EIMC  Webinar,  January  28th  2015  Janet  Kayita  

EIMC  and  Maternal  Newborn  &  Child  Health  (MNCH):  PerspecGves  from  an  MNCH  Point  of  View

Outline/session  objecGves  

•  To  contextualize/frame  the  integra4on  of  EIMC  into  MNCH  dialogue  

•  Outline  opportuni4es  for  EIMC  within  the  MNCH  community;  the  HIV  community  

•  Discuss  an4cipated  challenges  •  Draw  conclusions  &  frame  a  way  forward  towards  making  EIMC  in  MNCH  clinics  a  reality  

1.  RMNCH  (&A)  Health  -­‐  the  context  •  Global  mobiliza4on  to  end  preventable  maternal  newborn  

and  child  deaths    –  Imminent  MDG  &  Global  Plan  ‘eMTCT  &  KPA’  4meline  –  Consensus  on  related  post-­‐2015  targets    

• MMR  –  (2030)  •  U5MR–  (2035)  ‘A  Promise  Renewed’  &  NMR    •  interim  milestones  for  2020  

•  Clarity  on  where,  when,  why  &  therefore  what,  and  how    •  Reinforced  by  the  Every  Newborn  Ac4on  Plan  (ENAP),  and  

the  Every  Newborn  Lancet  Series  -­‐  May  2014)  •  Govt.  with  partners  held  accountable  -­‐  tracking  results  and  

resources  for  targets  set  –  (CoIA,  iERG  global  repor4ng)    •  Lessons  learned  from  disease  programs  –  AIDS,  Malaria  

No baby

stillborn

Our  delivery  goal  

No newborn is born to die

3.7  million  die  ~  280,000  die   2.9  million  die  

No child

stunted or dying

2.6  million  die  

3.5  million  within  a  few  days  of  birth  

10  million  deaths  

Coverage  High  Impact  RMNCH  intervenGons  in  ESAR  

Data  sources:  The  State  of  the  word  children  2015;  HIV  data  from    data.unicef.org  |  online  HIV/AIDS  database  2014  

0%   10%   20%   30%   40%   50%   60%   70%   80%   90%   100%  

DPT1  

HEI  with  EID<2  mths  

Postnatal  care  <48hrs  

HIV  exposed  infant  ARVs  

Early  ini4a4on  of  B/feeding  

Skilled  adendant  at  birth  

ANC  at  least  4  visits  

PWLHIV  received  ARVs  

ANC  at  least  one  visit  

Contracep4ve  prevalence  

Coverage  of  RMNCH  IntervenGons  across  0-­‐59  days  of  age  Gmeline      

2.  (PotenGal)  opportuniGes/benefits  for  integraGng  EIMC  within  the  MNCH  pla\orm    

Opportuni4es/benefits  (1)  •  Long-­‐term  Health  &  HIV  preven4on  benefits  •  Opportunity  for  postnatal  contact  

–  36%  newborn  deaths  occur  on  day  of  birth;  73%  first  week  –  but  what  about  girls???  

•  ‘Bundling’  with  other  services  –  PNC;  DPT1  +  FP  &  Ca  Cancer  screening  (mom)  +  VMMC  (father)  –  something  for  everyone  

•  EIMC  a  credible  hook  to  engage  male  partners  in  family  health  –  fathers  &  EIMC  decision-­‐making  process  –  Fathers’  being  circumcised,  acceptance  &  uptake  of  EIMC    –  Poten4al  for  EIMC  to  increase  referrals  for  VMMC  

•  Reinforce  primary  HIV  preven4on  in  MNCH  seings    •  Carte  blanche  to  innovate  –  there  are  no/few  experts  •  Avoid  what  did  not  work  well  e.g.  for  PMTCT    

Opportuni4es/benefits  (2):  Op4mizing  delivery  plakorms  for    outcomes  EIMC  can  strengthen  and/or  leverage  ongoing  efforts  to  bridge  MNCH    implementa4on  and  quality  shorkalls  including:  •  Facility-­‐based  quality  of  care  improvements  •  Reinforce  return  visits  for  f/u  and  other  services  •  Community-­‐based  delivery  plakorms  linked  to  high-­‐quality  

facility  care    •  Outreaches  including  Maternal  &  Child  Health  Days    •  Financial    plakorms  (social  transfers,  insurance,  vouchers,  

