{"id":12231,"date":"2014-02-04T00:00:00","date_gmt":"2014-02-04T05:00:00","guid":{"rendered":"http:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/"},"modified":"2017-08-21T18:10:57","modified_gmt":"2017-08-21T22:10:57","slug":"an-afghan-success-story-fewer-child-deaths","status":"publish","type":"resource","link":"https:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/","title":{"rendered":"An Afghan Success Story: Fewer Child Deaths"},"content":{"rendered":"<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-12231-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/20140204_me_an_afghan_success_story_fewer_child_deaths.mp3?_=1\" \/><a href=\"\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/20140204_me_an_afghan_success_story_fewer_child_deaths.mp3\">\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/20140204_me_an_afghan_success_story_fewer_child_deaths.mp3<\/a><\/audio>\n<p class=\"rteleft\"><em>This news report was originally published on <\/em><a href=\"http:\/\/www.npr.org\/2014\/02\/04\/269551459\/an-afghan-success-story-fewer-child-deaths\"><em>NPR<\/em><\/a><em>.<\/em><\/p>\n<p class=\"rtecenter\"><img decoding=\"async\" src=\"http:\/\/media.npr.org\/assets\/img\/2014\/02\/03\/afghan-child-1-3923ab0892b40ba5f85d4fa3c77a2f998e138fbd-s40-c85.jpg\" alt=\"\" width=\"475\" height=\"356\" \/><\/p>\n<p><em>A young girl receives a polio vaccine at the Isteqlal hospital in Kabul on Sept.19, 2011. Photo By:\u00a0Adek Berry\/AFP\/Getty Images<\/em><\/p>\n<p>One of the most dramatic changes in Afghanistan since the fall of the Taliban is the increase in average life expectancy from 45 to 62 years. That gain is almost entirely a function of reductions in child mortality due to the spread of basic health services.<\/p>\n<p>Yet Afghanistan still has one of the highest child mortality rates in the world, and there could be significant backsliding as the international community reduces aid after NATO troops withdraw at the end of this year.<\/p>\n<p>At the Goldara clinic on a recent day, a two-month-old baby cries loudly, expressing her dissatisfaction with having a needle jabbed into her thigh. But this Penta vaccine will protect her from five different diseases that contribute to infant and child mortality.<\/p>\n<p>In 2001, one of every four children born in Afghanistan died by the age of five. Today, one in 10 children dies by age 5. It&#8217;s a dramatic improvement \u2014 although children are still dying in large numbers from preventable conditions like diarrhea, pneumonia and hypothermia.<\/p>\n<p><strong>Creating Access<\/strong><\/p>\n<p>The Goldara clinic sits in the center of a ring of destitute villages in the vast Shomali Plain north of Kabul. It&#8217;s one of some 2,000 health facilities in the country today, up from only 400 a dozen years ago. According to the Afghan government, more than 60 percent of the population now has access to health services.<\/p>\n<p>The clinic is part of a program run by Afghanistan&#8217;s Ministry of Public Health and administered entirely by non-governmental organizations. The clinic provides vaccinations, midwife services and other basic medical education and treatment.<\/p>\n<p>Samia, covered in a traditional blue burka, has come to the spartan six-room clinic to have one of her four children vaccinated.<\/p>\n<p>She says she&#8217;s been pregnant six times; the first ended in an abortion due to complications, the second time she gave birth at home and the baby died within four days.<\/p>\n<p>&#8220;Across Afghanistan, we&#8217;re still looking at up to 80 percent of women giving birth at home,&#8221; says Rachel Maranto, director of program development for Save the Children, an international organization that&#8217;s been doing health work in Afghanistan since the 1970s.<\/p>\n<p>One of the group&#8217;s programs is training volunteer community health workers who go out into the villages and raise awareness of the importance of things like prenatal care and going to a clinic or midwife for childbirth.<\/p>\n<p>It was a community health worker who convinced Samia to seek medical services after her baby died. Since then, she&#8217;s had four children, all born in clinics and all vaccinated.<\/p>\n<p>Noorzia, one of the community health workers at the clinic, says the biggest challenge is changing cultural practices.<\/p>\n<p>&#8220;Once a mother-in-law threw me out of the house during a counseling, and often mothers-in-law won&#8217;t even allow us into the house,&#8221; she says.<\/p>\n<p>Eid Mohammed who suffers from from chronic malnutrition, lies on a bed at Indira Gandhi Children&#8217;s Hospital, in Kabul, Afghanistan in 2011. In 2001, one of every four children born in Afghanistan died by the age of five. Today, one in 10 children dies by age 5.<br \/>\n<img decoding=\"async\" src=\"http:\/\/media.npr.org\/assets\/img\/2014\/02\/02\/afghanistan_mortality_wide-f18f55096cd6134128101d4586dc6d249badd49c-s3-c85.jpg\" alt=\"\" width=\"200\" height=\"112\" align=\"left\" \/><em>Eid Mohammed who suffers from from chronic malnutrition, lies on a bed at Indira Gandhi Children&#8217;s Hospital, in Kabul, Afghanistan in 2011. In 2001, one of every four children born in Afghanistan died by the age of five. Today, one in 10 children dies by age 5. Photo By:\u00a0Muhammed Muheisen\/AP<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>Health workers struggle to convince older woman to allow their daughters to deliver in clinics.