Dr Nabila Zaka UNICEF Presentation

An Action Plan To End Preventable Deaths

#EveryNewborn

EVERY NEWBORN

Global Progress Dr. Nabila Zaka

Senior health Adviser UNICEF HQ

Presentation Outline

• Partner coordination for ENAP • Progress on

- Advocacy - Support to country implementation - Data and Metrics - EMEN QI

• Opportunities for strengthening ENAP implementation

Partner Coordination for ENAP

Country Implementation Advocacy Data and

metrics

Research as cross-cutting

Support to Country Implementation

Progress tracking:

• Tool developed and tested in 10 countries • Revision of tool in progress for application

to countries with highest NMR and highest burden of neonatal deaths

• Country progress updated for WHA 2015 for 28 priority countries since 2013 − National Newborn action plan developed in 8/28

countries with 9 in progress − RMNCH plan sharpened in light of ENAP in 6/28 − Plans costed in 8/28

Technical support

Conducted a global review to identify the implementing partners and donors currently providing technical support to maternal and newborn care at the time around birth.

Developed a database which lists the organizations providing technical assistance and the activities and initiatives that they are involved in per country (completed for 24 countries) Compiled a list of key organizational focal points for future engagement (45 organizations reached) Compiled a list of consultants for future technical support to

countries.

Advocacy for Newborns

Work plan 2015 developed: global and regional plans for Asia

and Africa

Support dissemination opportunities for the Lancet Every Newborn Series and/or national maternal-newborn action plans National events in India, Nigeria, Ethiopia, South Africa

Engagement with the development of the updated Global Strategy for Women’s and Children’s Health.

Support the next development agenda, including the

Sustainable Development Goals, targets, indicators and means of implementation to ensure inclusion of stillbirths and newborn.

Support and promote key advocacy moments. A calendar of upcoming events is maintained at www.everynewborn.org

www.everynewborn.org #EveryNewborn

• Indicators for impact, coverage, process of maternal & newborn care • Initial focus on the 4 + 1 treatment interventions

• KMC (led by KMC acceleration group) • Resuscitation (UNCoLSC, USAID, SNL Bangladesh, WHO, HBB etc) • Antenatal Corticosteroids (WHO and UNCoLSC TRT etc) • Sepsis case mx (WHO, UNCoLSC etc) • CHX cord cleansing (UNCoLSC, SNL etc)

• Priority research to improve the metrics for use

Technical mapping & planning of indicators, tools & work in progress

1

Institutionalise in national collection platforms and in global metrics architecture, with accountability

2

Leadership development to improve & use the data for action

3

• Birth and perinatal death certificates, coverage & quality • Develop and test Minimum Perinatal Dataset • Perinatal Mortality audit tool, linked to Maternal Mortality audit • Inputs to facility HMIS, Health Facility Assessments such as SARA, and to household surveys

• Testing in countries also linked to EMEN work • Southern institutions as centres of excellence • Integrated technical oversight especially with maternal health • User friendly formats eg score cards, links to accountability and parent voices (eg partnerships with E4A and WRA)

Data and Metrics

ENAP Milestones by 2020

• Count births and deaths in CRVS (women, newborns and stillbirths)

• Minimum perinatal dataset & perinatal mortality audit being widely used in countries

• ENAP core indicators to be defined , incorporated in national metrics platforms and widely used

