Implementing the Every Newborn Action Plan · 2017-05-24 · a comprehensive Situation Analysis,...

EVERY NEWBORN RESULTS FRAMEWORK 2017 +2018

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Implementi

Every Newborn VISION

A world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential

Every Newborn and Ending Preventable Maternal Mortality STRATEGIC OBJECTIVES

1. Strengthen and invest in care around the time of birth, with a focus on improving quality and experience of care, while ensuring full integration of services for mothers and babies across the continuum of care

2. Strengthen health systems to optimise the organisation and delivery of care, the workforce, commodities, and innovation

3. Reach every woman and newborn by minimising inequities in access to and coverage of care

4. Harness the power of parents, families, and communities, and engage with society

5. Improve data for decision making and accountability

Every Newborn GOALS

Goal 1: End Preventable Newborn Mortality; no more than 12 deaths per 1,000 live births by 2030, and 15 death per 1,000 live births by 2020 Goal 2: Ending Preventable Stillbirth; no more than 12 stillbirths per 1,000 total births by 2030

and 14 stillbirths per 1,000 total births by 2020

Implementing the Every Newborn Action Plan

Results Framework for 2017 and 2018 toward reaching the Every Newborn 2020 Milestones

This Results Framework articulates work at the global level to accelerate country progress to reduce maternal and newborn mortality and stillbirth. The work supports progress towards the Milestones of the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health (see Appendix 1), for

which progress is underpinned by achieving the Every Newborn 2020 Milestones set out in the Every Newborn Action Plan endorsed by 194 Member States of the World Health Assembly in 2014. This Results Framework sets out Progress to date and Activity and Outputs in 2017 and 2018 to accelerate progress toward the

2020 Global and National Milestones and Coverage Targets. This document was endorsed by the Every Newborn Management team in December 2016.

Activities in 2017 and 2018

Outputs by 2018

Outcomes by 2020

The Every Newborn 2020 Global and National Milestones, and Coverage Targets


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Every Newborn Global


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Every Newborn Global Milestones by 2020

Column A lists the Global Milestones that mirror National Milestones.

Column B lists the three additional Global Milestones.

These are presented as a scorecard, with green for those milestones that are achieved and orange for those in progress.

The Every Newborn Results Framework is set out as follows


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Section 1

Global efforts in support to country efforts to reach National Milestones

National Milestone: National Plans…………………………………………………… page 6

National And Global Milestone: Quality of Care…………………………………………………. Pages 10-12

National Milestone: Health Workforce………………………………………………... page 19

National and Global Milestone: Community Engagement

National and Global Milestone: Engagement and Parents and Champions………. page 17

National and Global Milestone: Data…………………………………………………………………. Page x

National and Global Milestone: Innovation and Research…………………………………. pages 13-15

Section 2

Global only Milestones

Global Milestone: Accountability…………………………………………………….. page 5

Global Milestone: Investment………………………………………………………….. page 18

Global Milestone: Coordination……………………………………………………….. page 20

All Milestones are annotated as follows:

1. Progress by December 2016

2. Agreed Activity in 2017 and 2018 to accelerate progress toward each Global and National 2020 Milestones

3. Agreed Outputs by 2018 per Milestone

4. Lead organisation/s responsible to ensure achievement of the 2018 Outputs

Section 3

Every Newborn Coverage targets……………………………………………………… page 21

Appendix 1 ………………………………………………………………………………………….. page 22


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National Milestone: National Plans Review and sharpen national strategies, policies and guidelines for RMNCAH in line with the goals, targets and indicators in ENAP, including a clear focus on care around the time of birth and small and sick babies

Outcomes by 2020 1. Newborn Health is integrated into National Health Development Plans for those countries with 80% of the global burden of newborn mortality

2. X countries have a costed National Plan and budget allocation

National Progress by December 2016 National Activities in 2017 and 2018

National Outputs by December 2018 Lead/s

1. ENAP/Strengthened newborn component finalised and costed (See 2017 Progress Report)

2. RMNCAH Plans in progress in Angola, Sierra Leone, Guinea Bissau, CAR, Mali, South Sudan, Djibouti, Mozambique

3. Essential Newborn Care Action Plans finalised and costed in Vietnam, Thailand, Cambodia, Lao PDR, Mongolia, Solomon Islands and China

4. Regional Task Team established for the 24 countries of West and Central Africa

5. Regional Meetings in EMRO and West and Central Africa to support preparation of newborn component of RMNCAH Strategies.

1. Provide technical support to X countries for the development of a costed National Plan, on the basis of Technical Assistance requests make in the Every Newborn Tracking Tool (as completed in 2016), and the stage of the health strategy planning cycle, and in tandem with H6 work-plans.

A. Develop a planning and costing Toolkit for standardizing the

technical assistance process for national plan development and

costing. This includes with checklists and examples for processes for

preparing:

a comprehensive Situation Analysis, including a Bottleneck Analysis

prioritization of activities using the EQUIST tool, developing both national and sub-national plans

setting maternal, newborn and stillbirth targets using the LiST tool

designing a Monitoring and Evaluation framework (with Data leads)

costing using the One Health tool.

B. Establish a pool of consultants (national and regional) to provide

prompt technical support to countries

C. Ensure national uptake of new WHO guidance including on recent

new guidance on PBSI (2015) Antenatal Care (2016) and Quality of

Care (2016). Webinars held in 2017.

