By Kate Kerber, senior technical specialist, Save the Children; Elaine Scudder, senior manager of Newborn Health, Save the Children.
Priority medicines are medicines with potential to save lives and should be available in all health systems. In South Sudan, shortages of these priority medicines are reaching critical levels. Coupled with fuel and other commodity shortages, the situation is becoming even more challenging for hundreds of thousands of displaced people, and those who are trying to serve them. Last month, the President of international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF), Dr Joanne Liu, wrote an open letter warning of the potential widespread shortages of essential medicines in South Sudan.
The first hours of a baby’s life are the most critical for survival. Nearly half of all newborn deaths occur in the first 24 hours. If appropriate equipment and medications are not available, a newborn’s condition can deteriorate within hours, or even minutes. The UN Commission on Lifesaving Commodities (UNCoLSC) identified 4 underused, low-cost, and high-impact commodities for newborn care that if implemented at scale could make the greatest impact in reducing preventable deaths. The findings of the recent UNCoLSC assessment revealed that these neonatal commodities have even more bottlenecks to access and availability than maternal and child health commodities. Key barriers included lack of monitoring, insufficient regulatory capacity, and supply chain management. Across the 12 countries assessed, stock-outs were common, with misoprostol, antenatal corticosteroids, female condoms, and newborn resuscitation equipment out of stock in at least half of facilities.
Lancet editor Richard Horton has recently pointed out that in order to reach global goals, we need to make humanitarian settings an over-riding priority. While the UNCoLSC findings apply to all countries, they provide no additional provisions for countries in the grip of conflict or recovering from disaster. During humanitarian response efforts, pre-packaged kits comprising of medicines, disposable items and equipment are procured based on international standards and best practice for a given setting. While reproductive health kits and child health kits exist, there has not been a validated kit for newborn care. While some of the essential supplies for newborn care overlap with other kits, there is a need for smaller quantities of certain medicines to reduce wastage, and newborn size devices, like preterm-size face masks for resuscitation, for example.
To help address these critical needs, an inter-agency collaboration between UNHCR, UNFPA, UNICEF, WHO, CDC, IRC, Save the Children, World Vision International, IMC, MSF, and Women’s Refugee Commission developed the Newborn Health in Humanitarian Settings: Field Guide, which includes newborn care supply kits – pre-packaged kits containing critical medicines, drugs, and supplies needed to address the health needs of newborns. There are three kits being proposed: a community kit, a primary clinic kit, and a hospital kit (see table).
Community kits are available for use by families at home or in health facilities, while primary care kits are intended to provide essential newborn care for uncomplicated live births and newborn resuscitation, to stabilize newborns with possible serious infections, and to care for low birth weight and preterm babies. Hospital kits are meant for use at a referral level to effectively treat complications, infections, and to provide resuscitation. The kits include items ranging from blankets and socks, to cups for feeding expressed breastmilk and weighing scales, and to chlorhexidine for clean umbilical cord care and gentamicin to treat possible severe bacterial infections.
| Community Level Kit | Primary Level Kit | Hospital Level Kit | |
| Use | · Part A: Packaged for distribution to every pregnant woman · Part B: Items to be held and used by Community Health Workers |
Essential newborn care for uncomplicated births, newborn resuscitation, stabilizing newborns with serious infection prior to referral, and caring for preterm babies. | Referral level care of newborn infections, newborn resuscitation, and care for preterm babies with complications. |
| Instructions | Distributed with illustrative instructions on how to use the kit contents and easy-to-use educational materials for essential newborn care. | For use by trained personnel. A short training should accompany the kit demonstrating how to use equipment and counsel mothers and families. | For use by trained personnel. Items are applicable for most hospital settings. Advanced supplies are available but should not be included in the kit if key competencies are not available. |
| Target population | · Part A: assuming 100 deliveries in 3 months in a population of 10,000 people. · Part B: assuming 10 CHWs for a population of 10,000 people. |
Assuming 300 deliveries in 3 month period for a population of 30,000 people and crude birth rate of 4%, and of which 15% may be preterm and/or low birth weight and 20% may develop complications. | Assuming 1,500 deliveries in 3 months for a population of 150,000 people and crude birth rate of 4%, and of which 15% may be preterm and/or low birth weight and 20% may develop complications. |
| Complementary Reproductive Health kit | Clean Delivery Kit (Kit 2) of the inter-agency reproductive health kit (UNFPA) | Clinical Delivery Kit (6A and B) of the inter-agency reproductive health kit, UNFPA | Referral Emergency Obstetric Kit (11A, 11B, and 12) of the inter-agency reproductive health kit (UNFPA) |
The Field Guide is being piloted at the community and facility levels in protection of civilian sites in Juba and Malakal and in refugee camps in Maban, South Sudan, with the much needed newborn kits arriving in May. Findings from this study will be used to improve health service delivery for women and their newborns, training of health workforce, and collection and use of newborn health information. In addition, findings will be used to finalize the Field Guide and complementary newborn kits in 2017.
In mid-May, reports emerged that the main hospital in Maban, serving both refugee and host populations, is experiencing dire drug shortages due to rising needs and numbers. The Commissioner of Maban County warned of the health implications if the stocks outs are not addressed before the imminent rainy season begins. Across all settings, more needs to be done to achieve implementation of the UNCoLSC recommendations including the strengthening of supply chains. In humanitarian settings, we need to finalize the items and amounts for a standard newborn kit that can be incorporated into existing kits. In South Sudan, there is no time to wait.