Improving, institutionalising & using ENAP metrics for action

x World Health

Assembly

May/June 2014

Dec 2014 Meeting To scope

ENAP Metrics improvement plan

June 2015 - May 2018 Testing indicators and

tools in limited number of countries

June 2018 - May 2020 Wide use in many countries CRVS, facility HMIS, surveys

linked to health systems scale up

2020

Jan- May 2015 Refining and consulting on

metrics plan & ENAP monitoring FW

Presenter

Presentation Notes

We are climbing from success to success Lancet stillbirths, in April 2011 -- more than 2.6 m stillbirths per year, with barely more than 1% annual progress in reduction. Testimonials from parents. Multi city launch. 600 m reach global media. But no concrete advocacy plan, just noise. Born Too Soon learned lesson. This time broad-based report, 40+ partners working through PMNCH health professional constituency, 1.1m global media but linked to commitments, foreword from SG and linked to EWEC and CoIA/iERG reporting, Uganda champion country. Strategic advocacy post launch at WHA (minister's breakfast with MoH China) and follow up with partners to form basis for EN A Promise Renewed for Child Survival by India, Ethiopia, the US, and supported by UNICEF in June 2012. 175+ governments have signed a pledge to scale up progress, as well as 400 CSOs. About 10 countries have held national launches. The five strategic shifts of the Promise Renewed roadmap include focus on newborn and equity. Leadership of USAID and UNICEF key, and repeated with Every Newborn. * Save the Children with its annual State of the World's Mother's report and its in-country work through Saving Newborn Lives, supported by the Gates Foundation, have driven attention at national, regional and global levels together with other major NGO groups like World Vision through its work on the Child Health Now campaign platform. First ever global newborn conference in Johannesburg in April 2013, hosted by the Government of South Africa. 500 participants, including champions like Graca Machel. Launch pad for Every Newborn effort. * Every Newborn: consultation meetings in 17 countries and two regions, with bottleneck analyses in these countries to determine where gaps needs to be priortized and filled in support of sharpening costed national plans. Website and toolkit. World Prematurity Day, which led to events in more than 60 countries, many driven by parent groups, Empire State building in purple, FB, NY and GVA events, 24 hour Twitter relay, Celine Dion PSAs on CNN, new research, global media coverage, est reach of 1.4 b. 40+ partner agencies. Save the Children’s Ending Preventable Deaths report launched in February 2014 leveraged media attention and launch efforts were used to promote Every Newborn consultation process in countries. * Launch of The Lancet Every Newborn series - the clearest picture so far of the ongoing slow progress in newborn survival and stillbirths, providing new focus beyond survival, and combining research and reality in countries to set targts for post-2015 to ensure that every newborn has a healthy start in life. +90 individual media hits with articles across the world; +100 million twitter impressions in first week and 12 million people reached through social media Launch events in NYC and Geneva to coincide with WHA WHA endorsed the Every Newborn Action Plan with more than 50 countries took to the floor during the debate to express their support, including those who represented regional blocs. The resolution calls on all member-states to implement the plan and to report on progress to the World Health Assembly through 2030. The Saving Every Woman, Every Child Summit in Toronto from May 28 to 30, 2014 resulted in powerful high-level moment including Prime Minister Harper announcement of Canada's commitment of $3.5 billion to improve the health of mothers and children for the period of 2015–2020. The Partners Forum and the launch of the ENAP – high level participants make supporting statements, over 40 new commitments to EWEC, Blanket of Hope to mobilize civil society, +100 tweeter impressions

Health system

Individual and facility-level outcomes Coverage of key practices People-centred outcomes

Health outcomes

EXPERIENCE OF CARE

4. Effective communication

5. Respect and dignity

6. Emotional support

Quality of Care

7. Competent and motivated human resources

PROVISION OF CARE 1. Evidence based practices for

routine care and management of complications

2. Actionable information systems

3. Functional referral systems

Stru

ctur

e Pr

oces

s O

utco

me

8. Essential physical resources available

Framework for Quality of Care by WHO

Main elements of the EMEN QI Country introduction and implementation of the certification model will include four main components:

1. National dialogue for adoption of the standards and implementation planning

2. Routine self-assessment of maternal-newborn care in health facilities by health facility staff with support from the facility committees/boards and oversight from local health authorities

3. Targeted support to low performing facilities to improve skills and resources, including the provision of

respectful care 4. External validation of findings (certification) by a team

Working standards

Clinical Care • Evidence-based safe antenatal care is provided. • Evidence-based safe care is provided during labor and childbirth. • Evidence-based safe postnatal care is provided for all mothers and the newborns. Patients’ Rights • Human rights are observed and the experience of care is dignified and respectful for every

woman and newborn. Crosscutting • A governance system is in place to support the provision of quality maternal and newborn care. • The physical environment of the health facility is safe for providing maternal and newborn care. • Qualified and competent staff are available in adequate numbers to provide safe, consistent and

quality maternal and newborn care. • Essential drugs, supplies and functional equipment and diagnostic services are consistently

available for maternal and newborn care. • Health information systems are in place to manage patient clinical records and service data. • Services are available to ensure continuity of care for all pregnant women, mothers and

newborns.

Next Steps

• Three EMEN fore-runner countries • National support focusing on institutionalization

of EMEN QI framework • Sub-national level efforts to develop the national

EMEN QI framework • The different country models are used to find

common principles of QI that can be replicated globally.

Opportunities for ENAP

• A Promise Renewed • RMNCAH Fund • Global Financing facility • EWEC Strategy 2.0 • Sustainable Development Goals

Thank you

Documents

Dr Nabila Zaka UNICEF Presentation