E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 1

Annual implementation review and planning guide

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 1

Annual implementation review and planning guide

© World Health Organization 2018Some rights reserved.

ISBN 978 92 9061 836 2 This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules).

Suggested citation. Annual implementation review and planning guide (Early Essential Newborn Care, Module 1). Manila, Philippines. World Health Organization Regional Office for the Western Pacific; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. 1. Infant, Newborn. 2. Infant care. I. World Health Organization Regional Office for the Western Pacific. (NLM Classification: WS113)

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: wpropuballstaff@who.int

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. For inquiries and request for WHO Western Pacific Regional Publications, please contact the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: wpropuballstaff@who.int

Cover, photo credit: © WHO/Yoshi Shimizu

CONTENTS

Foreword .................................................................................................................................................................................................................................. v

About the EENC modules .........................................................................................................................................................................................vi

OVERVIEW ...............................................................................................................................................................................................................................1

SECTION 1. Evaluation of selected facilities that have introduced EENC ...............................................................5

1. Interviews with postpartum mothers:.....................................................................................................................................6 – term babies (Checklist 1.1) ..................................................................................................................................................8 – preterm or low-birthweight babies (Checklist 1.2) .............................................................................................10

2. Chart reviews of interviewed postpartum mothers: ....................................................................................................13 – term babies (Checklist 2.1) ...............................................................................................................................................14 – preterm or low-birthweight babies (Checklist 2.2) .............................................................................................16

3. Observations of delivery practices and environmental hygiene: ..........................................................................18 – delivery practice for breathing babies (Checklist 3.1) .......................................................................................20 – delivery practice for non-breathing babies (Checklist 3.2) .............................................................................22 – environmental hygiene (Checklist 3.3) ......................................................................................................................24

4. Review availability of key medicines and supplies for EENC..................................................................................27 (Checklist 4) ....................................................................................................................................................................................28

5. Review activities of the EENC team and hospital data in the past 12 months ...............................................30 (Checklist 5) ....................................................................................................................................................................................31

SECTION 2. Synthesize findings from the facility evaluations ........................................................................................32

SECTION 3. Review EENC monitoring and evaluation tables ..........................................................................................42

SECTION 4. Use findings to develop an EENC annual implementation plan ......................................................49

SECTION 5. Review and develop five-year EENC action plan ..........................................................................................53

CHECKLISTS

CHECKLIST 1. Interviews with postpartum mothers ......................................................................................................................................6

– Checklist 1.1: term babies ....................................................................................................................................................8 – Checklist 1.2: preterm or low-birthweight babies ...............................................................................................10

CHECKLIST 2. Chart reviews of interviewed postpartum mothers .....................................................................................................13 – Checklist 2.1: term babies .................................................................................................................................................14 – Checklist 2.2: preterm or low-birthweight babies ...............................................................................................16

CHECKLIST 3. Observations of delivery practice and environmental hygiene ..............................................................................18 – Checklist 3.1: delivery practice for breathing babies .........................................................................................20 – Checklist 3.2: delivery practice for non-breathing babies ...............................................................................22

– Checklist 3.3: environmental hygiene: delivery room, operation room, neonatal care unit and postnatal care room...............................................................................................................24

CHECKLIST 4. Review availability of key medicines and supplies for EENC..................................................................................27 – Checklist 4 ...................................................................................................................................................................................28

CHECKLIST 5. Review activities of the EENC team and hospital data in the past 12 months...........................................30 – Checklist 5 ...................................................................................................................................................................................31

Summary forms for all health facilities

SUMMARY CHECKLISTS 1.1, 1.2, 2.1, 2.2 ...........................................................................................................................................................33

SUMMARY CHECKLIST 3.1 Delivery practice for breathing babies ......................................................................................................34

SUMMARY CHECKLIST 3.3 Environmental hygiene ......................................................................................................................................36

SUMMARY CHECKLIST 4. Availability of key medicines and supplies for EENC .......................................................................38

SUMMARY CHECKLIST 5. Review activities of the EENC team and hospital data in the past 12 months ....................40

TABLES

TABLE 1. Benchmarks of EENC scale-up readiness, 2015–2020 .............................................................................................43

TABLE 2. Health facility EENC standards, 2015–2020 ...................................................................................................................44

TABLE 3. Hospital impact indicators, 2015–2020 .............................................................................................................................46

TABLE 4. Coverage indicators for EENC interventions, 2015–2020 .......................................................................................47

TABLE 5. Impact indicators for newborn health, 2015–2020 ....................................................................................................48

TABLE 6. Synthesis of EENC review findings: national sample of health facilities .........................................................50

TABLE 7. EENC annual implementation plan .......................................................................................................................................52

TABLE 8. Review of strategic actions for implementing EENC ...................................................................................................55

v

Foreword

The World Health Organization, Member States and stakeholders in the Western Pacific Region have a vision for every newborn infant: to have a healthy start in life. Yet, a newborn infant dies every two minutes in the Region – often needlessly.

Together, we have taken bold steps to make childbirth and newborn life safer. Member States endorsed the Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020). The plan aims to improve the quality of care for mothers and babies in health facilities, where the vast majority of children are born in the Region.

We offer five teaching modules of Early Essential Newborn Care, or EENC, starting with the Early Essential Newborn Care Clinical Practice Pocket Guide. Countries have already shown that reductions in newborn deaths, infections and intensive care unit admissions are possible in facilities employing EENC.

This volume, Annual Implementation Review and Planning Guide, is the first EENC module. It is essential for evaluating the quality of maternal, delivery and postnatal care in facilities. Policy-makers and programme managers across the Region recognize the power of data to better understand and change health-worker practices and mobilize political support and resources.

EENC modules help save lives and money by applying best practices to sustain the actions and policies with the regional plan. Already governments, health-care facilities and families are saving precious resources; health systems are more accountable; and quality care is more attainable.

Together, we must push to meet the Sustainable Development Goal target of a global maternal mortality ratio of less than 70 deaths per 100 000 live births, with no country above 140; and a regional neonatal mortality target of 10 or less deaths per 1000 live births in countries.

To reach these ambitious targets, we must work with Member States and partners to bring improved high-quality EENC to all mothers and newborn infants in every part of the Region.

Shin Young-soo, MD, Ph.D.Regional Director

ABOUT THE EARLY ESSENTIAL NEWBORN CARE MODULES

The five Early Essential Newborn Care (EENC) modules support planning, imple-mentation, improvement, and monitoring and evaluation of EENC.

Module Title Primary user level

1 Annual implementation review and planning guide National and subnational

2Coaching for the First Embrace:

Facilitator's GuideNational and subnational facilitators

3Introducing and sustaining EENC in hospitals:

Routine childbirth and newborn care

Hospital with national support for scale up

4Introducing and sustaining EENC in hospitals:

Kangaroo Mother Care (KMC) for preterm infants

5Introducing and sustaining EENC in hospitals:

Managing childbirth and postpartum complications

Module 1 is used at the national and subnational levels to collect data for the development of annual implementation plans and five-year national action plans.

National and subnational facilitators use Module 2 to upgrade skills of health workers involved in the management of routine childbirth and newborn care nationwide. In hospitals, EENC teams are formed to regularly assess quality of care and use of data for action using Module 3. Once excellent routine childbirth and newborn care are well established, coaching and quality of care follow-up are added for Kangaroo Mother Care (KMC) for preterm infants in Module 4. Management of childbirth and postpartum complications are treated in Module 5.

FACILITATORS GUIDE

Coaching guide for the First Embrace

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 2

M O D U L E 2

Routine childbirth and newborn careINTRODUCING AND SUSTAINING EENC IN HOSPITALS

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 3

M O D U L E 3

Kangaroo mother care (KMC) for preterm infantsINTRODUCING AND SUSTAINING EENC IN HOSPITALS

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 4

M O D U L E 4

Managing childbirth and postpartum complicationsINTRODUCING AND SUSTAINING EENC IN HOSPITALS

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 5

M O D U L E 5

2-day coaching KMC for pre- term infants

Managing complications

Formation of EENCteam

Quarterly EENC assessments through weekly / bi-weekly progress monitoring meetings to improve clinical practice

vi

pp

1

The Early Essential Newborn Care (EENC) annual implementation review provides data on national progress to inform annual planning. Evaluators determine the status of EENC implementation at selected health facilities using observations, interviews and reviews of policies, supplies and environments.

From this, areas needing improvement and actions for annual implementation plans are identified. The national EENC action plan is updated every five years, building on annual review findings.

PARTICIPANTS

At least 10 evaluators are needed to carry out the annual implementation review. The review team may include members of the national newborn health technical working group, EENC coaching facilitators or members of EENC hospital teams. Evaluators should have completed EENC coaching. High-level representatives from the Ministry of Health and development partners may participate in data analysis and planning.

TIMING

The process requires six to eight days, including one day for preparation, three to five days for field work, and two days for data analysis, interpretation and use for annual planning. If strategic planning is required, one to two days are added (see page 3).

OVERVIEW

2

EENC Module 1 – Annual implementation review and planning guide

PREPARATORY STEPS

1. Ensure availability of the following items:

a. meeting venue: sufficiently large room in a central venue on Days 1, 7, 8 and 9, 10 (when the five-year action plan is developed);

b. supplies: pencils, laptop computer, LCD projector, flipchart paper and markers;

c. documents: national EENC action plan, last EENC annual implementation plan, completed checklists from health-facility evaluations and timetable;

d. budget: per diem for the review team members, transportation for field visits, meeting venue, supplies, photocopying and other costs; and

e. letter of introduction from the Ministry of Health to present at the courtesy call with the hospital director or designate at each health facility visited.

2. Complete the EENC monitoring and evaluation tables except sections that require data from the facility evaluation (see Section 3 for monitoring and evaluation tables).

Evaluation of selected health facilities

3. List all hospitals nationwide that have introduced EENC and randomly or purposively select a total of 15 hospitals (three national, four provincial and two district hospitals within the same prov-inces). If EENC implementation has begun in subdistrict facilities, randomly select one facility from four selected districts for a total of 19 facilities. Larger sampling or reviews at more peripheral levels needs proportionally more teams or time.1

4. Group the 10 evaluators into pairs. Assign national hospitals to one pair. For each of the remaining four pairs, assign one provincial and two district hospitals (if 15 selected) or three subdistrict facilities (if 19 selected).

5. Obtain clearance to visit selected health facilities from hospital directors or designates and subnational authorities. Ideally, selected facilities will not be notified in advance of scheduled field visits.

1. If too few hospitals at one level are implementing EENC, supplement them with hospitals at another level so as to get a total of 15 hospitals. The primary target is hospitals; however, if subdistrict facilities conduct a high proportion of deliver-ies, consider randomly selecting additional subdistrict facilities. For larger countries, the review can be expanded to collect data for 15–19 facilities for main subregions of a country, each of which is visited by a review team of 10 persons.

3

Key steps of the annual implementation review

Timing & key actions – Venue

Tasks Tools

SECTION 1: Evaluation of selected facilities that have introduced EENC

Day 1: Team preparation– Central venue

• Review evaluation checklists with team• Finalize arrangements Checklists:

1 / 2 / 3 / 4 / 5

Days 2, 3, 4, 5, 6: Facility visits – Selected health facilities

• Interviews with postpartum mothers • Chart reviews of interviewed postpartum mothers Checklists:

1 / 2

• Observations of delivery practice and environmental hygiene Checklist: 3

• Review availability of key medicines and supplies for EENC Checklist: 4

• Review activities of the EENC team and hospital data in the past 12 months

Checklist: 5

SECTION 2: Synthesize findings from the facility evaluations

Day 7: Data synthesis – Central venue

• Synthesize facility evaluation findings Summary checklists for all health facilities

SECTION 3: Complete EENC monitoring and evaluation tables

Day 7: Data synthesis – Central venue

• Complete and review EENC monitoring and evaluation tables Tables: 1 / 2 / 3 / 4 / 5

SECTION 4: Use findings to develop an EENC annual implementation plan

Day 8: Planning – Central venue

• Complete EENC Action Framework and link with previous plan Tables: 6 / 7

SECTION 5: Review and develop a five-year EENC action plan (every 5 years)

Days 9, 10: Planning – Central venue

• Review and complete EENC action plan • Allocate responsibility for costing and finalizing plan

Table: 8

SECTION 1.

EVALUATION OF SELECTED FACILITIES THAT HAVE INTRODUCED EENC

Facility name: ...............................................................................................................................................................

Province: .........................................................................................................................................................................

District: ............................................................................................................................................................................

Facility applies EENC for caesarean section deliveries:

Yes No (circle one)

Date(s) of visit (DD/MM/YY): ....................... / ...................................... / .......................

Evaluators:

.................................................................................................................................................................................................

.................................................................................................................................................................................................

.................................................................................................................................................................................................

.................................................................................................................................................................................................

Informants/staff interviewed to complete checklists:

.................................................................................................................................................................................................

.................................................................................................................................................................................................

.................................................................................................................................................................................................

Ensure evaluators have:

£ a short meeting with the hospital director or designate to explain the purpose of the visit;

£ local hospital staff to accompany teams to wards;

£ space for conducting interviews with mothers; and

£ a debriefing session with relevant hospital staff at the end of the visit.