D. New guidance prepared on Post Natal Care and KMC

E. Place final national plans on the Healthy Newborn Network

website

1. Costed Maternal and newborn national health plans of X countries to include:

a costed human resource plan

specific targets for Maternal, Newborn and Stillbirth reduction

ENAP coverage indicators and a clear focus on quality of care + care for small and sick newborns in the first week of life

All relevant WHO guidelines adopted : Quality of Care, Antenatal care, management of Possible Severe Bacterial Infection, preterm birth outcomes, maternal and peri-partum infections and Kangaroo Mother Care Operational Guidance and upcoming PNC and KMC guidance

Attention to equity tracking especially for ~100 countries who have reached national targets

2. A planning and costing Toolkit to strengthen national plans and is utilized for the development of X country plans

3. X countries have clear plans for monitoring progress towards maternal, newborn and stillbirth reduction targets

UNICEF, WHO, MCSP and UNFPA

6.


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Global Milestone : Quality of Care Develop standards of quality of care and a core set of indicators for accessing quality of maternal and newborn care at all levels of health facilities

Outcome by 2020: Accelerated country implementation of newborn specific interventions in all setting within the overall Maternal and Newborn Health Quality of Care framework

Every Newborn Action Plan 2020 Coverage Targets:

1. 90% of women giving birth and babies born in facilities will receive effective high-quality and respectful care that includes essential care during pregnancy, labour and

following birth, with preventive care and appropriate management of complications for the mother and newborn.

2. At least half of babies who do not breathe spontaneously at birth after thorough drying and stimulation will be resuscitated with bag and mask ventilation;

3. At least half of stable preterm newborns or babies weighing less than 2000g will receive kangaroo mother care and other supportive care;

4. At least half of newborns with possible serious bacterial infection will receive antibiotic therapy

Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018 Leads

I. WHO Quality of Care Standards and Framework for all Mothers and Newborns

1. Standards and Framework for Implementation finalised and published

2. First Wave countries identified, capacity for joining a global network built, and preparations in progress

3. Results Framework in support of a global network on quality of care prepared

4. Quality of Care Regional Meeting Held for countries of South and South East Asia, coaching, perinatal death audit and online learning programme established

5. The First Embrace initiative made steady progress in 9 countries of the Western Pacific Region Quality of Care regional strategy prepared and capacity building for improvement interventions in progress in countries of South East Asia Region

6. EMRO hostel Quality of Care meeting for 14 countries

1. Establish and strengthen a Global Network and National Networks on Quality of Care for Mothers and Newborn to:

A. Build and strengthen national institutions and mechanisms for improving quality of care in the health sector in X countries

B. Accelerate and sustain implementation of quality of care improvements for mothers and newborns

C. Facilitate learning, share knowledge and generate evidence on quality of care

D. Develop, strengthen and sustain institutions and mechanisms for accountability for quality of care

2. Support country level partners with guidance uptake, implementation and financing;

3. QED Advocacy support uptake, underpinned by voice and participation

1. Global and National mechanisms to share knowledge and support a learning network are developed including: A. Data systems for quality of care

improvement are developed B. Data and practice are being

analysed and synthesised to generate an evidence base on quality of care improvement

2. Progress report and external evaluation is published on: A. The Progress of the WHO Network

on MNH quality of care B. Impact of the Network on MNH

quality of care is independently evaluated

QED Secretariat at WHO with support from all partners


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II. Quality of Care for Small and Sick Newborn Care

1. Working Group established across organisations to lead work for Small and sick Babies

2. Roll out of guidelines for management of possible severe infections in newborns in progress and partnership formed

3. Global Working Group to support the adoption at scale of PSBI guidelines

4. WHO Early Newborn Care 2.0 course finalised 5. Baby Friendly Hospital Initiative reviewed.

1. Multi-country situational analysis of care for small and sick newborns

2. Global Survey on who cares for the small and sick newborn

3. Using the results from the situational analysis, survey and the study on the Signal Functions for Service Readiness for Small and Sick Newborn, prepare guidance on the care for small and sick newborns and improved measurement

4. Update KMC manual including links to multimedia materials

5. Technical briefs on funding for Low Birth Weight babies and newborn Resuscitation prepared by MCSP (May 2017)

6. Technical Briefs on premature babies prepared by Every Preemie Scale (by June 2017)

1. Report published from a situational analysis of sick newborn care disseminated in X countries

2. Expert review meeting hosted by WHO 3. State of the World’s Care of Small and

Sick Newborn is published in 2018 4. Guidance on the Care of Sick Newborns

is included in the updated version of WHO Quality of Care Guidance for all Mothers, Newborn and Children

WHO, UNICEF, LSHTM. MCSP, Every Preemie Scale, SNL + USAID

III. Strengthened Humanitarian Response

1. Newborn Health in Humanitarian Settings Interim Field-guide https://www.unicef.org/videoaudio/PDFs/NewBornHealthBook-ProductionV12A.pdf

2. Guide field testing in Somalia and South Sudan – including Perinatal Audit in Humanitarian settings

1. Final draft of the guide Newborn Health in Humanitarian Settings completed and incorporated in the Interagency Field Manual by Dec 2017

2. WHO interim standards on care in Humanitarian settings are developed and disseminated

3. X number of countries supported to adopt the WHO interim standards on care in Humanitarian settings

4. X staff representing humanitarian organizations completed training on MNH in emergencies using UNICEF Online training course, which will incorporate new guidelines, implementation research and data system needs.

