1 - LEADERSHIP AND GOVERNANCE
Progress on Newborn Action Plans
In December 2015, UNICEF’s Regional Office for South Asia (ROSA) and the World Health Organization’s Regional Office for South East Asia (SEARO) jointly held a technical advisory group (TAG) meeting in New Delhi, India. At this meeting, six partner agencies (WHO, UNICEF, UNFPA, World Bank, UN Women and UNAIDs) signed a Joint Statement to support countries to end preventable maternal, newborn and child mortality by 2030. TAG members provided their recommendations for action and identified technical assistance required from partners. In addition, government leaders, academics and other stakeholders from across South Asia discussed priority actions to reduce newborn death. Follow-up actions are underway.
Political commitment from Afghanistan
In May 2015, the ‘Kabul Declaration for Maternal and Child Health’ was signed with targets to reduce maternal, newborn and child mortality by 2020. Reproductive, Maternal, Newborn, and Child Health Scorecards were developed and formally released with data on key indicators down to district-level, which are designed to improve public accountability in the health sector. In addition, Afghanistan’s government has made high-level commitments to the Secretary General’s Global Strategy for Maternal, Newborn, Child and Adolescent Health for 2030.
Raising awareness about premature babies in Pakistan
To observe World Prematurity Day in 2015, several events were organised in Pakistan. These included press releases and advocacy events at both federal- and provincial-level to emphasise the importance of, and to share key messages on, prevention and treatment of preterm births.
2 - HEALTH FINANCING
Financing-related policies and trainings in the region
To better inform planning for resource allocation and priority setting decisions on newborn health, a regional training on the One Health Tool was held in April 2015. Government officials and researchers from academic institutions across South Asia joined the training. Technical support to countries for costing of national or provincial ENAPs is ongoing from UNICEF’s Regional Office.
Investing in newborn health in Nepal
In 2015, Nepal endorsed the National Safe Motherhood and Newborn Health Act, which provides legal provisions for the rights of women to maternity leave during pregnancy and the postpartum period, and free health services for mothers and newborns. Using an investment case approach, the district action plans produced through these efforts supported by UNICEF have been instrumental in ensuring adequate resource allocations for MNCH services at district-level.
3 - HEALTH WORKFORCE AND TRAININGG
Ensuring a supply of skilled birth attendants
In 2015, Afghanistan, Bangladesh, India, Nepal and Pakistan developed national human resource plans or strategies for skilled birth attendants.
The South to South Collaborative for Health
UNICEF’s new South 2 South Collaborative for Health brings colleagues together for learning opportunities on key issues in reproductive, maternal, newborn, child and adolescent health. The aim of the S2S initiative is to systemically share practical experiences and ‘know how’ from one country to another, mainly in South Asia.
Facilitated by UNICEF, Health Promotion Officials from the Ministry of Public Health and officials from the Ministry of Rural Rehabilitation and Development in Afghanistan undertook a mission to Nepal to learn appreciative inquiry in 2015. As a result of this visit, preparations were completed to establish ‘Golden Villages’ in which communities commit to achieving 100 percent skilled birth attendance among new deliveries.
In addition, facilitated by UNICEF, an exchange was held in October 2015 in which paediatricians, obstetricians, midwives and nurses from Bangladesh were trained at the All India Institute of Medical Science on Kangaroo Mother Care (KMC). KMC was subsequently established in two facilities in Bangladesh.
In November 2015, facilitated by UNICEF, staff from Sri Lanka’s Ministry of Health, national obstetric association and paediatric association visited one of India’s Special Newborn Care Units (SNCUs) to learn about the newborn online (and real-time) data monitoring system. Since this exchange, an online monitoring system has been planned for Sri Lanka.
4 - HEALTH INFORMATION SYSTEMS
The global ENAP supports monitoring progress within countries, including to map the coverage of four specific newborn care interventions: use of antenatal corticosteroids, resuscitation, Kangaroo Mother Care (KMC) and management of neonatal sepsis. In South Asia, India has integrated all four of these newborn-specific indicators in its national Health Management Information System (HMIS). Other high burden countries have included at least one or two newborn indicators in their national HMIS.
