India<\/a>, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level.<\/p>\nMaterials and Methods<\/h2>\n
A situation analysis was conducted through a mixed-methods approach to identify the lacunae in the health system and develop an implementation strategy to improve newborn vaccination coverage across six priority states in India.<\/p>\n
Results<\/h2>\n
Issues in stewardship and human resources, vaccine-related stock-outs, and poor service delivery were some of the reasons for low facility-level vaccination coverage. After implementation of a health system\u2013based strategy, newborn vaccination improved from 55% to 88% across 10 quarters of program implementation. Factors such as sensitization of stakeholders, vaccination on holidays, rigorous documentation, and supportive supervision of health staff were primary reasons for improvement in service delivery.<\/p>\n
Conclusion<\/h2>\n
Importance of newborn immunization at birth is well established. The results from six states prove that \u201chealth systems approach\u201d as an implementation strategy is a viable tool to improve newborn immunization at birth.<\/p>\n","protected":false},"excerpt":{"rendered":"
Introduction Newborn vaccination is an integral part of routine immunization program in India, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level. Materials and Methods A situation analysis was conducted through a mixed-methods approach to identify … Continued<\/a><\/p>\n","protected":false},"author":7211,"featured_media":36678,"comment_status":"open","ping_status":"closed","template":"","toolkit":[],"acf":[],"yoast_head":"\nHealthy 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\/experience-from-six-states-of-india-implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Experience from six states of India: Implementation of \u201chealth systems approach\u201d to improve vaccination at birth in institutional deliveries at public health facilities - Healthy Newborn Network\" \/>\n<meta property=\"og:description\" content=\"Introduction Newborn vaccination is an integral part of routine immunization program in India, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level. Materials and Methods A situation analysis was conducted through a mixed-methods approach to identify … Continued\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.healthynewbornnetwork.org\/resource\/experience-from-six-states-of-india-implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities\/\" \/>\n<meta property=\"og:site_name\" content=\"Healthy Newborn Network\" \/>\n<meta property=\"article:modified_time\" content=\"2019-06-21T15:03:16+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-india.png\" \/>\n\t<meta property=\"og:image:width\" content=\"805\" \/>\n\t<meta property=\"og:image:height\" content=\"927\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\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=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.healthynewbornnetwork.org\/resource\/experience-from-six-states-of-india-implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities\/\",\"url\":\"https:\/\/www.healthynewbornnetwork.org\/resource\/experience-from-six-states-of-india-implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities\/\",\"name\":\"Experience from six states of India: Implementation of \u201chealth systems approach\u201d to improve vaccination at birth in institutional deliveries at public health facilities - 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from six states of India: Implementation of \u201chealth systems approach\u201d to improve vaccination at birth in institutional deliveries at public health facilities"}]},{"@type":"WebSite","@id":"https:\/\/www.healthynewbornnetwork.org\/#website","url":"https:\/\/www.healthynewbornnetwork.org\/","name":"Healthy Newborn Network","description":"Addressing critical knowledge gaps in newborn health.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.healthynewbornnetwork.org\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"}]}},"featured_image":"<img width=\"768\" height=\"884\" src=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-india-768x884.