Regina Obeng (pictured center, above) was recipient of the first International Neonatal Nursing Excellence Award in 2010. Ms Obeng, from Kumasi, Ghana, has been the driving force behind her hospital’s introduction of Kangaroo Mother Care, promotion of exclusive breastfeeding and increased infection control. Photo by Jane Hahn/Save the Children.
Saving newborns against the odds is the mission of neonatal nurses. Every day they fight to reduce the 3 million newborn deaths each year – working quietly often in challenging settings, providing kangaroo mother care, giving injection antibiotics, resuscitating babies and supporting mothers at a very stressful time. Over three-quarters of these deaths occur in South Asia and Sub-Saharan Africa, where there is a critical shortage of medical care, midwives and nurses.
Most countries have plans to train doctors and midwives and community health workers – yet few low-income countries include neonatal nurses in their health system human resource planning. In the whole of sub-Saharan Africa, despite having the world’s highest risk of neonatal deaths there are only a handful of accredited neonatal nurse courses. India, with over 800,000 neonatal deaths each year, does not have a systematic neonatal nurse training scheme.
To raise a united voice for newborn babies who are the most vulnerable citizens of our nations, the Council of International Neonatal Nurses and Save the Children’s Saving Newborn Lives program seek your help in identifying champions in neonatal nursing in high burden, low-resource settings. The 2013 International Neonatal Nursing Excellence Award will recognize the commitment of nurses working on the frontlines of newborn care in resource-challenged countries, where the majority of newborn deaths occur.
The aim of this prestigious award, which is open to all nurses who specialize in the care of newborns in high burden, low-resource settings, is to recognize an individual nurse’s achievements and to encourage excellence in the provision of neonatal care around the world.
Although these nurses would be recognised in their work places by their colleagues and the families that benefit from their care, COINN and Save The Children would like to formally acknowledge internationally, the contributions made by nurses who are considered by others to perform at a consistently high standard.
Each nomination will be recognised by a certificate of excellence, and two winners will be sponsored to attend the 8th International Congress on Neonatal Nursing to be held in Belfast in September 2013, where they will be presented with an award in recognition of their achievement.
This is a great opportunity to acknowledge neonatal nurses who display excellence in a neonatal nursing roles in high burden, low-resource settings. This award was also created to highlight the fact that skilled nursing care is critical to the reduction of the global neonatal death toll of 3 million newborns a year. Meeting the global Millennium Development Goal 4 for child survival will be increasingly determined by how well countries can reduce newborn deaths, as now more than 43 percent of under-five deaths globally occur in the first month of life.
Please consider supporting the nomination a neonatal nurse for the 2013 International Neonatal Nurse Excellence Awards. Nominations are now open through April 28th at the Healthy Newborn Network, and welcomed from the following countries (in alphabetical order): Afghanistan, Angola, Bangladesh, Burkina Faso, Cameroon, Cote d'Ivoire, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Malawi, Mali, Mozambique, Nepal, Niger, Nigeria, Pakistan, Philippines, Sudan, Uganda, United Republic of Tanzania.
It is easy to nominate a champion! Simply click here to read the conditions and fill out the nomination form.
> Click here to learn more about the awards
This blog was originally published by MCHIP.
The man brings his pregnant wife into the health center and is confronted by the irritated midwife who raises her voice: “I’m too busy, what do you want? Go outside, this is no place for a man!” Later, the man returns for news about his wife’s condition and is promptly told to “go back and sit there.”
This role play session about abuse and disrespect in maternity care was part of a training in Burkina Faso sponsored by MCHIP. Through role play, MCHIP trainers demonstrated to doctors and midwives what not to do when attending to their patients, as disrespectful treatment of pregnant women and their families is all too common in health facilities around the world. This is especially true in developing countries, where doctors and midwives often lack basic infrastructure, supplies, manpower, or even awareness about patients’ rights to be treated with dignity during birth.