5

6

EENC Module 1 – Annual implementation review and planning guide

Interviews with postpartum mothers – term babies and preterm or low-birthweight babies

Checklist 1 Checklist 1.1 and Checklist 1.2

Instructions

Evaluators conduct 10 interviews with postpartum mothers of term babies and 10 interviews with mothers of preterm (< 37 weeks) or low-birthweight (LBW) (< 2500 grams) babies before discharge (total 20 interviews).

1. Identify a room away from patients and staff for conducting interviews. If this is not possible, locate a quiet corridor or corner where the conversation can be more private.

2. Use postpartum registers to systematically select 10 mothers of normal birthweight term babies (≥ 37 weeks). If 10 or fewer postpartum mothers meet the selection criteria, select all mothers who meet the criteria. If more than 10 postpartum mothers meet the selection criteria, use systematic random sampling.2 All women sampled should have delivered at least 90 minutes prior to the interview. However, they should not have been admitted for abortion, or had a stillbirth or newborn death.

3. Determine where preterm (< 37 weeks) or LBW babies (< 2500 g) are being managed (for example, KMC ward, postnatal ward, neonatal care unit [NCU]). Find the registers for each unit. If 10 or fewer postpartum mothers of preterm or LBW babies meet the selection criteria, select all mothers who meet the criteria. If more than 10 postpartum mothers of preterm or LBW babies meet the selection criteria, use purposive or random sampling.2 If numbers are adequate, select five babies from the postnatal ward and five babies from the NCU.

2. If more than 20 women meet the selection criteria, consider systematic random sampling. Number the women in the delivery admission register in the order they arrived. Divide the total number of admissions in the register by 10 to find the sampling interval (For example, if 40 women meet the criteria, select every fourth women on the list). Start randomly and use the sampling interval to select women after the random start until 10 women have been sampled.

1.

7

4. Interview mothers who delivered by caesarean section only if the hospital has begun imple-menting EENC with caesarean sections. If not, include only mothers with vaginal deliveries. If including caesarean section deliveries, ensure that at least five vaginal deliveries are included.

5. In smaller facilities, few women may be available on the day of the visit. In this case, use clinic registers to select one to five women who have delivered in the previous 7 to 10 days. Use address information to conduct a home visit and interview. If a phone number is recorded, consider doing a phone interview.

6. Obtain informed verbal consent. State: “We are trying to understand your delivery experience so that we can help improve care for women. Everything you say here will be kept confiden-tial, meaning no one will know you said it. Anytime you want to stop, you may. Your care will remain the same. Do you agree to do this interview?” Record informed consent given.

7. Record findings in Checklist 1.1 and in Checklist 1.2, indicating “Y” (Yes), “N” (No) or as otherwise instructed in the questions.

8. Summarize each row in Checklist 1.1 and in Checklist 1.2 as follows: – n = total number of “Y” (Yes) responses, unless otherwise specified; – N = total interviews conducted.

8

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 1.

1 In

terv

iew

s w

ith p

ostp

artu

m m

othe

rs –

term

bab

ies

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) or N

(No)

unl

ess

othe

rwise

spe

cified

12

34

56

78

910

n* /

N**

(%)

1.Ve

rbal

info

rmed

con

sent

obt

aine

d

2.Id

entifi

catio

n nu

mbe

rs o

f mot

her a

nd b

aby

(pro

vide

her

e)

3.M

ode

of d

eliv

ery:

V (V

agin

al) o

r CS

(Cae

sare

an se

ctio

n)

Inte

rview

mot

hers

who

deli

vere

d by

CS

only

if th

e ho

spita

l has

beg

un im

plem

entin

g EE

NCn

(# C

S) =

4.

Age

of th

e ba

by (i

n ho

urs)

5.Du

ring

child

birth

:a.

Did

the

mot

her a

dopt

a n

on-s

upin

e po

sitio

n (f

or e

xam

ple,

rolli

ng

onto

sid

e, s

ittin

g-up

, sta

ndin

g, w

alki

ng, s

quat

ting)

for s

ome

or a

ll

of th

e se

cond

sta

ge o

f lab

our?

b. D

id th

e m

othe

r hav

e a

com

pani

on o

f her

cho

ice?

c. W

as th

e m

othe

r enc

oura

ged

to e

at a

nd d

rink

durin

g la

bour

?

d. D

id a

nyon

e pu

sh d

own

on th

e m

othe

r’s b

elly?

e. W

as a

n en

ema

done

?

6.W

as th

e ba

by b

athe

d?a.

If y

es, h

ow lo

ng a

fter b

irth?

*A

nsw

er: <

1 h

/ 1–6

h /

7–24

h /

≥ 24

hn

(≥ 2

4 h)

=

7.W

as th

e ba

by p

lace

d in

ski

n-to

-ski

n co

ntac

t with

the

mot

her?

a. I

f yes

, how

long

afte

r birt

h?

*Ans

wer

: < 1

min

/ 1–

10 m

in /

11–5

9 m

in /

≥ 60

min

n (<

1 m

in) =

b. H

ow lo

ng d

id th

e ba

by re

mai

n in

uni

nter

rupt

ed sk

in-to

-ski

n co

ntac

t bef

ore

bein

g se

para

ted

from

the

mot

her f

or a

ny re

ason

?

*Ans

wer

: <10

min

/ 10

–29

min

/ 30

–59

min

/ 60

–89

min

/ ≥ 9

0 m

in

No in

terru

ptio

ns e

ven

of sh

ort d

urat

ion

are

allo

wed

.

n (≥

90

min

) =

c. Di

d th

e ba

by c

ompl

ete

the

first

bre

astfe

ed (a

ttach

ed w

ith d

eep

suck

ing)

bef

ore

bein

g se

para

ted

from

the

mot

her?

d. W

hy w

as th

e ba

by se

para

ted

from

the

mot

her?

Reas

ons:

CHECKLIST 1.1

Interviews with postpartum mothers – term babies

9

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) or N

(No)

unl

ess

othe

rwise

spe

cified

12

34

56

78

910

n* /

N**

(%)

e. Di

d th

e ba

by re

ceive

imm

edia

te sk

in-to

-ski

n co

ntac

t, no

sepa

ratio

n fo

r at l

east

90

min

and

unt

il th

e fir

st b

reas

tfeed

was

com

plet

ed?

An

swer

Y o

nly

if: a

. < 1

min

, b. ≥

90

min

and

c. =

Y

8.

Did

the

baby

sta

y w

ith th

e m

othe

r dur

ing

the

entir

e ho

spita

l sta

y (ro

omin

g in

)?

9.Is

the

mot

her b

reas

tfeed

ing?

a. I

f yes

, how

long

afte

r birt

h di

d th

e ba

by fi

rst b

reas

tfeed

?

*Ans

wer

: < 1

5 m

in /

15–9

0 m

in /

> 9

0 m

in

The

baby

mus

t hav

e be

en a

ttach

ed w

ith d

eep

suck

ing.

n (1

5–90

min

) =

b. H

ow lo

ng d

id th

e ba

by b

reas

tfeed

the

first

tim

e? (i

n m

inut

es)

n (≥

15 m

in) =

c. Si

nce

deliv

ery,

was

the

baby

fed

anyt

hing

oth

er th

an b

reas

t milk

?n

(# N

o) =

d. D

id th

e ba

by re

ceive

ear

ly (w

ithin

15–

90 m

in) a

nd e

xclu

sive

brea

stfe

edin

g?

An

swer

Y o

nly

if bo

th: a

. = 1

5–90

min

and

c. =

N10

.If

the

baby

has

bee

n fe

d an

ythi

ng o

ther

than

bre

ast m

ilk,

wha

t is

bein

g gi

ven?

Flui

ds g

iven

:

11.

Has

the

baby

bee

n fe

d an

ythi

ng fr

om a

bot

tle?

12.

Did

the

mot

her r

ecei

ve a

ny c

ouns

ellin

g fro

m s

taff

on b

reas

t feed

ing

since

the

birth

(for

exa

mpl

e, fe

edin

g cu

es, p

ositi

onin

g of

the

baby

, sig

ns o

f atta

chm

ent,

how

ofte

n to

feed

and

how

long

to fe

ed,

impo

rtanc

e of

giv

ing

only

bre

ast m

ilk a

nd n

o ot

her f

ood

or fl

uids

)?

13.

Was

any

thin

g ap

plie

d to

the

cord

stu

mp?

n (#

No)

=

a. I

f yes

, wha

t was

app

lied?

Su

bsta

nces

:

14.

Does

the

mot

her h

ave

infa

nt fo

rmul

a, b

aby

bottl

es, g

ifts

or o

ther

pr

oduc

ts s

pons

ored

by

baby

-food

com

pani

es a

t the

hos

pita

l?

n (#

No)

=

a. I

f yes

, ask

her

to sh

ow th

em to

you

and

not

e do

wn

the

type

s of

pro

duct

s.Pr

oduc

ts:

CHECKLIST 1.1

Interviews with postpartum mothers – term babies (continued)

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of m

othe

rs in

terv

iew

ed

10

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 1.

2 In

terv

iew

s w

ith p

ostp

artu

m m

othe

rs –

pre

term

or L

BW b

abie

s

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) or N

(No)

unl

ess

othe

rwise

spe

cified

Post

nata

l reg

iste

rN

CU r

egis

ter

n* /

N**

(%)

12

34

56

78

910

1.Ve

rbal

info

rmed

con

sent

obt

aine

d

2.Id

entifi

catio

n nu

mbe

rs o

f mot

her a

nd b

aby

(pro

vide

her

e)3.

Mod

e of

del

iver

y: V

(Vag

inal

) or C

S (C

aesa

rean

sect

ion)

In

terv

iew m

othe

rs w

ho d

elive

red

by C

S on

ly if

the

hosp

ital h

as b

egun

impl

emen

ting

EENC

n (#

CS)

=

4.Ag

e of

the

baby

(in

hour

s)

5.W

as th

e ba

by p

lace

d in

ski

n-to

-ski

n co

ntac

t with

the

mot

her?

a.

If y

es, h

ow lo

ng a

fter b

irth?

*A

nsw

er: <

1 m

in /

1–10

min

/ 11

–59

min

/ ≥

60 m

inn

(< 1

min

) =

b. H

ow lo

ng d

id th

e ba

by re

mai

n in

uni

nter

rupt

ed sk

in-to

-ski

n co

ntac

t bef

ore

bein

g se

para

ted

from

the

mot

her f

or a

ny re

ason

?

*Ans

wer

: < 10

min

/ 11

–29

min

/ 30

–59

min

/ 60

–89

min

/ ≥ 9

0 m

in

No in

terru

ptio

ns e

ven

of sh

ort d

urat

ion

are

allo

wed

.

n (≥

90

min

) =

c. Di

d th

e ba

by c

ompl

ete

the

first

bre

astfe

ed (a

ttach

ed w

ith d

eep

suck

ing)

bef

ore

bein

g se

para

ted

from

the

mot

her?

d. W

hy w

as th

e ba

by se

para

ted

from

the

mot

her?

Reas

ons:

e. Di

d th

e ba

by re

ceive

imm

edia

te sk

in-to

-ski

n co

ntac

t, no

sepa

ratio

n fo

r at l

east

90

min

and

unt

il th

e fir

st b

reas

tfeed

was

com

plet

ed?

*A

nsw

er Y

onl

y if:

a. =

< 1

min

, b. =

≥ 9

0 m

in a

nd c

. = Y

6.Is

the

mot

her b

reas

tfeed

ing

dire

ctly

from

the

brea

st?

a. I

f yes

, how

long

afte

r birt

h di

d th

e ba

by fi

rst b

reas

tfeed

?

< 1

5 m

in /

15–9

0 m

in /

91 m

in–2

4 h

/ 1–2

day

s / >

2 d

ays

The

baby

mus

t hav

e be

en a

ttach

ed w

ith d

eep

suck

ing.

n (1

5 –90

min

) =

b. H

ow lo

ng d

id th

e ba

by b

reas

tfeed

the

first

tim

e? (i

n m

inut

es)

n (≥

15

min

) =

c. Si

nce

deliv

ery,

was

the

baby

fed

anyt

hing

oth

er th

an b

reas

t milk

?n

(# N

o) =

d. D

id th

e ba

by re

ceive

ear

ly (w

ithin

15–

90 m

in) a

nd e

xclu

sive

brea

stfe

edin

g? A

nsw

er Y

onl

y if

both

: a. =

15–

90 m

in a

nd c

. = N

CHECKLIST 1.2

Interviews with postpartum mothers – preterm or LBW babies

11

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) or N

(No)

unl

ess

othe

rwise

spe

cified

Post

nata

l reg

iste

rN

CU r

egis

ter

n* /

N**

(%)

12

34

56

78

910

7.In

the

last

24

hour

s, ho

w m

any

times

was

bre

ast m

ilk g

iven

?n

(≥ 8

/24

h) =

8.If

the

baby

has

bee

n fe

d an

ythi

ng o

ther

than

bre

ast m

ilk:

a. W

hat w

as g

iven?

Fl

uids

giv

en:

b. W

as a

nyth

ing

give

n be

fore

the

first

bre

astfe

ed?

9.Is

the

mot

her g

ivin

g br

east

milk

by

mea

ns o

ther

than

dire

ctly

fro

m th

e br

east

(e.g

. by

expr

essin

g br

east

milk

and

feed

ing

by

oth

er m

eans

)?

a. I

f yes

, how

is th

e br

east

milk

bei

ng g

iven?