5. Disseminate the Rapid Checklist for Humanitarian Performance Monitoring and guidance package to X countries

6. Newborn care kits prepare by UNICEF Supply Division and made available by end 2017

7. Maternal and Perinatal Death Surveillance and Review for Humanitarian Settings is undertaken – led by Data leads

1. Interagency Field Manual includes Newborn guidance

2. Countries in Humanitarian crisis have adopted the WHO interim standards for maternal and newborn health in Humanitarian settings

3. Rapid checklist and technical assistance provided to support Guidance Package to X countries by X date

UNICEF WHO MCA PPP + Saving Newborn Lives

https://www.unicef.org/videoaudio/PDFs/NewBornHealthBook-ProductionV12A.pdf

https://www.unicef.org/videoaudio/PDFs/NewBornHealthBook-ProductionV12A.pdf


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National Milestone: Quality of Care Adopt Quality and Indicators for assessing quality of maternal/newborn care at all levels of health facilities National Progress by December 2016 National Activities in 2017 and 2018 National Outputs by December 2018 Leads

1. WHO Standards and Framework for Implementation finalised and shared with countries

2. First Wave countries established and support began for the adoption of the Standards, Network launch and country commitments to the Quality, Equity, Dignity Framework

3. Landscape Analysis prepared by First Wave Countries

4. Stakeholder consultations undertaken in Bangladesh, Malawi, Nigeria, India, Ethiopia

5. KMC Acceleration Partnership

(KAP) Community of Practice (COP) Regional meetings held in Dhaka and Kigali to support acceleration of KMC in 7 priority KAP countries

1. Support countries to adopt WHO standards and measures, prepare National Quality Improvement Plan and begin quality improvement in health facilities – multi-country workshops held in 2017 and 2018

2. Quality of Care Network launched in February 2017 with country commitments to Quality, Equity, Dignity Framework

Learning Platform for quality of care within and between the First Wave countries engaged

3. Community-scale up of simplified management of PBSI being supported in 7 countries

4. Update the WHO KMC implementation/operationalization manual

5. Quality of Care for Small and Sick babies

Support X number of countries on care of sick newborn, kangaroo mother care, newborn resuscitation, infection management, and antenatal corticosteroids in X countries including

Second KMC Acceleration Partnership (KAP) Community of Practice (COP) meeting bringing together MOH, professional association members, key partners and in-country champions of KMC in 7 KAP priority countries. COP to be maintained via online Knowledge Gateway between meetings.

1. Implementation of WHO Quality of Care Standards and Framework in X countries:

A. National and district governance structures for Quality of Care are strengthened (or established) and functioning

B. National operational plan for improving quality of care in MNH services is developed and funded

C. National advocacy and mobilisation agenda for quality of care is developed

D. National framework and mechanisms for accountability for Quality of Care are established and functioning

2. Implementation of improved Quality of Care for Small and Sick babies in X countries:

A. WHO evidence-based standards of care for mothers and newborns are adapted and disseminated in country

B. National package of improvement interventions is developed, adapted and disseminate

C. Clinical, interpersonal, intercultural and managerial capabilities to support quality improvement are being developed in conjunction with the strategy to improve in health workforce

D. Implementation of quality improvement interventions for MNH is being scaled-up

QED Secretariat at WHO with support from all partners


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Milestone: Investment in Healthworkforce Develop or integrate costed human resources for health strategy into RMNCAH plans, ensure sufficient financial resources are allocated

Global Progress by December 2016

Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead/s

Global Strategy on Health Workforce launched in 2016

X countries are supported to develop their Human Resources Strategy 1. Assist countries with the implementation of the Global Strategy for

Health Workforce (launched in 2017 2. Support countries to implement the Global Strategy for Health Work

Force Support countries to increase the number of qualified midwives and to develop strategies to sustain their performance

3. Support countries in building capacity of their health workforce to implement standards for quality of care for MNH

4. Support countries in adopting policy of task shifting with a focus on newborn health

National Human Resource Strategy: 1. All countries have developed a human resources for

Health Plan that adequately considers newborns and sufficient financial resources are allocated

2. Indicators on the care of newborns by health workers included in the HMIS of X countries

WHO WH, MCA PPP and UNFPA


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Milestone: Health workforce capacity and support Ensure the training, deployment, and support of health workers, in particular midwifery personnel, nurses and community health workers

Global Progress by December 2016

Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead/s

1. Midwife Realities, Midwife Voices published in 2016

2. WHO Strategic Direction for Nursing and Midwifery

3. Coaching for First Embrace – Facilitator Guide Published - http://thefirstembrace.org/

1. Midwifery Education improved Midwifery education Survey

A. Mapping of midwives educated to ICM Midwifery competencies B. Mapping of education materials utilised amongst partners C. Evidence Based Midwifery Competency Modules/Toolkit

updated and launched in X countries of highest burden of mortality

D. A “Global 15 year Action Plan for Midwifery Education 2016-30”developed, to include a monitoring and evaluation component.

2. Complete Situation Analysis on Neonatal Nursing and clearer definitions of neonatal nurse cadres and plan for how to track.

