Photo: Jonathan Hymes/Save the Children
Mamie, thirty two, begins her three hour walk home after giving birth to her son Darius the day before at the clinic in Peterstown, Margibi county, Liberia. Pregnant women and mothers in some rural parts of Liberia have to walk up to eight hours to reach the nearest health clinic. Maternal waiting homes, some supported by international partners including Save the Children, provide pregnant women like Mamie with a place to stay in their final week before delivery.
“Equity needs to be the heart of what we are doing. We need to be doing more to reach the most vulnerable communities and ensure that members in the communities have access to better newborn and child care.”
These words by UNICEF Representative Sheldon Yett rang out at a recent workshop held for community health workers, county health directors, senior health ministry officials and programme staff in Monrovia, Liberia.
This diverse group of public health practitioners were there to learn about the new UNICEF handbook for newborn and child health and how they could implement some of its recommended practices in their own communities. Importantly, infection prevention and management along with Kangaroo Mother Care were part of the discussion. Neonatal infections now account for 28 percent of all newborn deaths in Liberia.
In 2011, it is estimated that 13 percent of all the under five deaths in Liberia occured on the day a baby was born. Stregthening the quality and impact of newborn care is thus very important for helping to reduce mortality and morbidity. One of the county health directors in attendance said that the handbook will be important for strengthening Integrated Community Case Managment (iCCM) interventions.
With the annual rate of newborn mortality reduction moving from 1.64 percent from 1990-2000 to 4.02 percent from 2000-2012, Liberia is certainly making progress. We must keep in mind, and use as motivation, that newborn mortality now accounts for a larger percentage of under five deaths than it did in 1990. Last summer's commitment to A Promise Renewed was an important milestone for attention and resources for newborn and child health. Based on the excitement and commitment of all those at the workshop, this momentum has not waned and has brought even more involvement across the country to address this issue.
Photo by: Cameron Taylor
“Every system is perfectly designed to achieve exactly the results it achieves.” USAID Applying Science to Strengthen and Improve Systems (ASSIST) Deputy Director Dr. Kathleen Hill shared this quote from W. Edwards Deming with an audience of more than 40 leading experts in technology, health care, and international development that gathered on January 31st in Washington, D.C. for an m/eHealth Health System Strengthening technical working group meeting. The Bridging the Gaps: Leveraging m/eHealth to Achieve Strong Health Systems and High Quality Care in Low-Resource Settings technical meeting considered a working framework developed by the USAID ASSIST project and discussed how m/eHealth solutions can bridge common quality and systems gaps in low-resource settings to augment system strengthening and quality improvement efforts to achieve better health outcomes.
As a gender specialist working for WI-HER LLC, Women Influencing Health, Education and Rule of Law, on the ASSIST project, my interest in m/eHealth is twofold: first, I am examining how technology can be leveraged to transform traditional gender norms to improve health outcomes for women, men, girls and boys. My second interest is in mitigating the negative impact that m/eHealth interventions can potentially have on gender relations. One of the biggest takeaways from the meeting for me was the idea that technology is often developed and packaged as a solution before the problem and its root cause are defined. There can be a lack of discussion and consensus about what the problem is, what response is required to solve the problem and close the gap, and to what extent m/e technology can aid in that. It’s important that the technology solutions benefit the women, men, newborns and children they are meant to serve.
An example is the push in recent years to target women through mHealth interventions, sometimes without sufficiently analyzing whether the problem warrants a response which includes mHealth and targets women exclusively. If the problem identified, for example, is that neonatal mortality is very high, and it is observed that very few mothers in the community receive antenatal care (ANC) or deliver with skilled providers, an mHealth project might provide mobile phones to pregnant women and girls or communicate with expecting mothers through their cellphones to tell them about the importance of seeking care throughout their pregnancy. The reasoning behind this makes sense: mothers who do not receive high-quality ANC and childbirth care are more likely, along with their newborns, to suffer serious consequences of childbirth complications such as pre-eclampsia. But if one of the root causes of pregnant women not attending ANC visits is because the power and decision-making dynamics in households limit women’s and girls’ ability to make health-related decisions, and male partners do not appreciate the value and therefore do not want their partners to attend ANC visits, then the mHealth intervention would not be as effective as it could be. In some cases the receipt of text instruction that challenges a male partner’s authority in the home may even put the woman or girl at risk.
