Yesterday, the Lancet released its Every Newborn series,presenting the most up-to-date picture on progress and remaining challenges on decreasing newborn and maternal deaths around the world. The series continues from Lancet’s Neonatal Survival series, which was released in 2005, and is comprised of five papers:
- Who has been caring for the baby?
- Progress, priorities, and potential beyond survival
- Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
- Health-systems bottlenecks and strategies to accelerate scale-up in countries
- From evidence to action to deliver a healthy start for the next generation
The Series lays out the grim reality of newborn and maternal health and survival. Progress has been achieved - since 1990, under-5 and maternal deaths have been halved globally largely due to the Millennium Development Goals – but despite the progress, 2.9 million newborn babies die and 2.6 million are stillborn every year. Though maternal mortality rates have declined 45% since 1990, there still were an estimated 289,000 maternal deaths in 2013 – nearly 800 per day. The issue of newborn and maternal mortality remains a largely unfinished agenda, and an issue that deserves and gravely needs more global attention and prioritization urgently.
According to the data presented in the Series, preterm births continue to rise, and while under-5 mortality has received notable attention globally, the issue of stillbirths remains largely ignored and invisible. In addition, as highlighted in the series,
"Most newborns and nearly all stillborn babies enter and leave the world without a record of their existence"
This means that most of the babies who lose their lives within the first 28 days after birth and almost all stillborn babies are never registered, and never receive birth certificates. Additionally, preterm babies are less likely to be counted or registered, even in wealthy countries. This points to low expectations towards the babies’ survival, and social acceptance towards neonatal and stillborn deaths as something that is inevitable and maybe even a natural part of life. Women’s and babies’ lives are too often viewed as expendable, and these deaths treated as unpreventable – but, as stated by Professor Bhutta, one of the Series’ authors:
"Our research shows that three million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage, and improving care at the time of birth gives a triple return on investment saving mothers, newborns and stillbirths."
The Series presents several concrete suggestions for dramatically improving the health and survival of mothers and newborns around the world, drawing also from the Every Newborn Action Plan. The fifth paper in the Series presents a path towards action, underlining the importance of the following shifts that need to take place at global, national and local levels:
- Intensification of political attention and leadership
- Promotion of parent voice, supporting women, families, and communities to speak up for their newborn babies and to challenge social norms that accept these deaths as inevitable
- Investment for effect on mortality outcome as well as harmonisation of funding
- Implementation at scale, with particular attention to increasing of health worker numbers and skills with attention to high-quality childbirth care for newborn babies as well as mothers and children
- Evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups
Maternal and newborn deaths are not inevitable – and they are never, ever acceptable. Low cost and low-tech solutions can have a huge impact on child and maternal survival. As noted by one of the Series' authors, Professor Joy E Lawn,
"The fact that a vast majority of these [stillbirths and newborn] deaths - which have a huge effect on the women and families involved - are never formally included in a country's health registration system signifies acceptance that these deaths are inevitable, and ultimately links to inaction."
There's simply no more time for inaction, because every day that passes means hundreds of women lost to preventable maternal deaths, and thousands of newborn deaths and stillbirths that could have been avoided. Research shows that the day of birthis often the mostdangerous for both the mother and the baby. The day of a child's birth should be the happiest, most joyous and miraculous day for a mother, the baby and the other parent - and it never, ever end in the untimely death of the mother or child.
Without healthy mothers and healthy babies, we cannot build health and prosperous societies. If protecting and saving the lives of mothers and babies isn't worth all of our energy, time and attention, I really don't know what is.
Follow Girls’ Globe for our coverage of upcoming events such as the International Confederation of Midwives Global Congress (#ICMLive) and the Partnership for Maternal, Newborn and Child Health Partners Forum (#PMNCHLive), and the on-going World Health Assembly (#WHA67).
This is the transcript of Melinda Gates' speech at the 67th World Health Assembly, 20 May 2014.
Mr. President, Director-General Dr. Chan, First Lady Dr. Christine Kaseba-Sata, Excellencies, ladies, and gentlemen.
Thank you for inviting me to speak to you today.
Global health is my second career. I wasn’t formally trained in the field, but I have spent the last 15 years learning about it from experts, many of you in this room. I have travelled to dozens of countries to see for myself how the right investments can help people tap into potential that has been buried under the burden of poverty and disease.
One thing I’ve learned during my apprenticeship in global health is how complex and how absolutely critical your work is, both as part of this assembly and in your ministries. Here, you debate what is possible, and encourage the world to see what we can accomplish together. Back home, you do the challenging work of turning big plans into results.