3. Strengthen partnership with Professional Associations

Strengthen coordination and partnership with Health Professional Association (IPA, FIGO, ICM, ICN and COINN) to support advocacy, training, and mentoring for implementing the Quality of Care Framework

Joint statements on PSBI, KMC, preterm care, and quality of care disseminated and promoted by global and national professional associations

4. WHO Child Birth Course finalised 5. Essential Newborn Care course finalised 6. E-learning format prepared for:

Standards of paediatric care

KMC

The hospital pocketbook

1. Midwifery Education is strengthened A. Global Midwifery Competency Modules being

implemented in X countries B. Global Midwifery Advocacy campaign with Health

Professional Associations in X high burden countries

2. Work linked to the Care for Small and Sick Newborns A. State of the World’s Small and Sick Newborns

Report includes guidance prepared with healthcare professional associations (IPA, ICM, COINN and FIGO)

B. Neonatal nursing cadre: finalise a definition of neonatal nurse and commencement of tracking of numbers at a national level

C. Define a standard training package

WHO MCA PPP and UNFPA with partners WHO, UNICEF, SNL, MCSP and USAID

http://thefirstembrace.org/

http://thefirstembrace.org/


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Milestone: Community Engagement Involve communities, civil society and other stakeholders to increase demand and ensure access to and coverage of essential maternal and newborn care.

Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead/s

20 countries developed national communication strategies while another 2 were in process.

29 countries have a community engagement strategy for maternal and newborn health.

WHO work to Synthesize research and guidance on community engagement - and research on the experience of care

Evidence Gap-Map for social, behavioural and community engagement interventions for RMNCH published by WHO in 2017

Toolkit to strengthen district level integration of health promotion/SBCE interventions for Maternal and Newborn Health

THIS MILESTONE IS IN DRAFT AND WILL BE ARTICULATED IN 2017

WHO MCA PPP and UNICEF with partners


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Global Milestone: Champions Develop new newborn champions for RMNCAH to integrate newborn messaging

1. X number of champions being mentored in X countries of the highest burden of newborn mortality

2. Evidence of increased voice by parents and community and civil society groups in national plans of X countries

3. PNC indicator - At least a 20% increase (or an increase to 90% if their baseline is above 70%) of early postnatal care for women and newborns within two days of

birth to promote breastfeeding, counselling, screening, and care-seeking for maternal and newborn complications and postpartum family planning.

Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead

1. Saving Newborn Lives published the Champions Toolkit.

2. Mobilisation of Partners and Champions;

Engaged multiple RMNCAH champions at events and in media to focus on MNH and stillbirth issues.

Joint Statements on PBSI, QoC, Pre term Birth and KMC acceleration prepared in collaboration with HPAs.

1. Quality Equity Dignity Advocacy Strategy is prepared and implemented in X countries

Stakeholder consultations undertaken with parents, communities and civil society in x countries to inform national Advocacy and mobilisation plans

2. Advocacy undertaken at all regional and country meetings on RMNCAH for newborn health to ensure the voice of parents and communities are part of national and subnational planning processes

3. Provide key messages on maternal and newborn health on optimal behaviours and care-seeking for complications, to parents groups, community and civil society partners including an inter-faith campaign to reach out to parent groups, community and civil society

4. Develop strategic links to the global and national adolescent health strategies on maternal and newborn health

5. Establish a Champion Award System for actors in all constituencies (parents and communities, health facilities, health workers and health profess subnational and national government)

1. Advocacy plans as a component of the National Quality of Care plans, are prepared by X countries which include country voices and the voices of health workers

2. X events with voices of mothers, and health workers held

3. X media coverage on newborn health and stillbirth

4. Mechanism for appreciated Maternal and Newborn Champions established

Awards for QED Champions in X countries for Midwives, QED Champions etc.

Identifying, nurturing and documenting activities of at least 5 global champions for newborn health and/or stillbirth and/or QED

PMNCH and Saving Newborn Lives (QED Advocacy)


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National Milestones: Parent voices, champion Shift social norms so that it no longer acceptable for babies to die needlessly, just as it has become unacceptable for women to die giving birth

Engagement Involve communities, civil society representatives, and other stakeholders, to harness the power of individuals, families and communities ensuring access and coverage of essential maternal and newborn care

National Progress by December 2016 National Activities in 2017 and 2018 National Outputs by December 2018 Lead

Mapping of Partner activity on newborn health and compilation of organizational focal points for engagement.

+100 Citizen Hearings on RMNCAH

Mobilization around national and global advocacy days (IDM, WPD, WBW)

National Policy Champions supported engagement.

1. Quality Equity Dignity National Networks to be established and Strategy is prepared and implemented in X countries

Stakeholder consultations undertaken with parents, communities and civil society in x countries to inform national Advocacy and mobilisation plans

2. Advocacy undertaken at all regional and country meetings on RMNCAH for newborn health to ensure the voice of parents and communities are part of national and subnational planning processes

3. Prepare and provide key messages on maternal and newborn health on optimal behaviours and care-seeking for complications, to parents groups, community and civil society partners including an inter-faith campaign to reach out to parent groups, community and civil society

4. Engage Healthcare Professional Associations actively engaged with national governments to support quality improvement

Inter-faith initiative to change social norms launched at the Acting on the Call meeting, 2017.