PBF)  •  Data  collec4on  plakorms  –  ra4onalize  new  demands,  support  

move  to  fit-­‐for-­‐purpose,  reliable,  4mely  data    •  Link  with    exis4ng  interven4ons  which  have  dedicated  funding  

–  e.g.  malaria,  PMTCT,  MNTE,  VMMC  etc  

3.  AnGcipated  Challenges    

Challenges  introducing  EIMC  in  MNCH  Some  similari4es  with  integra4ng  PMTCT  in  MNCH  •  Enabling  environment  

–  financing  &  sustainability!;  mo4va4ng  investments  for  long-­‐term  results  a  challenge  for  poli4cians  

–  Legal/policy  framework  –  e.g.  who  licenced,  devices  registered?  in  na4onal  essen4al  list?  

–  Moving  to  EIMC  as  a  social  norm  –  look  to  WCAR  for  lessons  –  Mobilizing  cri4cal  partnerships  –  RMNCH,  CSOs,  professional  associa4ons,  private  sector  

•  Programma5c  considera5ons  -­‐  supply  –  priori4za4on  &  buy-­‐in  by  RMNCH  (&  HIV)    –  management/coordina4on  –  who  is  accountable?  –  What  service  model  –  concentrate  skills  &  resources  at  high  volume  clinics  or  EIMC  ‘everywhere’?  

–  Data  and  repor4ng  demands  –  another  ‘program’?  register?  

Challenges  introducing  EIMC  in  MNCH  (2)    

•  Opera5onal  challenges  of  introducing  a  ‘new’  service  –  3  ‘Ss’  •  Staff  -­‐  adding  to  providers’  exis4ng  MNCH  du4es  •  Space  -­‐  need  for  clean  dedicated  space    •  Supplies  –  another  supply-­‐chain  to  get  right  •  Time  –  risk  short-­‐changing  counselling    

•  Engaging  CSOs  as  an  a>er-­‐thought  •  Safety,  quality  and  poten5al  to  do  harm  –  a  game  changer  

–  Overlaps  a  period  of  excess  mortality  –  Must  have  an  agile  system  to  report  and  respond  to  AEs  

•  Transi5oning  from  research  &  pilots  à  prac4ce  and  scale  up?  –  Former  typically  led  by  the  HIV  community  –  Lader  expected  to  be  led  by  RMNCH  –  Unclear  incen4ve  for  either  to  scale  up  

4.  Making  EIMC  a  reality  in  MNCH  clinics,  drawing  from  Lessons  learned  from  PMTCT  

Conclusions  •  MNCH  is  a  natural  home  for  EIMC  however:  •  Cri4cal  that  Govt  makes  the  decision,  leads,  manages,  

coordinates  and  is  accountable  for  the  service  to  ci4zens  •  Cri4cal  to  contextualize  the  incen4ves/disincen4ves  for  

RMNCH  to  integrate  and  sustain  EIMC  at  scale      •  Plan  for  (poten4al)  incen4ves  to  be  realized  •  Minimize/pre-­‐empt  disincen4ves    •  Guarantee  quality  at  outset    •  Reinforce/support  ongoing  efforts  to  op4mize  delivery  

plakorms  •  Don’t  underes4mate  system  constraints  •  Start  small,  but  with  a  view  to  scale  –  cul4vate  partnerships  •  Carte  blanche  –  INNOVATE  around  the  challenges  

Way  forward  EIMC  in  MNCH  •  Back  to  basics  -­‐  a  public  health  approach,  implementa4on  science/art  •  Draw  on  lessons  learned  (good/bad)  from  programs  which  came  

before    •  Posi4on  to  learn  and  share  learning  as  you  implement  •  Innovate  to  solve  problems  –  no/few  experts!  

Acknowledgements  

•  Photo  credits:  Kim  Mar4n,  Marta  Moroni  Contributors  –  Slides,  reviewers:  •  ENAP  advisory  group  •  Eric  Ribaira  (UNICEF,  ESARO)  •  Lauren  Bellhouse  (UNICEF,  NYHQ)  •  Tin  Tin  Sint  (UNICEF,  NYHQ)  •  Stephanie  Marie  Davis,  CDC  •  Emmanuel  Njeuhmeli,  USAID