*

Answ

er: c

up, s

poon

, sto

mac

h tu

be o

r bot

tle?

n (#

cup

, spo

on,

tube

) =

b. I

n th

e pa

st 2

4 h,

how

ofte

n di

d sh

e ex

pres

s bre

ast m

ilk?

n (≥

8/2

4 h)

=

c. Fo

r bab

ies o

ver 3

2 w

eeks

, did

the

mot

her a

ttem

pt b

reas

tfeed

ing

befo

re g

iving

bre

ast m

ilk n

ot b

y br

east

?

10.

Has

the

baby

bee

n fe

d an

ythi

ng fr

om a

bot

tle?

11.

Did

the

mot

her r

ecei

ve a

ny c

ouns

ellin

g fro

m s

taff

on b

reas

tfeed

ing

since

the

birth

(e.g

. fee

ding

cue

s, po

sitio

ning

of t

he b

aby,

signs

of

atta

chm

ent,

how

ofte

n to

feed

and

how

long

to fe

ed, i

mpo

rtanc

e of

giv

ing

only

bre

ast m

ilk a

nd n

o ot

her f

ood

or fl

uids

)?

12.

Does

the

baby

wei

gh <

200

0 g?

a. I

f yes

, did

the

baby

rece

ive K

MC

in th

e pa

st 2

4 ho

urs?

b. F

or h

ow m

any

hour

s was

KM

C ap

plie

d?

*Ans

wer

: 0 /

<1

h / 1

–4 h

/ 5

–19

h / ≥

20

h?n

(≥ 2

0 h)

=

c. Ho

w lo

ng w

as th

e lo

nges

t sep

arat

ion?

n (<

30

min

) =

d. W

as th

e ba

by k

ept i

n KM

C po

sitio

n (i.

e. sk

in-to

-ski

n co

ntac

t)

whi

le b

reas

tfeed

ing?

13.

Does

the

mot

her h

ave

infa

nt fo

rmul

a, b

aby

bottl

es, g

ifts

or o

ther

pr

oduc

ts sp

onso

red

by b

aby-

food

com

pani

es w

ith h

er a

t the

hos

pita

l?n

(# N

o) =

a. I

f yes

, ask

her

to sh

ow th

em to

you

and

not

e do

wn

the

type

s of

pro

duct

s.Pr

oduc

ts:

CHECKLIST 1.2

Interviews with postpartum mothers – preterm or LBW babies (continued)

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of m

othe

rs in

terv

iew

ed

13

Chart reviews of interviewed postpartum mothers – term babies and preterm or low-birthweight babies

Checklist 2 Checklist 2.1 and Checklist 2.2

Instructions

1. Use identification numbers to find the charts of women who participated in an interview and those of their babies. If a mother’s chart is separate from that of her baby, it may be necessary to review both charts to complete the review.

2. Complete Checklist 2.1 and Checklist 2.2. If data were not recorded in the chart, the response is “NR” (Not Recorded).

3. Summarize each row in Checklist 2.1 and in Checklist 2.2 as follows: – n = total number of “Y” (Yes) responses, unless otherwise specified; – N = total chart reviews conducted.

2.

14

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 2.

1 Ch

art r

evie

ws

of in

terv

iew

ed p

ostp

artu

m m

othe

rs –

term

bab

ies

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

( Yes

) / N

( No)

/ N

R ( N

ot R

ecor

ded)

unl

ess

othe

rwise

spe

cified

12

34

56

78

910

n* /

N**

(%)

1.Id

entif

ying

info

rmat

ion

of m

othe

r and

bab

y (p

rovi

de h

ere)

2.W

ere

syph

ilis

test

resu

lts (d

urin

g an

tena

tal c

are)

reco

rded

in

the

mot

her’s

cha

rt?

a. I

f yes

, was

the

test

pos

itive

?

b. I

f yes

, wer

e ac

tions

take

n in

the

ante

nata

l per

iod

to a

ddre

ss

the

posit

ive sy

phili

s tes

t?

3.W

ere

HIV

test

resu

lts (d

urin

g an

tena

tal c

are

or p

oint

-of-c

are

ra

pid

test

) rec

orde

d in

the

mot

her’s

cha

rt?

a. I

f yes

, was

the

test

pos

itive

?

b. I

f yes

, wer

e an

y ac

tions

take

n du

ring

preg

nanc

y to

pre

vent

m

othe

r-to-

child

tran

smiss

ion?

c. If

yes

, wer

e an

y ac

tions

take

n du

ring

labo

ur a

nd d

elive

ry

to p

reve

nt m

othe

r-to-

child

tran

smiss

ion?

4.W

as a

par

togr

aph

com

plet

ed c

orre

ctly

? a

a. I

f par

tial o

r no,

spec

ify re

ason

.M

ain

reas

ons:

5.W

as a

rtific

ial r

uptu

re o

f mem

bran

es (a

mni

otom

y) d

one?

6.W

as th

e m

othe

r’s la

bour

indu

ced

or a

ugm

ente

d?

a. I

f yes

, wha

t wer

e th

e in

dica

tions

? bM

ain

indi

catio

ns:

7.W

as th

e ba

by d

eliv

ered

by

caes

area

n se

ctio

n?

a. I

f yes

, wha

t wer

e th

e in

dica

tions

? bM

ain

indi

catio

ns:

CHECKLIST 2.1

Chart reviews of interviewed postpartum mothers – term babies

15

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

( Yes

) / N

( No)

/ N

R ( N

ot R

ecor

ded)

unl

ess

othe

rwise

spe

cified

12

34

56

78

910

n* /

N**

(%)

8.

Was

an

episi

otom

y do

ne?

a. I

f yes

, wha

t wer

e th

e in

dica

tions

? bM

ain

indi

catio

ns:

9.W

ere

blee

ding

vol

ume,

ute

rine

tone

, fun

dal h

eigh

t, bl

ood

pres

sure

, pu

lse a

nd te

mpe

ratu

re a

ll do

cum

ente

d in

the

mot

her’s

cha

rt w

ithin

1 h

afte

r del

iver

y?

10.

Was

a s

econ

d bl

ood

pres

sure

mea

sure

men

t doc

umen

ted

in

the

mot

her’s

cha

rt w

ithin

6 h

afte

r del

iver

y?11

.W

as u

rine

void

doc

umen

ted

in th

e m

othe

r’s c

hart

with

in 6

h

afte

r del

iver

y?

12.

Was

rout

ine

eye

care

giv

en to

the

baby

?

13.

Was

vita

min

K g

iven

bet

wee

n 90

min

and

6 h

of b

irth?

c

14.

Was

hep

atiti

s B

vacc

ine

give

n w

ithin

24

h of

birt

h? c

15.

Was

BCG

vac

cine

giv

en w

ithin

24

h of

birt

h? c

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of c

hart

revi

ews

a.

If th

e as

sess

or is

una

ble

to d

eter

min

e w

heth

er t

he p

arto

grap

h ha

s be

en fi

lled

in c

orre

ctly

, the

ans

wer

sho

uld

be v

alid

ated

with

the

ove

rsee

ing

staf

f mem

ber

or

atte

ndin

g ph

ysic

ian.

A c

orre

ctly

com

plet

ed p

arto

grap

h sh

ould

nor

mal

ly in

clud

e ba

sic d

etai

ls of

the

mot

her,

reco

rdin

g of

vita

l sig

ns a

nd p

roce

dure

s un

dert

aken

at t

he

deliv

ery

(suc

h as

indu

ctio

n or

aug

men

tatio

n, a

rtifi

cial

rupt

ure

of m

embr

anes

), an

ale

rt li

ne a

nd a

n ac

tion

line,

and

med

icat

ions

giv

en d

urin

g la

bour

and

imm

edia

tely

af

ter d

eliv

ery.

How

ever

, req

uire

men

ts m

ay v

ary

depe

ndin

g on

the

form

at u

sed

natio

nally

.b.

If

indi

catio

ns fo

r the

pro

cedu

re a

re n

ot re

cord

ed in

the

char

t, w

rite

“NR”

(Not

Rec

orde

d).

c.

If tim

ing

of a

dmin

istr

atio

n is

not s

peci

fied,

indi

cate

“Y”

(Yes

) and

“TN

S” (T

ime

Not

Spe

cifie

d).

CHECKLIST 2.1

Chart reviews of interviewed postpartum mothers – term babies (continued)

16

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 2.

2 Ch

art r

evie

ws

of in

terv

iew

ed p

ostp

artu

m m

othe

rs –

pre

term

or L

BW b

abie

s

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

( Yes

) / N

( No)

/ N

R ( N

ot R

ecor

ded)

unl

ess

othe

rwise

spe

cified

Post

nata

l reg

iste

rN

CU r

egis

ter

n* /

N**

(%)

12

34

56

78

910

1.

Iden

tifyi

ng in

form

atio

n of

mot

her a

nd b

aby

(pro

vide

her

e)

2.

Birth

wei

ght (

in g

ram

s)

a. >

200

0 g

b. 1

500

– 20

00 g

c. 1

000

–149

9 g

d. <

100

0 g

3.

Ges

tatio

nal a

ge a

t birt

h (in

wee

ks)

a. >

36

wee

ks

b. 3

2–36

wee

ks

c. 2

8–31

wee

ks

d. <

28

wee

ks

4.Di

d th

e m

othe

r del

iver

at 2

4 – 34

wee

ks o

f ges

tatio

n?

a. I

f yes

, wer

e m

ater

nal c

riter

ia fo

r use

of a

nten

atal

cor

ticos

tero

ids

met

? a

b. W

as a

full

cour

se o

f ant

enat

al c

ortic

oste

roid

s give

n to

the

mot

her?

c. W

as th

e fir

st d

ose

give

n w

ithin

1 h

of h

er a

rriva

l at t

he h

ospi

tal?

b,c

5.Di

d th

e m

othe

r del

iver

bef

ore

32 w

eeks

of g

esta

tion?

a. I

f yes

, was

mag

nesiu

m su

lfate

give

n to

the

mot

her f

or fe

tal

neur

opro

tect

ion?

b.

Was

mag

nesiu

m su

lfate

give

n w

ithin

1 h

of h

er a

rriva

l at

the

hosp

ital?

b

CHECKLIST 2.2

Chart reviews of interviewed postpartum mothers – preterm or LBW babies

17

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

( Yes

) / N

( No)

/ N

R ( N

ot R

ecor

ded)

unl

ess

othe

rwise

spe

cified

Post

nata

l reg

iste

rN

CU r

egis

ter

n* /

N**

(%)

12

34

56

78

910

6.W

ere

syph

ilis

test

resu

lts (f

rom

ant

enat

al c

are)

reco

rded

in

the

mot

her’s

cha

rt?a.

If y

es, w

as th

e te

st p

ositi

ve?

b. I

f yes

, wer

e ac

tions

take

n in

the

ante

nata

l per

iod

to a

ddre

ss

the

posit

ive sy

phili

s tes

t?7.

Wer

e HI

V te

st re

sults

(dur

ing

ante

nata

l car

e or

poi

nt-o

f-car

e ra

pid

test

) rec

orde

d in

the

mot

her’s

cha

rt?8.

Was

arti

ficia

l rup

ture

of m

embr

anes

(am

niot

omy)

don

e?

9.W

as th

e m

othe

r’s la

bour

indu

ced

or a

ugm

ente

d?

a. I

f yes

, wha

t wer

e th

e in

dica

tions

? d

10.

Was

the

baby

del

iver

ed b

y ca

esar

ean

sect

ion?

a. I

f yes

, wha

t wer

e th

e in

dica

tions

? d

11.

Wer

e bl

eedi

ng v

olum

e, u

terin

e to

ne, f

unda

l hei

ght,

bloo

d pr

essu

re,

pulse

and

tem

pera

ture

all

docu

men

ted

in th

e m

othe

r’s c

hart

with

in 1

h a

fter d

eliv

ery?

12.

Was

a s

econ

d bl

ood

pres

sure

mea

sure

men

t doc

umen

ted

in

the

mot

her’s

cha

rt w

ithin

6 h

afte

r del

iver

y?13

.W

as u

rine

void

doc

umen

ted

in th

e m

othe

r’s c

hart

with

in 6

h

afte

r del

iver

y?14

. W

ere

the

baby

’s vi

tal s

igns

mea

sure

d at

leas

t 4 ti

mes

in th

e pa

st

24 h

?

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of c

hart

s rev

iew

ed

a.

Ges

tatio

nal a

ge c

an b

e ac

cura

tely

ass

esse

d; p

rete

rm b

irth

is im

min

ent;

no c

linic

al e

vide

nce

of m

ater

nal i

nfec

tion.

If th

ere

is no

reco

rd o

f the

se c

riter

ia, i

ndic

ate

“N”

(No)

.b.

If

timin

g of

adm

inis

trat

ion

is no

t spe

cifie

d, in

dica

te “

N”

(No)

. c.

If

the

wom

an re

ceiv

ed c

ortic

oste

roid

s be

fore

arr

ival

, the

n tim

ely

adm

inis

trat

ion

shou

ld b

e as

sess

ed a

ccor

ding

to ti

min

g of

pre

viou

s do

se (a

t 6 h

ours

aft

er p

revi

ous

dose

of d

exam

etha

sone

or 1

2 ho

urs

of b

etam

etha

sone

).d.

