Addressing Critical Knowledge Gaps in Newborn Health

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By Pragya Vats on April 16, 2015
India
Asia


Photo: The Centre for Catalyzing Change

Empower citizens and see the difference

Meera Devi is a ward member from Muzaffar district in Bihar. She admits that when she was first elected she did the basic work. When she got reelected, she had a chance to take the women’s leadership programme by the Centre for Catalyzing Change. She learned a lot more about rights and entitlements. Today Meera is an active voice on issues ranging from education to women’s empowerment.

“I realized how much more I can do, and the power I had in influencing change for my people,” said Meera at the Citizen Hearing in Delhi, the national capital, “Today I dream with my eyes open. Change is possible.”

Over 150 people joined Meera, including government representatives, media, community representatives and civil society members. The White Ribbon Alliance, The Centre for Catalyzing Change, Plan, FPA India, IPPF, Save the Children India, World Vision India, action/2015 and partners helped to organize the event.

Geeta Regar, former Sarpanch (village head) from Rajamand, Rajasthan, is another inspiring example of a catalyst for change whom also underwent a similar programme as Meera on rights and entitlement. During her tenure, Geeta noticed that participation of communities and women in particular was very minimal.

“Engaging women was the start, it was important to engage families – men, mother-in-laws,” she said.

One of the first things she did was to ensure a functioning primary health centre. Women either delivered babies at home or had to travel far to facility. She started with delivery room.

“When I heard the first cry at the birth in that room, the happiness was unparalleled. It became my mission that every woman will have a safe delivery and every child will have a healthy start.

She took people along in her mission. And there we had indeed a healthy start.

Leave no woman, no child behind

If statistics are to go by, every year as many as 44,000 Indian women die needlessly during pregnancy and childbirth, and 1.3 million children in India lose their life every year due to preventable causes.

Today, the world is at the brink of a major breakthrough to ensure mothers, newborns and children everywhere survive. If there is one place to trace the seeds of this brewing revolution it is India.

India has witnessed dramatic a decline of maternal mortality of 70 percent between 1990 and 2012. The staggering number of newborn deaths has been reduced from 327 per 100,000 live births to 167 per 100,000. In the same period child mortality in India has come down to 52 per 1000 lives from a whopping 114. Speaking at the hearing, Dr Rakesh Kumar, Joint Secretary, Reproductive and Child Health, Ministry of Health and Family Welfare said that the keyword is ‘preventable deaths’, the fact that we still have women, newborns and a child dying is somewhere the failure of the system towards people. He stressed the need to draw lessons learned from India’s successful polio campaign.  

“We have lots to learn from the polio eradication campaign. But most important was the people’s participation, people’s engagement. That was the key to mitigate challenges on ground,” he stressed, “Citizens engagement is critical for generating demand from the communities. Just the availability of services is not enough.”


Dr. Aparajita Gogoi, National Coordinator for the White Ribbon Alliance India. Photo: The Centre for Catalyzing Change

The year 2015 - an opportunity for people and planet

As the Millennium Development Goals (MDGs) agreed to in the year 2000 are to expire at the end this year, there is an opportunity to approach the next set of goals differently.

2015 is a turning point, with the Sustainable development Goals (SDGs) replacing the MDGs. There are clear opportunities to influence mechanisms for greater citizen engagement in the next round of proposed goals, at the local, national and global levels.

What will truly set apart the next development framework from the preceding one is engaging citizens in not just setting the goals but also in realising them more meaningfully than ever before. The collection of Citizen Hearings is one such significant step in including the voices of people to inform the global and national development agenda for the next 15 years.

Political will must pave the way

More than ever before, there is an deliberate effort to take the closed door discussion on next set of goals to wider civil society engagement, from ivory towers to people.

As Raghav Chaddha, spokesperson of Aam Admi Party (AAP) said at the Citizen’s Hearing, “The principle of Swaraj (self rule) recognises the role of people in identifying their problems and also solutions to their problems.”