SBCC efforts undertaken in XX countries

Identifying, nurturing and documenting activities of national champions for newborn health and/or stillbirth and/or QED (MNH)

Citizens systematically engaged in advocacy for improved quality, equity and dignity in X countries Mobilization around national and global advocacy days (IDM, WPD, WBW)

PMNCH and Saving Newborn Lives (QED Advocacy)


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Global Milestone: Data Monitoring plan, improving and using programmatic coverage data, and equity, quality gap assessments, evaluation and improved indicators and investment to ensure these are tracked at scale. Count every birth and death for women babies and stillborn, invest in civil registration and vital statistic, and innovate to improve and ensure the poorest are counted. Design and test a minimum perinatal dataset.

Outcomes by 2020 1. ENAP Metrics (goals and coverage targets) are being used in countries for programme improvement and accountability 2. ENAP Core Metrics are being reported on within Global Reporting mechanisms 3. X number of countries have functioning Maternal and Perinatal Death Surveillance and Review Systems 4. X number of countries of highest burden countries have birth and maternal/neonatal death registration data


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Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead/s

I. MoNITOR 1. MoNITOR (Maternal and Newborn

Information Tracking for Outcomes and Results) established to improve coordination to improve the measurement, data and use of data on maternal and newborn health

2. Bi-annual Policy survey on MNCAH

3. Feasibility testing of Quality of Care Measures underway

4. WHO ICPDM and Perinatal Audit Guide Published

5. WHO Maternal and Perinatal Death Surveillance and Review Guide Published

1. Establish MONITOR to facilitate recommendations on maternal and newborn metrics work

A. Map all current work underway across maternal and newborn health metrics

B. Finalise mapping document identifying gaps by June 2017 C. Working to determine where are the data sources for the

SDG and Global Strategy Maternal and Newborn Health indicators

D. Global Metrics face to face consultation to be held in July-October 2017 to review progress, country guidance etc.

2. WHO Policy Survey on Maternal, Newborn and Child Health

3. Support Quality of Care Metrics to determine and promote assessment of quality of care in health services and support the use of data for planning

4. Work with Health Data Collaborative to visual

HMIS indicators

Facility surveys

100 core indicators 5. New data on LBW and Prematurity released in 2017 by

WHO

1. A. Mapping completed by June 2017 B. Further activities will be finalised across the ENAP and EPMM Metrics Team

2. Policy Survey 2018 and report including development of one platform developed to host the large volume of data that is currently being collated, and can report on this data

3. Quality of Care Metrics validated

4. X countries have clear plans for monitoring progress towards maternal, newborn and stillbirth reduction targets

5. X countries report coverage of newborn specific interventions through HMIS

WHO MCA Monitoring and Evaluation Team

II. ENAP Measurement Improvement Roadmap was prepared through broad consultation and some of the work funded

1. Testing of indicators and tools in process for 5 indicators (Uterotonics, Resuscitation, ANC. KMC, treatment of PBSI) underway in 3 countries

2. Established work for INDEPTH Network for improve household surveys on stillbirth and newborn deaths and birth weight and gestational age measurement

3. Began assessment of standardised metrics for Service Readiness for Small and Sick Babies

1. Test and validate indicators and tools in countries, and in various data platforms (CVRS, audit in Health Facilities, HMIS and household surveys) as per the ENAP Measurement Improvement Roadmap

2. Complete Facility based research in 3 sites (Bangladesh, Nepal and Tanzania) for the 5 coverage indicators Uterotonics, Resuscitation, Antenatal Corticosteroids, KMC Scale up, and treatment of PBSI (20000 births)

3. Research improved household surveys on stillbirth and newborn deaths and birth weight and gestational age measurement - INDEPTH Network for 5 country sites (70000 births)

4. Test, define and determine signal functions for Service Delivery Readiness for Small and Sick Babies.

1. Report on progress including:

Recommendations from validation study for 5 selected ENAP coverage indicators

Recommendations from INDEPTH ENAP-metrics work to improve household survey capture of birth outcomes

2. Guidance and tools are issued for measurement of Service Delivery Readiness for Small and Sick Babies, linked to EmOC measurement

London School of Hygiene & Tropical Medicine


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III. ENAP Progress Tracking Tool 1. Progress tracking Tool prepared and trialled

with countries in 2014 (10 countries), 2015 (30 countries) and 2016 (52 countries)

2. Equity Profiles created for all 28 ENAP Priority Countries and shared with countries

3. Countdown to 2015 annual reports prepared and in-depth country case studies completed in 5 countries, some with recommendations for newborn and maternal health

4. Western Pacific Region First Biennial Progress Report for Early Essential Newborn Care -http://thefirstembrace.org/

1. Improve tracking progress as part of a Maternal Newborn and Child Health data Platform to be launched by WHO MCA in July 2017 - add key Maternal health items – such as include indicators on EMOC, uterotonics, and key items for the time around birth

2. Support countries in identifying equity gaps for maternal and newborn health

3. Publish 2017 and 2018 Progress Reports

A. For 2017 - based on data collated in 2016 for 52 countries and further inputs from WHO and UNICEF Regional Offices.

B. For 2018 – based on the data gained from new WHO platform

4. Content of the Global Strategy Annual Progress Reports for 2017 and 2018 are supported by ENAP and EPMM Management guidance

1. Partners report on using country data from the Tracking Tool to prioritise the technical assistance to accelerate progress

2. Countries report using Equity Profiles 3. Global Strategy Annual Progress Reports

to the World Health Assembly in 2017 and 2018 contain specific attention to maternal and newborn health.