If

indi

catio

ns fo

r the

pro

cedu

re w

ere

not r

ecor

ded

in th

e ch

art,

writ

e “N

R” (N

ot R

ecor

ded)

.

CHECKLIST 2.2

Chart reviews of interviewed postpartum mothers – preterm or LBW babies (continued)

18

EENC Module 1 – Annual implementation review and planning guide

Observations of delivery practices and environmental hygiene

3.1 Observations of delivery practices

Checklist 3 Checklist 3.1 and Checklist 3.2

Instructions

1. Ask delivery and operation room staff to notify the evaluators of pending deliveries. If EENC is not being practised with caesarean sections, observe five vaginal deliveries and note that EENC is not being practised with caesarean sections as a gap. If EENC is being practised with caesarean sections, observe three vaginal and two caesarean section deliveries, if possible. As cases requiring resuscitation are uncommon, participants may not have the opportunity to observe such a delivery.

2. Move about the room to get a clear view of the delivery without obstructing the birth attendant(s), speaking or intervening.

3. Note the time of delivery in hours, minutes and seconds.

4. While observing the delivery, record findings individually on Checklist 3.1 or Checklist 3.2 as correctly done (Y = Yes), done but incompletely (P = Partial) or not done or done incorrectly (N = No). If a practice is not assessed, indicate “NA” (Not Assessed), and provide details in the “Summary” column.

5. After each observation, score the checklist: 2 points for yes, 1 point for partial and 0 points for no. The maximum possible scores for delivery of a breathing baby (Checklist 3.1) is 42 and for a non-breathing baby (Checklist 3.2) is 62. Upon completion, compare findings in the pair and reconcile differences.

6. Give feedback to staff at the end of the delivery away from the mother. Provide positive feedback first and then describe areas for improvement.

3.

19

7. Summarize each row in Checklist 3.1 as follows: – n = total number of “Y” (Yes) responses, unless otherwise specified; – N = total observations conducted.

8. Determine and record the average and a range of total scores. Note major areas for improve-ment. (In the unlikely event of more than one non-breathing baby, average the scores in Checklist 3.2.)

3.2 Observations of environmental hygiene

Checklist 3 Checklist 3.3

Instructions

1. Observe handwashing facilities for patients, newborn resuscitation areas, and supply and equipment in delivery rooms, operation rooms, postnatal care rooms and neonatal care units.

2. Complete Checklist 3.3.

3. For each aspect of environmental hygiene assessed, record the total number of observations (N) and how many meet the criteria (n).

4. Give feedback to staff at the end of the review on areas for improvement.

20

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 3.

1 De

liver

y pr

actic

e fo

r bre

athi

ng b

abie

s

Loca

tion

: ......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.. D

ate:

......

......

......

......

......

......

......

......

......

......

......

......

....

Obs

erva

tion

con

duct

ed b

y: ...

......

......

......

......

......

......

......

......

......

......

......

......

......

.

Act

ivit

yO

bser

vati

on n

umbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) / N

(No)

/ P

(Par

tial)

/ NA

(Not

Ass

esse

d) u

nles

s oth

erw

ise sp

ecifi

ed1

23

45

n* /

N**

(%)

Mod

e of

del

iver

y: V

(Vag

inal

) / C

S (C

aesa

rean

sect

ion)

n (#

CS)

=

Pre-

birt

h pr

epar

atio

n

1.

Chec

ked

room

tem

pera

ture

usin

g th

erm

omet

er; t

urne

d of

f fan

s and

/or a

ir co

nditi

onin

g

2.

Was

hed

hand

s be

fore

touc

hing

any

del

iver

y ar

ea s

urfa

ces

and

hand

ling

equi

pmen

t

3.

Plac

ed d

ry c

loth

on

abdo

men

(or u

pper

bod

y fo

r cae

sare

an s

ectio

n)

4.

Prep

ared

the

new

born

resu

scita

tion

area

5.

Chec

ked

if ne

wbo

rn a

mbu

bag

and

mas

ks w

ere

func

tiona

l

6.

Was

hed

hand

s be

fore

glo

ving

for d

eliv

ery

7.

Wor

e tw

o pa

irs o

f ste

rile

glov

es (i

f sam

e at

tend

ant h

andl

es th

e co

rd) a

8.

Arra

nged

forc

eps,

cord

cla

mp/

ties

in e

asy-

to-u

se o

rder

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

9.

Calle

d ou

t tim

e of

birt

h (in

hou

rs, m

inut

es, s

econ

ds)

......

.... /

......

.... /

......

....

10.

Star

ted

dryi

ng w

ithin

5 s

afte

r birt

h?

*A

nsw

er:

Y (<

5 s)

/ P

(5 –

10 s)

/ N

(>10

s)

11.

Drie

d th

e ba

by th

orou

ghly

(wip

ed th

e ey

es, m

outh

, nos

e, fa

ce, h

ead,

fron

t, ba

ck,

arm

s an

d le

gs) b

12.

Rem

oved

the

wet

clo

th

CHECKLIST 3.1

Delivery practice for breathing babies

21

Act

ivit

yO

bser

vati

on n

umbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) / N

(No)

/ P

(Par

tial)

/ NA

(Not

Ass

esse

d) u

nles

s oth

erw

ise sp

ecifi

ed1

23

45

n* /

N**

(%)

13.

Plac

ed b

aby

in d

irect

ski

n-to

-ski

n co

ntac

t

14.

Cove

red

baby

’s bo

dy w

ith c

loth

and

hea

d w

ith a

hat

15.

Chec

ked

for a

sec

ond

baby

c

16.

Inje

cted

oxy

toci

n IM

to m

othe

r with

in 1

min

17.

Rem

oved

firs

t (so

iled)

pai

r of g

love

s a

18.

Chec

ked

for c

ord

pulsa

tions

bef

ore

clam

ping

, cla

mpe

d af

ter c

ord

pulsa

tions

st

oppe

d (u

sual

ly 1

–3 m

in)

19.

Plac

ed c

lam

p/tie

at 2

cm

and

forc

eps

at 5

cm

from

um

bilic

al b

ase

20.

Deliv

ered

pla

cent

a

21.

Coun

selle

d m

othe

r on

feed

ing

cues

(dro

olin

g, m

outh

ope

ning

, ton

guin

g/lic

king

, ro

otin

g, b

iting

han

d, c

raw

ling,

etc

.)

*Ans

wer

: Y (>

2 c

ues)

/ P

(1–2

cue

s)

Tota

l sco

re =

(# Y

es x

2) +

(# P

arti

al) =

(max

imum

sco

re p

ossib

le =

42)

Aver

age

scor

e =

(max

imum

sco

re p

ossib

le =

42)

Scor

e ra

nge

(from

low

est t

o hi

ghes

t) =

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of d

eliv

erie

s obs

erve

d

a.

If de

liver

y is

by c

aesa

rean

sec

tion

or a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

, mak

e a

note

in c

omm

ents

. If a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

and

use

s st

erile

glo

ves

whe

n do

ing

so, s

core

pra

ctic

e as

“Y”

(Yes

). b.

De

duct

5 p

oint

s if

baby

was

suc

tione

d un

less

bab

y w

as d

ried

thor

ough

ly a

nd h

ad n

o to

ne a

nd a

mni

otic

flui

d w

as m

econ

ium

sta

ined

.c.

Fo

r cae

sare

an s

ectio

ns, s

core

this

as “

Y” (Y

es).

Chec

klist

3.1

Del

iver

y pr

actic

e fo

r bre

athi

ng b

abie

s (c

ontin

ued)

CHECKLIST 3.1

Delivery practice for breathing babies (continued)

22

EENC Module 1 – Annual implementation review and planning guide

CHECKLIST 3.2

Delivery practice for non-breathing babiesCh

eckl

ist

3.2

Deliv

ery

prac

tice

for n

on-b

reat

hing

bab

ies

Loca

tion

: ......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.. D

ate:

......

......

......

......

......

......

......

......

......

......

......

... O

bser

vati

on c

ondu

cted

by:

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Act

ivit

yO

bser

vati

on n

umbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y

(Yes

) / N

(No)

/ P

(Par

tial)

/ NA

(Not

Ass

esse

d) u

nles

s oth

erw

ise sp

ecifi

ed1

2n*

/ N

** (%

)

Mod

e of

del

iver

y: V

(Vag

inal

) / C

S (C

aesa

rean

sect

ion)

n (#

CS)

=

Pre-

birth

pre

para

tion

1.

Chec

ked

room

tem

pera

ture

usin

g th

erm

omet

er; t

urne

d of

f fan

s and

/or a

ir co

nditi

onin

g

2.

Was

hed

hand

s be

fore

touc

hing

any

del

iver

y ar

ea s

urfa

ces

and

hand

ling

equi

pmen

t

3.

Plac

ed d

ry c

loth

on

abdo

men

(or u

pper

bod

y fo

r cae

sare

an s

ectio

n)

4.

Prep

ared

the

new

born

resu

scita

tion

area

5.

Chec

ked

if ne

wbo

rn a

mbu

bag

and

mas

k w

ere

func

tiona

l

6.

Was

hed

hand

s be

fore

glo

ving

for d

eliv

ery

7.

Wor

e tw

o pa

irs o

f ste

rile

glov

es (i

f sam

e at

tend

ant h

andl

es th

e co

rd) a

8.

Arra

nged

forc

eps,

cord

cla

mp/

ties

in e

asy-

to-u

se o

rder

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

9.

Calle

d ou

t tim

e of

birt

h (in

hou

rs, m

inut

es, s

econ

ds)

......

.... /

......

.... /

......

....

10.

Star

ted

dryi

ng w

ithin

5 s

afte

r birt

h?

*Ans

wer

: Y

(< 5

s) /

P (5

–10

s) /

N (>

10 s)

11.

Drie

d th

e ba

by th

orou

ghly

(wip

ed th

e ey

es, m

outh

, nos

e, fa

ce, h

ead,

fron

t, ba

ck, a

rms

and

legs

) b

12.

Rem

oved

the

wet

clo

th

13.

Plac

ed b

aby

in d

irect

ski

n-to

-ski

n co

ntac

t

14.

Cove

red

baby

’s bo

dy w

ith c

loth

and

hea

d w

ith a

hat

15.

Det

erm

ined

whe

ther

the

baby

was

gas

ping

or n

ot b

reat

hing

c

16.

Calle

d fo

r hel

p an

d in

form

ed th

e m

othe

r

17.

Rem

oved

firs

t (so

iled)

pai

r of g

love

s a

23

CHECKLIST 3.2

Delivery practice for non-breathing babies (continued)A

ctiv

ity

Obs

erva

tion

num

ber

Sum

mar

yA

nsw

er t

he q

uest

ions

wit

h:

Y (Y

es) /

N (N

o) /

P (P

artia

l) / N

A (N

ot A

sses

sed)

unl

ess o

ther

wise

spec

ified

12

n* /

N**

(%)

18.

Qui

ckly

cla

mpe

d an

d cu

t cor

d

19.

Mov

ed b

aby

to re

susc

itatio

n ar

ea

20.

Cove

red

baby

qui

ckly

dur

ing

and

afte

r tra

nsfe

r

21.

Posit

ione

d he

ad c

orre

ctly

to o

pen

airw

ays

22.

Appl

ied

face

mas

k fir

mly

ove

r chi

n, m

outh

and

nos

e

23.

Gai

ned

ches

t rise

with

in 1

min

of b

irth c :

......

.... m

in .

......

... s

24.

Sque

ezed

bag

to g

ive

30–5

0 br

eath

s pe

r min

ute

25.

Mai

ntai

ned

good

che

st ri

se th

roug

hout

or t

ook

step

s to

impr

ove

vent

ilatio

n

26.

Stop

ped

vent

ilatio

n af

ter b

aby

brea

thin

g w

ell

27.

Retu

rned

to s

kin-

to-s

kin

cont

act,

cove

red

baby

28.

Chec

ked

for a

sec

ond

baby

d

29.

Inje

cted

oxy

toci

n IM

to th

e m

othe

r

30.

Deliv

ered

pla

cent

a 31

. Co

unse

lled

mot

her o

n ba

by’s

stat

us fo

llow

ing

resu

scita

tion

and

on fe

edin

g cu

es (

droo

ling,

mou

th

open

ing,

tong

uing

/lick

ing,

root

ing,

biti

ng h

and,

cra

wlin

g, e

tc.)

*Ans

wer

: Y (>

2 c

ues)

/ P

(1–2

cue

s)

Tota

l sco

re e =

(# Y

es x

2) +

(# P

arti

al)

(max

imum

sco

re =

62)

Aver

age

scor

e =

(m

axim

um s

core

pos

sible

= 6

2)

Scor

e ra

nge

(from

low

est t

o hi

ghes

t) =

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s), u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of d

eliv

erie

s obs

erve

d

a.

If de

liver

y is

by c

aesa

rean

sec

tion

or a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

mak

e a

note

. If a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

and

use

s st

erile

glo

ves,

sco

re p

ract

ice

as “

Y” (Y

es).

b.