Haoua Ba participating in an MCHIP Africa
Champions training in Bobo Dioulasso, Burkina Faso.
(All photos courtesy of Jhpiego.)
Training participant Haoua Ba had never heard about respectful care until this MCHIP training, even after 22 years as a midwife in Mali. Haoua and about 30 other midwives, pediatricians and obstetricians are known as Africa “Champions” (or advocates) for improving maternal and newborn health by promoting up-to-date knowledge, practices and attitudes in their countries and region. Mali is one of 10 key African countries—along with Benin, Guinea, Kenya, Liberia, Madagascar, Senegal, South Sudan, Uganda and Zambia—where the MCHIP Africa Champions Program is being implemented over two years (2011-2013).
[Above: Pregnant woman with companion at the renovated maternity ward in Bobo Dioulasso, Burkina Faso.]
MCHIP maternal and newborn health trainings have always emphasized “women friendly care,” for example by introducing skills checklists with which providers are evaluated on their ability to provide respectful care. However, given the prevalence of disrespect and abuse—in Africa in particular—and the lack of knowledge about this issue, Africa Champion trainers developed an entire training module devoted to this topic. In this 1.5 hour session, a facilitator helps training participants understand during group discussion that there is evidence that key components of respectful care, such as involving a woman in her care, will make the birth experience go more smoothly for both the woman and the health care provider.
Haoua described how this training session taught her to respect pregnant women and their families by greeting them politely and continually informing them in a soothing voice about everything she is doing. And since the training last year, Haoua has seen a big difference after putting into practice these new skills.
“When you show respect, it really facilitates things," she said. "If you calmly tell the woman what to do and explain things her, it comforts her. And word gets around so women know who is going to treat them well and they request that midwife when they come into the hospital.”
It is important that women and their families are welcomed and have a positive birth experience at health centers so that they choose to have subsequent children at a health center. Women and their newborn babies have better odds of survival when women deliver in a facility than at more risky home births.
After participating in three Africa Champions maternal and newborn health trainings on innovative, lifesaving practices, Haoua is uniquely positioned to transfer these lessons learned. She plans to do so with both staff and student interns at the busy Referral Health Center in Bamako, Mali, where she also works as a midwife with 22 other midwives and three gynecologists. In fact, one of her primary goals as a Champion is to help strengthen the health center team by promoting evidence-based care. She described how she and one of the doctors will organize trainings about twice a month on a particular theme and have attendees practice on mannequins under their supervision to ensure they are correctly using their newly acquired skills and knowledge.
Importantly, Haoua has taught her colleagues that a woman should be allowed to have a companion by her side during the birth, which is a central tenant of respectful care. Having a loved one present provides women with essential comfort and support during the birth process, especially when the health center staff are busy or overworked. Evidence supports this practice as one that can help to shorten labor and increase normal outcomes.
[Above: Renovated maternity ward in Bobo Dioulasso, Burkina Faso, where each room has a chair so that the woman in labor can be accompanied by a family member.]
As MCHIP Africa Champion trainer and obstetrician Blami Dao explained, “Timing can make a big difference. Maybe in the morning, when there are lots of hospital staff, a provider can take good care of the patient. But at two or three in the morning when there may be 10 or 11 patients and only one provider to attend to them, the mood may be very different.”
Seasoned trainer Blami further explained that “health providers behave better where the woman has a companion, because there is an external observer watching them provide care. If the facility can accommodate it, the woman will receive better care if she is not alone.”
Blami is intimately familiar with the challenges that resource poor countries face when it comes to having basic equipment to enable pregnant women to give birth under decent conditions. Blami and his colleagues took advantage of the 2002 renovation of the hospital in Bobo Dioulasso, Burkina Faso, where he was the head of the maternity ward, and wisely made sure that each birthing room was equipped with both a door to ensure privacy, and a chair for a birth companion. Thanks to concerted efforts of people like Blami, this hospital in Bobo Dioulasso is a model of respectful maternity care relative to many other hospitals throughout Africa.
