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7/28/2019 Daelmans: Framework for Newborn Health Continuum of Care Package
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Framework for newborn healthcontinuum of care package
Bernadette Daelmans,
Coordinator Policy, Planning and Programmes
Department of Maternal, Newborn, Child and Adolescent Health (MCA)
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The continuum of care
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Essential interventions
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Essential interventions
Prevention of too early, unwanted, or
rapid successive pregnancies
Adequate nutrition, including iron and folic
acid supplementation, and treatment of
anaemia
Immunization (rubella, HepB, TT)
Prevention of HIV and STIs
Prevention and treatment of substance
use
Smoking cessation
Protection from harmful exposures and
from interpersonal violence
Tetanus toxoid immunization
Birth and emergency planning
Detection and management of problems
complicating pregnancy
Detection and treatment of syphilis
Intermittent preventive therapy for
malaria*
Information and counseling on self-care
Sleeping under an insecticide treated
bednet
Prevention of mother to child transmission
of HIV* (PMTCT)
Before pregnancy During pregnancy
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Essential interventions
Monitoring of progress of labour, maternal
and foetal wellbeing with partograph
Social support (companion) during birth
Immediate newborn care (resuscitation if
required, thermal care, hygienic cord care,
skin-to-skin contact, early initiation of BF)
Emergency obstetric and newborn care for
complications
Antibiotics for pre-term premature rupture of
membranes (pPROM)
Antenatal corticosteroids for preterm labour
PMTCT
Exclusive breastfeeding
Thermal care
Hygienic cord care
Prompt care-seeking for illness
Extra care for low-birth-weight babies,
including kangaroo mother care
Immunization
Management of newborn illness
PMTCT
During child birth In the newborn period
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Family/
community
HOME VISITS
DURING
PREGNANCY
MANAGEMENT OF
NEWBORN PROBLEMS
SAFER HOME BIRTH
EARLY POSTNATAL HOME VISIT
CARING FOR THE
NEWBORN AT HOME
Newborn/postnatalPre-pregnancy Pregnancy
Outpatient
Clinical
ANTENATAL
CAREPOSTNATAL CARE
ESSENTIAL LABOUR AND
CHILDBIRTH CARE
MANAGEMENT OF
NEWBORN PROBLEMS
REPRODUCTIVE
CARE
AND
PRE-
PREGNANCY
CARE
Intersectoral: improved housing, water and sanitation, and nutrition; education and empowerment
Childbirth
Packages of care
TREATMENT
FOR
PREGNANCY
COMPLICATIONS
IMMEDIATENEWBORN CARE
MANAGEMENT OF
NEWBORN PROBLEMS
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The time AROUND childbirth:A window of opportunity for impact
Labour and childbirth care
Labour monitoring
Childbirth care
Essential newborn care
Birth: drying, skin-to-skin
First week: early/excl. BF,
warmth, cord care, hygiene
Obstruction/Fetal
distress: CS, vacuum
PT labour: corticosteroids,
antibiotics for PPROM
Preterm birth: Kangaroo
Mother Care, BF support,
immediate treatment ofsuspected infection
Suspected sepsis:Early antibiotic
treatment
Not breathing at
birth: Resuscitation
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Ending preventable newborn deaths
Labour and childbirth care
Labour monitoring
Childbirth care
Essential newborn care
Birth: drying, skin-to-skin
First week: early/excl. BF,
warmth, cord care, hygiene
Obstruction/Fetal distress: CS,
vacuum
PT labour: corticosteroids,
antibiotics for PPROM
Preterm/LBW: Kangaroo Mother
Care, BF support, immediate
treatment of suspected infectionSuspected sepsis: Early
antibiotic treatment
Not breathing at birth:
ResuscitationCARE DURING
PREGNANCY
TREATMENT
FOR
PREGNANCY
COMPLI-
CATIONS
PRE-
CONCEPTION
CARE
REPRODUCTIVE
CARE
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Quality of care: a barrier to progress
Quality of care has been recognized
as a neglected issue in the
international health agenda.
Global data show that quality of care
provided in referral facilities is often
poor.
Poor quality of care leads to
significant morbidity and mortality.
Existence of a quality gap is a mostlikely contributor to slow progress
towards MDG 4 and 5.
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Improving quality of care
practice guidelines, structural standards, trainingstandards
assessment and indicators
motivation, professional development, incentives,accreditation, etc.
champions, MoHs, local authorities, professionalassociation, NGOs & international agencies.