Simply put, you have proved that your bold ambition is justified. The world is getting healthier—faster—than ever before. To me, the best measure of success is declining child mortality in the last 20 years. When you think about global health as a choice between saving more children or letting more children die, I think it is very clear what we want.
The world’s record on child mortality is strong. Since 1990, the baseline year for the Millennium Development Goals, the number of children dying has gone down by 47 percent. This improvement is even more impressive if you account for population growth. If the rate of death had remained constant since 1990, then 17 million children would have died last year. Instead, the number was 6.6 million. That is incredible progress, but still too many children dying.
That progress is stunning. And yet the fact that 6.6 million children still die—almost all of whom could have been saved—is just as stunning. It’s also an urgent call to action. Getting that number down as close to zero as possible is a cornerstone of your work.
My husband Bill has had the honor to address this assembly on two occasions. In 2005, when our foundation was still very young, he explained who we are, why we were getting involved in global health, and how we think about solving problems together with our partners.
He told the story of the newspaper article we read about rotavirus, which kills hundreds of thousands of children in poor countries but almost none in rich countries.
We were shocked by this glaring inequity, but we were also inspired by the world’s ability to address it. Innovations like oral rehydration therapy and rotavirus vaccines are making it possible to save those lives—and to live out the principle that all lives have equal value.In 2011, Bill talked specifically about our foundation’s work on vaccines. This body committed to make this the Decade of Vaccines, and you committed to reaching all children with the vaccines they need by 2020. The WHO regional committees are tracking progress against this Global Vaccine Action Plan.
The GAVI Alliance, which has worked with you to drive global immunization rates higher than ever before, is hosting a replenishment conference this year. The results of that process will have a major impact on the story of child survival in the coming years.
Bill also spoke about the world’s fight to eradicate polio. At the time, there were four polio-endemic countries in the world. Now, thanks to India’s heroic efforts, there are just three. We still face serious challenges, including outbreaks. But new partners are joining the initiative. And they are using innovative approaches, including creating a Global Islamic Advisory Group under the Grand Imam of Mecca to support vaccination.
Since you first heard about our foundation, our core values haven’t changed—and they never will. We will always do this work because we despise inequity, and because we believe in the power of innovation to solve problems.
Today, I’d like to talk about the issue I spend the majority of my time thinking about: the health of women and children around the globe.
A few years ago, I visited a hospital in Lilongwe, Malawi. It was an excellent hospital, with a highly trained staff. As I was talking to a doctor in the neonatal unit, a nurse rushed in carrying a baby girl suffering from birth asphyxia. She was purple when she was born, and I watched as the staff used a bag-and-mask device to resuscitate her. The doctor told me they had intervened in time; the baby was unlikely to suffer any long-term consequences from the asphyxia.
Even though this was a top-of-the-line hospital, it was crowded. The girl whose life has just been saved was lying on a warmer right next to a boy with asphyxia. Except the boy hadn’t been as fortunate. He was born on the side of the road, where his mother was waiting for a ride to the hospital. By the time they got there, it was too late for her son. He was dying.
Those two babies, side by side, one taking her first breaths, the other taking his last, are a symbol of what we are here to do. There are two versions of the future. One is full of promise. The other is a broken promise. How well we care for women and children will determine which future comes to pass.
To the global health community, newborns are part of a broader continuum. We talk about their lives in the context of five letters: RMNCH. Reproductive, Maternal, Newborn, and Child Health.
It’s a cumbersome acronym and a mouthful, but there are good reasons to link those letters together.
In people’s experience, they are inextricably linked. Newborns don’t undergo a transformation on the 29th day of their lives, regardless of the fact that we suddenly categorize them as children. As far as parents are concerned, there is no difference between the N and the C.
And each step along the continuum relies on the previous step that was before it.
- If women can plan their families, they are more likely to space their pregnancies.
- If they space their pregnancies, they are more likely to have healthy babies.
- If their babies are healthy, they are more likely to flourish as children and later as adults.
When mothers have healthy pregnancies, and when children thrive, the positive benefits last a lifetime.
This isn’t true just in developing countries where maternal and child mortality is relatively high. It’s true everywhere. In fact, we keep seeing new evidence that links maternal and child health to non-communicable diseases like cardiovascular disease, diabetes, and obesity that increasingly plague all countries.
The data is convincing. If we want thriving societies tomorrow, we need healthier mothers and children today.