<\/p>\n<p>&#8220;They say, &#8216;When I was younger I gave birth to many children without going to a health facility, so my daughters can do the same,'&#8221; Noorzia says.<\/p>\n<p>Mothers also pass along bad practices like feeding their infants tea and biscuits instead of breast milk.<\/p>\n<p>Malnutrition is a major contributor to child mortality, and actually an even bigger challenge, says Save the Children&#8217;s Maranto. She says about 60 percent of all children experience stunted growth.<\/p>\n<p><strong>A Continuing Struggle<\/strong><\/p>\n<p>Continuing the progress of the last decade also requires recruiting and training more female health workers, which is no small task, she says. For example, in Uruzgan, the province where the group works, less than half of 1 percent of the women are literate.<\/p>\n<p>Save the Children ended its support for the community health workers in Goldara several months ago, and part of the purpose of Maranto&#8217;s visit is to see if the services are continuing.<\/p>\n<p>A group of burka-clad women say they are carrying on as community health workers, but they miss the neonatal kits that Save the Children used to provide. They say that villagers are accusing them of stealing the kits.<\/p>\n<p>This gets to the thorny issue of sustaining the gains that have been made so far. The World Bank, the European Union and the U.S. Agency for International Development are the primary funders of Afghanistan&#8217;s basic health services. Continued support from USAID is most in doubt as the international community draws down its support for Afghanistan, says Maranto.<\/p>\n<p>&#8220;We hope very much that USAID will continue to commit for another three years,&#8221; she says.<\/p>\n<p>USAID says it intends to continue providing $100 million a year for health services in Afghanistan, but officials warn their funding is subject to congressional approval. And Congress just voted to cut Afghan aid almost in half.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Afghanistan still has one of the highest child mortality rates in the world, and there could be significant backsliding.<\/p>\n","protected":false},"author":3998,"featured_media":3687,"comment_status":"open","ping_status":"open","template":"","toolkit":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Healthy Newborn Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"An Afghan Success Story: Fewer Child Deaths - Healthy Newborn Network\" \/>\n<meta property=\"og:description\" content=\"Afghanistan still has one of the highest child mortality rates in the world, and there could be significant backsliding.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/\" \/>\n<meta property=\"og:site_name\" content=\"Healthy Newborn Network\" \/>\n<meta property=\"article:modified_time\" content=\"2017-08-21T22:10:57+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/NPR_0.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"160\" \/>\n\t<meta property=\"og:image:height\" content=\"160\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/\",\"url\":\"https:\/\/www.healthynewbornnetwork.org\/resource\/an-afghan-success-story-fewer-child-deaths\/\",\"name\":\"An Afghan Success Story: Fewer Child Deaths - 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Interventions include skilled care at birth, basic and comprehensive obstetric care, and management of preterm births.<\/h2>\n<p>It is important that the childbirth care interventions for mother and newborn are seen as a functional unit delivered in a narrow time window by the same healthcare provider (or team) and in the same place, with referral for management of complications including mother and baby together.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">1.3<\/span>m<\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1666029713081{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of intrapartum stillbirths globally in 2015<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">66<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690994883939{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percent of births attended by a skilled health professional in least developed countries (2016-2023)<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-blue\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">18<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690994111505{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percent of cesarean section deliveries globally (2016 - 2021)<br \/>\n<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][\/vc_column_inner][\/vc_row_inner][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a>\u00a0page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"More information\"][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]The interaction between skilled healthcare workers and mothers before, during, and just after labor is critical for saving lives and ensuring good, healthy birth outcomes. Best practices include ensuring mothers are involved in the decision-making (including where they will give birth) and are provided with supportive care at all stages and that the birth proceeds without intervention as long as labor progresses normally and the woman and baby are well. When complications arise, health workers must be ready to respond appropriately.