A more appropriate solution which utilizes mHealth would be to design an intervention that also sends messages to male partners about the importance of ANC, appointment reminders for their partners and promoting their participation in education and counseling sessions. This gender-sensitive mHealth intervention would be more likely to lead to increased use of ANC services and skilled delivery care by pregnant women and help to contribute to improved outcomes for mothers and newborns if the quality of care is high. This highlights the importance of m/ehealth projects incorporating a gender analysis and strategies to implement gender-sensitive interventions into the project.
The most moving and powerful part of the meeting was listening to Dr. Hill share the heartbreaking story of Mariama. Mariama is a pregnant woman who arrives at a local clinic with symptoms of pre-eclampsia, and faces a number of health care quality gaps which cause her to not get the treatment she needs: from lack of appropriate diagnosis and transportation to the hospital, a lack of triage to receive care promptly and then finally when she delivers her preterm son Bulakai, who is alive but not breathing and the health care team is unable to locate a bag and mask to resuscitate him. Dr. Hill used storytelling to make this hypothetical case study come alive for all of the meeting participants. Dr. Hill then linked the loss of the life of Bulakai to a system and quality failure which could have been prevented in part by integrating m/e health into MNCH quality improvement efforts.
The “Bridging the Gaps” meeting highlighted the importance of leveraging m/eHealth solutions as part of broader health system strengthening and QI efforts to achieve better health outcomes for women, men, newborns and children. Specifically, experts in the field discussed strategies for leveraging m/eHealth to strengthen essential health system functions related to service delivery and real time care, workforce, commodities and supply chain, and data and information systems in low-resource settings and identified many areas for participant collaboration. The meeting offered a very useful platform for collaboration and learning and the expectation is that m/eHealth HSS/QI technical working meetings such as this will continue in the future.
The Bridging the Gaps: Leveraging m/eHealth to Achieve Strong Health Systems and High Quality Care in Low-Resource Settings technical meeting was jointly organized by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project managed by University Research Co., LLC (URC) with support from the U.S. Agency for International Development (USAID) Office of Health Systems. For more information about USAID ASSIST’s work to leverage technology to improve systems, please contact Allison Foster at firstname.lastname@example.org.
Photo: Caroline Trutmann/Save the Children
By the time you finish reading this, approximately five newborns around the world will have died. That’s five mothers and fathers who are now mourning the loss of a child, and five families whose lives have been irrevocably upended.
As an increasing proportion of child deaths, newborns now account for 44 percent of under-five child deaths globally. Yet, it’s not that we know how to save a 4-year-old and not a 4-day-old.
In fact, there are existing interventions that, if scaled up, have the potential to reduce newborn deaths by as much as 75 percent. What’s lacking is the political will and funding to deliver these solutions to all the mothers and babies who need them.
That’s why Save the Children has declared 2014 the “year of the newborn.” With today’s launch of the Ending Newborn Deaths report, we hope to build steady momentum leading up to the World Health Assembly in May, where the Every Newborn Action Plan—a roadmap for ending newborn deaths from preventable causes—will be presented to world leaders.
We know that without greater investment and support for newborn programs, we will never be able to reach the fourth Millennium Development Goal (MDG 4) of reducing by two-thirds the under-five mortality rate by 2015. Unfortunately, time is not on our side. With a little less than two years to go before world leaders meet in New York to discuss the post-MDG framework, it is imperative that we tackle, in earnest, the scandalously high number of newborns deaths.
We have seen the progress that can be made when political action is taken. Ethiopia, for example, has made great strides in reducing child mortality, recently achieving its MDG 4 targets. Newborn mortality has also decreased from 54 to 29 between 1990 and 2012, leading to health and nutrition improvements, particularly in rural areas. For a country that had one of the worst child mortality rates in the world just two decades ago, this gives us hope that success elsewhere is possible.
In 2012, the U.S. joined 173 other nations and pledged to end preventable child deaths. We will never reach this goal without focusing more intently on the newborn.
To that end, we are calling not just on our government, but on all world leaders to reaffirm their commitment to ending newborn deaths once and for all.
Together, we can ensure that the five babies who are no longer with us have not died in vain.
Miles is president and CEO of Save the Children. Wilson has represented Florida's 24th Congressional District since 2011. She sits on the Education and the Workforce and the Science, Space and Technology commissions.
Photo: Jiro Ose/Save the Children
Ethiopia, my country, is the cradle of humanity. The first stone tools were found here and Lucy, a 3 million year old skeleton and the first Homo sapiens, was found in the village of Hadar, on the southern edge of the Afar triangle.
Our history is ancient and continuous. We are fiercely proud of the fact that we are the only African nation never to have been colonised. But like every nation our history is chequered and we have suffered.
