Challenges, Bottlenecks and Solutions to Scaling-up Newborn Care in Cameroun

AU Maternal, Child and Newborn Conference1-3 August, 2013

Johannesburg, South Africa

Dr Martina L. Baye MD,MPH

Technical Advisor, MOHGENAP Advisory Group Member

Outline of the presentation

BACKGROUND1. The GENAP Advisory Group2. Regional GENAP Consultation in Dakar, 9-11 July 20133. Overview of the standard bottleneck analysis (BNA) tool

MAJOR BOTTLENECKS AND SOLUTIONS TO SCALE-UP NEWBORN CARE IN CAMEROUN

4. Country profile5. Summary of identified bottlenecks and solutions6. Opportunities

BACKGROUND

THE GENAP ADVISORY GROUP

Purpose: • provides strategic guidance on the GENAP development process (e.g to

review draft documents, support global, regional, and national GENAP consultations)

• advocates for the GENAP to help generate a strong, coordinated global, regional and national platform for this effort.

Composition: • Key constituencies with expertise and/or interest in investing in global

newborn health; • Country representatives from Africa (Cameroun, Ghana, Nigeria, and

Uganda) , Asia, Latin America/Caribbean, the Middle East and Mediterranean.

• Funding agencies, professional associations, the private sector, non-governmental organizations and civil society.

REGIONAL CONSULTATION ON “EVERY NEWBORN ACTION PLAN”Dakar, 9-11 July 2013

Main purpose: to promote coordinated efforts among key country stakeholders focusing on newborn care to identify what needs to happen to scale-up evidence-based interventions to address preventable newborn deaths in the West and Central African region.

Specific objectives:• To provide a forum for countries to identify their bottlenecks and solutions

to accelerate the scale up of newborn programmes• To provide a forum for high level consultation to review and provide input to

the global Every Newborn draft document

Participants: Representatives from 8 countries (Government, Midwives, Pediatricians, NGOs, UN, etc)

Outcomes: Country bottlenecks identified, country follow-up plans to accelerate in-country actions on MNH; Inputs on the GENAP

Overview of the standard BNA tool

• Divided into 2 sections:Section I includes questions to assess bottlenecks to scale-up newborn health programmes in general

Section II is sub-divided into 9 sub-sections. Each section includes questions to assess bottlenecks to scale-up each of the 9 critical maternal and newborn interventions

• Each section also includes a chapter on solutions and strategies to address identified challenges/barriers

Overview of the standard BNA tool Health system building blocks Critical maternal and newborn health interventions

1. Leadership and governance

2. Health financing

3. Health work force

4. Essential medical products and technologies

5. Health services delivery

6. Health information system

7. Community ownership and participation

1. Management of pre-term birth - focus on antenatal corticosteroids

2. Skilled care at birth - focus on the use of the partograph

3. Basic Emergency Obstetric Care - focus on assisted vaginal delivery

4. Comprehensive Emergency Obstetric Care - focus on caesarean section

5. Basic Newborn Care - focus on cleanliness including cord care, warmth, and feeding

6. Neonatal resuscitation 7. Kangaroo mother care - focus on skin to skin,

breastfeeding and feeding support for premature and small babies

8. Treatment of severe infections - focus on using injectable antibiotics

9. Inpatient supportive care for sick and small newborns - focus on IV fluids/feeding support and safe oxygen

Situation Analysis of MNH in Cameroun

COUNTRY PROFILE

• Population : 20 386 799 in 2012 (RGPH)

• Expected Deliveries : 940206

• NMR 31 per 1000 LB

• IMR 62 per 1000 LB

• Surface Area : 475 650 Km²• Economic growth: 4.4% in 2012 (Economic Perspectives in Africa)

• Poverty rate 40% in 2007 (ECAM, 2007)

• GNI = $ 1,400/Capita in 2012 (CEMAC, 2013)