Dedu

ct 5

poi

nts

if ba

by w

as s

uctio

ned

unle

ss b

aby

was

drie

d th

orou

ghly

and

had

no

tone

, and

am

niot

ic fl

uid

was

mec

oniu

m s

tain

ed.

c.

Onl

y sc

ore

as “

Y” (Y

es) o

r “N

” (N

o) re

spon

ses;

no

part

ial o

ptio

n is

poss

ible

.d.

Fo

r cae

sare

an s

ectio

ns, s

core

this

as “

Y” (Y

es).

e.

Dedu

ct 5

poi

nts

if re

susc

itatio

n is

perf

orm

ed w

hen:

(1) t

he b

aby

is no

t bre

athi

ng b

ut h

as m

uscl

e to

ne a

nd g

rimac

e, a

nd (2

) the

bab

y is

not d

ried

at a

ll or

is n

ot d

ried

imm

edia

tely

or t

horo

ughl

y.

24

EENC Module 1 – Annual implementation review and planning guide

Chec

klis

t 3.

3 EN

VIRO

NM

ENTA

L HY

GIE

NE:

Deliv

ery

room

, ope

ratio

n ro

om, n

eona

tal c

are

unit

and

post

nata

l car

e ro

om

Que

stio

nD

eliv

ery

room

(s)

Ope

rati

on

room

(s)

Neo

nata

l ca

re u

nit

PNC

room

(s)

TOTA

L

all r

oom

s*

Han

dwas

hing

faci

litie

s an

d to

ilets

for p

atie

nts a

1.

Wha

t is t

he to

tal n

umbe

r of r

oom

s? (N

R)

2.Ho

w m

any

room

s ha

ve a

t lea

st o

ne s

ink

for w

ashi

ng h

ands

ava

ilabl

e

for u

se in

the

room

? b (n /

NR)

3.

Wha

t is

the

tota

l num

ber o

f sin

ks?

(NS)

4.Ho

w m

any

sinks

:

a. A

re c

lean

? (n

/ NS)

b. H

ave

cont

inuo

us su

pply

of c

lean

, run

ning

wat

er? c (

n / N

S)

c. Ha

ve so

ap d a

vaila

ble?

(n / N

S)

d. H

ave

at le

ast o

ne m

etho

d fo

r han

d dr

ying

avai

labl

e (s

ingl

e-us

e to

wel

s, fu

nctio

ning

ele

ctric

han

d dr

ier,

reus

able

ster

ile to

wel

s)?

(n/N

S)5.

How

man

y ro

oms

have

ade

quat

e ha

ndw

ashi

ng fa

cilit

ies

avai

labl

e? (n

/ NR)

(n

= Y

if th

e ro

om h

as a

t lea

st 1

sink

and

4a.

– 4d

. = 1

00%

for a

ll sin

ks

in th

e ro

om)

6.Ho

w m

any

room

s ha

ve a

t lea

st o

ne b

ottle

of a

lcoh

ol g

el / h

and

rub

avai

labl

e fo

r use

in th

e ro

om? e (

n / N

R)7.

How

man

y ro

oms

have

ade

quat

e ha

ndw

ashi

ng fa

cilit

ies A

ND

alco

hol g

el /

hand

rub

avai

labl

e fo

r use

in th

e ro

om?

(n / N

R) (n

= Y,

if 5

. = Y

and

if 6

. = Y

)

New

born

resu

scita

tion

area

8.Ho

w m

any

deliv

ery

beds

(DB)

hav

e a

resu

scita

tion

area

ava

ilabl

e

with

in 2

m? f

(n / N

DB)

9.Ho

w m

any

resu

scita

tion

area

s (R

A) a

re a

vaila

ble?

(NRA

)

CHECKLIST 3.3 ENVIRONMENTAL HYGIENE:

Delivery room, operation room, neonatal care unit and postnatal care room

25

Que

stio

nD

eliv

ery

room

(s)

Ope

rati

on

room

(s)

Neo

nata

l ca

re u

nit

PNC

room

(s)

TOTA

L

all r

oom

s*

New

born

resu

scita

tion

area

(con

tinue

d)

10.

How

man

y re

susc

itatio

n ar

eas

are

clea

n an

d dr

y? (n

/ NRA

)

11.

How

man

y re

susc

itatio

n ar

eas

have

func

tiona

l new

born

am

bu b

ag

and

pret

erm

and

term

mas

ks (s

izes

0 a

nd 1

) ava

ilabl

e? (n

/ NRA

)

Pro

mot

ion

of b

aby

food

com

pany

pro

duct

s12

. Ho

w m

any

room

s ha

ve b

aby

food

com

pany

mat

eria

ls vi

sible

(pos

ters

, br

ochu

res,

stic

kers

, pai

nted

wal

ls, e

tc.)?

(n / N

R)

13.

How

man

y ro

oms

have

hos

pita

l ord

ers

proh

ibiti

ng u

se o

f inf

ant f

orm

ula

an

d ot

her l

inka

ges

with

milk

form

ula

com

pani

es v

isibl

e an

d po

sted

pr

omin

ently

? (n

/ NR)

* Ad

d da

ta re

cord

ed in

eac

h ro

om to

cal

cula

te a

n ov

eral

l tot

al fo

r all

room

s co

mbi

ned.

a.

To u

nder

take

a c

ompl

ete

hand

hyg

iene

ass

essm

ent,

see

Hand

Hyg

iene

Sel

f-Ass

essm

ent F

ram

ewor

k (W

HO, 2

010)

.b.

If

mor

e th

an o

ne ro

om is

ava

ilabl

e in

a c

ateg

ory,

repo

rt a

vaila

bilit

y in

eac

h ro

om s

epar

atel

y an

d th

en s

um to

get

a to

tal f

or a

ll ro

oms.

c.

A

wat

er su

pply

that

is e

ither

pip

ed o

r fro

m o

nsite

stor

age,

with

app

ropr

iate

disi

nfec

tion,

mee

ting

appr

opria

te sa

fety

stan

dard

s for

mic

robi

al a

nd c

hem

ical

con

tam

inat

ion.

d.

Soap

: det

erge

nt-b

ased

pro

duct

s th

at c

onta

in n

o ad

ded

antim

icro

bial

age

nts

or m

ay c

onta

in th

ese

sole

ly a

s pr

eser

vativ

es. I

t may

be

in v

ario

us fo

rms

incl

udin

g ba

r so

ap, t

issu

e, le

af a

nd li

quid

pre

para

tions

.e.

N

ote

if al

coho

l gel

/han

d ru

b is

avai

labl

e fo

r sta

ff us

e bu

t not

for u

se b

y pa

tient

s an

d fa

mili

es.

f. N

ewbo

rn re

susc

itatio

n ar

ea m

ay in

clud

e a

tabl

e, b

ench

or w

arm

er w

ith a

t lea

st a

bag

and

mas

k in

pla

ce fo

r con

duct

ing

bag

and

mas

k re

susc

itatio

n.

CHECKLIST 3.3 ENVIRONMENTAL HYGIENE:

Delivery room, operation room, neonatal care unit and postnatal care room (continued)

27

Review availability of key medicines and supplies for EENC

Checklist 4

Instructions

1. Review the list of medicines and supplies by direct observation. Staff who work in the areas of delivery, postnatal care and neonatal care are often familiar with the availability of essential medicines, equipment and supplies and can help identify where medicines and supplies are stored and answer key questions.

2. If EENC team members are unsure of the status of some medicines or supplies, determine who should be consulted to determine the status. This may include staff from maternal or neonatal wards or the hospital pharmacy.

3. Complete Checklist 4.

− The WHO definition of “normal storage conditions” is: “Storage in dry, well-ventilated premises at temperatures of 15–25 °C or, depending on climatic conditions, up to 30 °C”.

− Note items not available on the day of the review and those that have had stock-outs in the previous 12 months.

− Note problems with storage or functionality of equipment.

− Note items without stock records.

4.

28

EENC Module 1 – Annual implementation review and planning guide

CHECKLIST 4

Review availability of key medicines and supplies for EENCCh

eckl

ist

4. R

evie

w a

vaila

bilit

y of

key

med

icine

s an

d su

pplie

s fo

r EEN

C

Med

icin

es a

nd s

uppl

ies

Avai

labl

e

on th

e da

y

of th

e re

view

? Y

(Yes

) or N

(No)

Stoc

k st

ored

cor

rect

ly?

No

expi

red

drug

s?

Equi

pmen

t fun

ctio

nal?

Y (Y

es) o

r N (N

o)

Stoc

k

reco

rds

avai

labl

e?

Y (Y

es) o

r N

(No)

Num

ber o

f st

ock-

outs

in

the

past

12

mon

ths

All c

riter

ia m

et?

Answ

er Y

(Yes

) on

ly if

: A

, B &

C =

Y

and

D =

0A

BC

D P

re-d

eliv

ery

and

deliv

ery

area

s

1.M

agne

sium

sul

fate

for s

ever

e pr

e-ec

lam

psia

and

ecl

amps

ia,

and

feta

l neu

ropr

otec

tion

if ge

stat

iona

l age

< 3

2 w

eeks

£ N

orm

al s

tora

ge a

£ N

o ex

pire

d dr

ugs

2.O

xyto

cin

for I

M o

r IV

use

– im

med

iate

ly p

ostp

artu

m

and

for c

ontro

l of h

aem

orrh

age

£ 2

–8 °

C b

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

3.Co

rtico

ster

oids

for w

omen

at 2

4–34

wee

ks o

f ges

tatio

n

at ri

sk o

f pre

term

del

iver

y

£ N

orm

al s

tora

ge a

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

4.An

tibio

tics

for p

rete

rm p

rela

bour

rupt

ure

of m

embr

anes

d £

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

5.Sy

phili

s te

st k

its

6.HI

V te

st k

its

7.Fi

rst-l

ine

ART

regi

men

: ten

ofov

ir di

sopr

oxil

fum

arat

e (T

DF),

lam

ivud

ine

(3TC

) or e

mtri

cita

bine

(FTC

), ef

avire

nz (E

FV)

8.Fu

nctio

nal n

ewbo

rn a

mbu

bag

and

pre

term

and

term

m

asks

(siz

es 0

and

1) w

ithin

2 m

of e

ach

deliv

ery

bed

9.O

xyge

n fo

r new

born

use

e

10.

Ster

ile g

love

s

11.

Func

tiona

l aut

ocla

ve o

r cen

traliz

ed s

teril

izat

ion

serv

ices

29

Med

icin

es a

nd s

uppl

ies

Avai

labl

e

on th

e da

y

of th

e re

view

? Y

(Yes

) or N

(No)

Stoc

k st

ored

cor

rect

ly?

No

expi

red

drug

s?

Equi

pmen

t fun

ctio

nal?

Y (Y

es) o

r N (N

o)

Stoc

k

reco

rds

avai

labl

e?

Y (Y

es) o

r N

(No)

Num

ber o

f st

ock-

outs

in

the

past

12

mon

ths

All c

riter

ia m

et?

Answ

er Y

(Yes

) on

ly if

: A

, B &

C =

Y

and

D =

0A

BC

D N

eona

tal i

nten

sive

car

e

12.

Inje

ctab

le a

ntib

iotic

s fo

r man

agem

ent o

f new

born

sep

sis£

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

13.

New

born

am

bu b

ag a

nd p

rete

rm a

nd te

rm m

asks

(s

izes

0 a

nd 1

) in

each

NCU

room

14.

Cont

inuo

us p

ositi

ve a

irway

pre

ssur

e (C

PAP)

Not

app

licab

le fo

r firs

t-lev

el fa

ciliti

es15

.O

xyge

n fo

r new

born

use

16.

Ster

ile g

love

s

Pos

tnat

al c

are

area

s

17.

Rout

ine

eye

prop

hyla

xis

£ N

orm

al s

tora

ge a

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

18.

Vita

min

K£

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t c

£ N

o ex

pire

d dr

ugs

19.

Hepa

titis

B va

ccin

e£

2–8

°C

£ N

o ex

pire

d dr

ugs

a.

Stor

age

in d

ry, w

ell v

entil

ated

pre

mis

es a

t tem

pera

ture

s of

15–

25 °

C or

, dep

endi

ng o

n cl

imat

ic c

ondi

tions

, up

to 3

0 °C

.b.

O

xyto

cin

shou

ld b

e st

ored

in a

refri

gera

tor t

hat m

aint

ains

a te

mpe

ratu

re o

f 2–8

°C.

Sm

all a

mou

nts c

an b

e ke

pt a

t roo

m te

mpe

ratu

re in

del

iver

y ro

oms d

urin

g w

orki

ng

hour

s.c.

Pr

otec

ted

from

ligh

t is

defin

ed a

s no

t exp

osed

to d

irect

sun

light

or b

right

fluo

resc

ent l

ight

– m

ost c

omm

only

in ro

oms

with

out w

indo

ws

or c

ontin

uous

ligh

ting

or in

dr

awer

s. O

xyto

cin

(unl

ike

met

herg

in) i

s no

t lig

ht s

ensi

tive,

but

it is

stil

l goo

d pr

actic

e to

pro

tect

it fr

om li

ght a

s th

ere

is a

7% lo

ss in

pot

ency

whe

n ex

pose

d to

ligh

t if

stor

ed a

t 21–

25 °

C.

d.

