Addressing Critical Knowledge Gaps in Newborn Health


By Luisa Hanna on February 23, 2015

The blog was originally published by Save the Children UK. Written by Luisa Hanna.

“… the dumbest thing I ever heard.” That was the reaction of a Norwegian midwife in a new film from Save the Children when she was presented with the idea of women having to pay for childbirth.

In the parody, real-life midwives react to the news that under new cost-control measures, they will now be issuing women with an invoice for the birth of their babies. Of course, credit checks would be performed up front. A birth meter clocks every minute, adding to the bill. A menu of extras is available, including additional costs for pain relief.

The birth meter pauses to check in at the moment of the epidural whether the women has given her consent. “Consent to the procedure?” asks the nurse. “No, consent to the cost,” is the response.

The baby is born, the invoice printed, a bar code attached to the baby’s leg. After all, “It is practical for the patient to know what she has to pay when leaving the hospital.”

The midwives in the film are stunned: “Is this for real?”, “Crazy”, “Not on my watch.” Their reasons follow straight after: “Not everyone has the money to pay,” and “Are you telling me that I should put this to a women giving birth, that a woman in the most critical situation of her life should consider what care to have depending on the size of her wallet?”

No joke

But while in Norway this film is a spoof, in other countries charging women for childbirth is all too real.

The film could go further. What isn’t shown is a life threatening situation needing a caesarean section, an anaesthetic, a blood transfusion, or resuscitation. That birth meter would add these costs from its ‘menu’ of treatments. But it’s not really like a restaurant menu because a woman in labour doesn’t have a choice about what she can pick and choose.

Yes, this is a skit, and these are Norwegian midwives. Norway spends $9,000 a head every year on health, and most of that is government money. But the idea that people should access care, free at the point of use, should not be reserved for the richest in the world. It’s crazy, the dumbest idea ever that women have to pay to give birth.

No sense

Economists used to argue that user fees in health– paying for services – would detract people from using services unnecessarily. That they would keep costs down, while also (in a second, contradictory argument) raising money for health. These arguments have long been shown to be unfounded. Relying on user fees to finance health doesn’t make economic sense . But more importantly, it is inequitable and unjust. Even the World Bank agrees.

The reality is that in some countries, despite global momentum and years of campaigning to abolish user fees for maternal and child care, they still exist.

Attaching a cost to maternity care is particularly problematic. Most maternal deaths are caused by complications during and immediately after delivery, and can only be averted through prompt access to emergency care. These potential complications can rarely be predicted so, in economics jargon, the ‘price of care is uncertain’ – people can’t plan and save ahead. The need for prompt, immediate care means any time spent looking for money to pay for a complicated delivery can be fatal.

Pushed into poverty

The costs attached to maternity care can be expensive, catastrophic in cases, particularly for complicated deliveries, which can cost up to 10 times more than normal deliveries. These costs can push already poor households further into poverty. It is the poorest women who die from maternal health complications, and the poorest women who cannot afford the treatment they need.

When it comes to essential health service, such as maternity care, countries need to move away from relying on private and out-of-pocket spending, and move towards national systems, based on pre-paid funding – that allows healthcare to be available to all, regardless of their income, or whether they are employed.

Should a woman, in the most critical situation of her life consider what care to have depending on the size of her wallet?

By Katrin DeCamp on February 20, 2015
Africa, Asia

Photo: Jhpiego

This blog was originally published by MCSP. Written by Katrin DeCamp.

It’s amazing how quickly the new year gets under way!

On December 31st – after six incredible years – USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) officially ended as a global award. But there has been no pause in our efforts to end preventable child and maternal deaths: the Program remains active through associate awards in eight countries and USAID’s flagship Maternal and Child Survival Program (MCSP), MCHIP’s principal follow-on, is already up and running in 19 countries. As we end one program and begin another, we’re expanding our scope to reflect a changing global reproductive, maternal, newborn and child health landscape, as well as shifts in USAID’s own priorities.

Photo: Kate Holt/MCHIP

The global crises we faced in 2014 are fresh in our minds.

However, behind the scenes – more quietly and often without the fanfare they deserve – real successes and positive changes were taking hold in regions around the world. Many of these changes are thanks to continued efforts to reach every pregnant woman, delivery and childbirth with a minimum package of interventions. But much work is left to do: we must improve the quality of care for the most remote and vulnerable populations to truly realize the world we want for our mothers, newborns and children.

MCSP is supporting host countries to implement proven interventions and scale up their results.

