- C. Howson, M. Kinney, L. McDougall, J. Lawn, et al. Born Too Soon: Preterm birth matters.
- H. Blencowe, S. Cousens, D. Chou, et al.). Born Too Soon: The global epidemiology of 15 million preterm births.
- S. Dean, E. Mason, C. Howson, et al. Born Too Soon: Care before and between pregnancy to prevent preterm births: from evidence to action.
- J. Requejo, M. Merialdi, F. Althabe, et al. Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby.
- J. Lawn, R. Davidge, V. Paul, S. von Xylander, et al. Born Too Soon: Care for the preterm baby.
- J. Lawn, M. Kinney, J. Belizan, et al. Born Too Soon: Accelerating actions for prevention and care of 15 million newborns born too soon.
USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.
More than 85,000 infants in Nigeria are at risk of HIV transmission from their mothers every year. While the number of HIV-positive pregnant women who receive antiretroviral treatment (ART) is increasing, robust efforts to improve coverage are needed if national targets (PDF) for prevention of mother-to-child transmission of HIV (PMTCT) are to be met in 2015.
Over the past year, the Leadership, Management and Governance (LMG) Project helped support the PLAN-Health Nigeria project, funded by PEPFAR through USAID and managed by Management Sciences for Health (MSH), to pilot Leadership Development Program Plus (LDP+), which focuses on empowering teams to improve PMTCT results. The program also emphasizes new approaches tied in to country ownership, national health priorities, and specific health indicators.
LDP+ was piloted in the town of Gwagwalada, Nigeria. The Gwagwalada Council is one of the five Local Government Area Councils of the Federal Capital Territory (FCT) of Nigeria. LMG and PLAN-Health worked with the Gwagwalada Council, which selected 20 participants—two from each of the 10 facilities providing PMTCT services in the area—to form 10 teams to participate in the LDP+. Together, the teams decided to address PMTCT and focused on improving some standard indicators such as number of new antenatal care (ANC) clients; number of pregnant women tested for HIV, counseled and received their results; and the number of HIV-positive women. The program ran from October 2012 to May 2013. During this time, the teams worked within their facilities to create a vision of improved results around PMTCT, align stakeholders around this vision, implement their action plans, and share learning with other teams to identify the most useful local interventions and activities. The teams also received coaching in the areas of monitoring, evaluation, and reporting.
Most of the facilities reported encouraging results for their key indicators after participating in LDP+. For example, the Old Kutunku Health Center reported an increase from 17 to 61 new ANC clients per month. At the Gwako health center, the percentage of ANC clients who delivered in a health facility increased from 18 to 42 percent. Prior to LDP+, the Township clinic counseled and tested the partners of only three percent of pregnant women, compared with 20 percent after the program.
The Gwagwalada Council’s oversight committee plans to continue the program with its own resources, expanding it to another eight facilities in the area. Through these efforts, this local government agency is furthering Nigeria’s national efforts to ultimately eliminate mother-to-child transmission of HIV.
Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.
Photo: Jane Hahn/Getty Images for Save the Children
Three newborn babies sleep in the same bed in the High Dependency Ward in the Neonatal Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana.
This past week's announcement of the creation of the Maternal and Newborn Health Professional Society in Ghana by Evidence4 Action is intended to push national politicians to make greater commitments to and be more accountable for maternal and newborn health.
While Ghana has lowered the neonatal mortality rate from 40.2 in 1990 to 28.4 in 2012, making further efforts to scale up essential newborn care interventions will help the country to achieve Millennium Development Goal (MDG) 4 for under 5 child mortality. According to Dr. Jemima Dennis-Antwi of the International Confederation of Midwives, Ghana needs to lower maternal mortality from 350 to 150 per 100,000 live births, to reach MDG5.
By bringing health professionals from across the maternal and newborn sectors, more can be done to address both common goals, improving the chance of survival for both Ghana's mothers and their newborns.
Photo: Sebastian Rich/Save the Children
Habiba, 7 months pregnant, works in the fields of Namissica Village, Mozambique. At the time of this photograph Habiba was enrolled in a nutrition class in her village where she learned about how to set a balanced diet for herself during pregnancy and the importance of exclusive breastfeeding after giving birth, among other things.
Interestingly, three major events in the world of reproductive, maternal, newborn and child health took place over the last two weeks. The 3rd International Conference on Family Planning in Addis Ababa, Ethiopia, World Pneumonia Day and World Prematurity Day.
