every newborn · ref: every newborn: from evidence to action to deliver a healthy start for the...

An Action Plan To End Preventable Deaths

#EveryNewborn

EVERY NEWBORN

Metrics Improvement Plan

Webinar 11 March 2015

www.everynewborn.org #EveryNewborn

ENAP Metrics Webinar Agenda

1. Overview core indicators and improvement Joy Lawn, LSHTM

2. Integrating and institutionalising • Maternal and newborn health metrics Matthews Mathai, WHO

• Other UN groups and NBITWG

Agbessi Amouzou, UNICEF

• INDEPTH network

Peter Waiswa, Makerere University, Uganda

3. ENAP Metrics meeting at WHO and outputs Suzanne Fournier, CIFF

4. Questions and discussion

5. Closing and how to get more information

www.lancet.com/series/everynewborn #EveryNewborn

Every Newborn Series

5 papers

6 comments

55 authors from 18+ countries

60+ partner organisations

Every Newborn Action Plan

Based on the evidence from the Series

Co-led by UNICEF & WHO,

Consultation >60 country governments

>80 organisations, >1000 individuals

World Health Assembly 2014 resolution

Launched June 2014

Now to action in many countries…

Main funders: Bill & Melinda Gates Foundation, USAID, Children’s Investment Fund Foundation

@joylawn


Three main streams of activities are ensuring the

action plan leads to real change in countries:

1. Country implementation: identifying and

responding to technical support needs,

supporting translation of evidence into action,

including Every Mother Every Newborn quality

improvement initiative.

2. Data and metrics: improving and

institutionalizing metrics to track coverage and

impact based on the goals and targets of the

ENAP and five strategic objectives.

3. Advocacy: strengthening maternal and

newborn health advocacy efforts globally and in

countries, building a movement for change.

Every Newborn action now:

Research as cross cutting


CO CHAIRS WHO: Matthews Mathai

LSHTM: Joy Lawn

COORDINATION GROUP

(to link to existing metrics

work, and institutionalize)

UNICEF: Agbessi Amouzou, Holly Newby

UNFPA: Sennen Hounton

SNL/NBITWG: Lara Vaz

CIFF: Suzanne Fournier

Gates: John Grove

USAID: Allisyn Moran

MHTF: linked via by ENAP management team

TASK TEAMS Task teams with initial focus on specific newborn care interventions linked

with existing initiatives especially UNCoLSC and others

ACADEMIC PARTNERS

to promote leadership

especially Africa & Asia

Three countries with EMEN project sites (Ghana, Tanzania, Bangladesh)

Two networks:

1. Mortality focus: led by INDEPTH Maternal and Newborn Group

(Peter Waiswa et al)

2. Beyond Survival /follow up of at risk newborns: led by

All India Institute of Medical Sciences (Ashok Deorari et al)

Also welcoming inputs from other institutions, partners and countries

WIDER INTEREST

GROUP

wide and inclusive

>50 at ENAP metrics improvement planning meeting by WHO Dec 2014

>100 people drawn from wider metrics community including Newborn

Indicators Technical Working Group

ENAP Metrics work and who is involved


Three tracks of work linked with ENAP metrics - overview

• Indicators for impact, coverage, process of maternal & newborn care • Initial focus on the 4 + 1 treatment interventions

• KMC (led by KMC acceleration group) • Resuscitation (UNCoLSC, USAID, SNL Bangladesh, WHO, HBB etc) • Antenatal Corticosteroids (WHO and UNCoLSC TRT etc) • Sepsis case mx (WHO, UNCoLSC etc) • CHX cord cleansing (UNCoLSC, SNL etc)

• Priority research to improve the metrics for use

Technical mapping & planning of indicators, tools & work in progress

1

Institutionalise

in national collection platforms and in global metrics architecture, with accountability