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" decoding=\"async\" srcset=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-india-768x884.png 768w, https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-india-261x300.png 261w, https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-india.png 805w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>","author_name":"HNN Team","author_image":"<img src=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/themes\/hnn\/dist\/images\/member-default.jpg\" alt=\"\" class=\"avatar avatar-32 photo\" height=\"32\" width=\"32\"\/>","acf_custom_fields":{"publication_date":"20190531","authors":[{"ID":4827,"user_firstname":"Rakesh","user_lastname":"Parashar","nickname":"Dr Rakesh Parashar","user_nicename":"dr-rakesh-parashar","display_name":"Rakesh Parashar","user_email":"drrakesh.parashar@gmail.com","user_url":"","user_registered":"2017-05-16 11:17:23","user_description":"I am a physician and public health professional working for improving health outcomes of mothers and children in India. My core focus of work has been around strengthening health systems to respond persisting and emerging needs of health of mothers and newborn, specially stillbirths and newborn deaths. Currently, I am associated with USAID - Vriddhi (Scaling Up RMNCHA) interventions project, in India. \r\nMy key interest areas for research and action are building high quality health systems, addressing inequities in mother and newborn health and innovative and feasible implementation models in health service delivery.","user_avatar":"<img alt='' src='https:\/\/secure.gravatar.com\/avatar\/3c58614ce93e0a45bc3c04c8b4cd7674?s=96&d=mm&r=g' srcset='https:\/\/secure.gravatar.com\/avatar\/3c58614ce93e0a45bc3c04c8b4cd7674?s=192&d=mm&r=g 2x' class='avatar avatar-96 photo' height='96' width='96' decoding='async'\/>"},{"ID":4649,"user_firstname":"Gunjan","user_lastname":"Taneja","nickname":"gunjan","user_nicename":"gunjan","display_name":"Gunjan Taneja","user_email":"gunjan_mgm@yahoo.co.in","user_url":"","user_registered":"2016-12-07 17:59:36","user_description":"I am right now working as the National Technical Lead in the USAID supported VRIDDHI (Scaling up RMNCH+A Interventions) Project where we provide techno-managerial support to the National Ministry and 6 states of the country where USAID is the State Lead Partner (SLP) in planning, implementation and monitoring of key RMNCH+A Interventions. My current job profile involves an integral component of leadership and entails overall backstopping to a team of more than 75 public health professionals working in various technical capacities, supporting the Ministry of Health and Family Welfare (MoHFW), Government of India, 6 states of the country and 26 High Priority Districts (HPDs) to design, plan, monitor, implement and scale up RMNCH+A interventions. In addition working closely with the MoHFW, I am involved with formulation of policy guidelines and decisions which intend to have an overarching impact across the country.\r\nSince completing my Post Graduation in Community Medicine in 2010, I have worked with USAID supported projects (apart for a brief period from August to November 2011). For more than 5 years I worked in the state of Jharkhand which has been a priority state for Government of India due to poor socio demographic indicators. My district level experience gave me exposure to the operational aspects of health programs and role of health systems at implementation level while the state level work helped me understand the nuances of adopting and aligning national programs to state contextualities. Now at the National level, this experience is immensely helpful in designing robust and comprehensive implementation models with strong components of evidence based technical interventions and health systems strengthening. Very recently I have been instrumental in designing and implementing the Supportive Supervision mechanism for Reproductive Maternal Newborn Child and Adolescent Health (RMNCHA+) strategy in Jharkhand which was subsequently scaled up across 184 High Priority Districts (HPDs) of India impacting an annual cohort of impacting 8.3 million pregnant women and 7.6 million infants. In addition I have led the designing of the Care around Birth strategy: an integrated approach to improve Quality of Care for Maternal and Newborn Health during and around birth which is being implemented across 141 high case load government health facilities with an annual birth cohort of more than 200,000 across 26 High Priority Districts (HPDs) of the country. I have also been closely associated with the development of an implementation model for Community Based Advance Distribution of Misoprostol in the country.","user_avatar":"<img alt='' src='https:\/\/secure.gravatar.com\/avatar\/0b9066a5932d5d2f47ad565ba6dd8591?s=96&d=mm&r=g' srcset='https:\/\/secure.gravatar.com\/avatar\/0b9066a5932d5d2f47ad565ba6dd8591?s=192&d=mm&r=g 2x' class='avatar avatar-96 photo' height='96' width='96' decoding='async'\/>"}],"additional_authors":"Rajeev