We’ve helped launch the global Every Newborn Action Plan, and assisted in designing and drafting the new WHO-led Global Routine Immunization Strategic Plan. We’re focusing more on adolescent reproductive health – developing global age and stage counseling materials for family planning – and remain a vital contributor to the global movement to end preventable child deaths. MCSP works closely with countries to identify and extend key child health services to those populations most as risk, closing the stubborn achievement gaps that remain. And as new data reveals a shift in the leading drivers of maternal mortality to indirect causes, we are enhancing linkages between maternal and newborn health, nutrition and family planning, and infectious diseases.

Photo: Kate Holt/MCHIP

We’re placing greater emphasis on innovation, e/mHealth, equity, quality, gender and public-private partnerships.

MCSP is extending its reach through increased involvement with civil society, integrating community approaches and behavior change interventions. While maintaining focus on high impact interventions, the Program is working toward sustainable scale up to include strengthening the health systems that deliver these interventions.

Photo: Kate Holt/MCHIP

2015 marks a turning point for the public health community.

While we work to keep the promises we made to the world’s mothers and children in 2000, we are already looking beyond the Millennium Development Goals to 2030. The Sustainable Development Goals will help guide the global agenda, and we’re pleased to see maternal and child health included in the list of shared priorities. Truly, stakeholders everywhere are realizing that healthy nations begin with healthy women and families.

Photo: Karen Kasmauski/MCHIP

Connect with us and join the conversation.

Now more than ever, we’re engaging with advocates and partners on Twitter and Facebook. Thanks for connecting with us and keeping the drumbeat going! We also encourage you to share our countdown clock in blogs, social media or embedded on your website to show solidarity in reaching these goals. Together, every day and around the world, we can deliver on the promise of a healthy new year for all.

By Ian Hurley on February 13, 2015
Guinea, Liberia, Sierra Leone

Midwife Kebeh uses disinfectant while working at the Dolo Community Health Centre in Liberia during the Ebola outbreak. Photo: Aubrey Wade/Save the Children

Health workers like Kebeh are everyday heroes though they almost never receive recognition for the lifesaving and inspiring work that they do. It took a tragedy like the Ebola epidemic for the world to realize the invaluable contribution that midwives, nurses, doctors and the like provide communities all around the world on a daily basis.

It's considerably more special given the enormous risks thousands of them across Liberia, Guinea and Sierra Leone are taking to treat Ebola patients and putting themselves at risk of catching the disease. It is reported that nearly 850 health care professionals have been infected and 500 have died. 

The recent 136th Executive Board session of the World Health Organization held a special session on Ebola with several frontline health workers giving remarks about their experiences treating patients. The hard work is far from over and health workers will continue doing what they always do, work to serve their patients. 

By Morooph Babaranti on February 12, 2015

Photo: MamaYe Nigeria

This blog was originally published by MamaYe Nigeria. Written by Morooph Babaranti.

In the face of the gloomy health situation of women, newborn and children as presented in the 2013 National Demography Health Survey (NDHS), the Bauchi State Accountability Mechanism (BaSAM) for Maternal, Newborn and Child Health (MNCH) is resounding the long forgotten call by CSOs in the State to enact a bill on free MNCH in the State.

During one of its meetings held at the National Union of Journalists Secretariat, Bauchi, BaSAM deliberated on key indicators for improving the poor health indices. Among the issues raised were inadequacy and poor distribution of midwives (especially within urban and rural health centres), inadequate life saving drugs, equipment and consumables.

The discussion was centred on glaring evidence of over-dependence by Governments on donor funding in running certain health plans which are not sustainable (e.g. withdrawal by donors on HIV/AIDS), the long JOHESU strike which is not client-centered, and at the background of the dwindling economy as occasioned by the fall in oil revenue. This calls for innovation, sacrifice and political will from policy makers to ensure that the required resources and legislation to turn around the poor maternal and child health indices are harnessed.

BaSAM therefore underscored the significance of revisiting the free MNCH bill, which was touted several years back (around 2003) and championed by civil society organisations. There was also a move then even within the State Ministry of Health to develop a draft bill to that effect but somehow the process was truncated.

In its wisdom, BaSAM, whose membership comprises officials within the health sector, health and allied professional bodies and the media, developed a strategy under its Knowledge Management and Communication sub-committee to advocate for the revisit and passage of Free MNCH bill in Bauchi State.

The sub-committee took opportunity of the commemoration of the World Religion Day to sensitise the public during a 30-minute radio discussion on Globe FM/FRCN on its Lafiya Jari (Health is Wealth) platform. The program hosted religious leaders, a health professional, and a member of the State’s House of Assembly.

The discussion, which centered on the relationship between cleanliness in religion and the health of pregnant women and newborns, was first aired between 9.30am and 10.00am on Monday 26th January, 2015, with repeat broadcasts envisaged within the week and subsequent weeks to the 2015 election.