I have three children. When I travel, I find myself drawn to other mothers. Their stories—which are about their tenacious fight to give their children a better life than they had— ring in my ears and inspire me to do the work I do. When I look at the data about maternal and child mortality, I always try to remember that the numbers are telling their stories.
Women and children are a leading indicator of the health of the world. So the trend lines are encouraging. I already mentioned child mortality. And it’s not just that more children are surviving; it’s also that more children are developing cognitively and physically in ways that will help them lead productive lives.
The trajectory for maternal mortality is also similar. Between 1990 and 2010, the annual number of maternal deaths dropped from about 550,000 to fewer than 300,000. When you think of the ripple effect that 250,000 mothers who are alive and well have on their communities, the improvement is even more momentous.
However, the exciting child and maternal health data highlights the fact that the data for newborn health isn’t nearly as good. The world is saving newborns at a much slower rate than children under five. Each year, 2.9 million children die within their first month of life. One million of those newborns die on their first day of life.
The vast majority of newborn deaths are preventable. I want to be very clear about what I mean when I say preventable. I don’t mean theoretically preventable under ideal but unrealistic circumstances. I mean preventable with relatively simple and relatively inexpensive interventions. Preventable with systems and technology available we have now in almost every country.
Let me give five examples of these interventions, which you can read more about in the Lancet series on newborns published today.
- Resuscitating babies who aren’t breathing, like I saw nurses doing at the hospital in Malawi. It requires basic training and a bag mask that costs $5.
- Drying the baby immediately and thoroughly, which helps prevent hypothermia.
- Using chlorhexidine, a basic antiseptic that costs a few cents, to clean the umbilical cord and stop infection.
- Breastfeeding within the first hour, and breastfeeding exclusively for six months. Breast milk is the global gold standard for infant nutrition, and it serves as a baby’s first immunization by delivering antibodies from mother to child.
- Kangaroo mother care, skin-to-skin contact between a mother and a newborn to regulate the baby’s temperature, heart rate, and breathing; prevent infection; and promote the flow of breast milk.
These are best practices that work everywhere, but that aren’t being used optimally anywhere. The United States spends more than $10 billion a year to treat babies with conditions resulting from sub-optimal breastfeeding. And U.S. pediatricians only recently began to recommend skin-to-skin care over putting babies in incubators.
Resuscitation. Drying the baby. Chlorhexidine cord care. Immediate breastfeeding. Skin-to-skin contact.
If we could manage to get these five interventions scaled up around the world, we would save hundreds of thousands of newborns each year.
What’s more, these inexpensive measures can be incorporated into health systems already in place in countries throughout the world.
When it comes to managing serious complications, it’s best for mothers and newborns to be in health facilities, provided that the quality of care in those facilities is high.
However, the high-impact interventions I just mentioned can also be delivered by frontline health workers. For example, Ethiopia trained health extension workers in certain regions to provide improved maternal and newborn care, including the five interventions I just mentioned. The result was an impressive 28 percent reduction in newborn mortality.
The same frontline worker who manages sepsis can counsel women about contraceptives, conduct pre-natal visits, and give vaccines. Ultimately, it’s the combination of all these interventions that will help women and children lead healthy, productive lives. Even though I have been focusing on newborn health, I want to reiterate that the goal is not to prioritize newborns above the other priorities along the RMNCH continuum, but to keep them in their proper place alongside the other priorities.
These interventions have to be integrated, and, with your leadership, they can be.
This week, you will consider the Every Newborn Action Plan. If you endorse the plan, I encourage you to use the full power of this assembly, as well as the regional committees and national engagements of the WHO, to track its progress in detail. We will be tracking along with you at our foundation, where aligning our investments to help newborns thrive. It is one of our top priorities.
You will be the ones responsible for translating the plan into action when you go back home. No public health intervention, no matter how successful it seems to be in the laboratory, can succeed without your leadership and management on the ground. The clinical science is one thing. The complex process of making sure that women and children in your countries benefit from the science is something else.
I don’t claim to understand the competing pressures that cross your desk every day. But I know that no health minister can drive change alone. Progress requires working with other government officials, not to mention the private sector, civil society, religious organizations, and community leaders. And winning allies requires making a case that newborn health is more than just one priority among many.
