
• Danger signs recognition and referral
• Training of the care providers
• Postnatal home visits day 1- 3, 7
• Community mobilization
• Advocacy

13
Reached more mothers and babies
14
Results to Action

• Nepal
• Results led the development of the National
  Newborn Health Strategy
• Led MOH to scale up community based newborn care
  package
• Bangladesh
• Interventions scaled up through MOH and national
  programs
• National Core Committee formed to develop
  National Neonatal Health Strategy

15
Challenges

• High initial cost for incorporating services and
  training
• Donors likely to support one component
• Overburden on health workers and thus the quality
  of services falls Integrating vs Imposing!
• Pressure from vertical programs to show result

16
what is required?

• High level political commitment
• Fund mobilization
• Partnerships with clear vision
• Integration at all levels

17
Newborn Health Bridging the gap through
continuum of care


Child Survival
Newborn Health