Gera, Neelesh Kapoor, Pradeep Haldar, Sachin Gupta, Shailendra Singh Tomar, DP Taneja, Saumyadripta Chaudhuri, Subodh Chandra","type":"articles","language":["en"],"external_links":[{"link":"http:\/\/www.jfmpc.com\/article.asp?issn=2249-4863;year=2019;volume=8;issue=5;spage=1630;epage=1636;aulast=Gera"}],"files":[{"file":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/implementation-of-health-systems-approach-to-improve-vaccination-at-birth-in-institutional-deliveries-at-public-health-facilities-experience-from-six-states-of-India.pdf"}],"partners":[{"ID":834,"post_author":"2613","post_date":"2010-10-25 19:41:46","post_date_gmt":"2010-10-25 19:41:46","post_content":"<p>The U.S. Agency for International Development (USAID) is an independent agency that provides economic, development and humanitarian assistance around the world in support of the foreign policy goals of the United States.<\/p>\r\n<p>U.S. foreign assistance has always had the twofold purpose of furthering America's foreign policy interests in expanding democracy and free markets while improving the lives of the citizens of the developing world. Spending less than one-half of 1 percent of the federal budget, USAID works around the world to achieve these goals.<\/p>\r\n<p>USAID's history goes back to the Marshall Plan reconstruction of Europe after World War Two and the Truman Administration's Point Four Program. In 1961, the Foreign Assistance Act was signed into law and USAID was created by executive order.<\/p>\r\n<p>Since that time, USAID has been the principal U.S. agency to extend assistance to countries recovering from disaster, trying to escape poverty, and engaging in democratic reforms.<\/p>\r\n<p>USAID is an independent federal government agency that receives overall foreign policy guidance from the Secretary of State. <a href=\"http:\/\/www.usaid.gov\/our_work\/\">Our Work <\/a>supports long-term and equitable economic growth and advances U.S. foreign policy objectives by supporting:<\/p>\r\n<ul>\r\n <li> economic growth, agriculture and trade;<\/li>\r\n <li> global health; and,<\/li>\r\n <li> democracy, conflict prevention and humanitarian assistance. <\/li>\r\n<\/ul>\r\n<p>We provide assistance in five regions of the world:<\/p>\r\n<ul>\r\n <li> <a href=\"http:\/\/www.usaid.gov\/locations\/sub-saharan_africa\/\">Sub-Saharan Africa<\/a>;<\/li>\r\n <li> <a href=\"http:\/\/www.usaid.gov\/locations\/asia\/\">Asia<\/a>;<\/li>\r\n <li> <a href=\"http:\/\/www.usaid.gov\/locations\/latin_america_caribbean\/\"> Latin America and the Caribbean<\/a>,<\/li>\r\n <li> <a href=\"http:\/\/www.usaid.gov\/locations\/europe_eurasia\/\"> Europe and Eurasia<\/a>; and<\/li>\r\n <li> <a href=\"http:\/\/www.usaid.gov\/locations\/middle_east\/\">The Middle East<\/a>. <\/li>\r\n<\/ul>\r\n<p>With headquarters in Washington, D.C., USAID's strength is its field offices around the world. We work in close partnership with private voluntary organizations, indigenous organizations, universities, American businesses, international agencies, other governments, and other U.S. government agencies. USAID has working relationships with more than 3,500 American companies and over 300 U.S.-based private voluntary organizations.<\/p>\r\n<h2>What we do<\/h2>\r\n<p>The objective of USAID’s neonatal program is to reduce neonatal mortality by building on and strengthening neonatal interventions within existing maternal and child health programs and linking with prevention of mother-to-child transmission (PMTCT) in high HIV\/AIDS prevalence countries.<\/p>\r\n<p>Key program strategies include treating the mother and baby as a dyad by integrating maternal and newborn programs to support the full continuum of care during pregnancy, labor and birth, and after the birth of the baby with evidence-based perinatal and newborn interventions. USAID programs strengthen community-based approaches and empower families and communities to care for the newborn with simple preventive interventions such as warmth, hygienic cord care, early and exclusive breastfeeding, and to recognize and refer for complications such as infection. The program links communities to facilities, strengthens health systems, trains health providers, and improves quality of care in health facilities.<\/p>\r\n<p>By putting a spotlight on postpartum care, USAID has renewed its program efforts to strengthen the weakest link in the continuum of care to reach new mothers and their newborns for health services and information when most maternal and neonatal deaths occur. In a relatively new and evolving field, USAID’s newborn care program supports operations research to guide the identification, bundling, and scaling up of interventions and emphasizes the support of global and regional leadership and advocacy.