[\/vc_column_text][vc_text_separator title=\"Key resources\"][\/vc_column][\/vc_row][vc_row][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<ul>\n<li><a href=\"https:\/\/www.unfpa.org\/sowmy\">State of the World\u2019s Midwifery Report<\/a><a href=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/MCPC-2nd-ed.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u00a0<\/a>(2021)<\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/MCPC-2nd-ed.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">WHO guidelines Managing complications in pregnancy and childbirth: A guide for midwives and doctors\u00a0<\/a>(2017)<\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/every-newborn-action-plan\/\" target=\"_blank\" rel=\"noopener\">Every Newborn Action Plan<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<ul>\n<li><a href=\"https:\/\/www.who.int\/tools\/essential-newborn-care-training-course\">Essential Newborn Care Course<\/a>\u00a0\u2013 interim version of the second edition (2022)<\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/blog\/ending-preventable-stillbirths-requires-improving-quality-of-care\/\" target=\"_blank\" rel=\"noopener\">Ending Preventable Stillbirths requires improving quality of care<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","post_title":"Childbirth care","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"childbirth-care","to_ping":"","pinged":"","post_modified":"2023-08-02 12:48:31","post_modified_gmt":"2023-08-02 16:48:31","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&#038;p=117","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":135,"post_author":"7211","post_date":"2015-10-21 15:20:52","post_date_gmt":"2015-10-21 15:20:52","post_content":"[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]\r\n<h2>Many countries, even those that have achieved improvements in the last 15 years, still experience high rates of maternal and newborn deaths due to poor quality services.<\/h2>\r\nPoor quality can affect the demand for care from communities. Accelerating reduction of preventable deaths and poor outcomes depends on service quality improvements, including addressing health system challenges such as infrastructure, supplies, skilled and appropriately deployed health providers, and management. Quality improvement systems that address both the content and standards as well as the process and experience of care should be an important area of investment during the period of the new <a href=\"http:\/\/www.un.org\/sustainabledevelopment\/sustainable-development-goals\/\" target=\"_blank\">Sustainable Development Goals<\/a>.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_single_image image=\"13784\"][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_empty_space height=\"16px\"][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]","post_title":"Quality improvement","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"quality-improvement","to_ping":"","pinged":"","post_modified":"2016-02-25 15:58:05","post_modified_gmt":"2016-02-25 20:58:05","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&#038;p=135","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":323,"post_author":"7211","post_date":"2016-01-12 17:55:54","post_date_gmt":"2016-01-12 17:55:54","post_content":"<p>[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453922923730{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<h2>As reflected in Millennium Development Goals 4 and 5 and now the Sustainable Development Goals, our objective is to <strong>reduce the global burden of preventable deaths<\/strong>.<\/h2>\n<p>In the case of newborn work, we focus particularly on stillbirths, maternal deaths, and newborn deaths. Meeting our objectives at the level of whole populations requires that we do much better in ensuring that the highest proportion possible adopt key practices and receive specific interventions. We need <strong>high effective coverage at scale<\/strong> for key behaviors and specific high-impact elements of care. While \u201cscaling-up\u201d may be part of how we achieve sustained impact at scale, we must guard against scale-up as an end in itself. It is easy to fall into the \u201cempty scale-up\u201d trap.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">287<\/span>k<\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690998058971{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of women who died due to pregnancy or childbirth-related complications in 2020<br \/>\n<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">5<\/span>m<\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1651603452364{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of children under age 5 who died in 2020<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-blue\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">47<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1651603474028{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of all under-5 deaths that occurred during the first 28 days of life in 2020<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_empty_space][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"More information\"][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]Where effective coverage is low, program efforts need to contribute to increasing and sustaining improved coverage. In some instances the interventions are already available and in use but at low effective coverage. In these cases improved delivery is needed \u2013 which may entail strengthened implementation or new delivery strategies. In situations where effective interventions are novel and not yet widely introduced, these methods may require some kind of scaling-up process to increase coverage. Because there are important differences between settings, a specific strategy or package will not be the answer for all settings.