With the issues of family planning, prematurity and pneumonia being critical for the improvement of maternal, newborn and child mortality, there seems to be a building momentum about how interrelated the health of the newborn, child and mother are.
Health experts from around the world and across disciplines are talking about the synergy and holistic thinking that is needed to scale-up progress in high-burden countries. The new evidence presented at the family planning conference along with new preterm birth research can serve as useful tools to help guide programmatic objectives moving forward.
Their efforts are complemented by the large scale advocacy efforts for World Pneumonia Day and World Prematurity Day. Those calls, coming from all corners of the world, seek action from governments, the private sector and civil society to address child pneumonia along with the causes of and complications from preterm birth. These three events show that improving reproductive, maternal, newborn and child health is possible and that by working together we can help to innovate and scale-up progress.
2014 must be the year of the newborn. As Smith’s recent article states, despite huge strides in child survival, progress during the neonatal period has been disproportionately slow. Inaction is no longer an option – in many countries, persistently high rates of newborn mortality will hold countries back from attaining their Millennium Development Goal (MDG) 4 targets. Looking forward, beyond 2015, as we raise ambition to end all preventable maternal and child deaths, the newborn burden is ever more pertinent. Achieving such gains will require greater political resolve and investment to increase coverage of interventions for those who need them most, while tackling the social determinants of health that shape health inequities. But as the article critically demonstrates, efforts to scale up and sustain coverage must promote complementary and integrated solutions for the sector through strengthening the health system. As such, our focus on newborns must be a catalyst for progress towards universal health coverage (UHC).
A proxy for health system strength
The time of birth and the weeks that follow are when a child is most vulnerable and in need of responsive, quality care. Patterns in newborn survival are a powerful proxy for the strength of the health system, with wide inequities revealing our failure to build robust health systems that ensure all expectant mothers are in reach of a health worker who is appropriately trained, skilled, equipped, supported, remunerated and motivated to meet her needs and those of her newborn baby. Inadequate, ineffective and inequitable health financing, leave the system weak and underfunded and place the burden of ill-health on those most vulnerable and in need, causing an estimated 100 million people to face impoverishment each year.
As countries endeavour to improve newborn survival they will need to address the systemic bottlenecks that impede access to quality care. Progress for mothers and newborns will require comprehensive primary health care systems with referrals that provide integrated care across the two continuums (house to hospital, and reproductive through childbirth to childhood). This will bring value for money with benefits felt during the first month of life and beyond.
A catalyst for UHC
UHC is a concept that links the objectives of scaling up coverage of quality needed interventions and preventing financial hardship whilst doing so. It critically involves the removal of user fees for essential services and increased cross-subsidisation through mandatory and progressive prepayment. It also helps us to move away from thinking and acting in silos within the sector – a danger the article clearly highlights. Comprehensive primary care – that is sufficiently and equitably resourced, and free at the point of use – may be a first step towards UHC.
If our objective is to improve equity in health outcomes of the newborn and its mother, improved nutrition and a focus on the most vulnerable are no doubt imperative. But the current modus operandi in health fosters competition and silos, as expressed by Smith, when discussing the case of newborn survival in Bolivia: “Morales’ presidency came with an agenda promoting the social welfare of the very populations most affected by newborn health problems (poor, rural, indigenous). How could political priority for newborn survival decline in this context?” We must learn to leverage such opportunities to realise our ambition for the newborn baby and his or her family. The basis of UHC in the human right to health has great appeal and we must find ways to seize the potential of sub-sectoral priorities to galvanise progress towards UHC. The Every Newborn Action Plan, which will go through the World Health Assembly in May next year, presents an opportunity to shift gear and accelerate progress towards MDG 4 and beyond.
Time to strengthen accountability
We need increased political will backed with sufficient resources to achieve this. As the article documents, political champions and priorities present both a contribution and challenge to our plight. As fast as they raise the profile of an agenda, attention can turn. This volatility underscores the importance of strengthening accountability. Here the role of communities and civil society organisations is crucial. We’ve seen the potential of health budget advocacy to empower civil society to hold governments accountable for promises, policies and plans. The article cites the pivotal role of evidence to force attention to an otherwise silent scandal – whether it’s survey data or a budget analysis.
When a mother or her baby dies in the act of giving life, the world must hear. Ending this injustice requires political will, strong systems and accountability.
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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