Tracking sick newborns in India
In 2015, India’s Special Newborn Care Unit (SNCU) monitoring system, initiated by UNICEF, was scaled up to 17 states covering 440 out of 602 SNCUs. An additional 450,000 newborns were registered in the system, representing an 81 percent increase over the 248,000 registered in 2014. Thirteen states initiated community follow up of newborns discharged from SNCUs, facilitating timely data review, feedback and corrective actions.
5 - HEALTH SERVICE DELIVERY
Initiatives to improve the quality of newborn health care
UNICEF, WHO and the US Agency for International Development (USAID) held a regional workshop in Dhaka, Bangladesh in April 2015 on a series of competency-based newborn care training modules called “Helping Babies Survive.” Participants from Afghanistan, Bangladesh, India, Nepal, and Pakistan joined this training. Afghanistan subsequently conducted a “Training of Trainers” on Helping Babies Survive.
In addition, four South Asian countries (Afghanistan, Bangladesh, India and Nepal) implemented quality improvement guidelines for maternal and newborn health in 2015.
In Bangladesh, a national Quality Improvement Secretariat (QIS) and a Total Quality Management (TQM) Unit were established, along with a ‘National Strategic Plan for Quality of Care’ and a related monitoring framework. With support from UNICEF, Bangladesh adopted Every Mother Every Newborn (EMEN) quality improvement standards and criteria and implemented models of Quality Improvement. The Ministry of Health and Family Welfare developed a plan for scaling up Special Care Newborn Units (SCANU). Bangladesh will also start implementing Kangaroo Mother Care (KMC) in two hospitals and in 30 facilities at primary/ secondary and tertiary levels during 2016-17.
Improving facility-based newborn care in India
Global evidence shows that 39 percent of newborn deaths could be averted with hospital care. With UNICEF support, many states in India adopted innovative approaches to leverage funding so as to ensure human resources and equipment maintenance in SNCUs and to set up model labour rooms (a standard design to enable labour rooms to handle both normal and complicated labour). Functional SNCUs in the 23 states supported by UNICEF under the Call to Action increased from a baseline of 49 percent of the high priority districts in 2012 to 63 percent (i.e. 66 out of 105 high priority districts). In addition, the percentage of delivery points in high priority districts having at least one trained staff in SBA increased from 28 percent to 75 percent during this same time period. Currently, about 40 percent of high priority districts have at least one model labour room.
Saving newborn and maternal lives after the earthquake in Nepal
After the devastating April 2015 earthquake, UNICEF supported the re-establishment of essential life-saving MNCH services in areas of Nepal where health facilities were destroyed or damaged. With UNICEF support, 46,522 mothers and newborns were reached with essential and emergency care in earthquake-affected areas, and 22 transitional shelter homes were established to provide care for pregnant women waiting for labour and new mothers and their newborns.
Scaling up postnatal care in Bhutan
A great effort has been made by Bhutan to improve postnatal care with support from UNICEF. Based on the results of a pilot implementation of postnatal care outreach services, a nationwide scale-up covering all 20 districts was launched in 2015.
6 - ESSENTIAL MEDICAL PRODUCTS AND TECHNOLOGIES
Essential medicines for newborns
The extent to which recommended essential medicines and commodities for high-impact interventions are included in National Essential Medicines Lists (NEMLs) varies by country. Within South Asia, Pakistan is the only country to date that has included all essential drugs relating to newborn health in its NEML. Further, Punjab and Sindh provinces introduced chlorhexidine for cord care, an intervention proven to reduce newborn deaths by up to 23 percent. Chlorhexidine introduction will be replicated in Khyber Pakhtunkhwa (KP) and Balochistan provinces in 2016. Some progress on essential medicines have also been made in Afghanistan and Bangladesh.
Prioritization of a research agenda
The prioritization of a research agenda for maternal and newborn health has begun in several countries in South Asia. However, planning for a research agenda around the issue of stillbirths still needs to gain greater traction.
7 - COMMUNITY, OWNERSHIP AND PARTNERSHIP
Communication strategies are available in Nepal and Pakistan. In 2015, Afghanistan, Bangladesh, and India worked to develop national communication strategies on newborns.
Establishment of a community support system in Bangladesh
To create demand for maternal and newborn health services, UNICEF Bangladesh supported the establishment of 2,061 Community Support Systems (ComSS) in 14 districts through existing community groups formed by the Ministry of Health and Family Welfare. More than 7,300 female community health volunteers were trained to conduct birth preparedness sessions, to facilitate referral, and on newborn health and major childhood illnesses.