8. nguyen van hai
TRANSCRIPT
Research to Advocacy, Policy, and Action
Evidence for effectiveness of interventions in newborn care at district level
Evidence for effectiveness of interventions in newborn care at district level
Presented by: Nguyen Van Hai
Saving Newborn Lives (SNL), Save the Children, Vietnam
August, 2010
Overview of SNL
SNL is implemented in 18 countries globally (9 in Africa, 7 in Asia, including Vietnam, 2 in LAC)
Vietnam:“Demonstrate an effective, feasible and scalable
intervention package for newborn health that can be replicated at scale”
Timeframe: Jan, 2008 – Oct, 2011Donor: The Bill and Melinda Gates FoundationLocation: Thanh Hoa province
Background
Country situation – some figures– Over 20,000 newborns still die each year.[1]– NMR is 15-30%o .[2]– NMR takes ½ Under-five child mortality rate – NMR takes > 70% of infant mortality rate,– NMR varies across 7 regions of Vietnam – High NMR falls in the northern mountainous and the northern
central coast regions.– Lack of availability of newborn care services at district level – Poor quality of newborn care at district and commune– Distance geographic access in remote areas– Cultural barriers – affect practice of newborn care
Source: [1] UNICEF (2008) The State of the World’s Children 2009
[2] SC (2006) Situational analysis of newborn health in Vietnam
Background
System failure– District hospitals and commune health centers
are poorly equipped.– Staff lack adequate training in essential newborn
care, and management of newborn complications.
– No unified neonatal care model at provincial and district level
Key indicators at baseline
Indicators Nhu Thanh (2006) Ngoc Lac (2006)
Population 85,227 141,436
Number of communes 17 22
Neonatal death rate (%o) 21.9* 19.4*
Delivery in health facility (%) 70 76
Home delivery rate (%) 30 24
Number of delivery per year 1,078 1,876
Source: *Reports from neonatal death screening in Thanh Hoa, March 2007
Goal: Reduced neonatal mortality in selected intervention sites
Strategic Objective: To improve use of key practices and services that protect and promote the health of newborns through the intervention package
IR 1Increased access to
and availability of key services,
equipment, and supplies for
newborn health at all levels
IR 2Increased quality of essential newborn
care and complications
management at all district and
communal levels of care
IR 3Improved
knowledge, skills, and home care
practices for newborns at
household and community levels,
and increased demand for
newborn care services
IR 4Strengthened
management, social support, and
enabling environment for
newborn survival in the intervention
sites
Result Framework
Key interventions
• IR1: Provide essential NBC equipment and IEC/BCC materials at health facilities (Commune Health Center and District Hospital); Set up NBC Unit at district hospital..
• IR2: Provide training on clinical care for doctors and nurses at district newborn care unit of District hospital..
• IR3: Provide training on IEC/BCC and conduct education and communication campaigns in selected intervention sites...
• IR4: Advocate to create enabling environment for SNL to be adopted at scale (e.g., Provincial People’s Committee, Hospital Directors, Leadership of Provincial Health Department, etc…)..
Data source
• District hospital records– NBC unit registers– Obstetric dept registers
• Community records– Maternal and neonatal registers at village– NBC complications registers at CHC
Preliminary results
IndicatorPre-intervention
(2006)Preliminary results
(2008-2009)
Ngoc Lac Nhu Thanh Ngoc Lac Nhu Thanh
# Newborn admission to district newborn care unit
N/A N/A 867 215
Treatment outcomes
Cured N/A N/A 767 178
Referred to higher level N/A N/A 79 (9%) 32 (15%)
Dead N/A N/A[1] 13 2
Request to go home N/A N/A 34 3[1] No records of newborn care and complications were available at district hospitals. It was, therefore, assumed that almost all newborns with complications were referred to higher level for treatment.
Preliminary results (cont’)
Key indicators Pre-intervention (2006)
Preliminary result (2009)
Neonatal death - Ngoc Lac - Nhu Thanh
19.4‰21.9 ‰
14.8‰8.4 ‰
Referral rate - Ngoc Lac - Nhu Thanh
95% (25%)*98% (24%)*
9%15%
Home delivery - Ngoc Lac - Nhu Thanh
23.9%30%
12.1%7.7%
Institution delivery - Ngoc Lac - Nhu Thanh
76.1%70%
87.9%92.4%
Some key indicators as a result from both institution and community-based interventions
Increased
opportunities
of investments/revenu
e
Improved
quality of
neonatal care for the hospita
l
Regain competence of district health worker
s in complications
Take advantage of availab
le human resour
ces
Avoid wastin
g human resour
ces
Contribute to improved newborn health/reduced neonatal death
Benefits for Hospital
District Newborn Care Unit
Place credit
to hospital when seeking care
Reduced non-medical costs
for patient
s
Convenient for
patients when seeking care
Benefit for community
Reduced
patient load at higher levels of care
Better management
of information
system
Bridge to
other health facilitie
s /techni
cal suppor
t to lower level
Benefits for the health sector
NEWBORN CARE UNIT AT DISTRICT HOSPITAL: INNOVATIVE APPROACH
Listen to what hospital managers say!
Dr. Nguyen Van Phung,Director of Nhu Thanh District Hospital
“The techniques of resuscitation have improved much. Other skills like place
stomach sonde ..are also advanced. This NBC Unit has changed the face and service
provision of this hospital. More patients come, that means more revenue we
collect.”
Dr. Pham Van Xuan,Director of Ngoc Lac General District Hospital
“So far, never before have we had such a professional contingent of staff. The techniques of taking blood vein, place endorcheal tube are very quick and skilled. I
hope the province can replicate this model of NBC Unit.”
Limitations
• This is an ongoing project• Data collection is ONLY in its halfway of the journey to its end date
(Oct, 2011).• Data just show facility-based interventions (IR1, IR2)• Other community-based interventions (IEC/BCC) are ongoing and
only have results at endline survey (June, 2011). • No detailed analysis of newborn complications by disease category,
case-fatality rate.• No correlation between complications and place of delivery, socio-
economic status of the family, and other health determinants
Thank you very much!