Five things to do differently

JOY LAWN: And so we have looked at the data to drive action. And finally we want to underline the fact that data alone will not change things. We need to act. And we need to act differently. So what things do we need to do differently? Let’s highlight five. And these five came out of The Lancet Every Newborn series. Looking back and saying, what has worked? And what hasn’t worked? What gaps are there? And what things do we really need to do differently to make a difference for newborns and stillbirths? So first of all, integrated plans. You’re never going to have a vertical system that works to reduce newborn deaths and stillbirths.

They sit within maternal and child health care with an important component linking to reproductive health care. We need integrated service delivery. We talk about the continuum of care for maternal and newborn and child health. We need coordination because there are so many different programmes and services. And we need different partners to align. Now, this wasn’t anything new. This is exactly what we called for in The Lancet neonatal series in 2005 and what was called for again in the stillbirth series in 2011 and has been called for in probably many Lancet series. So what hasn’t worked in calling for this integrated approach? So one thing is that people don’t implement. Many countries have been good at setting out policies.

But they don’t implement. Maybe we innovate with gadgets. But we don’t think enough about systems innovation. We don’t think about analysing specific health system bottlenecks. So for a part of the Every Newborn series, there was a country-based health system bottleneck analysis. So looking at what are the gaps in health system, the specific challenges for each specific intervention. This was carried out in 12 countries. And the data is published in BMC Pregnancy and Childbirth with really interesting context-specific and intervention-specific and health system-specific bottlenecks that we need to address. It’s no good just saying we should scale up. We need to know what are we scaling up? What’s stopping it being scaled up? How are we going to innovate to overcome that?

And how are we going to make that actually work in large-scale implementation? One of the critical things that we’ve failed on for newborn care and for stillbirths is to measure programme coverage. So for example, if you look at the infectious diseases in child health that have made the greatest progress, immunisation we have 30-year history of really thoughtful work on indicators and making sure that every child is reached. But in newborn care, our highest-impact interventions don’t have coverage data.

So as part of the Every Newborn action plan, there’s urgent and ambitious work in progress to make sure that we’re able not just to define coverage interventions, coverage of interventions, but measure those and measure those in routine health systems as part of improving health system measurement and also linked to civil and vital registration improvement. So we definitely need better data on the outcomes, particularly stillbirths and notably intrapartum stillbirths. But to really drive progress, it’s the programmatic data that is the biggest gap. And then, finally, it’s really about people. So we can have plans. We can implement. We can innovate. We can get the data. But in the end it is leadership that changes things.

And that leadership won’t just come about by Brownian motion. We need leaders from the highest-burden countries. We need leaders who aren’t just able to advocate but who are able to have technical skills to drive change. And then critically, critically we need the voice of women. Women’s voices for their own rights, for their expectation that not only they, but also their babies, will survive and will thrive. The very families and the very women who are most affected don’t have voices. And movements such as the attention to women’s groups and so on are critical.

But we also need to be intentional in raising the voices of women within accountability systems so that their own action for change becomes part of the driver for what we do to change things for them and for their babies all around the world.