[\/vc_column_text][vc_column_text]<strong>Key resources<\/strong>:<\/p>\n<ul>\n<li><a href=\"http:\/\/www.expandnet.net\/tools.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Expandnet scale-up resources<\/a><\/li>\n<li><a href=\"https:\/\/www.msiworldwide.com\/sites\/default\/files\/additional-resources\/2018-11\/ScalingUp_3rdEdition.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Scaling Up\u2014From Vision to Large-scale Change: A Management Framework for Practitioners<\/a><\/li>\n<li><a href=\"http:\/\/implementationscience.biomedcentral.com\/articles\/10.1186\/s13012-016-0374-x\" target=\"_blank\" rel=\"noopener noreferrer\">A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa.<\/a><\/li>\n<li><a href=\"http:\/\/www.mcsprogram.org\/resources\/lessons-learned-from-the-scale-up-experience-of-six-high-impact-interventions-in-reproductive-maternal-newborn-and-child-health\/\" target=\"_blank\" rel=\"noopener noreferrer\">Lessons Learned from the Scale-Up Experience of Six High-Impact Interventions in Reproductive, Maternal, Newborn, and Child Health<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<strong>Related\u00a0resources<\/strong>:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/Empty-Scale-up-Meeting-Report.pdf\">Empty Scale-Up Meeting Report<\/a><\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/Empty-Scale-Up-Working-Paper_Dec2016.pdf\">Empty Scale-Up\u00a0Draft Working Paper<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_row_inner][vc_column_inner][vc_btn title=\"Scaling Up Substance Working Group\" color=\"1\" link=\"url:https%3A%2F%2Fwww.healthynewbornnetwork.org%2Fworking-group%2Fscaling-up-substance%2F||\"][vc_column_text]<\/p>\n<h3>Note: This working group is for members only. If you are a member on HNN, please log in <a href=\"https:\/\/www.healthynewbornnetwork.org\/login\/\">here<\/a> and email <strong><a href=\"mailto:info@healthynewbornnetwork.org\">info@healthynewbornnetwork.org<\/a> <\/strong>to join this working group. If you are not a member, please register <a href=\"https:\/\/www.healthynewbornnetwork.org\/join-the-network\/\">here<\/a> and tell us in your short bio that you\u2019d like to join this working group.<\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n","post_title":"Scale-up","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"scale-up","to_ping":"","pinged":"","post_modified":"2023-08-02 13:42:00","post_modified_gmt":"2023-08-02 17:42:00","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&#038;p=323","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":124,"post_author":"7211","post_date":"2015-10-21 15:18:57","post_date_gmt":"2015-10-21 15:18:57","post_content":"<p>[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<h2>In order to meet our maternal and newborn health objectives, we need health professionals and community health workers that:<\/h2>\n<ul>\n<li>Are readily available where and when needed<\/li>\n<li>Have the necessary knowledge and skills for the services they are providing<\/li>\n<li>Are appropriately motivated to provide the needed service<\/li>\n<li>Are adequately supported and enabled with supervision, support systems (supply chain and\u00a0information systems), necessary infrastructure (space, water, electricity, and communications), and more<\/li>\n<\/ul>\n<p>Ensuring that this set of conditions is met depends on adequate human resources policy and management.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">82<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1691004009799{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of global births that were assisted by suitably qualified health workers between 2016 and 2021<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">66<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1691004076215{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of women in least developed countries that were assisted by suitably qualified health workers during birth between 2016 and 2021<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][vc_row_inner content_placement=\"middle\"][vc_column_inner][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"More information\"][\/vc_column][\/vc_row][vc_row][vc_column width=\"1\/2\"][vc_column_text]Over the past decade and a half, considerable emphasis within global maternal-newborn health programs has been placed on \u201cskilled birth attendance,\u201d i.e., births assisted by suitably qualified health workers. This reflects the observation that for women delivering at home without ready access to emergency obstetrical care, support from traditional birth attendants proved inadequate to substantially reduce risk of death for the mother or newborn. Considerable effort has been expended in many settings to help ensure that women give birth with the assistance of qualified human resources, specifically a health worker, and generally in a health facility.