2

Leadership development to improve & use the data for action

3

• Birth and perinatal death certificates, coverage & quality • Develop and test Minimum Perinatal Dataset • Perinatal Mortality audit tool, linked to Maternal Mortality audit • Inputs to facility HMIS, Health Facility Assessments such as SARA, and to household surveys

• Testing in countries also linked to EMEN work • Southern institutions as centres of excellence • Integrated technical oversight especially with maternal health • User friendly formats eg score cards, links to accountability and parent voices (eg partnerships with E4A and WRA)


ENDING

PREVENTABLE CHILD

AND MATERNAL DEATHS

@joylawn


Lancet GH Sept 2013 : The Lancet Global Health 2013; 1:e176-e177 (DOI:10.1016/S2214-109X(13)70059-7)

Ending preventable maternal deaths Maternal mortality target also included in Every Newborn Action Plan

Global average MMR of 70 per 100,000 with different targets for different countries

Also need clear target for sexual and reproductive health (MDG 5 b)

http://www.thelancet.com/journals/langlo/article/S2214-109X(13)70059-7/abstract




Ending preventable child and newborn deaths Mortality targets in Every Newborn Action Plan and A Promise Renewed

Source: Lancet Every Newborn series, paper 2

From 2.8 to 0.8 million neonatal deaths ~100 countries have already met the target – focus on equity gaps

About 29 countries will have to more than double their rates of progress

Every Newborn target by 2030:

National NMR of 12 or less


Source: Lancet Every Newborn series, paper 2

From 2.6 to 1.1 million stillbirths Aligned with NMR target but more ambitious change needed

Stillbirths still NOT MENTIONED in any SDG document… few weeks left to change this – please sign the petition on Everynewborn.org

Also ending preventable stillbirths

Every Newborn target by 2030:

National SBR of 12 or less

11


ACTING ON

THE ACTION PLAN


5 things to do differently

Integrated Plans

Integrated service delivery, continuum of

care, coordination

Implementation & Innovation

Address health system bottlenecks, Every Mother Every Newborn initiative

Indicators & metrics Targets in post 2015

Measurement of progress and impact

Intentional leadership

development

Especially in countries with highest burden

AMBITIOUS MEASUREMENT

CHANGE IS CRITICAL TO EVERY

STEP Eg for HIV/AIDS, malaria and EPI

Investment for impact

Governance, community participation, partner

alignment


Core indicators selection during ENAP development

Step 1: Developed matrix of relevant indicators Organised according to ENAP Framework from impact (mortality) down to inputs including financial (>120 rows in the Excel!)

Step 2: Graded each indicator as follows: Direct relevance to the 5 ENAP objectives and focus (from A to C)

Current availability of the data (from 1 to 3)

Step 3: Ranked indicators By A to C, with A being closest match to ENAP focus. By 1 to 3 where 1 is most currently available

Ref: Every Newborn: From evidence to action to deliver a healthy start for the next generation. Mason et al for the Lancet Every Newborn Study Group. Lancet 2014.

Ambition to count what matters Indicators prioritised by importance (category A)

Urgent work to improve the input data, specific milestones in ENAP for this


Every Newborn action plan included core indicators Core ENAP Indicators Additional Indicators

Impact

1. Maternal Mortality Ratio

2. Stillbirth Rate Intrapartum Stillbirth Rate

3. Neonatal Mortality Rate Low birth weight rate

Preterm birth rate

Small for gestational age

Neonatal morbidity rates

Disability after neonatal conditions

Coverage:

Care for all

mothers and

newborns

4. Skilled attendant at birth

5. Early postnatal care for mothers and babies

6. Essential newborn care (tracer of immediate

breastfeeding)

Coverage:

Complications &

extra care

7. Antenatal corticosteroid use Caesarean section rate

8. Newborn resuscitation

9. Kangaroo mother care, feeding support

Chlorhexidine cord cleansing 10. Treatment of neonatal sepsis

Counting Birth registration Death registration, cause of death

ENAP service

delivery packages

(process)

Every Mother Every Newborn quality initiative

Care of small and sick newborn

Shaded = not currently routinely tracked.

