The continuum of care for maternal, newborn and child health

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The continuum of care for maternal, newborn and
child health

• Opportunities to address gaps in coverage along
  the continuum of care throughout the lifecycle
  and at all levels of the health system
• Overview of Section II from Opportunities for
  Africas Newborns

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Adapting this presentation

• Consider the audience and how technical or
  detailed you want to be and how much time you
  have select and adapt slides to fit
• Consider adding regional or country level data,
  or charts. Charts and graphs are based on best
  available data up to November 2006.
• Personalise with local photos or examples

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What does the book provide?

• I. Information on Africas newborns
• Where, when and why do they die?
• How many lives could be saved?
• II. An overview of the care needed for mothers,
  newborns and children
• III. The opportunities and practicalities of
  including newborn health in nine existing health
  programmes
• Reaching every mother and baby in Africa with
  essential care
• Examples of countries that are progressing
• Operationalising action and integration
• Data profiles for 46 African countries
• CD ROM with programme and action guides

II
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Each year in Africa

• 30 million women become pregnant, and around
  250,000 of these women die of pregnancy-related
  causes
• Approximately 1 million babies die as stillbirths
• At least 1.16 million babies die in the first
  month of life
• Another 3.3 million of these children will die
  before they reach their fifth birthday
• 4 million low birthweight babies and others with
  neonatal complications may live but not reach
  their full potential

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Policy invisibility- Lost between maternal and
child health Where is the N in MNCH?
1978
MCH Alma-Ata Primary Health Care
2000
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Paradigm shifts.
Adapted from Lawn J et al, Lancet Sept 2006
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Why the continuum of care?

• Efficiency and effectiveness
• Similar packages save the lives of mothers,
  newborn and children.
• Integrating service delivery more lives saved
  at less cost
• Matching risk with results
• Most newborn and maternal deaths occur during
  childbirth and the first few days of life when
  coverage of care is lowest. This time must be a
  priority to save more lives.
• MNCH packages are the backbone of a healthy
  health system

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Connecting care through the lifecycle
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Connecting places and approaches of caregiving
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Integrated packages that reduce newborn deaths
Antenatal 7 14 reduction of NMR
Intrapartum 19 34 reduction of NMR
Postnatal 10 27 reduction of NMR
26- 51 NMR reduction
10 - 30 NMR reduction
14 - 32 NMR reduction
Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
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Health system reality
Sick baby and child care in hospital
Childbirth
Postnatal and newborn care
Antenatal
Routine Postnatal care package
PMTCT of HIV
Family planning
IMCI
Behaviour Change and community mobilisation,
community IMCI
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Coverage along the continuum of care in
sub-Saharan Africa
The days of highest risk have the lowest
coverage of care
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Progress for essential MNCH packages in sub
Saharan Africa 1990 to 2000
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Reaching the poor when scaling up
Gap in coverage along the continuum of care in 30
African countries
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Existing programmes have opportunities, and
missed opportunities, particularly for newborn
care
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Opportunities in antenatal care
Africa has relatively high coverage of at least
one ANC visit yet many missed opportunities for
high impact interventions and for birth
preparedness
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Opportunities for childbirth care

• Missed opportunities
• Adding essential newborn care and resuscitation
  to skilled attendance
• Linking immediate emergency newborn care with
  EmOC

• Policy opportunity
• Since 2004 35 of 46 countries have started a
  national Road Map to accelerate reduction of
  Maternal and Newborn deaths

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Opportunities in postnatal care

• Opportunity
• New recognition of the importance of postnatal
  care, especially the first hours and days of life
  - crucial for mother, baby and for initiation of
  healthy behaviours

• Missed opportunities
• Even if half of women deliver in facilities, only
  a small minority receive an effective postnatal
  visit
• If existing postnatal contact points (eg
  immunization), have high coverage, other services
  could be linked

• Challenges
• Poorly defined package, especially regarding the
  how and the who of implementation
• In many African cultures taboos exist that affect
  careseeking for mothers and babies in the
  postnatal period
• Effective postnatal care involves linking
  intrapartum and postnatal care leading into child
  health and family planning services, AND linking
  communities with facilities

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Opportunities for Integrated Management of
Childhood Illness
Almost every country in Africa has started IMCI
and at least 14 countries have IMCI in more than
50 of districts

• Opportunities exist to add newborn care to
• the facility IMCI component (primary
  and referral)
• the community IMCI component

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Opportunities to save newborn lives within
vertical programmes

• Immunisation
• Maternal and Neonatal Tetanus Elimination - 60
  million from GAVI
• Nesting other MNCH interventions in the EPI
  system
• Linking selected MNCH indicators in the EPI data
  system?
• Malaria
• Major investments in scaling up ITNs and moderate
  investment in IPT p
• Social marketing of ITNs could link other MNCH
  messages?
• PMTCT of HIV
• PMTCT coverage is low during childbirth and
  postnatal crosslink to reach the unreached
• Need for HIV-free survival not just HIV-free
  outcome

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Opportunities at home and in communities

• 264,000 newborn lives could be saved in Africa
  through increasing healthy behaviours practiced
  and promoted at home and in the community
• Creative health education and behaviour change
  communication strategies
• Social marketing of products such as
  contraceptives, ITNs or clean birth kits

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Opportunities in outreach and outpatient services

• Mobile and outreach services link home and
  facility care, focusing mostly on antenatal and
  child health
• Outreach ANC services can counsel women to move
  closer to a health facility before the onset of
  labour
• Opportunity to use outreach for early basic PNC
  for mother and newborn

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Opportunities to save lives through existing
facility based care

• The percentage of child deaths in facilities
  varies from lt5 in Ethiopia to over 90 in some
  Southern African countries.
• In every country quality of care, especially for
  newborns could be improved including
• Setting standards
• Systematic human resource strengthening
• Supplies management (and innovation)
• Essential drugs
• Audit as an intervention

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Adapting this presentation

• Consider adding practical examples from the book
  or from your experience or your setting to
  illustrate community care, or improving facility
  care or outreach services.

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Lives can be saved now
If the essential interventions in The Lancet
Newborn Survival series reached 90 of African
women and babies then 67 of newborn deaths could
be prevented 800,000 babies could be saved
per year in Africa alone, one-third
through family behaviours and community care

Up to one third of newborn deaths could be
prevented through community-based solutions
possible even with weak health systems
Additional cost of 1.39 per capita per year
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A continuum of care that works

• High coverage of essential care that connects
• Similar packages save the lives of mothers,
  newborn, children
• Integrating service delivery more lives saved
  at less cost
• Health care that cares
• Equity
• High quality
• Partnership with families and communities
• Health outcomes that count
• Results focused and accountable

Investment of time and money will save the lives
of mothers AND newborns AND children and give
Africa a healthier future
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Thank you !