Setting the stage for dialogue on participatory governance, Raghav Chadha, Spokesperson, AAP, spoke the participatory budget development exercise initiated by AAP and said that the vision of the party is to “Move from a parliamentary democracy to a participatory democracy. Creating accountability structures, citizens’ engagement for policy making, the AAP government is working to include citizens through the Mohalla Sabhas (neighbourhood meetings) and the newly developed Delhi Dialogue Council,”

Supporting this call for engaging citizens, Shri, Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family Welfare, Government of India, said “People need to be more responsive and demanding so that no mothers die in India. We need to empower citizens to demand fulfillment of entitlements and quality health services.”

For citizen engagement to truly work, mechanisms need to be created where citizen’s voices are heard and acknowledged in designing, implementing and monitoring the programs for women’s and children’s health.

There is a growing need to create space that recognizes the citizen’s voice and empowers people to make better sense of efforts that will directly impact their lives.

Indeed ‘nothing about us, without us.’

By Ian Hurley on April 10, 2015
Africa, Asia

 Women wait with their children to see a doctor at a mobile health clinic in the Okhla Industrial Area slum in Delhi, India. Photo: SuzannaLee/Save the Children

IPPF, the White Ribbon Alliance, Save the Children and World Vision are joining with partners to host community and national Citizens’ Hearings this spring - as well as a global Citizens’ Hearing during the World Health Assembly in Geneva this May and one at the United Nations General Assembly in New York this September. These organizations, other partners and the public are calling governments to account for their delivery on MDGs 4 and 5, and are pushing for a strong accountability framework in the new Every Woman Every Child Global Strategy 2.0 and within the Sustainable Development Goals.

Citizen Hearings have already taken place in India, Indonesia, Nepal, Nigeria, Tanzania and Uganda

This forum has given people at the local and national level the opportunity to highlight the challenges to improving maternal, newborn, child and adolescent health in their area. Citizens have engaged with parlimentarians, ministries of finance, ministries of health, and representatives from other government bodies. 

Stay tuned to CitizensPost.org for information on upcoming hearings in Malawi, Bangladesh, Ghana, South Africa, Lesotho, Guinea, Sierra Leone, Pakistan, Afghanistan and many more countries. 

If you are interested in coordinating your own Citizen Hearing, there are toolkits available in English, French and Spanish

By Sylvia Nabanoba on April 7, 2015
Uganda
Africa


The author, Sylvia Nabanoba, and her newborn son Nathan.

I clenched my fists and tightly closed my eyes. After about one minute, I slowly stretched my fingers and opened my eyes. I heaved a sigh of relief. That contraction had passed.

Another contraction came and the process repeated itself. It was during one of those moments of relief that my eyes caught a sign hanging on the wall. The sign was in the corner above a small mattress lying next to the delivery bed that I was on. This was in a labour ward at Case Medical Centre in Kampala.

‘Helping Babies Breathe’, the sign read. In the midst of my pain, I smiled. I knew that sign very well. I had worked with our Helping Babies Breathe (HBB) senior officer, Harriet Othieno, to create it. We had considered it good to brand the resuscitation corners for babies that were being put up in and outside of labour wards. This is because these corners were largely a result of the training that Save the Children and partners were giving to midwives on how to resuscitate babies that have difficulty breathing at birth.

I felt like a guardian angel was watching over me. I had always known that the HBB+ project carried out training, but was not aware of it reaching beyond health centres in rural areas. I did not know that even health workers from hospitals in urban areas received this kind of training, because I thought they had everything they needed to save babies.

My labour did not progress as well as the doctor had thought, and before long, I was bleeding. The bleeding worried the midwives, who immediately summoned the doctor. A decision was made to take me for an emergency caesarean operation, with the doctor explaining that if we delayed, the baby could die. I was operated on, and gave birth to baby Nathan. Later, the doctor explained that the bleeding had been caused by a condition called abruptio placentae, or placental abruption, whereby the placenta had begun separating from the uterus before the baby had been delivered.

It was on discharge from the hospital that I learnt that my baby’s apgar score had not been very good. In fact, he had had to be resuscitated.

This experience has made me even more proud of working for an organization such as Save the Children, and of the partnership that has ensured the HBB+ programme reaches hospitals throughout the country. I only wish every mother and newborn all around the world could have access to skilled health care when they need it. Every mother deserves to live, and every mother deserves a live baby.

