Every Newborn Action Plan: two examples of action

KIM DICKSON: This presentation is going to give two examples of action, action that ENAP will deliver at global and at national levels. The first example is about implementing quality of care. And this is coordinated by UNICEF and WHO. The ENAP Milestones relating to quality of care that should be met by 2020, it revolves around developing quality standards and indicators for quality maternal and newborn care. Also that country level policy makers will adopt the Every Mother Every Newborn Quality Initiative standards and core indicators for national use.

And Every Mother Every Newborn Quality Initiative is an initiative that focuses on improving the quality of facility based care for every month and for every newborn, really focusing on ensuring that the high impact interventions are delivered to every mother and every newborn. WHO has moved forward to lead the way and has developed a vision for quality of maternal and newborn care. The vision is that every pregnant woman and newborn receives quality care throughout pregnancy, childbirth, and the postnatal period. Based on this vision, WHO has come out with eight domains of quality care. And for each of these domains, standards and prioritised quality statements have been developed.

The domains are in two main sections, focusing on the provision of care and the experience of care. This is very important in ensuring that in providing care to mothers and newborns, we not only look at the supply, but work towards improving the demand for care. The eight domains under provision of care, it focuses around ensuring that the evidence based clinical interventions are delivered, that information systems are strengthened, and that functional referral systems are in place. In the experience of care arena, the domains focus around ensuring that there is effective communication, that the mothers’ respect and dignity is upheld, and that emotional support is provided to women during labour and delivery.

The cross-cutting domains are ensuring that there are competent and motivated human resources available to support mothers, and that the physical resources and infrastructure is available.

To implement these quality standards, we have a process whereby we will synthesise evidence and experience that is available. We recognise that they are already initiatives that are focusing on quality of care. Much has been learned already, and so the focus is on really looking at what exists. What experience is there? What lessons are out there? And synthesise this information to feed into the development of global standards and criteria. These global standards and criteria will then be adapted at national level, but ensuring that we get a model that is sustainable and institutionalised, that these maternal newborn quality standards are linked to resistant ongoing quality of care initiatives within countries, and that we pilot at sub-national level, to form wider scale up.

UNICEF is leading on supporting countries to implement these standards. And we’re working in, specifically, Bangladesh, in Tanzania, and Ghana, to support the development of context-specific models that are taking these global standards and criteria and adapting them to the circumstances and contexts of these countries. The second example of action by ENAP partners is improving measurement. This action is coordinated by the World Health Organisation and the London School of Hygiene & Tropical Medicine. The ENAP Milestones relating to measurement that need to be met by 2020 revolve around counting births and deaths in CRVS systems, and ensuring that we include, that we count, births and deaths for women, newborns, and that we count stillbirths.

The second is around ensuring perinatal mortality audit systems are developed, and that minimum perinatal data sets are being implemented and widely used in countries. The third is around ENAP core indicators to be defined and incorporated into international metric platforms and supporting the wide use and application of these indicators.

So just to outline what these 10 core indicators that have been developed by the data and metrics group of the Every Newborn Action Plan group of partners are, there are indicators relating to impact, indicators relating to coverage, coverage for all mothers– coverage of care for all mothers and newborn, but also coverage of care for complications and extra care for small and sick babies. Then there are also input indicators relating to quality of care and relating to counting. I won’t go through all of these indicators. But just to highlight that in looking at the core and additional indicators, we have looked at indicators that need to be developed, and they require validation or feasibility.

But they’re important, because these relate to the high impact interventions that should be implemented. So the fact that they’re not there, does not mean that we’re going to ignore them. So relating to antenatal cortical steroid use, relating to a neonatal resuscitation, indicators relating to Kangaroo Mother Care, and indicators relating to the treatment of severe neonatal infections, for example. These relate to high impact intervention. The indicators for measuring the coverage are not there, but Datamatrix Group is working on developing these indicators, validating these indicators, and testing the feasibility of widespread use of these indicators. I’ll also draw attention to some of the indicators that do exist, but are not routinely tracked at global level. For example, the stillbirth rate.

This has not been routinely tracked, but stillbirth rate is a really sensitive indicator of the quality of care that mothers are receiving in the facility. It’s a real sensitive indicator of the sensitivity and the strength of the health system. And therefore, it’s an important indicator that needs to be measured. Therefore, the Every Newborn Action Plan group of partners have come up with a series of indicators that need to be measured, those that currently exist and those that do not exist, but are important, to ensure that we meet the goals and the targets of the Every Newborn Action Plan.

Just to look at some of the progress that has been made since the launch of the plan in 2014– a short time, but some significant progress. The Every Newborn progress report was published in May 2015, and it highlights some of the key achievements that we have made over the past year. And I’ll just highlight a few of these. More than 50 countries have made measurable changes. So if you read the progress report, in there, there’s a highlight of what has been achieved in countries. 15 high burden countries, for instance, have initiated plans. They’ve developed newborn plans. For example, in India, as one example, that came up with a newborn specific action plan.

But a number of countries have moved forward to develop newborn plans that are part of integrated reproductive, maternal, and child health plans. And so we continue to encourage countries to develop newborn plans, but not necessarily stand alone. These can be integrated into existing RMMCH plans. We’ve had over 50 new commitments to newborn health, to meeting the targets of newborn health. And these include many from the private sector. Progress has also been made for quality of care and for data metrics. And I’ve outlined what is happening around Every Mother Every Newborn Quality Improvement Initiative. And I’ve outlined some of the progress around the defining of indicators. There are still gaps. They’re noting specifically that there’s less attention for stillbirths.

But importantly, we’ve also made progress in ensuring that we are strengthening linkages with maternal health. A newborn cannot survive without the mother. And so the Every Newborn Action Plan partners have linked better and are working closely with the Ending Preventable Maternal Mortality plan, to ensure that as we seek to reduce newborn mortality and morbidity, we also seek to reduce maternal morbidity and mortality.