Bold = indicator requiring additional evaluation for consistent measurement



ENAP Milestones by 2020

• Count births and deaths in CVRS (women, newborns and stillbirths)

• Minimum perinatal dataset & perinatal mortality audit being widely used in countries

• ENAP core indicators to be defined , incorporated in national metrics platforms and widely used

Improving, institutionalising & using ENAP metrics for action

x World Health

Assembly

May/June 2014

Dec 2014 Meeting To scope

ENAP Metrics improvement plan

June 2015 - May 2018 Testing indicators and

tools in limited number of countries

June 2018 - May 2020 Wide use in many countries CVRS, facility HMIS, surveys

linked to health systems scale up

2020

Jan- May 2015 Refining and consulting on

metrics plan & ENAP monitoring FW


Every Newborn action plan core indicators Core ENAP Indicators

Impact

1. Maternal Mortality Ratio

2. Stillbirth Rate

3. Neonatal Mortality Rate

Coverage:

Care for all mothers and

newborns

4. Skilled attendant at birth

5. Early postnatal care for mothers and babies

6. Essential newborn care (tracer of immediate breastfeeding)

Coverage:

Complications & extra care

7. Antenatal corticosteroid use

8. Newborn resuscitation

9. Kangaroo mother care, feeding support

10. Treatment of neonatal sepsis

Chlorhexidine cord cleansing

C-Section rate

Counting Birth registration

ENAP service delivery

packages (process)

Every Mother Every Newborn quality initiative

Care of small and sick newborn

Shaded = not currently routinely tracked.

Bold = indicator requiring additional evaluation for consistent measurement


Excel sheet has details of definitions and testing questions Please send questions or ideas to Harriet Rees-Forman [email protected]

Task Teams

working.

Significant

progress

New work needed on

content of care – critical to

link with maternal metrics

communities

Definitions clear – but need

better tools, improved

quantity and quality of data


Civil Registration and Vital Statistics • Birth certificates (improved weight, possibly gestational age)

• Perinatal Death certificates and ICD codes (linked to new WHO ICD-perinatal mortality classification)

Facility and HMIS • Perinatal mortality audit (linked to maternal audit)

• Minimum perinatal dataset

• DHIS2 and other HMIS collation for highly prioritised data points

• Health facility assessment tools (treatment indicators, process)

Population based surveillance and surveys (DHS/MICS) • Mortality capture including recall, misclassification of stillbirth/neonatal death and

pregnancy vs live birth

• Verbal autopsy for stillbirths and neonatal deaths

• Social autopsy

• Birth weight, birth size and gestational age

Measurement tools to be improved/developed and linked

Core perinatal dataset

•Eg as per data on ICD perinatal death certificate

Facility based

•Eg South Africa

•PPIP

More complex facility setting

•Eg Vermont Oxford neonatal network

Research studies

•Potentially with biodata


Mortality data etc

Population-based pregnancy surveillance of births, stillbirths, neonatal deaths.

Opportunities to advance validation of pregnancy history modules, verbal autopsy, improved LBW assessment etc.

Networks to ensure testing and use in many contexts

“Beyond newborn survival” data

With UNICEF and others partners in India and beyond

INDEPTH Maternal & Newborn Interest Group 20+ sites in Africa and Asia

Follow up at risk newborns by varying levels of health care

Opportunities to validate and test feasibility of follow up, screening for disability, ROP and models to improve care


Building on 3 countries working on quality initiatives including “Every Mother Every Newborn”

Ghana Tanzania Bangladesh

Validation and feasibility testing for facility-based coverage data Also tools such as audit, min perinatal dataset, simplified gest age assessment etc

Also opportunities to test similar questions in other countries and with other organisations.

