CORE Group Global Health Practitioner

Conference May 8, 2014

Joy Riggs-Perla, Director, Saving Newborn Lives Program

#EveryNewborn

Presentation Topics

• What is ENAP and what are we trying to achieve?

• ENAP targets for newborns, stillbirths and maternal mortality

• Content of Action Plan• Process moving forward• Civil society contribution

A roadmap for change in countries…

A platform for harmonized action by all partners…

Sets out a clear vision with mortality targets, strategic objectives, innovative actions within the continuum of care

Supported by new evidence to be published in The Lancet in May 2014

Plan to be launched at Partner’s Forum end of June 2014

A movement for greater action and accountability…

The Every Newborn Action Plan: building a movement

Photo credit: Save the Children

The vision for Every Newborn Action Plan

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.

Vision statement in draft ENAP, March 2014

What are we aiming for? End preventable newborn deaths and stillbirths

as well as maternal and child deathsStillbirths and newborn deaths are not inevitable

Women and babies deserve quality care around birth and small and sick newborns need special care

Each year save the lives of 3 million newborns, stillbirths and women

1. Include newborns and stillbirths in post-2015 framework along with maternal & child health

2. Attention and funding for newborns and stillbirths within the RMNCH continuum

3. Sharpen national plans and improve demand and delivery of care at the time of birth

4. Develop and implement “Mother-Baby Friendly” package

5. Improve programmatic and impact data and use this for action in countries

Long term

Medium term

NOW

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

20222024

20262028

20302032

20340

10

20

30

40

50

60

70

80

90

100

Mor

talit

y ra

te (p

er 1

,000

live

birt

hs)

2000-2012AAR = 2.7%

2000-2012 AAR = 3.8%

Global U5MR

Global NMR

A Promise Renewed target: National U5MR of 20 or less[Global U5MR of 15]

Current trends continue: U5MR

AAR = 4.3%

Target for ending preventable newborn deaths

Current trends continue: NMR

Scenario 2035 global neonatal mortality rate 2035 neonatal deaths

If current trends are unchanged 13 1.8 million

Every country to NMR <10 per 1000 7 0.9 million

Similar to 2/3 reduction in NMR as if a continuation of MDG4

ENAP Neonatal Mortality target: National NMR of 10 or less[Global NMR of 7]

0

5

10

15

20

25

Glo

bal a

vera

ge sti

llbirt

h ra

te

(per

1,0

00 to

tal b

irths

)

2000-2009ARR = 1.3%

ARR required = 3.5%

Scenario 2035 global stillbirth rate 2035 stillbirths

If current trends are unchanged 15.9 2.2 millionEvery country reaches SBR of 10 per 1000 8.0 1.1 million

Also similar to ≥2/3 reduction in stillbirth rate for every country

With same time trends SBR

Every Newborn target: for stillbirths National stillbirth rate of 10 or less[Global SBR of 8]Consistent with neonatal and under5 mortality targets

Target for StillbirthsCountry consultations requested a specific stillbirth target

Lancet GH Sept 2013 : The Lancet Global Health 2013; 1:e176-e177 (DOI:10.1016/S2214-109X(13)70059-7)

Maternal mortality target in process of being set, coordinated by WHO and others

Hope to include a target for MMR

Fam

ily/c

omm

unity

Out

reac

h/ou

t pa

tient

Clin

ical

antenatal care postnatal care

early postnatal home visits for

mother and newborn

cleaner, safer birth

adolescent health at

home and school

child health care

obstetric and childbirth care including essential newborn care

emergency newborn care

reproductive health care

reproductive health care

intersectoral Improved living and working conditions including housing, water and sanitation, and nutrition Education and empowerment

emergency child care

ongoing care for the child at home

pregnancy home visits

What to focus on?Packages within RMNCH continuum of care

ChildhoodNewborn/postnatalBirthPregnancyPre-pregnancy Birth

What to focus on?Prevention & care for main causes of neonatal deaths (3 by 2)

Preterm birth• Preterm labor management including antenatal

corticosteroids*• Care including Kangaroo mother care, essential

newborn care

Birth complications

(and intrapartum stillbirths)

• Prevention with obstetric care *• Essential newborn care, and resuscitation*

Neonatal infections

• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*

• Case management of neonatal sepsis *

1

2

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

Over two-thirds of newborn deaths preventable – actionable now without intensive care

3

What to do differently?Every Newborn’s Five strategic objectives

1. Strengthen and invest in care during labour, birth and the first day and week of life

2. Improve the quality of maternal and newborn care

3. Reach every woman and every newborn; reduce inequities

4. Harness the power of parents, families and communities

5. Count every newborn – measurement, tracking and accountability

Every Newborn’s guiding principles

Country leadershipGood governance, community

participation, partner alignment

IntegrationIntegrated service delivery, continuum

of care, programme coordination

EquityUniversal coverage, closing the equity

gap

Human rightsPrinciples, standards

InnovationInterventions, delivery approaches,

technologies

Health Sector Strategic & Investment Plan

Integrated National RMNCH Plan

Increasing access and use of Family

Planning

Ending preventable

newborn deaths

Ending preventable deaths from pneumonia and

diarrhoea (GAPPD)

Ending preventable

maternal deaths

Sharpen focus within existing national RMNCH and health strategies and plans; not a new stand alone plan

UMBRELLA MESSAGEIn next decade, 3 million babies and women saved every year with quality care at birth

Every Newborn main events 2014

February NovemberJune September

LAUNCH!

May

Every Newborn

2014

UNGA

ICM

Problem identificationBurden of problemProgress for newborns has fallen behind

Lives saved and investment case

Cost-effective and feasible solutions available Lives saved and costTriple return on investment

Post-2015 action for newborn & stillbirths

Actions by all at country and global levelParent and civil society voice

* Developing detailed matrix of events for more details

WHA

SOWM Countdown

Unique Civil Society Contribution• Household Level Essential Newborn Care: Drying, wrapping,

delayed bathing, clean cord care including CHX, immediate/exclusive breastfeeding.

• Demand and Care Seeking: Preventive care around birth, sustained demand for services and timely care seeking for mothers and newborns

• Community leadership and accountability: Solve practical problems, hold health providers accountable to providing quality services, strengthen links between community and facilities, promote incentives for community health workers.

Unique Civil Society Contribution

• Champions: Develop local champions, including parliamentarians, parent groups, professionals, community health volunteers and community leaders; engage and link champions for RMNCH+A

• Adolescents: Give special attention to adolescent girls; help prevent early and unwanted pregnancies

• Quality and accountability: Be a voice for change. Demand quality, affordable, accessible services. Report poor services. Change social norms regarding preventable maternal and newborn death.