NEONATAL MORTALITY SOUTH ASIA HEADLINE RESULTS - PROGRESS REPORTS

  The vast majority of newborn deaths are preventable.

I don’t mean theoretically preventable under ideal but unrealistic circumstances. I mean preventable with relatively simple and relatively inexpensive interventions. Preventable with systems and technology available we have now in almost every country.”

Melinda Gates
World Health Assembly May 2014

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A newborn baby dying within the first month is a tragedy.

This tragedy strikes more than 1 million newborns and families every year in South Asia, causing families intense mental, physical and social trauma.
The good news is that almost 70% of newborn deaths are preventable, event without intensive care facilities – improvements are certainly possible.
In 2014, the international community through the Every Newborn Action Plan , committed to ending this tragedy. Some of the partners who are working together to reduce newborn deaths include:

SOUTH ASIA TARGET

Reduction in newborn mortality from 30 per 1000 live births in 2013 to 25 per 1000 live births in 2017. This will save an additional 240,000 newborn lives by 2017

GLOBAL TARGET

Reduction in newborn mortality to 10 per 1000 live births by 2035
 
 

IMPROVING KNOWLEDGE ACCELERATING RESULTS

theory of change

We know how to prevent newborn mortality. Almost 70 percent of newborn mortality is avoidable and requires a mix of interventions that need buy-in and action from families, communities, healthcare workers and governments.
The objectives of the global Every Newborn Action Plan, ratified at the World Health Assembly in May 2014, have been adapted and incorporated into UNICEF South Asia’s strategy to achieve our 2017 target.

DATA PROFILE

1990 = 2 million newborn deaths per year.
2013 = 1 million newborn deaths per year. Yet, nearly 3000 newborns died each day in 2013.
If the current trend continues, we will not meet either the regional result by 2017 or the global target by 2035. The blue striped area is the gap that needs to be addressed.



Data from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2014

If Afghanistan, Pakistan and India dramatically reduce their rate of newborn deaths, it will have a huge effect on the regional results.
India is particularly important given the vast size of the population.



Data from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2014

ACCELERATING CHANGE IN SOUTH ASIA

1 - SOUTH ASIA

Political Commitment to the Every Newborn Action Plan in South Asia

In 2014, the Government of India launched the India Newborn Action Plan – a direct response to the Global Every Newborn Action Plan, ratified at the 67th World Health Assembly in May 2014. Contributed to by UNICEF and other partners, the plan outlines a strategy to end preventable newborn deaths in India. The plan aims for equitable progress despite gender, geographical location, or wealth status.

Contextualized and costed national newborn action plans are essential for progress to reduce preventable newborn deaths. It is a priority for UNICEF regional and country offices in South Asia to technically contribute to developing these plans, and then assist governments to make sure changes really happen in an equitable way. Other countries in South Asia, including Bangladesh and Nepal, are in the process of forming their national newborn action plans, and UNICEF aims to see all countries with costed plans in 2015 and 2016.

2 - INDIA

Delivering innovative healthcare solutions in India

The issue of quality and timeliness of receiving data was identified as a problem for monitoring performance and follow up of newborns from special newborn care units - intensive care units for newborns with severe complications. To address this UNICEF supported the government to develop a real time monitoring and tracking system.
This innovation generates real time information on over 250 parameters to assist program managers to improve quality of newborn care. The system is also linked to an SMS network that sends periodic reminders to families and health care workers to follow up. This work was incorporated into the India Newborn Action Plan by the Government of India in 2014 and scaled up to cover eight states and 245 special newborn care units in the country (it was three states and 109 units in 2013).

3 - SRI LANKA

Regional consultation on newborns

UNICEF and the World Health Organization jointly led a regional specific consultation on the Every Newborn Action Plan in Colombo, Sri Lanka in November 2014.
Following the launch of the Global Every Newborn Action Plan in May 2014, South Asia was the first region to hold a regional consultation on the Every Newborn Action Plan. The meeting also included discussion of postnatal care for mothers and newborns. The meeting was inaugurated by the Minister of Health from Sri Lanka, and was well attended with about 100 delegates from ministries of health and development partners. There was a fantastic atmosphere of collaboration, learning and sharing at the consultation, as well as a highlighted need to develop, launch and cost tailored country specific newborn action plans.