<\/p>","post_title":"U.S. Agency for International Development","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"us-agency-international-development","to_ping":"","pinged":"","post_modified":"2016-01-21 19:44:00","post_modified_gmt":"2016-01-21 19:44:00","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=partner&p=834","menu_order":0,"post_type":"partner","post_mime_type":"","comment_count":"0","filter":"raw"}],"other_organizations":"Ministry of Health and Family Welfare, Government of India","issues":[{"ID":408,"post_author":"7211","post_date":"2016-01-20 17:59:41","post_date_gmt":"2016-01-20 17:59:41","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>While the term \u201cessential newborn care\u201d can be used in a variety of ways, the Healthy Newborn Network uses the term to refer to key routine practices in the care of the newborn, particularly at the time of birth and over the first hours of life, whether in the health facility or at home.<\/h2>\r\n[\/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]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">800<\/span>k<\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1667425498849{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of children under age 5 who <a href=\"https:\/\/www.healthynewbornnetwork.org\/blog\/the-lancet-breastfeeding-series\/\">might be saved every year<\/a> if optimally breastfed<\/span><\/h3>\r\n[\/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]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">44<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1666041181328{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percent of babies who are exclusively breastfed during their first six months of life globally (2014-2020)<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_column_text]\r\n<h6 style=\"text-align: center;\"><span style=\"font-style: italic;\">All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<\/span><a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\"><span style=\"font-style: italic;\">Newborn Numbers<\/span><\/a><span style=\"font-style: italic;\">\u00a0page and download the Excel spreadsheet to explore the data further.<\/span><\/h6>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" css=\".vc_custom_1452696349804{margin-top: 30px !important;margin-bottom: 30px !important;background-color: #f6f6f4 !important;}\"][vc_column][vc_text_separator title=\"More information\"][vc_column_text]Essential newborn care includes:\r\n<ul>\r\n \t<li>early initiation and exclusive breastfeeding<\/li>\r\n \t<li>thermal care (including prompt drying and covering at birth, maximizing skin-to-skin contact, delayed bathing, maintaining \u201cwarm chain\u201d)<\/li>\r\n \t<li>hygiene practices (including cord-care and caregiver handwashing)<\/li>\r\n<\/ul>\r\nThere is good evidence that adherence to these recommended practices substantially reduces mortality risk, especially for very small newborns. Health service contacts (notably associated with antenatal care and the hospital admission for childbirth) are important opportunities to influence these practices. In some settings, community health workers (CHWs) can serve as important channels to influence adoption of these practices among pregnant women.[\/vc_column_text][vc_text_separator title=\"Key Resources\"][vc_column_text]\r\n<ul>\r\n \t<li><a href=\"https:\/\/www.who.int\/tools\/essential-newborn-care-training-course\">Essential Newborn Care Course (WHO)<\/a>\u00a0\u2013 interim version of the second edition (2022)<\/li>\r\n \t<li><a href=\"https:\/\/www.aap.org\/en\/aap-global\/helping-babies-survive\/enc-now\/\" target=\"_blank\" rel=\"noopener\">ENC Now! (<\/a><a href=\"https:\/\/www.aap.org\/en\/aap-global\/helping-babies-survive\/enc-now\/\" target=\"_blank\" rel=\"noopener\">American Academy of Pediatrics (AAP) and Laerdal Global Health)<\/a><a href=\"https:\/\/www.aap.org\/en\/aap-global\/helping-babies-survive\/enc-now\/\" target=\"_blank\" rel=\"noopener\">\u00a0<\/a> \u2013 a digital version of the new WHO Essential Newborn Care 1 Basic Course (ENC) (formerly Helping Babies Breathe). (2022)<\/li>\r\n \t<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/no-harm-technical-briefs\/\" target=\"_blank\" rel=\"noopener\">Every Preemie\u2014SCALE: Do No Harm Technical Briefs<\/a> (2019)<\/li>\r\n \t<li><a href=\"http:\/\/www.who.int\/nutrition\/topics\/bfhi\/en\/\" target=\"_blank\" rel=\"noopener noreferrer\">Baby-friendly Hospital