Helping Babies Breathe annual meeting

Prof Bogale Worku

Washington DC July 17/ 2012

3

Data sources: Updated from Opportunities for Africa’s Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 data

Ethiopia’s Progress to meet MDG 4.

37

88

68

0

100

200

300

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010* 2015

Mort

alit

y per

1000 liv

e b

irth

sNeonatal mortality rate

Under 5 mortality rate

MDG 4 Target

2000 EDHS 48/1000 2005 EDHS 38/10002010 EDHS 37/1000 , SBA <10%Target ?25/1000

According to 2008 National EmONC assessment, 66 % of HCs did not have a resuscitation bag and mask.

National scale up strategy of HBB in Ethiopia

• Govt ownership with extensive collaboration among all maternal, newborn and child health partners

• HBB is integrated in existing and new trainings and programs: – NBC training /Newborn corner ,– NICU nurse training , – CEmONC / BEmONC, – PMTCT, – ICCM, New IMNCI – Pre-service training for midwifes – Others

National scale up strategy cont.

• Rollout strategy for Ethiopia– Champions and high level advocacy– Government coordination with all MNCH partners– Master level TOT for trainers and supervisors of

existing MNCH training programs– UNICEF making available resuscitation equipment

and for both training and service– No specific budget needed as the program is rolled

out through integration though existing programs

TOT Addis Ababa

TOT Addis Ababa

Evaluation - Newborn Corner• The newborn corner is an initiative to address gaps in

preventing newborn morbidity and mortality by ensuring standard newborn care immediately after birth in health facilities.

• Piloting in 100 facilities by EPS in collaboration with FMoH and UNICEF

354 HW including MDs, HOs, midwifes and clinical nurses 3 days on ENC, HBB, KMC and sepsis management providing supplies and clinical mentoring post training.

The newborn corner

Trained personnel to care for the babyA warm and clean surface Essential newborn resuscitation equipments

Evaluation - Results• Baseline and end line assessment in 60

facilities looking at knowledge, skills and availability of basic resuscitation equipment

The newborn corner

Comparison % health workers skill on neonatal resuscitation on base line and end line survey

Number of newborn with asphyxia(one month in 60 health facilities )

Number of deliveries

Still birth(%)

Number of babies not breathing at birth and required resuscitation (%)

Survived After resuscitation

Case fatality from PNA

8080 453(5.6) 212 (2.6) 180 (84.9) 32 (17.77)

Results to date in Ethiopia• Carders trained on HBB by 31 June 2012

Health workers 7 295HEWs 20 050Total 27 345

• Bag and mask distributed by 31 April 2012Health centers 354Hospitals 50Total 404 out of 3000 HF (13,5%)

• Resuscitation equipment available 8 000, plus an additional 10 000 to arrive shortly in Ethiopia. In addition 2 000 NeoNatalie training dolls are available in Ethiopia for HBB training.

Quality improvement process

• Neonatal registration book in place• Supportive supervision and clinical mentoring

post-training• Guidelines and protocols for newborn

resuscitation is being under development • Quarterly / annual review meetings planned

Lessons learned

• Integration has been a successful way to quickly train and orient a large number of health workers and community health workers (HEWs) on HBB in Ethiopia.

• Having a strong governmental leadership with close collaboration among partners is the only way to make changes to newborn survival in a large country with limited funding sources.

• Making training material and resuscitation equipment available has helped the HBB rollout.

• Early data shows that the training on HBB among HWs has improved their skills.

However…

• Still only around 10% of deliveries are conducted in health facilities, and only 1% of the HEW have the opportunity to conduct deliveries.

• Data on newborns not yet systematically collected as current HMIS does not fully address NB issues

Acknowledgements

• FMoH • UNICEF• WHO• ICAP – Ethiopia

Thank you