A pregnant woman who must give birth without the company of a loved one or who must lie on the floor because there are not enough tables, without the privacy of a curtain, is not receiving respectful care. But even in the worst conditions, said Haoua, “if you have the will to do things well, you can help women.”
She is a perfect example of how the USAID-funded Africa Champions program is helping to prevent the untold suffering of women during one of the most vulnerable but extraordinary times in their lives.
One-third of India's urban population resides in slums, their vulnerability being characterized by poverty, marginalization and powerlessness. Challenges in addressing the needs of newborns in urban poor settings exist not only at the community level, but also at the policy and programme levels. The changing demographics of India are rapidly influencing the health care requirements in the emerging urban areas of the country. Issues of health care management and operations, capacity building and training of human resources, infrastructure, financial accessibility and access to both public and private care remain a matter of concern for the urban poor.
To help address these barriers to care, the Global Partnership for Maternal, Newborn & Child Health (PMNCH), in collaboration with the Ministry of Health and Family Welfare, for the Government of India and Save the Children India worked together to develop the country’s very first Reproductive Maternal Newborn Child and Adolescent Health coalition (RMNCHA coalition). The RMNCHA coalition aims to bring evidence of success, recognise innovative models of scalability, promote evidence linked advocacy and ensure accountability of both health systems and communities through civil society and faith based organisations to guarantee equity in access to services in states, district and block level. This technical support at both the policy and implementation level in conjunction with support on ground will help bend the curve for child survival in India.
At India’s Call to Action Meeting to reinforce priorities on maternal, newborn and child health, the RMNCHA Coalition’s Strategic Approach document was highlighted to be used as a guiding document for all kinds of planning and program implementation in state district and block levels during 2013 to 2017 for accelerating progress in newborn health.
We are also proud to announce the publication of the National Consultation on "Potential Role of Private Sector Providers in Delivering Essential Newborn Care in under-served urban and peri-urban settings" BOOK OF PROCEEDINGS. Please follow the link to take a look!
Photo Credit: Kate Mitchell
Photo: Suzanne Lee/Save the Children
Myleene Klass, a high profile UK celebrity, TV host, violinist and pianist, visits Arlene, 34, a new mother and Hans, her 1 day old baby, who has been breastfed since birth, in the Florencio V. Memorial Hospital in Paranaque city, Metro Manila, The Philippines. Myleene Klass visted the Philippines, the homeland of her mother, with Save the Children to learn more about the importance of breastfeeding. In a new report, Superfood for Babies, the charity says that if babies receive Colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. And, if the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhoea.
There has been great progress in reducing child mortality over the last 15 to 20 years. According to UNICEF, 5 million fewer children died in 2011 than in 1990. This has created tremendous potential for countries around the world to leverage their human capital to help achieve other socio, economic and political objectives.
Despite these important steps forward, the pace of newborn mortality has decreased at a slower rate than maternal and child mortality and now represents a staggering 43% of under-5 deaths globally.
While that statistic seems daunting, there is a lot of hope. Hope that lies not in blind faith but in key interventions – ones that are low cost and scalable – that have the potential to save millions of newborn lives around the world each year.
One the interventions that has the potential to save hundreds of thousands of newborns is breastfeeding.
Save the Children recently released a comprehensive report on the state of breastfeeding around the world “Superfood for Babies” and the results were surprising. It determined that if breastfed in the first hour of life, an estimated 830,000 newborn lives could be saved ever year. That is truly exciting and should be cause for optimism.
Breastfeeding in developing countries, where the need for it is the greatest, faces challenges though. The report lays out 4 barriers to breastfeeding:
- Community and cultural barriers
- The health worker barrier
- Lack of maternal legislation
- Bad corporate behavior
The public response has been swift. People across world representing large sectors of civil society have spoken out, taken to their computers and to the streets to advance breastfeeding as a practical, low-cost and feasible intervention. For those interested in social media, just take a look at the #FirstHour hashtag to get a small sense of what people are thinking.