WHO MCA Monitoring and Evaluation Team +

UNICEF HQ

IV. Civic Registration and Vital Statistics

Global task team initiated and meeting of global partners held in October 2016

CRVS Global team determining the work-plan in the first half of 2017 (WHO, UNICEF, CDC, GAVI)

X number of countries have CRVS systems improvements to count each birth and maternal/neonatal death and stillbirth

UNICEF HQ

National Milestone: Data

Count Every Newborn by improving and using programmatic coverage data, and equity, quality gap assessments, institutionalise civil registration and vital statistics, adopt and use minimum perinatal dataset, implement maternal and perinatal death surveillance and review

Progress by December 2016 Activities in 2017 and 2018 Outputs by December 2018 Lead

I. Support to countries to prepare NMW and SBR targets and update their HMIS

Case by case support to countries to update their HMIS and include NMR and SBR targets

1. Identify a small number of key indicators per country to be included in their HMIS based on countries existing capability and situation

2. Undertake workshops to support countries to update their HMIS

X countries have incorporated validated indicators into the HMIS

WHO MCA Monitoring

and Evaluation Team + UNICEF HQ


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II. Maternal and perinatal death audits

1. WHO ICPDM and Perinatal Audit Guide Published

2. WHO MPDSR guide Published

1. Facilitate the implementation of maternal and perinatal death audit in X countries and the establishment of a minimum perinatal data set

2. Implement the Maternal and Perinatal Death Surveillance and Response in X number of countries

1. X number of countries have functioning MPDSR systems

2. X countries have implemented policies for perinatal audit for deaths in health facilities

WHO MCA Monitoring

and Evaluation Team + UNFPA

III. Civic Registration and Vital Statistics

Case by case support to countries

Provide technical assistance to X number of countries to prepare and implement CRVS systems

X number of countries have initiated improvement to the civil registration and vital statistics systems to sure each birth and maternal/neonatal death and stillbirth is counted

UNICEF HQ

Global Milestone: Innovation and research

Develop, adapt, and promote access to devices and commodities to improve care for mothers and newborn babies around the time of birth, and agree on, disseminate and invest in a prioritised and coordinated research agenda for improving preterm and newborn health outcomes. Particular focus is required for stillbirths, who have been left out and left behind. Outcomes by 2020

1. Prioritised Research Agenda to improve care for mothers and babies in the time around birth, and including preterm and stillbirth, and implementation research is determined and funded

2. Research is disseminated and informing improved quality of care outcomes

Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018

Lead


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I. A prioritised Research Agenda 1. Gap-mapping completed on newborn and stillbirth

health research completed at Aga Khan University 2. WHO MCA Research on Maternal and Newborn

Health:

Alliance for Maternal and Newborn Health Improvement (AMANHI) study on causes of newborn death in 13 countries

Intervention development and Evaluation studies for o KMC o Utility for Emollient Therapy for reduced

neonatal mortality o Safety of ANC in weeks GA 26 to 33 in low

resource settings o Barriers to increasing utilisations of SBA in Nepal

Improving Quality of Care in Primary Health care settings in India

WHO MCA work to synthesise Community Engagement research and guidance for maternal and newborn health

1. Innovation and Research Group to be established to develop and finalise the research agenda for key issues including:

implementation research

preterm birth outcomes

stillbirth

neonatal infections

community engagement

quality of care

beyond newborn survival 2. Global meeting in 2017 to discuss the research agenda and

prioritisation, and ensuring research prioritisation for metrics, quality of care and implementation

3. Develop an accountability strategy/tracking mechanism for donors, to include those already investing in birth outcomes research and other potential donors to this area

4. Develop a strategy to support a cadre of maternal and newborn health researchers in lower and middle income countries

1. Finalised research agenda

2. Priority research funded

3. Publish a strategy for technical leadership for maternal and newborn health research, learning from HIV, targeted to donors who fund technical assistance

4. Increased focus and funding on technical capacity for researchers in LIC – as the deliverable be a strategy and funding

Research Group for Maternal and Newborn Health – led by WHO

II. Research Dissemination and Communication

(not tracked to date)

Develop and implement a strategy for the effective communication of research

Strong dissemination and communication platform is established for maternal and newborn health research and devices and commodities in development and in use

Save the Children and PMNCH


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III. Innovations 1. Every Woman Every Child Innovation Marketplace:

(www.everywomaneverychild.org/networks/innovation-marketplace).

2. Born on Time: (bornontime.org). 3. Helping Babies Grow: (laerdalglobalhealth.com). 4. Preterm Birth Initiative: (ucsf.edu). 5. Every Preemie—SCALE: (everypreemie.org). 6. Preventing Preterm Birth Initiative:

(gapps.org/healthybirth). 7. Saving Lives at Birth https://savinglivesatbirth.net/

1. Establish a Newborn Innovations Group that leads on innovations identified to

Test for improving birth registration Innovations identified to test for improving birth weight

measurement

2. Work with the EWEC Innovations Working Group and identify types of innovations that are needed to address barriers

Link with partnerships that are supporting innovations and research including the Saving Lives at Birth – Grand Challenge initiatives (USAID, BMGF, Canada) DFID, Norway, KOICA

Innovations

At least three evidence assessed innovations programmed at scale

1.