<\/p>\n<p>However, in many instances there has not\u00a0been equal attention given to the actual substance of the care provided or the necessary supports to enable health workers to provide adequate care. In recent years, there has been increasing attention in program work to the quality and content of maternal-newborn services, particularly around the time of birth. This is reflected in current work at the World Health Organization on improving quality of maternal-newborn health care.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\"][vc_column_text]Part of what is implied in the \u201cskilled birth attendance\u201d strategy is that assisting in childbirth does not necessarily require a physician. Many interventions related to maternal-newborn health can be competently delivered by categories of health workers with comparatively modest training.<\/p>\n<p>Accordingly, certain maternal-newborn services can be provided by categories of health workers labelled as \u201ccommunity health workers\u201d (CHWs). This is a broad designation that includes:<\/p>\n<ul>\n<li>Health auxiliaries with training sometimes approaching that of registered nurses<\/li>\n<li>Paid full-time workers with several months of basic training<\/li>\n<li>Non-salaried but financially \u201cincentivized\u201d workers, typically working less than full-time<\/li>\n<li>Volunteers providing services on a periodic or intermittent basis with little or no financial incentives<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_single_image image=\"13796\" add_caption=\"yes\" alignment=\"center\" css_animation=\"appear\"][vc_column_text]In some settings, there is more than one tier of CHWs.\u00a0When robustly supported (as they can be under project conditions), non-salaried and volunteer CHWs have been demonstrated as effective for various maternal- and newborn-related services. There are fewer examples of such work being effectively delivered at national scale, under non-project conditions. A very important but frequently neglected factor is the supports needed for effective programs.<\/p>\n<p>The issue is not so much,<\/p>\n<ul>\n<li><em><strong>can <\/strong>CHWs be effective for a particular service?<\/em><\/li>\n<\/ul>\n<p>But rather,<\/p>\n<ul>\n<li><em><strong>what supports are necessary<\/strong> for effectiveness?<\/em><\/li>\n<\/ul>\n<p>And,<\/p>\n<ul>\n<li><em><strong>are such supports feasible at scale<\/strong> under normal, non-project conditions?<\/em><\/li>\n<\/ul>\n<p>Program efforts commonly address health worker knowledge and skills. This is typically done primarily by training. Motivation is less often given focused attention. Certainly, some aspects of performance can be positively affected by financial incentives, although such incentives can also have unintended negative consequences. However, motivation is more than just a matter of incentives.<\/p>\n<p>In many settings, legitimate and illegitimate absences from work significantly undermine reliable access to services. This can be a consequence, for example, of frequent off-site trainings. There are also many settings where health workers are either frequently away from their posts without authorization or where they offer services only for very limited periods of time each day.<\/p>\n<p>Even when health workers are at their posts, their practices are affected not only by material they may have been exposed to in training but also by other influences on what they consider appropriate care. For example, health workers may be well aware of what treatments are recommended or authorized in national treatment guidelines but may -- for any number of reasons -- prefer to offer treatments not reflected in official protocols. For human resources program efforts to be effective in ensuring availability of appropriate care, they need to respond to the actual factors influencing health worker practices.<\/p>\n<p>Supervision is often mentioned as an important performance factor in health worker practices. Certainly under project conditions, there are numerous examples of \u201csupportive technical supervision\u201d or \u201cmentoring\u201d that appear to have made a positive contribution to quality of care. There are, however, far fewer examples of this function being effectively delivered under non-project conditions. Health-facility-level quality improvement efforts can serve a somewhat similar function, whereby groups of health staff work collectively to improve performance, holding each other accountable.[\/vc_column_text][vc_column_text]<strong>Key resources<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/apps.who.int\/iris\/handle\/10665\/77764\">WHO Recommendations: Optimizing health worker roles for maternal and newborn health<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","post_title":"Human resources for health","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"human-resources","to_ping":"","pinged":"","post_modified":"2023-08-02 15:22:01","post_modified_gmt":"2023-08-02 19:22:01","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&#038;p=124","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"additional_authors":"","authors":false,"other_organizations":"","language":[],"type":"","external_links":[{"link":""}],"files":[{"file":false}],"regions":[{"ID":249,"post_author":"7211","post_date":"2015-11-22 21:37:22","post_date_gmt":"2015-11-22 21:37:22","post_content":"","post_title":"Middle