An Action Plan To End Preventable Deaths

#EveryNewborn

EVERY NEWBORN

EVERY NEWBORN UPDATE3 December 2014

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Agenda Current status

• History, structure, activities

Working group updates• Country Implementation• Metrics • Advocacy

Moving forward • Next steps and roles of partners

Questions and discussion

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Building a movement

xWorld Health

Assembly

The end of MDGs brings new clarity about what is left behind on the agenda – newborns, stillbirths,

adolescents

Country action for newborn health

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Main funders: Bill & Melinda Gates Foundation, USAID, Children’s Investment Fund Foundation

Every Newborn Series5 papers, 6 comments

55 authors from 18+ countries

60+ partner organizations

Published May 2014

www.thelancet.com/series/everynewborn

Every Newborn Action Plan

Based on the evidence from the Series

Co-led by UNICEF & WHO

World Health Assembly 2014 resolution

Over 300 experts consulted

60+ partner organization

Launched 30th June 2014

40+ commitments to EWEC

Building from evidence to action

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This is where we get the biggest bang for our buck. - Kim Dixon, Co-Chair ENAP, UNICEF

Our efforts have meaning only if those who are born today can enjoy them. - Cyril Ramaphosa, Deputy Vice President of South Africa

Progress is still too slow, especially for newborns. Today we launch the Every to speed up our response and save more lives. - Ban Ki-Moon, UN Secretary General

Graça Machel and other world leaders launched the Every Newborn action planPartners Forum, South Africa, June 2014

Newborn was a gap. The World Health Assembly agreed and passed ENAP.- Margaret Chan, World Health Organization

This plan demonstrates that together we can achieve the vision of a world in which there are no preventable

deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and

children survive, thrive and reach their full potential – Graça Machel

EVERY NEWBORNCommitments

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#EveryNewborn

World Health Assembly Resolution194 member states endorsed the Every Newborn Action Plan in May 2014

Now 40 new commitments, largest collection since launch of Every Woman, Every Child in 2010

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The partnerships forged during the development process for ENAP will work together on three main streams of activities:

1. Country implementation: to identify and respond to technical support needs to ensure that the proposed strategies and evidence are translated into action

2. Data and metrics: to improve and institutionalize metrics to track coverage and impact based on the goals and targets of the ENAP and the five strategic objectives

3. Advocacy: to strengthen and track maternal and newborn health advocacy efforts globally and in countries.

Every Newborn priority activities

Research

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New ENAP structure New management structure set up to

strengthen the support to the three main

streams of activities

Members include:• Three working groups co-leads: WHO, UNICEF, LSHTM, UN Foundation,

PMNCH, Save the Children • Chairs: WHO and UNICEF• Other core partners: BMGF, UNFPA, MHTF, USAID

Channels of communication for wider group of stakeholders:• Participation in one or more of the work streams either as core member or

wider group member • Regular updates from ENAP management team though different outreach

mechanisms e.g. email updates, discussion fora, webinars, global and national meetings.

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An Action Plan To End Preventable Deaths

#EveryNewborn

EVERY NEWBORN

ENAP COUNTRY IMPLEMENTATION

GROUP

Kim Dickson and Bernadette Daelmans

on behalf of team

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Purpose: To identify and respond to technical support needs to ensure

that the proposed strategies and evidence are translated into action

Goals: 1. To strengthen technical support coordination2. To strengthen monitoring of country implementation and track

progress3. To provide technical assistance for EMEN development,

implementation and assessment

Team Leads: WHO (Bernadette Daelmans) and UNICEF (Kim Dickson) Core partners: UNICEF, Save the Children, CIFF, BMGF, USAID

Country Implementation Group

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1.To orient and support action in countries by providing technical country support and facilitate coordination including mapping partners activities, available tools and engagement of partners as well as support in the development and launch of national action plans and capacity building for effective interventions

• Mapping of technical assistance currently available within countries underway and development of a repository of TA.