USAID, UNICEF, UNFPA, Sick Kids and partners

National Milestone: Innovation and research Develop, adapt, and promote access to devices and commodities to improve care for mothers and newborn babies around the time of birth, and agree on, disseminate and invest in a prioritised and coordinated research agenda for improving preterm and newborn health outcomes. Particular focus is required for stillbirths, who have been left out and left behind

National Progress by December 2016 National Activities in 2017 and 2018 National Outputs by December 2018 Lead

1. National research prioritization conducted in Uganda, Ethiopia (other countries?)

2. PhD students enrolled as part of the ENAP measurement improvement network research

1. Build technical research leadership in countries

2. Building Research capacity

1. X number of countries developing their own MNH research agenda

2. X number of researchers from lower income countries included as part of research teams

London School of Hygiene and Tropical Medicine and partners

Global Milestone:

Accountability in post-2015 work-plans Ensure the post 2015 development framework includes specific targets for newborn mortality reduction and stillbirth reduction.


Lead/s

http://www.bornontime.org/

http://www.laerdalglobalhealth.com/

http://pretermbirth.ucsf.edu/

http://www.everypreemie.org/

http://www.gapps.org/healthybirth

https://savinglivesatbirth.net/


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1. The Newborn Mortality Rate is included as one of the Sustainable Development Goal Targets and a core indicator for the EWEC Global Strategy monitoring framework (add URL)

2. The Stillbirth Rate is included as one of the core indicators in the EWEC Global Strategy Monitoring Framework (add URL)

3. The Lancet Ending Preventable Stillbirth series was published providing updated SBR estimates by country and used in advocacy for inclusion of SBR targets at national level

1. Ensure Newborn and Stillbirth Targets are included in national plans

2. Funding secured for UN IGME Stillbirth Rate estimates (UNIGME require greater capacity to generate stillbirth estimates).

3. Advocate to the High Level Advisory Group for Every Woman Every Child to ensure that newborns and stillborns are high on the United Nations agenda

4. Ensure effective mobilization and use of resources in countries by advocacy at the domestic level and by engaging with global financing mechanisms and actors including the Global Financing Facility, GAVI, the Global Fund, and African and Asian Development Banks. A. Advocate for further commitments particularly

support programmatic coverage of essential newborn interventions, increased ANC and quality of care improvements

B. Advocate at donor meetings for adequate financing for the implementation of key lifesaving interventions for maternal and newborn health

Advocate to leaders of G7 countries at the 2017 G7 meeting in Italy

1. SBR data collection is funded 2. Evidence of increased allocation for newborn care included in GFF investment plans and in other funding mechanisms

All the ENAP Management team members)

Investment Ensure that investment in maternal and newborn health is sustained in the post 2015 development era

Global Progress by December 2016 Global Activities in 2017 and 2018 Global Outputs by December 2018 Lead


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1. Newborn health considered in formulation of investment plans under the Global Financing Facility in 16 countries, plans finalized in (6) countries (Ethiopia, Kenya, DRC, Cameroon, Liberia and Uganda)

2. Maternal and newborn health a

priority of investment in 25 countries as part of the H4+ collaboration with financial support from CIDA, SIDA, France, Norway and United Kingdom

3. Over 100 commitments to EWEC with specific mention of newborn since 2014 including +50 private sector commitments

1. Technical Advisor on newborn health at the World Bank (GFF) to ensure newborn health and stillbirth is integrated into new GFF investment cases and incorporated into existing investment cases where possible

2. Tracking and accountability of MNH related commitments to EWEC

Country based efforts to track funding for MNH used as a basis for targeted advocacy for improved financing

Efforts to promote aligned investment in QED from newborn and maternal health interested partners

3. H6 pursues additional country commitments

1. Evidence of increased financial investment in maternal and newborn health and the reduction of stillbirth in National Account Tracking by WHO

2. Evidence of increased marked allocation for newborn care being tracked in GFF investment plans and other funding mechanisms such as the Global Fund and African and Asian Development Banks’ planning processes

3. A report published by WHA 2018 mapping accountability of these commitments. It will show increased investment but also hold partners accountable to their commitments

4. A tool or guidance published for national tracking of Maternal and Newborn Health expenditure and how to use this data for accountability

WHO for National Health Accounts data PMNCH/EWEC (TBD) for annual reporting

Global Milestone : Coordination Ensure coordinated support among UN partners, donors, academics, nongovernmental organisations and the private sector, and intensify effort in the 20 countries that account for 80% of all newborn deaths


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Lead

1. Regular calls and actions thereof completed

by the ENAP Management Team

2. Monthly calls Country Implementation

Workstream and sub working groups on

National Plans, Small and Sick Newborns,

Innovations, Newborn in Humanitarian

Settings,

3. Regular communication with EPMM leads

4. Support activities at National, Regional and

Global Meetings : World Health Assembly

Side-Session 2015, Global Maternal and

Newborn Conference 2015, Women Deliver

2016, EMRO/MENA ENAP Meeting 2016,

West and Central Africa Regional ENAP

Meeting 2016, SEARO/South Asia Quality of

Care Meeting 2016, Windsor Workshop

ENAP Metrics 2016

5. Regular Updates and Webinars to broader

maternal and newborn communities and

stories prepared on events and activities for

the ENAP Website, and now after transition,

on the HNN website

6. Global partnership on Quality, Equity and

Dignity with the aim to halve facility based

maternal and newborn mortality in 5 years

in participating sites

1. Consensus among partners on ENAP Results Framework

2. Coordinate Monthly calls of the ENAP Management team including Deep

Dives on one milestone and updates per working groups

3. Coordinate Monthly call of the Country Implementation Workstream and

sub-working groups on National Plans, Small and Sick Newborns,

Innovations, Newborn in Humanitarian Settings

4. Align work with Monthly call of the ENAP and EPMM metrics groups

5. Align work with Biweekly calls of Quality, Equity, Dignity Advocacy

6. Alignment with Network for Quality of Care for MNC Health

7. Establish structure / strengthen partners working groups for the research

prioritisation, health workforce and community engagement milestones

8. Every Newborn / EPMM alignment and coordination (combined work-plan

and all work aligned).