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Evidence based newborn guidelines (2009 13)
Care of the newbornimmediately after birth
Newborn resuscitation
Newborn immunization
Postnatal care
Care of the preterm and low
birth weight baby
Management of neonatalsepsis
Management of neonatal
seizures
Management of neonatal
jaundice
Management of necrotizing
enterocolitis
Care of the HIV-exposed
newborn
http://www.who.int/maternal_child_adolescent/documents/en
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Monitoring quality
WHO Safe Childbirth Checklistcontains 29 items addressing:
the major causes of maternal
death - haemorrhage, infection,
obstructed labour and
hypertensive disorders
intrapartum-related stillbirths -
inadequate intrapartum care
neonatal deaths - birth asphyxia,
infection and complications relatedto prematurity
http://www.who.int/patientsafety/implementation/checklists/childbirth/en/index.html
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Context matters: Health workforce
WHO Global Health Workforce Statistics. Countdown countries affected by a severe health workforce shortagein 2012, by UNICEF region.al Health Workforce Statistics.
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Midwifery: the dual gap
Quantity Not enough midwives, 38
countries have severe
shortages
Quality Many existing facilities are
poorly equipped, with
inadequate staffing levels
Competencies of staff may
be insufficient Motivation and respect are
compromised
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A call for bold steps
Governments:
Recognize midwifery and engage midwives at national policy decisions
Include midwifery in costed MNH plans, and align human resources for health plans.
Invest in active monitoring of the practising midwifery/MNH workforce.
Regulatory bodies
Educational standards and practice competencies.
License and relicense midwives.
By schools and training institutions
Improve and maintain competencies in midwifery and transformative education.
Support development of midwifery leadership
By professional associations
Establish solid governance, strengthen administrative capacity and improve financialmanagement
By partners:
Support programmes to scale up midwifery services enabling country commitments to
the Global Strategy
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Community health workers: a critical link
Pregnancy visits to promote:
Antenatal care
Birth with skilled birth attendant
Newborn care at birth: immediate
drying and skin-to-skin contact, early
initiation of breastfeeding, clean cordcare
Postnatal visits to support:
Early and exclusive breastfeeding
Keeping the newborn warm, hygienic
cord care
Extra care for LBW babies
Timely recognition of danger signs
Uptake of family planning
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Adolescence: a time for investment
Preventing early pregnancy Prevent early marriage
Prevent early pregnancy
Increase use of contraception
Combat coerced sex
Reduce unsafe abortions
Increase access to skilled care
Reaching out before conception Provide folic acid supplementation
Reduce harmful behaviors (tobacco, alcohol)
Pay attention to mental health
Providing extra care for mother and baby
During pregnancy and childbirth
In the postnatal period
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Conducive policies are essential
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Surveillance to save lives
Surveillance
Response
Identify
deaths
Report
deaths
Response
action
Review
deaths
MMR trackingQoC measurement
Vital registrationQoC improvement
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Life-saving commodities: a new impetus
13 life-saving commodities
10 recommendations Shaping global markets
Shaping local delivery markets
Putting in place innovative financing
Strengthening quality
Making regulation more efficient
Increasing supply and awareness
Increasing demand and utilization
Reaching the poorest women and children
Improving performance and accountability
Prioritizing and funding product innovation
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Closing the equity gap
:Source:2015Barros AJ D et al., Equity in maternal, newborn and child health interventions in Countdown toa retrospective review of survey data from 54 countries. Lancet 2012; 379: 1225-33.
Cove
rage
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Family Planning
SummitBorn too soon
A Promise
Renewed
Country leadership & Implementation
Decade of Vaccines
Global action plans: nutrition, pneumonia & diarrhea, newborn
Visit www.everywomaneverychild.org
Key advocacy events and catalytic initiatives in support of
Every Woman Every Child
Commission on Live-saving Commodities
CoIA Independent Expert Review Group
Innovations working group
Bringing it all together
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HOME: She and her family were visited by a
CHW during pregnancy, who encouraged ANC
and early care-seeking for danger signs
HOSPITAL: When the mother went into
premature labour, her husband urged her to go
to the hospital, and she delivered a LBW infant
weighting 1.5 kg
HOME:When discharged from the hospital on
day 5, the CHW visited to assist with feeding,
ensuring warmth and screen for danger signs
This young mother lives in an area covered by a home-based
newborn care program
The continuum in action
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Thank you