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Improving neonatal health inSri Lanka:
The Way Forward
Prof Dulanie Gunasekera
University of Sri Jayawardenapura
SL situation
• SL birth cohort – 385,000 births • 99.9% deliveries in Hospitals*-
90% with SCBU (59% with NICU)*
• Deaths - NOT due to coverage/access/ lack of infra structure
• These Babies die IN HOSPITALS after receiving care
NNMR – 6.8/1000 (LB 1950 deaths)
(Source FHB 2012)
Infant mortality in Sri Lanka
Asphyxia, 12%
Sepsis, 10%
Congenital abnormalities,
43%
Prematurity, 25%
Others, 10%Asphyxia
Sepsis
Congenitalabnormalities
Prematurity
Others
Source FHB 2012
Congenital defects
• Approx. 50% of birth defectsdeaths – due to complex CHD
(progress being made)• CNS malformations
• Lethal malformations – anencephaly?• Neural tube defects – do all eligible couples get
preconception Folic Acid?
∎
∎
WHO Health System Framework
Source: World Health Organization. Everybody’s Business:
Strengthening health systems to improve health outcomes—
WHO’s Framework for Action. Geneva: WHO, 2007, page 3.
Service Delivery I- Infrastructure
• LR
• NICU/SCBU
• MBC (18)
• LMC (33)
adequately equipped?
adequate staffing?
Service delivery - II
Standardize care (SOP/STP)
• Guidelines/STP/SOP
need to IMPLEMENT guidelines/SOP/STP
eg. hand washing, judicious use of AB
Service delivery – III
Skill Enhancement –
• NNR- mandatory skill for all HCW
• ENBC – essential knowledge for all HCW
• Sick NB – stabilization, retrieval/transfer
Maintain/improve levels of skills -
revalidate
Work force
• Adequate cover
• Adequately trained
• 24*7 cover of LR/ SCBU/NICU-MO/nurses/MW
• ADEQUATE numbers –per bed/shift
• Core skills training, certification – for LR/SCBU/NICU staff
Information
Quality control -
• monitoring & evaluation
• clinical audit -mortality/morbidity
• real time data base ( ICD- 10 classifications)
Drugs/ equipment/services
• Availability of essential drugs
• Other services
• dexa, antibiotics
• Surfactant
• CPAP/incubators
• In utero Transfer (high risk preg)
• NN retrieval services
• MBC- KMC
Financing
• Health expenditure - % of GNP – 1.2%• as % total govt. expenditure – 4.1%• Per Capita expenditure - Rs 4,392
• Disbursement • Utilization
(Source MoH 2012)
Advocacy/leadership Role
• SLCP – core group of experts – advocacy to MoH, governance
• Close collaboration/ partnership with MoH
• SLCP key partner
• Key issues – skills training
implementation
monitoring/evaluation/revalidation
decision making process