9. Add Health Care Professional Association Members to the ENAP

Management Team

10. Build public/private sector partnerships

11. Annual reporting to the World Health Assembly - Global Strategy reporting

12. Country Progress report on findings for 51 countries from the Every

Newborn Tracking tool and data used for WHA report, GS and IAP reporting

13. Support key events:

ICM June 2017

Acting on the Call meeting (April 2017) in Ethiopia

East Africa Maternal and Newborn Health Forum (September 2017)

14. Healthy Newborn Network serves as the central online hub for Every Newborn related activities and is regularly updated with coverage of activity

Results Framework implemented

Progress towards the completion of activities by the lead partner reported and document

Progress Report to the WHA and inclusion in Global Strategy and IAP reporting processes in 2017 and 2018

Regular calls and NfR from Management team and workstreams documented and shared and actions completed

Regular updates on Healthy Newborn Network

Strong linkages and information sharing with all newborn partners

ENAP Coordinator (WHO MCA and UNICEF HQ)


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Section 3

Every Newborn Coverage Targets by 2020 Coverage and quality of care around birth Summary of key activity to achieve this coverage

1. 90% of women giving birth and babies born in facilities will receive effective high-quality and respectful care that includes essential care during pregnancy, labour and following birth, with preventive care and appropriate management of complications for the mother and newborn.

2. Maternal and perinatal death surveillance, timely response and regular monitoring of quality of care will be an integral part of maternal and newborn health services.

1A. WHO Quality of Care Standards and Guidelines completed in October 2016 1B. ANC Guidelines launched in November 2016

2A. MPDSR Guidance launched in October 2016. 2B. Essential Newborn Care manual updated and training videos complete

Coverage and quality of care for small and sick new-borns Summary of key activity to achieve this coverage

1. At least half of babies who do not breathe spontaneously at birth after thorough drying and stimulation will be resuscitated with bag and mask ventilation;

2. At least half of stable preterm newborns or babies weighing less than 2000g will receive kangaroo mother care and other supportive care;

3. At least half of newborns with possible serious bacterial infection will receive antibiotic therapy.

4. Country-specific targets for comprehensive neonatal intensive care will be set, including tracking of disability.

1. Measurement Improvement Groups established for

Resuscitation

Preterm babies

PBSI Management

Use of Antenatal Corticosteroids

2. Quality of Care for Small and Sick Babies activities set out in the Results Framework to accelerate improved coverage and quality of these specific interventions

Home visits and participatory group support for women and newborns Summary of key activity to achieve this coverage

1. Each country will achieve at least a 20% increase (or an increase to 90% if their baseline is above 70%) of early postnatal care for women and newborns within two days of birth to promote breastfeeding, counselling and screening for maternal and newborn complications, and postnatal family planning.

2. Link to community participatory approaches and parent groups is an important component of this strategy.

1. MCA and Health Systems Alliance collaborating to improve measurement

2. WHO to prepare Guidance on PNC in the community and support implementation

3. Research and Guidance (operationalization for the 2013 PNC Guidelines) for PNC Home Visits prepared by SNL

4. See WHO draft module on women’s groups participation as part of the Caring for the Newborn and Child in the community

5. See UNICEF IYFP and Baby Friendly Hospital Initiative progress to date and 2017 re-launch.


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Appendix 1: Every Woman Every Child’s Global Strategy for Women’s, Children’s and Adolescent Health

2017 Milestones All countries have updated or developed plans for women’s, children’s and

adolescent's health to achieve the targets and ensure that they are fully

integrated into national health sector plans.

All countries have adopted the Global Strategy for Human Resources for

Health, and have developed health labour markets assessments and action

plans to strengthen the health workforce towards achieving Universal Health

Coverage

The global Health data Collaborative for measurement of core indicators is

fully functional, facilitating timely data generation and synthesis in countries

and providing essential information on progress

All countries are undertaking annual health sector reviews with due attention

to results, resources and rights for women’s, children’s and adolescents

health

In countries in fragile settings, integrated funding is provided to cover the

continuum of humanitarian, recovery, reconstruction, and development

activities with a particular attention to the needs of women, children and

adolescent health.

2018 to 2020 Milestones All countries have developed a health financing strategy that

progressively increases the allocation of domestic resources and

facilitates the attainment of national goals and targets for women’s,

children’s and adolescents’ health.

Countries accounting for 95% of the global burden of maternal,

newborn and child mortality show demonstrable progress toward

ending preventable mortality according to the nationally identified

targets.

Based on individual country assessments, civil registration and vital

statistics systems are aligned with international standards; regular

census schedules are established; household surveys are conducted;

and national health facilities have information capacities to improve

quality of services for women, children and adolescents and conduct

surveillance and response.

Source: Annex 2 A69/16 World Health Assembly 2016

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