The discussion also influenced a news item on NTA Bauchi on Sunday, January 25 2015. The news item highlighted the perspective of religion, political promises and the health of pregnant women and newborns, and used the opportunity to call on policy makers to keep to their promises on the survival of mothers and babies.

Follow up plans included writing of articles that would appear in print media, such as Daily Times, Daily Champion and News Agency of Nigeria (NAN), who were all represented in the meeting to call for the passage of a free MNCH bill in the State.

Another major opportunity to call for the passage of the bill is the forthcoming media interactive forum with the gubernatorial candidates of the political parties in the State. Selected members of BaSAM have been assigned to unearth the status of the draft free MNCH bill with a view to revisiting it and also tabling it at the State Executive and the legislatures for assent.

By Collins Mhango on February 11, 2015

Surviving birth asphyxia through Helping Babies Breathe in Malawi

Shanice Lukasi had a difficult entry into the world on 1st October 2014. After a prolonged second stage of labor, her mother, Eunice Lukasi, finally delivered with the assistance of the health personnel at Nthondo health facility in TA Nthondo, Ntchisi district.
But the delivery was not without complications. The baby came out legs first – a case of breech birth.
Shanice, who was born with asphxia. Photo: Save the Children Malawi
“The case of Shanice was a missed diagnosis during antenatal. It came with advanced labour stage.” Said Gresham Chinula, Nurse and Midwife Technician at Nthondo Health facility. Normally, with such a case, the facility is supposed to refer the mother to the district hospital.
Nthondo is only forty-five minutes’ drive to the district hospital. However, with the condition Eunice was in, and the bad condition of the road, they could not refer her in time to the district hospital. To save the baby and the mother, the nurse prepared the Helping Babies Breathe (HBB) kit. HBB is an evidence-based educational program developed to teach neonatal resuscitation techniques in resource-limited areas.
“The objective of HBB is to train birth attendants in the essential skills of newborn resuscitation, with the aim of having at least one person skilled in neonatal resuscitation at the birth of every baby.” Says Victoria Shaba, HBB Coordinator for Save the Children. 
After delivery of Shanice, Gresham noted that the baby could not cry. Instead, she lay on her mother’s abdomen, unable to move or breathe. According to Gresham, the baby had asphyxia, a lack of oxygen that can cause permanent damage or even death. It was also noted that there was meconium - fetal distress – a condition where the baby is born with difficulties to breathe and cannot cry. After successfully bringing out the baby, the nurse quickly wiped the baby and then took her to the resuscitation area to stimulate breathing which did not happen.
Meanwhile the mother was not at peace.  She remarked. “After a difficult birth, my baby did not cry or move. I was very worried, having been told that the baby cries as soon as it is born. Hope was beginning to fade away.”
After wiping the baby, they started ventilation process which made the baby start breathing. The whole process took about five minutes.
“I quickly and thoroughly dried the baby, then covered him with a dry towel to prevent hypothermia. I cleared the mouth and nostrils with a penguin sucker, rubbed his back gently to stimulate breathing and used an Ambu bag and mask to ventilate him, assessing his progress all along,” said Gresham. “The baby started breathing on his own after about five minutes of resuscitation with the Ambu bag and mask.”
The equipment is surprisingly simple: The penguin sucker is a handheld instrument designed to clear the baby’s airways by sucking out fluids in the mouth and nostrils, and an Ambu bag is a manual device that, when squeezed, forces air into a patient’s lungs.
Thereafter, the baby and the mother were monitored until they were discharged. Based on the results of the checkups they have conducted on the baby, there is assurance that the child will grow normally as she is passing through the developmental milestones.
In the community where Eunice lives, people believe that such kind of births are a result of some black magic bestowed on the mother meant to kill or curse the child.
“As such we received a lot of ridicule and obscenities from the people around here.” Remarked Eunice. “It was very difficult to convince them that such a child was as normal as any other child.”
Nthondo health centre registers almost 3 such cases every month and the HBB training has equipped nurses with skills in helping such babies breathe and live their lives.
“Using these new skills and equipment, I have managed to successfully resuscitate several babies at this facility. I feel very happy when I do this, knowing that those new lives will get their due chance at a long life. Our new skills and tools must be made available across Malawi and the developing world.” Said Gresham.
HBB ensures adequate preparation during such kind of deliveries. Since 2013, there has only been one reported death case during resuscitation at the service centre.
Helping Babies Breathe (HBB) is one of Save the Children’s key focus areas to save newborn lives. It is one part of an essential newborn care package designed to significantly reduce neonatal mortality. The WHO (World Health Organization) estimates that one million babies die each year from birth asphyxia, i.e. inability to breathe immediately after delivery.