Initiative (WHO) <\/a>(2018)<\/li>\r\n<\/ul>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Essential newborn care","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"essential-newborn-care","to_ping":"","pinged":"","post_modified":"2022-11-02 17:44:19","post_modified_gmt":"2022-11-02 21:44:19","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=408","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&p=323","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"regions":[{"ID":251,"post_author":"7211","post_date":"2015-11-22 21:37:22","post_date_gmt":"2015-11-22 21:37:22","post_content":"","post_title":"Asia","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"asia","to_ping":"","pinged":"","post_modified":"2016-02-11 21:51:07","post_modified_gmt":"2016-02-11 21:51:07","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=region&p=251","menu_order":0,"post_type":"region","post_mime_type":"","comment_count":"0","filter":"raw"}],"countries":[{"ID":184,"post_author":"7211","post_date":"2015-10-21 21:58:21","post_date_gmt":"2015-10-21 21:58:21","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 India (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%221%25%20Diarrhoea%22%2C%22value%22%3A%221%25%22%2C%22color%22%3A%22vista-blue%22%7D%2C%7B%22title%22%3A%220%25%20Tetanus%22%2C%22value%22%3A%220%25%22%2C%22color%22%3A%22mulled-wine%22%2C%22custom_color%22%3A%22%23cec2ab%22%7D%2C%7B%22title%22%3A%227%25%20Pneumonia%22%2C%22value%22%3A%227%25%22%2C%22color%22%3A%22peacoc%22%7D%2C%7B%22title%22%3A%2239%25%20Preterm%20birth%20complications%22%2C%22value%22%3A%2239%25%22%2C%22color%22%3A%22blue%22%7D%2C%7B%22title%22%3A%2221%25%20Intrapartum%20related%20events%22%2C%22value%22%3A%2221%25%22%2C%22color%22%3A%22turquoise%22%7D%2C%7B%22title%22%3A%225%25%20Sepsis%20and%20other%20infectious%20conditions%20of%20the%20newborn%22%2C%22value%22%3A%225%25%22%2C%22color%22%3A%22pink%22%7D%2C%7B%22title%22%3A%229%25%20Congenital%20abnormalities%5Ct%22%2C%22value%22%3A%229%25%22%2C%22color%22%3A%22violet%22%7D%2C%7B%22title%22%3A%2218%25%20Other%20conditions%22%2C%22value%22%3A%2218%25%22%2C%22color%22%3A%22chino%22%7D%5D\" custom_stroke_color=\"#f6f6f4\" css=\".vc_custom_1686158564827{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&source=gmail&ust=1551964625737000&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_1686158668744{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">19.1<\/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_1686158653873{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">4<\/span><\/strong><\/span><\/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_1686158622111{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">62<\/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_1686158639136{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">12.2<\/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_1686158578078{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">89.4\r\n<\/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_1651070613999{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">57<\/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_1698696298715{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">13<\/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 <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_1686158608753{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">103<\/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":"India","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"india","to_ping":"","pinged":"","post_modified":"2023-10-30 16:03:36","post_modified_gmt":"2023-10-30 20:03:36","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=country&p=184","menu_order":0,"post_type":"country","post_mime_type":"","comment_count":"0","filter":"raw"}],"views":"1570"},"_links":{"self":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource\/36676"}],"collection":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource"}],"about":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/types\/resource"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/users\/7211"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/comments?post=36676"}],"version-history":[{"count":0,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource\/36676\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media\/36678"}],"wp:attachment":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media?parent=36676"}],"wp:term":[{"taxonomy":"toolkit","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/toolkit?post=36676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}