In 1983, when I was ten years old, the first flames of hunger were flickering throughout Ethiopia. It was that year my mother died due to birth related complications. In those days, in my village, this was not very unusual.
My mother died following birth complications. The women of the village tried to help, but when I think back I realise that none of them really knew what they were doing.
In so many ways, we have made progress in saving the lives of mothers and their newborns since then. Today, the number of children dying before their fifth birthday has been halved since 1990. The number of women who die in childbirth has declined by almost a third – that’s millions of kids who get to grow up with a mother and millions more getting a chance at life.
What we have achieved so far must be celebrated. The actions of our governments over the last fifteen years have brought about the greatest leap in children’s wellbeing survival in history. This change has been brought about by bold political leadership at the highest levels.
But even today, half of all women giving birth in sub-Saharan Africa give birth without any skilled help. Globally, 2 million women also give birth completely alone. A direct result of this lack of skilled health workers, as Save the Children has shown in a new report today, a million newborn babies die on their first day of life. A single baby’s death is one death too many.
The good news is that we know what needs to change: ensuring every birth is supported by quality trained health care workers who have the expertise to help premature babies survive, deal with birth complications and prevent newborn infections can, with some wider steps, help prevent as many as two-thirds of these newborn deaths. Every country in the world must ensure that all mothers-to-be have access to a midwife with life-saving medicines and equipment.
Africa is finally a continent on the rise – and children are the key to our continuing success. I want them to grow up to be the doctors, lawyers, teachers and even athletes that they are meant to be. The race for survival is a marathon, not a sprint. We are in this for the long haul. Like long distance running, this will take endurance, commitment and conviction. We have seen the incredible results when we put our minds to it.
Photo: Courtesy Accordia Global Health Foundation. VHT member Togonzangane Steven registering a client in a household.
The old adage “it takes a village to raise a child” is never more apt than in the lead-up to and first day in that child’s life, especially in rural and remote locations like Uganda’s Kibaale district.
The Saving Mothers, Giving Life program — a collaboration of United States and Norwegian government agencies, partner developing-country governments, and private-sector non-governmental organizations —helps mothers and newborns during this highly vulnerable time. The assistance offered by Togonzangane Steven and other volunteer frontline health workers involved in the program goes far beyond safe motherhood.
Steven, who earns his living as a farmer, is a 30-year-old village health team member volunteering in Nyamihindo village in Kibaale district. The Infectious Diseases Institute in Kampala, supported by the Accordia Global Health Foundation, is the lead implementing partner of Saving Mothers, Giving Life in the district. Responding to the shortage of health workers in the area, the program formed voluntary Village Health Teams (VHTs). Volunteers like Togonzangane create community awareness, sensitization, and surveillance, providing information about and encouraging visits to health facilities. In the Kibaale district, 1,900 VHT members, representing each village, have been trained.
From an early age, Steven has helped the health of people in his community, including as a sanitation monitor in his school and later a health representative in the community, making him a natural pick by his community to be a VHT member.
To manage the time and effort his VHT responsibilities require, Steven plans his schedule so he can stop by several houses in close proximity five or six days each week. In the first month of each quarter, he visits all the households in the village and then returns to those with at-risk individuals.
“While it can be difficult balancing personal duties with voluntary work, I have managed by drawing a plan and following it,” Steven said. “I visit households to collect data on members above 5 years of age, on pregnant mothers, and on children 5 years and below. My visits include monitoring household hygiene and sanitation. I sensitize members on health-related issues such as safe motherhood, malaria, and HIV/AIDS.” Steven visits three to five houses every day, sometimes having to go on foot because of impassable roads or lack of fuel for his motorbike.
When the program began, Steven’s efforts and diligence were not always understood or welcomed by all village members. “Some community members felt irritated when I visited them every month,” he said. “They regarded it as a waste of time and a disturbance. I have overcome this through continuous sensitization of the community members specifically about my role as a VHT, explaining that it entails reporting disease outbreaks and conducting referrals—especially for pregnant mothers and babies—all of which require constant monitoring.”
Steven’s commitment to achieving healthier outcomes for his community members keeps him motivated. “Mothers used to die without accessing care, but now they are able to get care and services,” he explained with pride. He added, “In the past, most people in my village—men inclusive—had a bias against using mosquito nets. They thought they contained chemicals that would make women infertile. I conducted a meeting in the village in conjunction with the district health team, then women started going to the health facility to receive the mosquito nets. Eventually, they started encouraging others to go the health facilities. As I speak, there is a mosquito net in every home in my village. I feel my efforts have paid off, and this gives me joy because the malaria cases have reduced in my village.”
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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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