Measuring progress and data gaps
Access to quality data is vital for measuring progress and staying accountable for meeting global targets for newborns and stillbirths. In this step, Dr Louise Tina Day, Assistant Prof from LSHTM, will outline the opportunities and priorities for measuring progress of newborn health based on “Data for Action” - Chapter 5 within the report Survive and Thrive – Transforming Care for Every Small and Sick Newborn.
Why is this a priority?
Globally 2.5 million newborn babies die each year and 2.6 million babies stillborn. Of children dying before their fifth birthday, a staggering 47% now die in the first month of their life. For the first time ever, newborns now have a specific global health goal. Endorsed in the Every Newborn Action Plan (ENAP) and incorporated in the Sustainable Development Goals (SDG): Health Target SDG 3.2 includes: “By 2030, end preventable deaths of newborns…with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births…”. While there is no SDG addressing the neglected issue of stillbirths, the ENAP endorsed targets to achieve < 12 stillbirths per 1000 live births in every country. Tracking neonatal mortality rate (NMR), one of the 100 WHO core health indicators, inform us that many Low and Middle Income Countries are not yet on target.
What is the current situation? Progress and Data Gaps
In recognition that using data for action is strategic, one of five ENAP objectives is transformation of metrics including a measurement improvement roadmap. Progress has been made, including identifying and defining core newborn indicators used for national and global tracking. Research is underway to test validity (accuracy) and the feasibility of uptake in national routine Health Management Information Systems (HMIS). However, as 2030 approaches, policy makers need much more information to guide investments for these vulnerable children, especially the small and/or sick newborn. Some data are available but not currently used but many data gaps remain across domains of Survive, Thrive and Transform.
Survive: As facility births now account for >75% of global births, using NMR disaggregated by sex and weight would help understand mortality patterns. Estimates suggesting that >80% of newborn deaths are Low Birth Weight highlighting the need for improved gestational age data. Monitoring coverage of high impact evidence-based interventions currently with low scale-up (e.g. Kangaroo Mother Care) has great potential to improve outcomes.
Thrive: Ability to track children who required inpatient newborn care and remain at increased nutritional and developmental risk is critical, as increasingly thrive is linked with survive. Measures of quality of care are important to both survive and thrive e.g. a preterm baby’s life may be saved by delivery of oxygen but without safe delivery of the lowest possible oxygen concentrations the child may unnecessarily lose their sight from Retinopathy of Prematurity.
WHO Quality of Care framework includes both provision and experience of care and new measures of agreed standards of care for newborns are needed. For example, research is needed to determine a valid measurement of unnecessary separation of parents and their newborns to promote respectful family-centred care.
Transform: To expand enabling environments for newborns requires measurement across all health system inputs: Service-readiness, health workforce, HMIS, health systems finance and leadership and governance. Such data can inform health system strengthening with a newborn-centred focus.
What next? Data for action: an important focus for newborns and stillborns
Many specific opportunities currently exist that could quickly have significant impact:
The linkage of civil registration and vital statistics (CRVS) data sources with increasingly available facility health measurements e.g. to increase low birth weight rate tracking.
Strengthening scale-up of newborn deaths and stillbirth reviews (perinatal death audit) within Maternal and Perinatal Death Surveillance and Response (MPDSR) to ensure we are “Making Every Baby Count”
Using available data to implement solutions and improve quality of care at all levels of the health system.
Prioritising closing remaining data gaps for newborns and increasing data use, can drive necessary action to fulfil the SDG promise for every newborn. The equitable delivery of this promise will include measurement at the beginning of their life-course. Ensuring no baby is “left behind”, even when born in high-burden settings, marginalized or hard-to-reach communities, urban-slums or humanitarian settings. The care we deliver to these most vulnerable global citizens, is a sensitive marker of Universal Health Coverage. We need to ensure data is used for action to transform care for every newborn baby, wherever they are born – to both survive and thrive.
© London School of Hygiene & Tropical Medicine 2019