Saving newborns is a tender-hearted act of love that also makes hard-headed business sense. The Lancet recently published the most advanced analysis to date of the links between public health and economic growth. The report finds that lower mortality by itself has accounted for about 11 percent of economic growth in low- and middle-income countries. And that’s not counting the enormous economic advantages of a healthier, more productive labor force. The report modelled a package of health interventions focused on RMNCH and found that every dollar invested yields at least $9 in economic benefits.
At the Gates Foundation, we’re committed to supporting your leadership. That’s why we’re working with you to generate the evidence you need to strengthen your case that investments in women and children’s health provide value for money. For example, based on requests from you, we funded research into the demographic dividend that shows the connection between family planning, maternal and newborn mortality, child survival, nutrition, and economic growth. We will continue to gather the evidence you need to advocate for your priorities. Your priorities are our priorities.
Another way we can help is by supporting additional clinical and operational research. Which interventions are most effective? Can they be cheaper? Can they be adapted so that they’re easier to use? Can they be implemented more efficiently? The answers to these questions will help you get more impact per dollar, and we are investing with you to find those answers.
Finally, we will always advocate for these issues—and for the women and children who are fighting for a better life.
As you define your national priorities and draw up your national plans, we will work with global donors, both private and public, to align around shared priorities. We will explain why we are investing our money in these issues, and we will try to persuade donors that they should, too.
For most of human history, we have been resigned to the fact that women and children die.
But you and I are fortunate to be living at a time when we don’t have to be resigned any more. The facts are clear: When we invest in health, we get results. That’s a paradigm shift, the notion that we have the power to prevent sickness and promote better health. That exists in front of us today.
But there are other perceptions that still need to change. There is still a sense that cutting-edge health care requires expensive technology. There is still a sense that improving health is a nice thing to do, but not a smart way for a country to invest money.
That is why this assembly is so important.
You are representing the nations of the world at a historic moment—at the moment when we have solid proof that investing in health is the best use of our collective resources. People still say that caring for women and children is too big an investment for too uncertain a return. You and I get to be the ones who present powerful evidence to the contrary.
And we can use that evidence to insist to the world that—from this day forward—every baby born will be a promise kept. Thank you.
Watch Melinda gates give her speech by clicking the video below:
Photo: Prashanth Vishwanathan/Save the Children
Even in the midst of madness over the election outcomes, India hasn’t forgotten its commitment towards its country’s children.
As the global leaders set out for the 67th World Health Assembly, the office of the Indian delegate to the forum is a buzz with an army of technical experts, senior bureaucrats, technocrats preparing with their mission.
Leading among nations India has already sets its pen to paper – drawing the roadmap for India newborn action plan.
India steps up effort
Today the world and India is on the brink of a major breakthrough to ensure newborns everywhere survive. If there is one place to trace the seeds of this brewing revolution, it’s India. In the last few years India has begun a major political movement to systematically take on the complex and large scale problem of newborn and child mortality. India has also made dramatic progress in reducing the under-five mortality to more than 50 percent since 1990 – at a much faster rate than the world put together, but newborn survival is critical to reach the last mile on the goal. While progress on newborn survival may not have been as fast in the last two years newborn mortality has declined at the rate of 6 percent annually.
India is fully committed to accelerating progress on material newborn and child health and comprehensive package of intervention through RMNCH+A (Reproductive Maternal Newborn Child Health + Adolescent) strategy following India Call to Action Summit on child survival.
From pledges to action
In this India has already initiated a nationwide momentum to scale up services to reach every mother and newborn by addressing demand-and-supply-related bottlenecks integrating maternal and newborn care into health systems and the RMNCH+A continuum of care in a life cycle approach than just looking at the singular vertical and segregated approach.
In a series of steps the national level plans and strategies are speedily being rolled out across the high priorities states in the country. Building on partnerships and forging new ones, the strategy aims at bringing together various sectors – businesses and private sector, training institutions, civil society and faith based organisations to deliver unprecedented breakthrough in newborn and child survival.
Can India surprise the world?
We know that curbing child mortality levels in India could dramatically bend the curve for child mortality levels globally, and the world is looking to India to turn our pledges into reality.
If statistics are to be believed India is on track to meet MDG5 target by reducing Maternal Mortality Rate (MMR) from 327 in 1999-2001 to 178 per 100,000 in 2010-2012. It is noteworthy that India’s decline between 1990 and 2012 has been an impressive 70 percent, while global decline in the same period has been just 48 percent.
In a historic achievement, this year, India has been officially declared polio-free clocking three full years after its last polio case was reported in 2011. It is a healthcare landmark for a country of 1.3 billion people to be proclaimed free of the disease by the World Health Organization.