•

• Regions : 10

• Health districts : 191 and > 3000 Health facilities

Trends in Maternal Mortality

Region Score

% poor Populations (

Q5+Q4) as EDS

Newborn Mortality

Home Births

Abscense of Post-partum

Care

Far North 28 79.7 38 75.6 79.3North 26 67.1 35 68.5 83.6East 21 47.4 23 52.4 62.9Adamaoua 20 39.6 41 53.7 50.5Center (w ithout Yaounde) 19 30.4 33 27.1 60.7South 18 31.1 23 21.8 59.3Littoral ( w ithout Douala) 14 15.1 34 6.8 41.1West 13 31.1 16 5.6 43.1Yaounde 11 0 33 6.6 41.1North- West 9 42.7 26 4.7 48.2South West 9 20.6 44 17.5 38.4Douala 7 0 34 1.4 26.2

EQUITY PROFILE : Analysis of Regional disparities

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Coverage of Key MNH interventions

Data Source: DHS

1. Roadmap for the reduction of maternal and neonatal mortality 2006-2015;

2. CARMMA plan 2011-2013;

3. RH Strategic plan 2010-2015 : revision ongoing, RMNCH Strategic plan 2014- 2020

Key MNH Strategies Supporting MNH in Cameroun

Bottlenecks and solutions to scale-up newborn care in Cameroun

BOTTLENECKS AND SOLUTIONSPRIORITY BOTTLENECKS STRATEGIES AND SOLUTIONS

LEADERSHIP AND GOVERNANCE

Newborn health not recognized as a specific issue

Advocacy and Awareness: policy makers, gynecologists, pediatricians, all stakeholders in the newborn health field

Inclusion of neonatal health in the pre-service training curriculum on RMNCH

HEALTH FINANCING

Existence of financial barriers to access maternal and newborn care No specific mention of the newborn in new funding allocations for healthcare delivery

Subsidies/ free care for newborns in health facilities Allocation of funding specific to the newborn for the supply of care services

BOTTLENECKS AND SOLUTIONSPRIORITY BOTTLENECKS STRATEGIES AND SOLUTIONS

HEALTH WORKFORCEInsufficient staff trained for newborn care (pediatricians, obstetricians, midwives, nurses)

Recruitment of staff (pediatricians, obstetricians, midwives, nurses) Incentives for staff to stay in hard-to-reach stations

Continuous training of staff based on identified needs and a functioning supervisory system

ESSENTIAL MEDICAL PRODUCTS AND TECHNOLOGIES

Absence of certain newborn drugs and supplies in national system of essential medicines and in facilities Frequent drug and commodity stock outs

Drafting of the newborn essential drugs and equipment list by level of care Scaling up of obstetric kits by including relevant newborn drugs Training / retraining providers and pharmacy personnel to handle inventory management

BOTTLENECKS AND SOLUTIONSPRIORITY BOTTLENECKS STRATEGIES AND SOLUTIONS

HEALTH SERVICE DELIVERYOutdated documents on norms and standards for RMNCH

Revision of norms and RMNCH standards with an emphasis on newborn careScale up Kangaroo Mother care Implementation of quality control systems

HEALTH INFORMATION SYSTEMSLack of key information on newborn health Lack of adequate tools

Multiplicity of tools

Update tools for data collection and data entry to include information on newborns Integrating newborn indicators into existing data collection tools Make recovery of data a functional tool

COMMUNITY OWNERSHIP AND PARTNERSHIPPoor community involvement and participation

Recruit and train CHW selected by communities CHWs to provide services for newborn and maternal health

OPPORTUNITIES• Political will – setting up of a specific multisectoral

program for reduction of maternal, neonatal and child mortality;

• Plan for Reproductive, Maternal, Neonatal and Child Health 2014 -2020 underway;

• Functional multi-sectoral Mother and Child Technical coordination platform;

• Setting up of nutrition program

• Commitment of Professional Associations – Pediatricians, Obstetricians and midwives

• Decentralization