• Inter-country meetings on Every Newborn e.g. Sri Lanka WHO/UNICEF regional meeting held in November 2014

Country Implementation Group Activity

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2.Monitor and track progress of country implementation• Progress tracking tool has been shared by

facilitating partners in many countries and countries have started returning completed tools. Data analysis to be completed by end December 2014

3.Develop, implement and evaluate the Every Mother Every Newborn Quality Improvement Initiative• Literature review of accreditation programmes,

country quality improvement activities and incentives programmes underway

Country Implementation Group Activity

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Country Implementation GroupNext steps/plan

Development of pre-term guidelines (for 2015) and guidelines for the management of possible severe bacterial infection (for 2015)

Progress report on newborn health to be prepared next year

Eastern Mediterranean Region meetings planned for Q1 2015

Stakeholders meeting on EMEN – date TBC

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An Action Plan To End Preventable Deaths

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EVERY NEWBORN

ENAP METRICS GROUP

Matthews Mathai and Joy Lawnon behalf of team

ENAP Milestones by 2020• Count births and deaths in CVRS (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

xWorld Health

Assembly

Metrics testing and use in countries

for programme improvement and accountability

May/June 2014

Dec 2014MeetingTo scope

ENAP Metrics improvement plan

Jan- May 2015Refining and consulting on

metrics plan & ENAP monitoring FW

June 2015 - May 2018Testing indicators and

tools in limited number of countries

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

2020

Every Newborn action plan core indicatorsCore ENAP Indicators Additional Indicators

Impact

1. Maternal Mortality Ratio

2. Stillbirth Rate Intrapartum Stillbirth Rate3. Neonatal Mortality Rate Low birth weight rate

Preterm birth rate Small for gestational age

  Neonatal morbidity rates , eg infection

  Disability after neonatal conditions

Coverage: Care for all mothers and newborns

4. Skilled attendant at birth

Immediate breastfeeding

5. Early postnatal care for mothers and babies 6. Exclusive breast feeding to 6 months

Coverage:Complications and extra care

7. Antenatal corticosteroid use Caesarean section rate 8. Newborn resuscitation

9. Kangaroo mother care, feeding support

Chlorhexidine cord cleansing 10. Treatment of neonatal sepsis

Counting Birth registration Death registration, cause of death

ENAP service delivery packages

"MotherBaby" high quality care at birth 

Care of small and sick newborn Shaded = not currently routinely tracked. Bold = indicator requiring additional evaluation for consistent measurement All indicators to be tracked so that they can be broken down to assess equity, e.g. urban/rural, regional, wealth quintile

Source: Every Newborn: From evidence to action to deliver a healthy start for the next generation. Mason E. , McDougall L, Lawn JE, Gupta G, Claeson M, Pillay Y, Presern C, Baye Lukong, M, Mann, G, Wijnroks M, Azad K, Taylor K, Beattie A, Bhutta ZA, Chopra M for the Lancet Every Newborn Study Group. Lancet 2014.

CO CHAIRS WHO: Matthews MathaiLSHTM: Joy Lawn

COORDINATION GROUP(purpose to link to existing metrics work, and institutionalise)

UNICEF: Holly Newby plus alternateUNFPA: Sennen HountonSNL/NBITWG: Lara VazCIFF: Suzanne Fournier Gates: John GroveUSAID: Allisyn Moran

TASK TEAMS (working on specific metrics, linked with existing initiatives)

Task teams Initial focus on the 4+1 specific newborn care interventions

WIDER INTEREST GROUP Very inclusive

>100 people drawn from wider metrics community including Newborn indicators technical working group

INSTITUTIONAL PARTNERS to build capacity especially Africa & Asia

Aim to have 2-4 academic institutional partners in high burden countries linked to EMEN pilot sites (Ghana, Tz, Bangladesh, Kenya)

Every Newborn Management team

work streams

Every newborn management including ENAP Metrics

3. Advocacy & mobilisation

1. Country Implementation

2. ENAP Metrics group

UNF/PMNCH & Save the Children

UNICEF & WHO

WHO & LSHTM

Research working group (Cross cutting)