Moving forward, it is important for governments to make commitments to promote breastfeeding. For with commitments, progress often follows.
“The good news is that our government is committed to working with partners to reduce pre-term births”.
The statement was made by Hon. Christine Ondoa Minister for Health in Uganda during last November’s World Prematurity Day, when the government of Uganda renewed its commitment to its mothers and newborns by pledging to improve prevention of preterm birth and care for preterm babies. The government’s actions are aimed at increasing availability, accessibility of quality maternal and newborn care services especially at national level. Today, these commitments are coming to life: the government has commissioned the construction of a 320-bed capacity women’s and neonatal hospital aimed at decongesting Mulago hospital and curbing maternal and neonatal deaths in the country.
Globally, preterm birth is the leading cause of neonatal mortality and now the number two cause of child mortality. Each year, it is directly responsible for approximately 1 million neonatal deaths, and many of the preterm babies who survive face a lifetime of disability. As many countries push towards achieving Millennium Development Goal 4, progress in reducing preterm mortality is identified as a major hurdle.
Save the Children’s Saving Newborn Lives Program in Uganda, along with valued partners in country, are supporting the Ministry of Health to take on the fight to reduce neonatal deaths due to prematurity among others. Different stakeholders in the health sector have been engaged to address the problem of preterm births. Uganda’s preterm birth rate is estimated at 14% and causes 38% of Uganda’s neonatal deaths, translating to 16,090 babies each year.
Through interventions at both community and health facility level, pre-term babies are getting an opportunity to live and to grow to their full potential. Most of these interventions are low-cost, and include effective antenatal care including prevention of malaria, giving steroid injections to women with premature labour to help speed up the development of the baby's lungs, teaching and encouraging mothers to practice kangaroo mother care which helps keep the baby warm and facilitates breastfeeding, and prescribing basic antibiotics to manage common neonatal infections. By this we commit and rally support to the global response and commitments made to reduce preterm births.
Uganda’s National Newborn Health Steering Committee, established in 2006 as an advisory arm within the Ministy of Health’s Maternal and Child health cluster, has helped push for the adoption, integration and scaling up of such life saving interventions. The multi-disciplinary committee comprises of members from different backgrounds, portfolios, institutions and organizations, and provides a forum for champions, implementers, researchers, academics and policy makers to regularly meet and share best practices as well as coordinate efforts and outputs for newborn survival.
The construction of a women and neonatal hospital is an encouraging and welcome announcement, and demonstrates the need for continued healthy partnerships and commitment to the cause. The hospital is to be constructed at Mulago Hospital complex. When the hospital becomes operational, it will reduce on the congestion in Mulago, where it is estimated that on a daily basis, between 80 and 100 mothers actually give birth on the floor because the hospital beds are too few. The hospital will be equipped and staffed in right proportions to deliver basic and advanced life saving care to mothers and their babies.
The $34.14m (about sh91.5b) state-of-the-art national maternal and neonatal referral centre construction project, is expected to be up and running in 2016. The hospital will be equipped to meet both and staffed to
- Uganda’s commttment to improving preterm prevention and care
 Mulago hospital is the biggest national referral hospital in Uganda.
Featured HNN Blogs
About the Blog
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
Recent Member Responses
I totally agree with the above article. As we all known the IMR data, apart from above suggested strategy i.e. strengthening of Village Health and...
Thank you for your comments; I agree with you that we are not reaching women as much as we should be to improve knowledge and behaviors for safer...
No doubt technological gains in maternal, newborn care, have improved newborn survival in last decade . Many simple interventions like kangaroo...
Your information is very useful to us. Our product is as used to protect children with lot of care By-...
The stdndard practice for cord care has been not to apply anything on the cord.after cleaning baby and bath cord is left to dry, this has been...