Pret

erm

pre

labo

ur ru

ptur

e of

the

mem

bran

es is

defi

ned

as ru

ptur

e of

the

mem

bran

es b

efor

e la

bour

has

beg

un in

a p

regn

ancy

with

a g

esta

tiona

l age

< 3

7 w

eeks

.e.

O

xyge

n fo

r new

born

use

sho

uld

be a

djus

tabl

e so

that

the

conc

entr

atio

n of

oxy

gen

prov

ided

can

be

care

fully

regu

late

d. V

entil

ator

y su

ppor

t of t

erm

infa

nts

shou

ld

star

t with

air.

For

pre

term

infa

nts,

eith

er a

ir or

a lo

w c

once

ntra

tion

of o

xyge

n (u

p to

30%

) sho

uld

be u

sed

initi

ally.

If, d

espi

te e

ffect

ive

vent

ilatio

n, o

xyge

natio

n (id

e-al

ly g

uide

d by

oxi

met

ry) r

emai

ns u

nacc

epta

ble,

use

of a

hig

her c

once

ntra

tion

of o

xyge

n sh

ould

be

cons

ider

ed.

CHECKLIST 4

Review availability of key medicines and supplies for EENC (continued)

30

EENC Module 1 – Annual implementation review and planning guide

Review activities of the EENC team and hospital data in the past 12 months

Checklist 5

Instructions

1. Obtain and review copies of EENC hospital documents for the previous 12 months, includ-ing notes or reports of EENC team meetings, quality improvement assessments and support visits. In Checklist 5, note if documentation supports regular EENC team meetings and EENC quality improvement reviews.

2. Determine whether the EENC coaching database is being maintained and is up to date. Record data on coaching coverage for main categories of health facility staff and the total EENC coaching coverage for all staff.

3. Determine whether an EENC quality assessment has been conducted at least twice in the previous 12 months. If so, obtain a copy of the findings.

4. Determine whether hospital impact data are being recorded. If yes, obtain a copy of the findings for the previous 12 months.

5. Determine how many maternal deaths, newborn deaths and stillbirths occurring in the health facility were reviewed in the past 12 months. If necessary, ask staff for other relevant documentation to obtain this information.

6. If evaluating subdistrict facilities, only record data on EENC coaching (question 2 and sub-questions 2.a–2.d). Other data do not need to be collected.

7. Provide feedback to EENC team members on strengths and concerns. Discuss approaches to addressing problem areas and improving performance.

5.

31

If evaluating subdistrict facilities, only record data for question 2 and subquestions 2.a–2.d.

Question Answer Y (Yes) or N (No) unless otherwise specified

1. In the previous 12 months

a. Has the EENC team been supported by the hospital director or senior staff? (e.g. encouraging meetings, attending meetings, asking about findings)

b. Has the EENC team met at least quarterly and documented meetings?

c. Have two EENC quality assessments been conducted and documented? If yes, obtain a copy.

d. Has the EENC plan been reviewed and updated at least quarterly?

e. Are key components of the EENC quality approach in place? *Answer Y, if b. and c. = Y

2. Is a staff coaching database available?

a. If yes, how many doctors have been coached in EENC? n =% =

How many doctors are currently working in maternity and paediatric wards? N =

b. If yes, how many midwives have been coached in EENC? n =% =

How many midwives are currently working in maternity wards? N =

c. If yes, how many nurses have been coached in EENC? n =% =

How many nurses are currently working in maternity and paediatric wards? N =

d. Total staff coached in EENC n =% =

Total staff working in maternity and paediatric wards N =

3. Is an EENC hospital impact database available for the past 12 months? If yes, obtain a copy of the data (see Section 3 for EENC hospital impact data table)

a. What issues were found with collecting EENC hospital impact data? Main issues:

4. How many maternal deaths occurred in the past 12 months?

a. How many maternal deaths were reviewed?

5. How many newborn deaths occurred in the past 12 months?

a. How many newborn deaths were reviewed?

6. How many stillbirths occurred in the past 12 months?

a. How many stillbirths were reviewed?

CHECKLIST 5

Review activities of the EENC team and hospital data in the past 12 months

32

EENC Module 1 – Annual implementation review and planning guide

Instructions

1. Draw summary forms for each checklist (eight in total) on flipchart paper and post them on the wall. Give each sampled health facility a number between 1 and 15.

2. Evaluator pairs record summary data for each health facility they evaluated on the summary forms, writing numerators (n) and denominators (N) for Yes/No questions or for questions that require a single response.

3. Calculate the totals for all health facilities combined on the summary forms.

4. Calculate separate totals for each of the three main categories of facility (national/regional, first-level referral and first level3).

5. Using final summary data, discuss indicators and mark those that are low with a red marker and those that show progress with a green marker.

6. Identify strengths and priority areas for improvements.

7. Discuss findings and reach consensus on main findings.

Note on summarizing data for all facilities combined

If data are presented as summary statistics for all facilities combined, data need to be weighted by the proportion of live births seen by facility level. This is because smaller facilities (health centres or district hospitals) are more likely to see a smaller fraction of all births than larger facilities (provincial, regional or national hospitals).

To calculate weights, obtain the most recent estimates of annual live births, by facility level. For each level, divide annual live births in facilities at that level by the total annual live births for the country. To weight aggregate summary statistics, multiply the numerator and de-nominator by the weight and divide to obtain the proportion. Weighted aggregate figures should give more weight to facilities seeing a large fraction of all births and less weight to those that see a smaller fraction.

SECTION 2.

SYNTHESIZE FINDINGS FROM THE FACILITY EVALUATIONS

3. National and regional hospitals: offer services of first-level referral hospitals plus advanced neonatal care including CPAP; serve as a teaching hospital; and provide support to lower-level facilities. First-level referral hospitals: offer services of first level where deliveries take place, plus management of preterm labour and common complications of prematurity (e.g. oxygen), complications of delivery including assisted delivery and caesarean sections. First-level facilities where deliveries take place: should have capacity for care of breathing and non-breathing babies.

33

SUMMARY FORM FOR ALL HEALTH FACILITIES

FOR SUMMARY CHECKLISTS: 1.1, 1.2 and 2.1, 2.2

SUMMARY CHECKLIST …….......

QuestionSummary data by health facility – n* / N** (%) TOTAL

n* / N** (%)By level a

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3

* n = total number of “Y” (Yes responses), unless otherwise specified**N = total number of mothers interviewed or charts reviewed

a. Facility levels are as follows: 1 = national and regional hospitals; 2 = first-level referral hospitals; and 3 = first level where deliveries take place.

34

EENC Module 1 – Annual implementation review and planning guide

Sum

mar

y Ch

eckl

ist

3.1

SUM

MA

RY F

ORM

FO

R A

LL H

EALT

H F

ACI

LITI

ES

Deliv

ery

prac

tice

for b

reat

hing

bab

ies

Act

ivit

ySu

mm

ary

data

by

heal

th fa

cilit

y –

n* /

N**

TOTA

Ln*

/ N**

(%)

By le

vel a

12

34

56

78

910

1112

1314

15

Pre-

birt

h pr

epar

atio

n 1

23

1.

Chec

ked

room

tem

pera

ture

usin

g th

erm

omet

er;

turn

ed o

ff fa

ns a

nd/o

r air

cond

ition

ing

2.

Was

hed

hand

s be

fore

touc

hing

any

del

iver

y ar

ea s

urfa

ces

and

hand

ling

equi

pmen

t3.

Pl

aced

dry

clo

th o

n ab

dom

en (o

r upp

er b

ody

for c

aesa

rean

sec

tion)

4.

Prep

ared

the

new

born

resu

scita

tion

area

5.

Chec

ked

if ne

wbo

rn a

mbu

bag

and

mas

ks

wer

e fu

nctio

nal

6.

Was

hed

hand

s be

fore

glo

ving

for d

eliv

ery

7.

Wor

e tw

o pa

irs o

f ste

rile

glov

es (i

f sam

e at

tend

ant h

andl

es th

e co

rd)

8.

Arra

nged

forc

eps,

cord

cla

mp/

ties

in e

asy-

to-

use

orde

r

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

9.

Calle

d ou

t tim

e of

birt

h

(in h

ours

, min

utes

, sec

onds

) ...

......

. / ...

......

. / ...

......

.

10.

Star

ted

dryi

ng w

ithin

5 s

afte

r birt

h?

*A

nsw

er: Y

(<5

s) /

P (5

–10

s) /

N (>

10 s)

11.

Drie

d th

e ba

by th

orou

ghly

(wip

ed th

e ey

es,

mou

th, n

ose,

face

, hea

d, fr

ont,

back

, arm

s

and

legs

)

12.

Rem

oved

the

wet

clo

th

SUMMARY CHECKLIST 3.1 SUMMARY FORM FOR ALL HEALTH FACILITIES

Delivery practice for breathing babies

35

Act

ivit

ySu

mm

ary

data

by

heal

th fa

cilit

y –

n* /

N**

TOTA

Ln*

/ N**

(%)

By le

vel a

12

34

56

78

910

1112

1314

15

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

12

3

13.

Plac

ed b

aby

in d

irect

ski

n-to

-ski

n co

ntac

t

14.

Cove

red

baby

’s bo

dy w

ith c

loth

and

hea

d w

ith a

hat

15.

Chec

ked

for a

sec

ond

baby

16.

Inje

cted

oxy

toci

n IM

to m

othe

r with

in 1

min

17.

Rem

oved

firs

t (so

iled)

pai

r of g

love

s

18.

Chec

ked

for c

ord

pulsa

tions

bef

ore

clam

ping

, cl

ampe

d af

ter c

ord

pulsa

tions

sto

pped

19.

Plac

ed c

lam

p/tie

at 2

cm

and

forc

eps

at 5

cm

fro

m u

mbi

lical

bas

e

20.

Deliv

ered

pla

cent

a

21.

Coun

selle

d m

othe

r on

feed

ing

cues

(d

rool

ing,

mou

th o

peni

ng, t

ongu

ing/

licki

ng,

root

ing,

biti

ng h

and,

cra

wlin

g, e

tc.)

Indi

vidu

al s

core

s: a

ll ca

ses

obse

rved

(max

imum

sco

re p

ossib

le =

42)

Aver

age

scor

e =

(sum

indi

vidu

al s

core

s/nu

mbe

r of c

ases

see

n)

Scor

e ra

nge

=(fr

om lo

wes

t to

high

est)

Com

men

ts(o

ther

issu

es n

oted

from

obs

erva

tions

)

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s) u

nles

s oth

erw

ise

spec

ified

**N

= to

tal n

umbe

r of d

eliv

erie

s obs

erve

d

a.

Faci

lity

leve

ls ar

e as

follo

ws:

1

= n

atio

nal a

nd re

gion

al h

ospi

tals

; 2 =

firs

t-le

vel r

efer

ral h

ospi

tals

; and

3 =

firs

t lev

el w

here

del

iver

ies

take

pla

ce.

SUMMARY CHECKLIST 3.1 SUMMARY FORM FOR ALL HEALTH FACILITIES

Delivery practice for breathing babies (continued)

36

EENC Module 1 – Annual implementation review and planning guide

Sum

mar

y Ch

eckl

ist

3.3

SUM

MA

RY F

ORM

FO

R A

LL H

EALT

H F

ACIL

ITIE

S –

ENVI

RON

MEN

TAL

HYG

IEN

E:De

liver

y ro

om, o

pera

tion

room

, neo

nata

l car

e un

it an

d po

stna

tal c

are

room

Que

stio

nSu

mm

ary

data

by

heal

th fa

cilit

y –

n* /

N**

TO

TAL

n* /

N**

(%)

By le

vel a

12

34

56

78

910

1112

1314

151

23

1.Ro

oms

with

ade

quat

e h

andw

ashi

ng fa

cilit

ies

avai

labl

e (n

/ NR)

2.Ro

oms

with

at l

east

one

bot

tle o

f alc

ohol

gel

/ha

nd ru

b av

aila

ble

for u

se in

the

room

(n/N

R)

3.Ro

oms

with

ade

quat

e ha

ndw

ashi

ng fa

cilit

ies

and

alco

hol g

el/h

and

rub

avai

labl

e fo

r use

in

the

room

(n / N

R)

4.De

liver

y be

ds w

ith a

resu

scita

tion

area

av

aila

ble

with

in 2

m (n

/ NDB

)

5.Re

susc

itatio

n ar

eas

avai

labl

e (N

RA)

6.Re

susc

itatio

n ar

eas

that

are

cle

an a

nd d

ry

(n / N

RA)

7.Re

susc

itatio

n ar

eas

that

hav

e fu

nctio

nal

new

born

am

bu b

ag a

nd p

rete

rm a

nd te

rm

mas

ks (s

izes

0 a

nd 1

) ava

ilabl

e (n

/ NRA

)

8.Ro

oms

with

bab

y fo

od c

ompa

ny m

ater

ials

visib

le (p

oste

rs, b

roch

ures

, stic

kers

, pai

nted

w

alls,

etc

.) (n

/ NR)

9.Ro

oms w

ith h

ospi

tal o

rder

s pro

hibi

ting

use

of

infa

nt fo

rmul

a an

d ot

her l

inka

ges w

ith m

ilk

form

ula

com

pani

es p

oste

d pr

omin

ently

(n / N

R)

* n =

tota

l num

ber o

f obs

erva

tions

mee

ting

the

crite

ria**

N =

tota

l num

ber o

f obs

erva

tions

a.