East","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"middle-east","to_ping":"","pinged":"","post_modified":"2016-02-11 21:49:15","post_modified_gmt":"2016-02-11 21:49:15","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=region&#038;p=249","menu_order":0,"post_type":"region","post_mime_type":"","comment_count":"0","filter":"raw"}],"countries":[{"ID":147,"post_author":"7211","post_date":"2015-10-21 21:49:29","post_date_gmt":"2015-10-21 21:49:29","post_content":"[vc_row][vc_column css=\".vc_custom_1453305596740{padding-top: 30px !important;padding-bottom: 30px !important;}\"][vc_text_separator title=\"Leading causes of neonatal deaths in Afghanistan (2020)\" el_class=\"transform:upperclass\"][vc_row_inner][vc_column_inner][vc_round_chart type=\"doughnut\" stroke_width=\"1\" stroke_color=\"custom\" values=\"%5B%7B%22title%22%3A%222%25%20Diarrhoea%22%2C%22value%22%3A%222%25%22%2C%22color%22%3A%22vista-blue%22%7D%2C%7B%22title%22%3A%221%25%20Tetanus%22%2C%22value%22%3A%221%25%22%2C%22color%22%3A%22mulled-wine%22%2C%22custom_color%22%3A%22%2358b9da%22%7D%2C%7B%22title%22%3A%228%25%20Pneumonia%22%2C%22value%22%3A%228%25%22%2C%22color%22%3A%22peacoc%22%7D%2C%7B%22title%22%3A%2238%25%20Preterm%20birth%20complications%22%2C%22value%22%3A%2238%25%22%2C%22color%22%3A%22blue%22%7D%2C%7B%22title%22%3A%2219%25%20Intrapartum%20related%20events%22%2C%22value%22%3A%2219%25%22%2C%22color%22%3A%22turquoise%22%7D%2C%7B%22title%22%3A%226%25%20Sepsis%20and%20other%20infectious%20conditions%20of%20the%20newborn%22%2C%22value%22%3A%226%25%22%2C%22color%22%3A%22pink%22%7D%2C%7B%22title%22%3A%226%25%20Congenital%20abnormalities%5Ct%22%2C%22value%22%3A%226%25%22%2C%22color%22%3A%22violet%22%7D%2C%7B%22title%22%3A%2220%25%20Other%20conditions%22%2C%22value%22%3A%2220%25%22%2C%22color%22%3A%22chino%22%7D%5D\" custom_stroke_color=\"#f6f6f4\" css=\".vc_custom_1685470668884{padding-right: 30px !important;padding-left: 30px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: contain !important;}\"][\/vc_column_inner][\/vc_row_inner][vc_column_text]\r\n<h6 style=\"text-align: left;\">Source: Estimates for causes of death 2000-2020 generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) 2023 and downloaded from <a href=\"http:\/\/data.unicef.org\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/data.unicef.org&amp;source=gmail&amp;ust=1551964625737000&amp;usg=AFQjCNFsFTtu9FzS8H64YC88NPOzQVbPwQ\">http:\/\/data.unicef.org<\/a><\/h6>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" gap=\"5\" css=\".vc_custom_1453306441839{background-image: url(\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/country-stat-bkgr.jpg?id=389) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}\"][vc_column css=\".vc_custom_1453306493120{margin-top: 30px !important;margin-bottom: 30px !important;}\"][vc_text_separator title=\"key indicators\" el_class=\"transform:uppercase text-white\"][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685471181545{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">34.1<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Newborn mortality rate (deaths per 1,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685471257865{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><strong><span style=\"color: #d9a23b;\"><span class=\"ticker\">2.8<\/span><\/span><\/strong><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Annual reduction in newborn mortality rate 2000-2021 (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685470494581{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">63<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Proportion of under-5 child deaths that are newborn (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685470521791{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">25.7<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Stillbirth rate (deaths per 1,000 births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685471095184{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">61.8<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Skilled birth attendance (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1578830229757{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">63<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Early initiation of breastfeeding (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1698691569988{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">13.2<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Preterm birth rate (births &lt;37 weeks per 100 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685470628487{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">620<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Maternal mortality ratio (deaths per 100,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_column_text css=\".vc_custom_1453307990481{margin-top: 20px !important;}\"]\r\n<h5 style=\"text-align: center;\"><span style=\"color: #ffffff;\">Visit our<\/span> <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> <span style=\"color: #ffffff;\">page to explore the most recent data further<\/span><\/h5>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Afghanistan","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"afghanistan","to_ping":"","pinged":"","post_modified":"2023-10-30 14:44:55","post_modified_gmt":"2023-10-30 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