Today we are at a critical juncture towards the achievement of Millenium Development Goals 4 and 5 and success seems within grasp.
Launching Save the Children’s report ‘Ending Newborn Deaths’ earlier this year, Ms. Anuradha Gupta, AS MD National Health Mission said, “India likes to surprise the world, we are on track to meet MDG 5 targets and we are confident that we will sure achieve the reduction in child mortality too.”
For the world to crack the breakthrough, India must lead the way. Will India surprise the world? Promises to keep.
Photo: David Wardell/Save the Children
In Indonesia, the number of newborns that die annually from preventable causes stands at 48,000. Despite making great progress in the last decade by cutting child mortality by 40%, Indonesia’s newborn mortality figures are stagnant and are slowing the effort to reach the global target of reducing child mortality rates by two thirds by 2015 as set out in the Millenium Development Goals.
To overcome these newborn deaths, the government of Indonesia has developed its version of the Every Newborn Action Plan - a joint action platform to help galvanize national commitments to reducing newborn mortality, and hold governments accountable for progress. Indonesia still struggles with a neonatal mortality rate of 19 out of 1,000 live births. Many of these deaths are caused by infections, complications during labour and birth such as asphyxia, prematurity and low birth weight, and pneumonia and diarrhoea. However most of these deaths can be prevented through relatively low-cost solutions, including improving nutrition and giving antenatal corticosteroid for preterm labour during antenatal care, safe and clean delivery, immediate and exclusive breastfeeding practices, infection prevention practice and antibiotics for infections, and “kangaroo mother care” or —keeping newborn babies warm through continuous skin-to-skin contact with the mother. Ensuring that skilled birth attendants are present to provide immediate care to mothers, and that health workers are accessible to mothers and newborn babies before, during and after child birth, is critical to delivering these life-saving services.
Access to and distribution of health services is a major issue in Indonesia. In a country of over 240 million, there are only 25,000 registered OBGYN’s--9,000 of those registered are in Jakarta alone. Children in the poorest 20% are more than twice as likely to die as children born into the wealthiest 20%. These inequalities will need to be addressed if we are make real progress in reducing preventable newborn deaths.
COLLABORATION OF ‘PONED-PONEK’ IN REFERRAL SYSTEM
Central to Indonesia’s Newborn Action Plan has been the need to strengthen the health system for emergency response and operationalized referral, such as Basic Emergency Obstetric Neonatal Care-BEONC or PONED and Comprehensive Emergency Obstetric Neonatal Care-CEONC or PONEK.
From the community perspective that lack of trained staff performance, poor sanitation and hygiene practice and a shortage of basic equipment meant women and their families did not feel confident going to a health centre or Puskesmas PONED even though it was usually the closest facility to them. Instead they would risk the longer journey to a hospital PONEK which was further away and usually overloaded and unable to take them in. So the mother would then make the long journey back to her village and instead of returning to the Puskesmas PONED, she would make the dangerous decision of giving birth at home, without the help of a skilled health worker. If a woman were to develop any complications with her pregnancy, that journey to the hospital PONEK would become life threatening for both her unborn child.
In response to this problem, the government recognised the need to invest heavily to improve the quality of care mothers received at the PONED and PONEK which in turn would play a critical role in reducing the mortality rates of mothers and newborns in Indonesia.
Health workers were given emergency obstetric training and facilities began receiving better equipment. The most recent data shows that this investment is working, as more women are now beginning to go to their local Puskesmas PONED to give birth instead of making the long trip to the hospital PONEK. Therefore to avoid preventable maternal and neonatal death, the delivery should be conducted by skill birth attendant at health facility which provide emergency for stabilization and pre-referral services.
INDONESIA’S NEWBORN ACTION PLAN:
Indonesia has not only developed its newborn action plan, it has already begun the process or rolling out and implementing the plan across the country by getting ownership and commitment from local districts. Between April and June 2014, Indonesia’s Newborn Action Plan, or Rencana Aksi Nasional tentang Neonatus-RAN as it’s called here, is being rolled out in six of its most populous provinces which contribute the highest rates of newborn mortality: North Sumatra, South Sulawesi, Banten, Central, East & West Java. Under USAID-EMAS funded program, Save the Children with its consortium members led by Jhpiego has been facilitating a collaboration between the Ministry of Health Indonesia, the Indonesian Paediatrician Association, and Indonesian Ob-gyn Society with representatives at the provincial and district level to roll out and implementation of INAP which aims to reduce maternal and newborn mortality rates by 25% by 2035.