Faci

lity

leve

ls ar

e as

follo

ws:

1

= n

atio

nal a

nd re

gion

al h

ospi

tals

; 2 =

firs

t-le

vel r

efer

ral h

ospi

tals

; and

3 =

firs

t lev

el w

here

del

iver

ies

take

pla

ce.

SUMMARY CHECKLIST 3.3 SUMMARY FORM FOR ALL HEALTH FACILITIES

ENVIRONMENTAL HYGIENE: Delivery room, operation room, neonatal care unit and postnatal care room

37

38

EENC Module 1 – Annual implementation review and planning guide

Sum

mar

y Ch

eckl

ist

4. S

UM

MA

RY F

ORM

FO

R A

LL H

EALT

H F

ACI

LITI

ES

Avai

labi

lity

of k

ey m

edici

nes

and

supp

lies

for E

ENC

Key

med

icin

e an

d su

pply

Num

ber

of a

ll he

alth

faci

litie

s w

ith

stoc

k av

aila

ble

on t

he d

ay o

f the

rev

iew

, st

ored

cor

rect

ly o

r fu

ncti

onal

, sto

ck r

ecor

ds a

nd n

o st

ock-

outs

in t

he p

ast

12 m

onth

s

Sum

mar

y da

ta b

y he

alth

faci

lity

– An

swer

Y (Y

es) o

r N (N

o)TO

TAL

n */ N

** (%

)By

leve

la

12

34

56

78

910

1112

1314

151

23

Pre

-del

iver

y an

d de

liver

y ar

eas

1.M

agne

sium

sul

fate

for s

ever

e pr

e-ec

lam

psia

an

d ec

lam

psia

, and

feta

l neu

ropr

otec

tion

2.O

xyto

cin

for I

M o

r IV

use

3.Co

rtico

ster

oids

for w

omen

at 2

4–34

wee

ks

of g

esta

tion

at ri

sk o

f pre

term

del

iver

y

4.An

tibio

tics

for p

rete

rm p

rela

bour

rupt

ure

of

mem

bran

es

5.Sy

phili

s te

st k

its

6.HI

V te

st k

its

7.Fi

rst-l

ine

ART

regi

men

(TDF

+3T

C(or

FT

C)+

EFV)

8.Fu

nctio

nal n

ewbo

rn a

mbu

bag

and

pre

term

an

d te

rm m

asks

(siz

es 0

and

1) w

ithin

2 m

of

eac

h de

liver

y be

d

9.O

xyge

n fo

r new

born

use

10.

Ster

ile g

love

s

11.

Func

tiona

l aut

ocla

ve

SUMMARY CHECKLIST 4 SUMMARY FORM FOR ALL HEALTH FACILITIES

Availability of key medicines and supplies for EENC

39

SUMMARY CHECKLIST 4 SUMMARY FORM FOR ALL HEALTH FACILITIES

Availability of key medicines and supplies for EENC (continued) K

ey m

edic

ine

and

supp

ly

Num

ber

of a

ll he

alth

faci

litie

s w

ith

stoc

k av

aila

ble

on t

he d

ay o

f the

rev

iew

, st

ored

cor

rect

ly o

r fu

ncti

onal

, sto

ck r

ecor

ds a

nd n

o st

ock-

outs

in t

he p

ast

12 m

onth

s

Sum

mar

y da

ta b

y he

alth

faci

lity

– An

swer

Y (Y

es) o

r N (N

o)TO

TAL

n */ N

** (%

)By

leve

la

12

34

56

78

910

1112

1314

151

23

Neo

nata

l int

ensi

ve c

are

12.

Inje

ctab

le a

ntib

iotic

s fo

r man

agem

ent

of n

ewbo

rn s

epsis

13.

New

born

am

bu b

ag a

nd p

rete

rm a

nd te

rm

mas

ks (s

izes

0 a

nd 1

) in

each

NCU

room

14.

CPAP

15.

Oxy

gen

for n

ewbo

rn u

se

16.

Ster

ile g

love

s

All

esse

ntia

l med

icin

es a

vaila

ble

An

swer

“Y”

onl

y if:

1.

= Y,

2. =

Y, 3

. = Y,

and

12.

= Y

All

esse

ntia

l equ

ipm

ent a

vaila

ble

An

swer

“Y”

onl

y if:

8.

= Y,

9. =

Y, 1

4. =

Y, a

nd 1

5. =

Y

Pos

tnat

al c

are

area

s

17.

Rout

ine

eye

prop

hyla

xis

18.

Vita

min

K

19.

Hepa

titis

B va

ccin

e

* n =

tota

l num

ber o

f “Y”

(Yes

) res

pons

es**

N =

tota

l num

ber o

f hea

lth fa

cilit

ies e

valu

ated

a. F

acili

ty le

vels

are

as fo

llow

s:

1 =

nat

iona

l and

regi

onal

hos

pita

ls; 2

= fi

rst-

leve

l ref

erra

l hos

pita

ls; a

nd 3

= fi

rst l

evel

whe

re d

eliv

erie

s ta

ke p

lace

.

40

EENC Module 1 – Annual implementation review and planning guide

Sum

mar

y Ch

eckl

ist

5. S

UM

MA

RY F

ORM

FO

R A

LL H

EALT

H F

ACI

LITI

ES

Revi

ew a

ctiv

ities

of t

he E

ENC

team

and

hos

pita

l dat

a in

the

past

12

mon

ths

Que

stio

nH

ealt

h fa

cilit

yTO

TAL

n* / N

** (%

)By

leve

la

12

34

56

78

910

1112

1314

151

23

1.In

the

prev

ious

12

mon

ths:

a. H

as th

e EE

NC

team

bee

n su

ppor

ted

by

the

hosp

ital d

irect

or o

r sen

ior s

taff?

b. H

as th

e EE

NC

team

met

at l

east

qua

rterly

an

d do

cum

ente

d m

eetin

gs?

c. Ha

ve tw

o EE

NC

qual

ity a

sses

smen

ts b

een

cond

ucte

d an

d do

cum

ente

d?

d. H

as th

e EE

NC

plan

bee

n re

view

ed a

nd

upda

ted

at le

ast q

uarte

rly?

e. Co

mpo

nent

s of a

n EE

NC

qual

ity a

ppro

ach

ha

ve b

een

put i

n pl

ace

(b. a

nd c

.)

2.St

aff c

oach

ing

data

base

is a

vaila

ble

an

d up

-to-d

ate?

a. N

umbe

r of d

octo

rs c

oach

ed (n

/ N)

b. N

umbe

r of m

idw

ives c

oach

ed (n

/ N)

c. N

umbe

r of n

urse

s coa

ched

(n / N

)

d. T

otal

staf

f coa

ched

(n / N

)

3.

EEN

C ho

spita

l im

pact

dat

abas

e is

avai

labl

e

for t

he p

ast 1

2 m

onth

s?

a. I

ssue

s fou

nd w

ith c

olle

ctin

g ho

spita

l im

pact

da

ta

Mai

n is

sues

:M

ain

issu

es:

SUMMARY CHECKLIST 5 SUMMARY FORM FOR ALL HEALTH FACILITIES

Review activities of the EENC team and hospital data in the past 12 months

41

Que

stio

nH

ealt

h fa

cilit

yTO

TAL

n* / N

** (%

)By

leve

la

12

34

56

78

910

1112

1314

151

23

4.

Num

ber o

f mat

erna

l dea

ths

occu

rring

in th

e pa

st 1

2 m

onth

s th

at w

ere

revi

ewed

(n/N

)?

5.

Num

ber o

f new

born

dea

ths

occu

rring

in th

e pa

st 1

2 m

onth

s th

at w

ere

revi

ewed

(n/N

)?

6.

Num

ber o

f stil

lbirt

hs o

ccur

ring

in th

e pa

st

12 m

onth

s th

at w

ere

revi

ewed

(n/N

)?

* n =

tota

l num

ber o

f “Y”

(Yes

resp

onse

s) o

r sum

of n

umer

ator

dat

a ac

ross

all

heal

th fa

cilit

ies

**N

= to

tal n

umbe

r of h

ealth

faci

litie

s eva

luat

ed o

r sum

of d

enom

inat

or d

ata

acro

ss a

ll fa

cilit

ies

a. F

acili

ty le

vels

are

as fo

llow

s:

1 =

nat

iona

l and

regi

onal

hos

pita

ls; 2

= fi

rst-

leve

l ref

erra

l hos

pita

ls; a

nd 3

= fi

rst l

evel

whe

re d

eliv

erie

s ta

ke p

lace

.

SUMMARY CHECKLIST 5 SUMMARY FORM FOR ALL HEALTH FACILITIES

Review activities of the EENC team and hospital data in the past 12 months (continued)

42

EENC Module 1 – Annual implementation review and planning guide

Tables 1 / 2 / 3 / 4 / 5

Instructions

1. Draw EENC monitoring and evaluation Tables 1–5 on flipchart paper and post them on the wall. Data for Tables 1, 3, 4 and 5 should have been entered in advance.

2. Complete Table 2. Health Facility EENC Standards using data from the facility evaluations.

3. Discuss indicators in Tables 1–5 and mark those that are low or have not improved over time with a red marker and those that show progress with a green marker. For Tables 2 and 3, note indicators that show significant differences between facility levels (national/regional, first-level referral and first level where deliveries take place).

4. Identify strengths and priority areas for improvements.

5. Discuss findings and reach consensus on main findings.

SECTION 3.

REVIEW EENC MONITORING AND EVALUATION TABLES

43

Benchmark Y (Yes) / N (No) / P (Partial) / ND (No Data)

StatusCountry target

2015 2016 2017 2018 2019 20201. Newborn health situation analysis conducted in

the previous 5 years used for strategic planning a Yes

2. Five-year EENC action plan developed based on the Regional Action Plan for Healthy Newborns,b costed and adopted by the Ministry of Health

Yes

3. EENC annual implementation review conducted at least biennially to inform development of annual implementation plans

Yes

4. Detailed annual EENC implementation plan funded Yes

5. EENC technical working/coordination group meets regularly c Yes

6. Full-time EENC/newborn health focal person appointed in the Ministry of Health Yes

7. EENC stakeholder group meets regularly d Yes

8. Clinical Intra-Partum and Newborn Care Protocol endorsed e Yes

9. Mechanisms established to ensure that professional associations are supporting implementation of EENC

Yes

10. Proportion of EENC interventions (normal and high-risk deliveries) included in pre-service training curricula: (a) medical; (b) nursing; (c) midwifery f

100% for all

a. Situation analysis includes: review of trends in newborn, child and maternal morbidity and mortality and intervention cover-age along the continuum of care; an analysis of newborn health equity for different populations and groups; and status of key systems inputs to support delivery of newborn health interventions.

b. World Health Organization and UNICEF. Action plan for healthy newborn infants in the Western Pacific Region (2014–2020). Manila: WHO Regional Office for the Western Pacific; 2014.

c. Membership may include: ministry of health public health divisions, obstetric and paediatric decision-makers, professional associations, civil society organizations and development partners. Quarterly meetings are recommended.

d. Membership may include: policy-makers, legislators, health providers, hospital administrators, civil society leaders, develop-ment partners, media practitioners, academia and health professional associations. Quarterly meetings are recommended.

e. Most countries adapt and use the Early Essential Newborn Care: Clinical Practice Pocket Guide (2014) developed by the WHO Regional Office for the Western Pacific.

f. Technical content consistent with international EENC standards – curricula include clinical EENC coaching as part of the teaching method. EENC core interventions are described in Annex 1: EENC Monitoring and Evaluation Framework 2015–2020. Manila: WHO Regional Office for the Western Pacific; September 2016.

TABLE 1

Benchmarks of EENC scale-up readiness, 2015–2020

44

EENC Module 1 – Annual implementation review and planning guide

Indicator Data by yearRegional

target2015 2016 2017 2018 2019 2020

1. Proportion of staff providing childbirth, newborn or postpartum care services at the health facility that are coached in EENC

90%

2. Proportion of facilities using a quality improvement approach to support implementation of EENC 90%

3. Pregnant women of 24–34 weeks of gestation at risk of imminent preterm birth and with no clinical evidence of infection administered the full course of intramuscular dexamethasone or betamethasone prior to childbirth

100%

4. Proportion of women receiving all key delivery care tasks:

4.a – 4.d all 90%

a. Companion of choice 90%

b. Non-supine position during second stage 90%

c. Food and fluids 90%

d. No fundal pressure 90%5. Proportion of mothers with a correctly completed

partograph 90%

6. Proportion of breathing newborns that receive:

a. Immediate skin-to-skin contact 90%

b. Early and exclusive breastfeeding in the immediate newborn period 90%

c. Immediate and sustained skin-to-skin contact for at least 90 min and a complete breastfeed 80%

7. Proportion of newborns with a birthweight ≤ 2000 g who in the previous 24 hours received: a. Any Kangaroo Mother Care 80%

b. Continuous Kangaroo Mother Care for at least 20 h 50%

8. Proportion of women who receive breastfeeding counselling in the immediate newborn period 100%

TABLE 2

Health facility EENC standards, 2015–2020

Use hospital summary forms to complete one table for all facilities of each level: a) national and regional hospitals; b) first-level referral hospitals; and c) first level where deliveries take place.a Note indicators where findings differ between different levels of facility. Combine summary data for term and preterm babies for all practice measures.