Every Newborn Steering Group

Light touch secretariat

ENAP Metrics group:

Three tracks of work for ENAP metricsInitial focus on testing 4 + 1 priority treatment interventions1. KMC (coordinated with KMC acceleration gp and LSHTM with SNL)2. Resuscitation (USAID/MCS, SNL Bangladesh, WHO, HBB, UNCoLSC, etc) 3. Antenatal Corticosteroids (WHO and UNCoLSC TRT etc) 4. Sepsis case mx (WHO, UNCoLSC etc)5. CHX cord cleansing (UNCoLSC, SNL etc)•Coverage/ content maternal & newborn care (with NBITWG & ICM)•Impact indicators including disability (LSHTM & WHO)•Priority research agenda for HMIS, surveys, and related tools, work in progress and gaps (LSHTM & WHO)

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

1

Improve & institutionalise

tools in national data collection platforms & global metrics architecture, accountability

2

Capacity developmentto improve & use the data for action

3

•Birth and perinatal death certificates, coverage & quality• Develop and test Minimum Perinatal Dataset•Perinatal Mortality audit tool, to link to maternal death surveillance and response, led by WHO•Household surveys modules and Verbal autopsy tools (eg birth/pregnancy history, improved birthweight and GA assessment) •Standard data collection in facility HMIS and facility assessments (eg SPA,SARA)• Improving birthweight and GA assessment tools

• User friendly formats, intentional links to accountability and parent voices (eg partnerships with E4A and WRA) •Testing linked to EMEN work (~4 countries)•Southern institutions & INDEPTH as centres of excellence• Integrated l oversight especially with maternal community

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An Action Plan To End Preventable Deaths

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EVERY NEWBORN

ENAP ADVOCACY GROUP

Anita Sharma, Lori McDougall, Mike Kiernanon behalf of team

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Purpose: To strengthen the linkages and track maternal and newborn health advocacy

efforts globally and in countries.

Goals: 1. Under the Every Woman Every Child umbrella support national coalitions

advocating for maternal-newborn health2. Maintain and strengthen global and regional commitments building on

growing ENAP support at country level 3. Ensure strong accountability for commitments made to ENAP4. Continue to raise awareness and bring new partners on-board with a special

focus on strengthening integration of MNCH

Team: Leads: UN Foundation, Save the Children, PMNCH Core partners: BMGF, UNICEF, World Vision, March of Dimes, Save the

Children, FCI, Johnson & Johnson, White Ribbon Alliance, MamaYe, Well Being Foundation and others

Advocacy Group

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• Focus on country progress• Lead from behind (ENAP is a goal, not

a brand) • Build on existing networks, coalitions

at country level • Leverage global efforts to deepen,

sharpen country commitments (EG: World Prematurity Day)

• Use evidence to guide policy, practice (EG: Lancet Every Newborn launches in country)

• Support integration of maternal-newborn health

Our Operating Principles

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Work plan 2015 currently under development

Support dissemination opportunities for the Lancet Every Newborn Series and/or national maternal-newborn action plans

Priorities for advocacy

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

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An Action Plan To End Preventable Deaths

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EVERY NEWBORN

MOVING FORWARD

Kim Dickson and Rajiv Bahlon behalf of team

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Country launch events for the Lancet Every Newborn Series and/or national maternal-newborn action plans

Implementation of national action plans with an emphasis on saving both mothers and newborns

Global and national tracking of benchmarks, milestones and outcomes with a special focus on identifying significant progress in specific countries or regions

Annual reporting to World Health Assembly

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

Support and promote key maternal and newborn resources and events. Information available at www.everynewborn.org

Next stepsEvery Newborn opportunities for action

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Actions of all stakeholders Every stakeholder has

committed to the actions in the ENAP

We would love to hear what are you doing and how can we work better together to deliver for every newborn?

Open to discussion

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An Action Plan To End Preventable Deaths

EVERY NEWBORNWe are still building a

movement…

BE PART OF THE ACTION

For more informationvisit

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