With a decentralised government, much of the implementation work around INAP is done at the district level, so a three day workshop was developed in each province to bring together civil society leaders, professional organizations, health workers, representatives from the provincial and district legislature. Participants received an updated situation of the newborn health in their own province, an overview of the national newborn action plan, and were then asked to adapt the national plan into a localized blueprint that could be implemented at the district level. Feedback from the first four provinces where the national plan has been unveiled will been incorporated into the final draft of the Indonesia Newborn Action Plan, which will be presented to the World Health Assembly next week by the Minister of Health.
The government of Indonesia has made a concerted effort to address the need to improve the health of its mothers and provide better care to newborns in their first day of life. If successful, the Indonesia Newborn Action Plan will result in a strengthened health system supported by fully trained and skilled health workers with an adequately serviced health facility which can save the lives of millions of newborns and their mothers.
“Since you came home from Jacaranda Maternity, have you had fever or chills?” asks Sharon, a Jacaranda Community Health Worker (CHW).
Ruth (*) came to Jacaranda Health three days ago to deliver her healthy baby girl. When it was time to leave the hospital, Jacaranda nurses counseled Ruth – as they do for all of our mothers – to make sure she and her newborn had the best opportunity to stay healthy once they returned home to Kasarani, just outside Nairobi.
But this is just the beginning of Jacaranda’s commitment to Ruth and her baby. Sharon’s question comes from Jacaranda’s Postpartum Home Follow-Up Checklist, a series of screening questions Jacaranda’s Community Health Workers (CHWs) ask once our mothers are leaving for home. This is part of an innovative strategy to ensure that mothers and babies delivered at a Jacaranda hospital safely transition from hospital to home. Our project was awarded a seed grant in 2012 by Saving Lives at Birth, a partnership between Grand Challenges Canada, the U.S. Agency for International Development (USAID), the U.K. Department for International Development (DFID), the Government of Norway and the Bill & Melinda Gates Foundation.
Photo: Jacaranda Health
Jacaranda’s trained CHWs use the checklists to conduct a comprehensive follow-up to reduce risk in the potentially dangerous time after delivery. The checklists guide CHWs to identify and refer danger signs early, and to provide reminders for essential counseling on topics like breastfeeding and cord care. Community Health Workers counsel the new mothers on the importance of seeking timely care and troubleshoot common barriers low-income women face when seeking care, such as lack of transport, hospital fees, and decision-making with their husband around postpartum family planning.
Jacaranda’s collaboration with researchers at the Harvard School of Public Health ensures that we rigorously evaluate these innovative delivery approaches. The evaluation of this program is currently underway, but we are excited to share four early insights from our pilot:
- Reduce health risks through early detection and action. Good news: when potential risks were detected by the CHW, nearly 70 percent of women followed through with our referral and sought the recommended care. What are some of those risks? Newborn jaundice, infection and breast issues were among the most common complications we identified.
- Promote Healthy Postpartum Behaviour. Here’s what we already know: less-educated and poor women are less likely to receive postnatal care than their wealthier and more educated counterparts in Kenya. Contact and follow-up shortly after delivery could reduce this disparity for Jacaranda’s low-income clients. We find that women who received a call or visit returned to our facility between 50% and 74% more frequently for postnatal care, family planning or child wellness services, as compared to delivery clients who did not receive a visit or a call.
- Promote timely postpartum family planning. Home visits and calls also provide a unique opportunity for counseling around postpartum family planning decision-making. As a part of our strategy integrating family planning education across the continuum, CHWs conduct structured health education (adapted from Population Council's great Balanced Counseling Strategy) to help women (and partners) decide on the family planning method that is right for them. During the follow-up, 76% of participating women are selected a specific method of family planning to be started at their six-week postnatal clinic visit.
- Importance of a multi-level care team. There has been a global call promoting task-shifting, particularly to CHWs, to combat health-worker shortages in low-resource settings such as Kenya. Yet, too frequently, the lifeline to expert trainers and clinicians is cut after the conclusion of a short training. We're taking a different approach by strengthening the facility-community link through teams of CHWs and nurses. This supprt is essential: they know why they have the nurses and, more importantly, the hospital behind them.
When providing this care Jacaranda mothers and their newborns, our preliminary findings show that we're able to reduce health risks, promote healthy behaviour postpartum and ensure a safe transition home in these critical few days after delivery.
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