Level of facility: ..................................................................................................................

45

Indicator Data by yearRegional

target2015 2016 2017 2018 2019 2020

9. Proportion of delivery room(s), operation room(s), neonatal care units (NCU), and postnatal care room(s) at the facility that have adequate handwashing resources

100%

10. Proportion of health facilities with no stock-outs of key life-saving medicines required to provide EENC

100% (10.a –10.d all 100%)

a. Magnesium sulfate for severe pre-eclampsia and eclampsia, and fetal neuroprotection if gestational age < 32 weeks

100%

b. Oxytocin for the prevention and control of postpartum haemorrhage for all births 100%

c. Corticosteroids for women at 24–34 weeks of gestation at risk of preterm delivery 100%

d. Injectable antibiotics for management of newborn sepsis 100%

11. Proportion of health facilities with functional key life-saving commodities required to provide EENC

100% (11.a –11.c all 100%)

a. Functional newborn ambu bag and preterm and term masks (sizes 0 and 1) within 2 m of each delivery bed

100%

b. Continuous supply of oxygen for newborn use (national, regional and first-level referral hospitals) 100%

c. Continuous positive airway pressure (CPAP) (national, regional and first-level referral hospitals) 100%

12. Proportion of health facilities that have eliminated baby-food industry conflicts of interest

100% (12.a –12.c all 100%)

a. Health facilities where no mother has products or gifts from baby-food companies 100%

b. Health facilities with a written policy to prohibit use of infant formula and other baby-food company activities

100%

c. Health facilities with no promotional baby-food materials including posters, brochures, pamphlets or items with logos on their premises

100%

13. Proportion of EENC health facility standards (1–12)achieved 70%

a. National and regional hospitals: offer services of first-level referral hospitals plus advanced neonatal care including CPAP; serve as a teaching hospitals; and provide support to lower-level facilities. First-level referral hospitals: offer services of first level where deliveries take place plus management of preterm labour and common complications of prematurity (e.g. oxygen), complications of delivery including assisted delivery and caesarean sections. First-level facilities where deliveries take place: should have capacity for care of breathing and non-breathing babies.

46

EENC Module 1 – Annual implementation review and planning guide

Indicator Data by year Country target

2015 2016 2017 2018 2019 2020

1. Neonatal care unit/nursery admission rate

2. Proportion of newborns by weight (in g):

a. <1000 g

b. 1000 –1499 g

c. 1500 –1999 g

d. 2000 –2499 g

e. ≥ 2500 g

3. Proportion of newborns born at the facility classified with newborn sepsis b

4. Proportion of newborns born at the facility classified with birth asphyxia c

5. Newborn mortality rate stratified by weight (in g):

a. <1000 g

b. 1000 –1499 g

c. 1500 –1999 g

d. 2000 –2499 g

e. ≥ 2500 g

6. Case fatality rate (% registered cases dying):

a. Preterm d newborns

b. Low-birthweight newborns e

c. Newborn sepsis

d. Newborn asphyxia

a. National and regional hospitals: offer services of first-level referral hospitals plus advanced neonatal care including CPAP; serve as teaching hospitals; and provide support to lower-level facilities. First-level referral hospitals: offer services of first level where deliveries take place plus management of preterm labour and common complications of prematurity (e.g. oxygen), advanced resuscitation, complications of delivery including assisted delivery and caesarean sections.

b. Bacterial sepsis of the newborn: ICD-10 P36 (codes P36.0–P36.9, sepsis of known cause or unknown cause).c. Birth asphyxia is defined as newborns who are gasping or not breathing at 1 minute of age. d . Preterm newborns are live births less than 37 completed weeks gestation (ICD-10 P07.2 and ICD-10 P07.3).e. Low birthweight is defined as a birthweight under 2500 grams.

TABLE 3

Hospital impact indicators, 2015–2020

Use routine health management information system (HMIS) data or register reviews from hospitals that have begun implementing EENC to complete one table for a) national and regional hospitals and b) first-level referral hospitals a for national estimates.

Level of facility: ...................................................................................................................

47

Coverage measure Data by year (specify source) Regional target

2015 2016 2017 2018 2019 2020

1. % of live births attended by skilled health personnel 90%

2. % of live births that take place at health facilities 90%

3. % of live births delivered by caesarean section ≤ 10%

4. % of live rural births delivered by caesarean section

5. % of newborns dried after birth 100%

6. % of newborns with delayed bath after birth b 100%

7. % of newborns placed on the mother’s bare abdomen or chest immediately after delivery (skin-to-skin) 100%

8. % of newborns breastfed within one hour of birth c 100%

9. % of newborns receiving a prelacteal feed 0%

10. % of live births with a reported birthweight 100%

11. % of women receiving postnatal care within 2 days of birth 100%

12. % of newborns receiving postnatal care within 2 days of birth 100%

13. % of newborns aged 0 –1 month who are exclusively breastfed 100%

a. For survey methods and standard definitions of coverage indicators see: http://www.dhsprogram.com/data/Data-Tools-and-Manuals.cfm and http://mics.unicef.org.

b. Delayed bathing: at least 24 hours after birth. c. The standard population-based survey indicator currently measures breastfeeding within 1 hour of birth and not the wider

90-minute window during which breastfeeding can occur.

TABLE 4

Coverage indicators for EENC interventions, 2015–2020

Use representative population-based surveys (Demographic and Health Survey [DHS], Multiple Indicator Cluster Survey [MICS] or other population-based surveys) to periodically measure coverage and HMIS and health facility assessment data to track trends in coverage between surveys. Data are disaggregated by administrative or geographic divisions for subnational tracking and programme planning.a

National or subnational area: ........................................................................

EENC Module 1 – Annual implementation review and planning guide

48

Measurement Data by year (specify source) Regional target

2015 2016 2017 2018 2019 2020

1. Neonatal mortality rate (per 1000 live births) 10

2. Stillbirth rate b (per 1000 births)

3. Perinatal mortality rate c (per 1000 live births)

4. Proportional causes of neonatal death:

a. Sepsis

b. Tetanus

c. Birth asphyxia

d. Preterm birth

e. Congenital anomalies

5. Low-birthweight rate (< 2500 g)

6. Preterm birth rate (< 37 weeks)

a. For survey methods and standard definitions of impact indicators, see: http://www.dhsprogram.com/data/Data-Tools-and-Manuals.cfm and http://mics.unicef.org/

b. For international comparisons and reporting WHO/ICD defines stillbirths as the death of a fetus that has reached a birth-weight of ≥ 1000 g, or if birthweight is unavailable, gestational age of ≥28 weeks or crown-to-heel length of ≥ 35 cm. It is expressed as the number of stillbirths, per 1000 births. A stillbirth is defined as, “death prior to the complete expulsion or extraction from its mother of a product of conception; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles without specification of the duration of pregnancy”.

c. Perinatal mortality rate: the sum of the number of stillbirths and early neonatal deaths divided by the number of pregnan-cies of seven or more months’ duration, expressed per 1000.

TABLE 5

Impact indicators for newborn health, 2015–2020

Use large sample population-based surveys (DHS, MICS or other large sample surveys) in most settings and civil registration and vital statistics (CRVS) data where available, valid and reliable. Modelled mor-tality data (United Nations Inter-agency Group for Child Mortality Estimation [IGME] and Child Health Epidemiology Reference Group [CHERG]) may be used to track trends. Routine HMIS data may be used to track trends in prematurity and low birthweight. Data are disaggregated by country administrative or geographic divisions for subnational tracking and programme planning.a

National or subnational area: .........................................................................

49

Table 6

Instructions: identifying priority areas for improvement

1. Draw on flipchart paper and post on the wall each of the five planning areas in Table 6: Synthesis of EENC review findings, as follows:

a. national policies, guidelines, coordination and resources to support implementation;

b. EENC clinical practice;

c. EENC facility resources and support;

d. EENC hospital teams and coaching of staff; and

e. EENC hospital impact data.

2. Review the findings from checklists and monitoring and evaluation tables – including differ-ences between different facility levels.

3. Identify technical issues or gaps and underlying reasons for gaps.4

4. Summarize the final list of prioritized areas for improvement to the group and ensure that there is consensus.

5. Write the final priority list on Table 6.

SECTION 4.

USE FINDINGS TO DEVELOP AN EENC ANNUAL IMPLEMENTATION PLAN

4. In some circumstances it may be useful to have participants write areas for improvement and reasons for gaps on metacards, individually, and to post metacards on the flip chart – to ensure contributions from all participants.

EENC Module 1 – Annual implementation review and planning guide

Programme area StrengthsPriority areas

for improvementUnderlying

reasons for gaps

National policies, guidelines, coordination and resources to support implementation

– M&E Table 1

EENC clinical practice

– M&E Tables 2 and 3 – Checklists: 1.1, 1.2, 2.1, 2.2, 3.1 & 3.2

EENC facility resources and support– Organization of work– Availability of space or basic amenities– Environmental hygiene– Supervision of practice– Medicines and commodities

– M&E Table 2– Checklists: 3.3 and 4

EENC hospital teams and coaching of staff

– M&E Table 2– Checklist 5

EENC hospital impact data

– M&E Table 3– Checklist 5

TABLE 6

Synthesis of EENC review findings: national sample of health facilities

50

51

Table 7

Instructions: develop an EENC annual implementation plan

1. Draw Table 7. EENC annual implementation plan on a flipchart (see next page).

2. Review actions in the previous EENC implementation plan for the priority areas of improve-ment identified in Table 6.

3. Review whether current actions need to be continued and brainstorm possible new actions to address the priority areas for improvement.

4. Base priority actions on underlying reasons for gaps. Consider:

a. importance to improving EENC clinical practice;

b. whether action can be taken with existing resources and personnel; and

c. whether action can be taken in the next three months (or for longer-term priorities, substantially start the process within three months).

5. Write the agreed priority actions on the flipchart.

52

EENC Module 1 – Annual implementation review and planning guide

Priority actions Person responsible TimeEstimated budget /source of funding

National policies, guidelines, coordination and resources to support implementation

EENC clinical practice

EENC facility resources and support

EENC hospital teams and coaching of staff

EENC hospital impact data

TABLE 7

EENC annual implementation plan

53

Purpose

The EENC Action Plan establishes long-term goals, strategies, activities and resources needed. It is based on data from the most recent annual implementation review and other sources such as nutrition, human resources and communication programmes. The action plan should be reviewed and updated every five years.

Participants

National strategic planning is usually done by a technical group of 20–25 persons from the national EENC team, programme and hospital staff who participated in the annual imple-mentation review, staff from the health promotion, communication, health information, monitoring and evaluation, human resources, and financing sectors, development partners and professional associations and academe. Larger groups may be considered if subnational participants also participate.

Table 8

Instructions

Preparatory steps

1. Identify suitable dates for the workshop.

2. Invite participants to the workshop.

3. Make copies available of: a. the previous five-year EENC action plan, if available;b. relevant policy and programme information on health-care financing, human resources,

availability of medicines and supplies, health communication, accreditation and other policy issues;

c. national-level newborn health needs assessment/situational analysis; d. research studies conducted to test newborn health services/packages in country

(including both published and unpublished studies);

SECTION 5.

REVIEW AND DEVELOP FIVE-YEAR EENC ACTION PLAN

54

EENC Module 1 – Annual implementation review and planning guide EENC Module 1 – Annual implementation review and planning guide

e. findings of subnational nongovernmental organizations or bilateral project assessments or evaluations; and facility assessments or surveys; and

f. data from the most recent annual implementation review.

4. Complete a draft Table 8 for each strategic action to anticipate needs and strategic direction the group thinks may be best.

5. Ensure availability of flipchart papers, markers and other materials for the workshop.

Strategic planning workshop

1. Review goals and objectives and revise them, if necessary. If this is the first action plan, the goals and objectives outlined in the Action Plan for Healthy Newborn Infants in the Western Pacific Region may be considered as a model.

2. For each strategic action of the national EENC action plan, write operational objectives and activities on a flipchart (Table 8).

3. For each activity, use data from the annual implementation review or other sources to determine:

a. the current status of the activity; and

b. whether it should be continued, modified or removed considering:

− its importance to improving EENC clinical practice and population coverage;

− whether action can be taken with existing resources and personnel; and

− whether action can be taken in one to five years and whether timing is realistic.

3. Discuss and write in Table 8:

a. staff responsible for the activity and timing for implementation;

b. sources of funding already committed or available and potential new sources; and

c. whether additional activities need to be added.

4. Agree on a process and staff responsible for writing up and reviewing the final EENC action plan – ensure that planned activities are linked with reproductive, maternal, newborn and child health routine plans and budgets.

55

Operational objective [insert operational objective number] ……………………………………

[insert title of operational action] ……………………………………………………………………………………

ActivityStatus:

Yes / No / PartialTasks to complete

the activities

Person responsible and timing

Funding source

Operational objective [insert operational objective number] ……………

[insert title of operational action] ……………………………………………………….

1.

2.

3.

Operational objective [insert operational objective number] ……………

[insert title of operational action] ……………………………………………………….

4.

5.

6.

TABLE 8

Review of strategic actions for implementing EENC