4 - NEPAL BANGLADESH

Promising results in Nepal and Bangladesh

Nepal and Bangladesh have made the most progress in reducing newborn deaths since 1990. In 1990 Bangladesh had a neonatal mortality rate of about 55 per 1000 live births and in Nepal it was 53. In the 2014 data from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) which reports on 2013 data, Bangladesh had plummeted to about 24 per 1000 live births and Nepal to 23.

UNICEF advises that a skilled birth attendant should provide care during delivery, as this is an important way to reduce neonatal mortality. Yet, there are:


• Huge inequities between countries in South Asia: Almost 100% of births in Sri Lanka are attended by skilled health staff vs only 32% in Bangladesh.


• Vast disparities between rural and urban: In Nepal, only 32% of rural births are attended by a skilled provider compared to 73% in urban areas.


• Wealth and education disparities: In Bangladesh, about two thirds of the wealthiest women, or those who have completed secondary or higher education, have a medically trained provider at birth. For the poorest women, or those with no education, it is just over 10%.

Millennium Development Goal 4: Reduce Child Mortality

In 2015, countries will make a final push to achieve the MDGs. Looking ahead to the next 20 years, reducing newborn mortality is an important challenge which needs to be faced.
Progress on MDG 4 in South Asia has been steady, but improvements in infant mortality (deaths at less than 12 months) and child mortality (deaths at less than five years) have been faster than neonatal or newborn deaths (deaths at less than 28 days after birth). The need to recommit to addressing MDG 4 (and MDG 5) was reiterated in a joint UN regional statement by the Regional Directors of WHO, UNICEF and UNFPA in April 2014.
Read the full statement

EVERY NEWBORN ACTION PLAN

Some of the development partners working together to reduce newborn deaths:

           

A 2014 EVALUATION

In Nepal in 2014 UNICEF assessed twelve hospitals for quality of care around the time of birth and for newborns – including a review of out of pocket expenses for patients. The analysis revealed that quality of care was low, including poor use of indicated medications and resuscitation equipment. Less than half of the healthcare workers in key clinical areas for newborns had the knowledge they needed on resuscitation and kangaroo mother care.
In terms of governance none of the hospitals had a quality improvement system, and out of pocket costs for sick newborns could be as high as a month’s wages. Although these types of analyses reveal many problems, they are invaluable for UNICEF, partners and government. At the core of our work in South Asia is identifying gaps in the system, and then working with government to increase investment in health, improve quality of care, and reduce out of pocket costs by working towards Universal Health Coverage.

IMPORTANT RESEARCH IN 2014

In May 2014, The Lancet published key research on newborn health, with UNICEF Regional Office for South Asia contributing to one of the academic papers.
The series covered health-system problems, ways to accelerate progress, and evidence based interventions.

Bottlenecks were studied in Afghanistan, Bangladesh, India and Pakistan, including problems in the areas of: leadership and governance, health financing, health workforce, essential medial products and technologies, heath service delivery, health information systems, and community ownership and partnership. Many bottlenecks were revealed.
For example, in the featured South Asia countries, issues with kangaroo mother care was noted. There were problems with investment, training, and institutionalization of this approach. Interventions to address the bottlenecks were suggested, and key factors overall were identified to accelerate progress, including: workforce planning, financial protection measures, and dynamic leadership.
read more

SHAGUFTA SHAHAZADI, Pakistan

Shagufta Shahzadi, Pakistan

Delivering skilled health and safety for mothers and newborns in rural Pakistan
KASUR DISTRICT, Pakistan, 3 December 2014

Shagufta Shahzadi, 30, is a skilled birth attendant who lives and works in the Nandanpura village in Pakistan’s Punjab province. A mother of two, Shagufta has completed an 18-month community midwife training course organized by UNICEF.
“There is a huge difference between services provided by a trained birth attendant and an untrained traditional midwife. A skilled person knows how to prevent and deal with complications during pregnancy, at the time of delivery and delivering postnatal care for mother and child,” says Shagufta.
A day’s work can include delivering a baby, advising pregnant women on prenatal care and walking to the neighbouring village to provide postnatal care to a mother and the newborn. She takes a lot of pride in her work and feels a sense of achievement that in the past year, there was not one case of an expecting mother or newborn dying in any area where she works. “When I was born, a traditional midwife came to our house to manage the delivery," she says. "She had no concept of hygiene and did not even wash her hands before checking my mother. She placed some ash from the stove on the floor and delivered me there. Things have changed now.”

Sources:
http://cbs.gov.np/
World Bank. n.d. World Development Indicators: Births Attended by skilled health staff [accessed 4 July 2014]
Bangladesh Demographic and Health Survey 2011