Sylvia is a Communications Manager for Save the Children in Uganda.

By Mariam Claeson on April 2, 2015
Africa, Asia

This blog was originally published on the Huffington Post Global Motherhood

Every once in a while, a major innovation comes along -- one that has the potential to change the lives and health of families all over the world -- especially in remote, hard-to-reach areas.

For several years in the 1980s, I traveled the globe as a clinician (and later as a public health officer) to care for mothers and children in Africa, Asia and the Middle East. Each setting was different. But in each place, caring for pregnant women and newborns with complications was among the most difficult challenges my colleagues and I faced.

One of the most challenging conditions we dealt with was newborns suffering from bacterial infections. It remains a major public health challenge even now. In remote regions, most mothers delivered their babies at home without access to a skilled birth attendant and quality care. Babies would develop serious infections in the days and weeks following delivery, sometimes caused by unsanitary conditions during childbirth or an infection carried by the baby's mother. Most newborn deaths were caused by infections, and today, they still claim more than 629,000 newborn lives every year, accounting for a third of all newborn deaths.

The treatment for severe infection (sepsis) in newborns is well-established -- a total of 14 injections given over seven days, twice a day, by a doctor while the child is in the hospital. But often, in low-resource settings, newborns and their families lack access to health facilities due to financial or logistical challenges. They come to the hospital as a last resort, and often too late for treatment to be successful.

This week, The Lancet medical journal published a new study detailing a simplified treatment with antibiotics that is a true breakthrough in the global approach to neonatal infection. Researchers, aiming to identify an alternative way to deliver life-saving medicines, studied what would happen if the antibiotics were administered differently. The study found that two alternative simplified regimens, which require either two or seven injections, in addition to oral antibiotics given at home were just as effective as 14 injections in treating newborn infections. The regimens, studied in clinical settings in Africa and Asia where neonatal deaths remain stubbornly high, were found to be safe, simple and more accessible. The results show that when given proper instruction from health care providers, families were willing and able to care for their newborns with oral antibiotics at home.

This innovation could bend the curve in favor of neonatal survival. It could make a dent in saving some 300,000 newborns every year.

When mothers are healthy and when children thrive, the positive benefits last a lifetime. For families with sick newborns who cannot make it to a hospital, or for those who cannot stop working or need to be home for other children, it means more days at home instead of in the hospital. The costs of catastrophic illness, such as a week-long hospital treatment of a sick newborn, push many households below the poverty line.

Despite the tremendous gains in saving the lives of children globally, the rates of newborn deaths haven't fallen as quickly. The Every Newborn Action Plan released last year laid out a roadmap to end preventable newborn deaths. Today's Lancet study provides evidence that there is in fact an alternative to the arduous treatment currently used that would help the world reach this ambitious goal.

I often think of the babies whose lives couldn't -- and still cannot -- be saved because they lacked access to the treatment they needed. This simplified antibiotic treatment puts an alternative, less cumbersome course of treatment into the hands of front line health workers and families in the most remote areas of the world -- and will allow newborns to receive the lifesaving care they need and deserve.

Follow Mariam Claeson on Twitter: www.twitter.com/MariamClaeson

By Kathryn Millar on April 2, 2015

This blog was originally published by the Maternal Health Task Force. Written by Kathryn Millar.

Newborn size at birth standards are now available from the INTERGROWTH-21st project. This package includes size charts, standards and z-scores for newborn length, weight and head circumference at birth for boys and girls.

These standards—based on a multicenter, multi-ethnic, population-based study—are the first global standards for newborn growth and debunk the myth that fetal and newborn growth differs by race and country of origin. In fact, results from the INTERGROWTH-21st project show that if a woman is healthy, the size and growth of her newborn should be consistent, no matter where she lives.

The newborn size at birth standards are currently in use at Oxford. In addition, these standards are being introduced and piloted at INTERGROWTH-21st study sites and medical centers in the Boston area. We encourage all clinicians to use these standards worldwide.

Next steps to implement these standards in your facility:

Forthcoming tools:

  • Interactive resources such as online calculators and mobile phone tools