Coordinated approach will yield the fastest collective progress


21




• Other UN groups and NBTWIG


• INDEPTH network






Linking metrics for maternal & newborn health WHO & partners are considering forming a Maternal Newborn Measurement Expert Reference Group (MNH MERG) Why?

• Convergence of efforts to end preventable mortality –

maternal, newborn, child

• Opportunities through harmonisation – effectiveness,,

more coordinated support for countries, more efficiency

• Greater potential for synergies in metrics innovations,

especially for tracking content and quality as well as

coverage

• Less chance of falling through the gaps – eg stillbirths

• Important common lessons learned eg on mortality audit

scale up and linking this to change

Who?

• WHO and partners will convene, learning from lessons

learned in other MERGs. May be time limited. Needs to

link to clear technical outputs







• INDEPTH network






Linking ENAP metrics improvement with other ongoing work by the UN and (many!) others

A Promise Renewed report 2014 had focus on newborns Links to many current work-streams including with H4 eg on

EmOC indicators

Countdown to 2015 linked to ENAP and the metrics work is linked in all the 4 CD technical working groups

Hopkins (JHU) grant on Improving Coverage Measurement testing specific indicators including for essential newborn care

Secretariat of NBITWG is with Saving Newborn Lives. Meets twice a year. Linked with ENAP by many organisations and individuals

Coverage Task teams for various treatment indicators (eg resuscitation, antenatal corticosteroids, Chlorhexidine etc) directly link with and build on the relevant UNCoLSC teams







• INDEPTH network






INDEPTH Maternal & Newborn Interest Group Leader: Dr Peter Waiswa Makerere University

Unique opportunity to

test and improve population-based

metrics especially for stillbirths and

neonatal deaths, LBW and preterm

birth, with mhealth

innovations

AND capacity-building







• INDEPTH network






WHO ENAP Metrics meeting December 2014 Who? >60 technical experts from Africa, Asia, North and

South America and Europe including UN, academics, clinicians, programme experts, DHS, MICS, SARA , SPA, DHIS, CVRS & many others

What? Two days of hard work! Emphasis on harmonisation

with related metrics work eg WHO QoC metrics,100 core indicator list

Results? Advances for core indicators and accelerating

improvement (ENAP metrics Improvement Plan). WHO Meeting Report in process

“Prioritization is key as ambitious timeline for collecting data at-scale!”

Selected quotes....

“Important to remember essential newborn care in our metrics’’

“Measurement of care for small and sick newborns is a total GAP! Could be tackled like EmOC core competencies”

“Treatment indicators “stink” and the worst part is the denominator!”


DISCUSSION

ENAP Metrics Webinar


Advocacy now for post 2015 targets • Neonatal and maternal mortality expected in SDGs but not

yet clear if universal or relative (%) targets

• Stillbirth counting still absent from SDGs! Sign petition at

EveryNewborn.org!

• Join ENAP advocacy - Anita Sharma, Lori McDougall & E4A.

• Post-2015 health measurement discussion (18th March 8.15-

10.00 ET – after this call!)

Improve and use the data in countries • Some metrics ready for wider scale use now

• ENAP for technical advances and linked tools

Intentional capacity development • To improve, use and further improve the data

Action now

3

1

2

@joylawn


Which indicators to use now for what and

more detail on ENAP metrics definitions • Review excel, welcome to send questions or ideas to

Harriet Rees-Forman [email protected] (on behalf of Matthews Mathai & Joy Lawn)

• Discussion opportunities at Newborn indicators Technical

Working Group in DC next week (18th) if you will be there

• Upcoming WHO ENAP meeting report and BMC paper

Metrics Improvement Plan • Ideas for improvement or other inputs please contact

Harriet Rees-Forman

More technical information 1

2

@joylawn

We have the potential to transform survival and health for EVERY newborn

EVERY mother including for the world’s poorest families –

Acting on the plan depends on better data

mailto:[email protected]



every newborn · ref: every newborn: from evidence to action to deliver a healthy start for the...

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