The Opportunity and the Challenge Delivering More for Mothers and Newborns on the Day of Birth

Koki Agarwal, M.D. Dr. PH Director Maternal and Child Survival Program / Jhpiego, USA

Outline •  Why focus on the day of

birth? •  Opportunities for

achieving better care on the day of birth

•  Challenges for delivering integrated services for mother and newborn

•  Aligning with global initiatives

When do Newborns Die?

0

20

40

60

80

100

120

140

160

Source: Ronsmans and Koblinsky 2006

Percen

tage  

Almost half of all newborn occur on the day of birth

Source: 2005 Lancet Every Newborn Series

When Do Newborn Deaths Occur?

Birth is the Time of Greatest

Risk of Death and Disability

for Mothers and Newborns

Photo Credit: John Healey /ACCESS

40% of all maternal and newborn deaths occur within 24 hours of birth

1.2 million intrapartum stillbirths 1 million neonatal deaths 113,000 maternal deaths

Day of Birth…

Source: Lancet Every Newborn: progress, priorities, and potential beyond survival

The Opportunity: Better Care on the Day of Birth

Pregnancy

•  Focused ANC •  IPTp •  GBV screening •  Immunizations •  Messages on danger signs for mother and newborn •  Messages on healthy life

conditions •  Emergency & delivery plans •  FP counseling •  Post abortion care •  Management of preterm

labor

Day of Birth Infection prevention

Respectful care at birth Effective labor care

AMSTL Immediate newborn care Neonatal resuscitation

Immediate postnatal care Vacuum extraction Early postnatal care Management of PPH Early detection and

management of complications PPFP

Postnatal

•  Essential newborn care •  Management of newborn and maternal sepsis •  KMC •  Nutrition messages •  FP counseling and services:

IUD & implants •  Messages on health life

conditions •  Immunizations •  Messages on danger signs for

mother and newborn •  Emergency plan

Challenges for Achieving: Better Care on the Day of Birth

•  Vertical policy, programming, measurement, and funding (e.g. ENAP, EPMM)

•  Poor alignment of maternal and newborn interventions

•  Compartmentalized provider training/capacity-building strategies

Photo  Credit:  Karen  Kasmauski/MCSP  

Local Realities: Access

Photo  Credits:  MCSP/MCHIP  

Where the Rubber Hits the Road

Local Realities

Photo  Credits:  MCSP/MCHIP  

Photo  Credits:  MCSP/MCHIP  

Photo  Credits:  Jhpiego  

Bringing the pieces together: Opportunities To Improve Care on the Day of Birth

Better Health Outcomes

ANC PNC Better Care

on the Day of Birth

Commodities

Quality Improvement

Measurement

Capacity- building

Health Systems Strengthening

WHO Quality of Care

Framework for Childbirth

Source: BJOG 2015

Maternal and Child Survival Program

(MCSP)

Well Positioned to Strengthen Day of Birth Services for Mothers and

Newborns

FAMILY PLANNING

MATERNAL HEALTH

NEWBORN HEALTH

CHILD HEALTH

IMMUNIZATION

NUTRITION HIV/TB

MALARIA

WASH MCSP

MCSP’s Commitment to Implementing at Scale

•  Strengthening local health systems (e.g. district) •  Integrated capacity building •  Ensuring commodities for mothers and newborns •  Continuous measurement of core DoB indicators •  Delivery of high-impact maternal & newborn

interventions •  Supporting health workers and managers

Photo  Credit:  Kate  Holt/MCSP  

Con$nuous  quality  improvement  to  achieve  effec$ve,  safe  and  people-­‐centered  care  for  

mothers,  newborns  and  families    around  the  day  of  birth  

 

Moving the Needle on the Day of Birth:

MCSP working in 22 of USAID 24 priority countries Commitment to continuous shared learning across countries

Contextual  learning  from  Bangladesh,  Pakistan  and  Tanzania  

Thank You

Learn more at: www.mcsprogram.org

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For more information, please visit www.mcsprogram.org

 This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not

necessarily reflect the views of USAID or the United States Government.

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