Mwansambo: Scaling-Up National Newborn Programs in Malawi

7/28/2019 Mwansambo: Scaling-Up National Newborn Programs in Malawi

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Scaling-up National Newborn

Programs in Malawi

Dr. Charles Mwansambo

Global Newborn Health Conference15th April 2013

JHB RSA


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Presentation Outline

Situation in Malawi

Trends in NMR

Moving to scale Progress

Opportunities

Challenges


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Situation in Malawi

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Population: 15.3 million

Districts :28

MMR: 675/100,000

NMR: 31/1,000

Preterm Birth rate: 18%

CPR: 42%

TFR: 5.7

Source: DHS 2010


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MDG 4 progress for newborn child survival in Malawi

Source: U5MR from UNICEF www.childmortality.org and Rajaratnam et alLancet

2010. NMR from Oestergaard et al 2011 under reviewwith journal [DO NOT SHARE] and Rajaratnam et al Lancet2010. Malawi DHS 1999, 2000, 2004, preliminary 2010 and MICS 2006. MDG 4

target from Countdown to 2015, decade report -- 2/3 reduction from 1990 U5MR

104

73

113

3031

0

50

100

150

200

250

1990 1995 2000 2005 2010 2015

Mortalityper1000livebirths

Year

Under-five mortality rate (UN)

Under-five mortality rate (IHME)

Under -five mortality rate (DHS/MICS)Neonatal mortality rate (UN)

Neonatal mortality rate (IHME)

Neonatal mortality rate (DHS/MICS)

MDG 4 target

On track to meet MDG 4 for child survival but

Under-5 mortality reduced at double the pace than neonatal mortality
http://www.childmortality.org/http://www.childmortality.org/


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Source: Zimba et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3):iii88iii103. Data: MalawiDHS/MICS. UN estimates (childmortality.org) with a new analysis of mortality trends by age of death. IHME estimates (Lozano et al. 2011). Note: Survey point estimates are

centred two years prior to survey date. MDG 4 target from Countdown to 2015 decade report reflecting a 2/3 reduction from 1990 U5MR.

NMR reducing at 3.5% per year, more than double the

regional annual average (1.5%)

Neonatal mortality trends from 1990


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Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3):iii88

iii103. Data source: Malawi-specific mortality estimates (Liu et al. 2012). Note: Severe infection includes sepsis, meningitis, pneumonia and tetanus.

Estimated causes of mortality around the

year 2010 for 18,000 neonatal deaths

3 causesaccount for 89%

of all newborn

deaths


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Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3):iii88iii103. Data : Malawi Demographic Health Surveys. Note: Due to changes in the questionnaire and methodology, data for postnatal care across the surveys cannot be

compared over time.

Trends in coverage data for newborn-related

interventions and packages (2000-2010)

Increases in coverage of key newborn-related interventions and

packages, some still remain low eg PNC


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Moving to Scale MOH-RHU strengthens coordination and collaboration

of all partners in Newborn Health programing to

leverage impact Incorporation of high impact interventions into

national maternal and newborn health strategies:

SRH Strategy

Road Map to accelerate reduction in maternal andnewborn mortality

Harmonized IMNC training manual that integrates

ENC, KMC and HBB Community Based Maternal and Newborn Care

(CBMNC ) and

Community mobilization (CM)


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Moving to Scale

Incorporation of high impact MNCH

interventions into pre-service curriculum Promotion of community, family and male

involvement through CM

Community case management (CCM)

integrated with community newborn

sepsis management

Introduction of ANC waiting homes


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High Impact Intervention packages implemented nation-

wide on Maternal and New-born

Focused antenatal care Skilled care at birth and immediate postnatal

care Emergency obstetric and new-born care Helping Babies Breathe Essential new-born care Kangaroo Mother care Community based maternal and new-born care

PMTCT Introduction of new interventions underway i.e.

corticosteroids for preterm birth community new-born sepsis Continuous positive airway pressure (CPAP)

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National scale up for facility- based newborn

care

Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl.

3 :iii88iii103.

Helping Babies Breathe initiative

launched in 13 districts in 2011, now

scaled up to 21 out of 28 districts

(2012), over 1173 service providerstrained

Pre-service ENC now includes HBB

HBB is integrated into the IMNC training

manual Aims to improve all aspects of care

around the time of delivery especially

neonatal resuscitation practices


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National scale up for facility- based newborn

care

Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl.

3 :iii88iii103.

Kangaroo Mother Care (KMC) was

first introduced in the late 1990s

First move to scale initiated in 2002

Over 121 KMC units now available,including in all of the government-run

district hospitals

KMC content is integrated into the

IMNC training manual Malawi is a learning site for scaling up

the intervention


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Community Based Maternal and Newborn Care

(CBMNC)Bringing Care Closer to the people

b d l d b


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Community-based Maternal and Newborn

Care (CBMNC) Package

HSAs are trained, equipped and supervised to :

visit women three times during pregnancy to counsel on the

importance of attending ANC clinic, birth preparedness, clean

delivery, delivery by skilled attendant

Visit postnatal women and their newborns three times to

provide essential newborn care, identify and classify mothers

and newborns with danger signs and refer

Mobilize communities on maternal and newborn health

Train health facility service providers on integrated maternal and

newborn care

Strengthen supervision and information systems


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National scale up for community-

based newborn care

Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. He alth Policy and Planning 27(Suppl. 3):iii88iii103.

By 2011,

17 of Malawis

28 districtswere

implementing

the standard

CBMNCpackage


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1. A combination of efforts contributed to Malawis

progress - scale up of community-based MNH;improved quality of facility-based services and

community mobilization

2. Convening mechanisms played a key role in buildingconsensus, catalyzing change and promoting

coordination (e.g. SRH-TWG, Safe Motherhood Sub-

committee, newborn-specific working groups)

3. Harmonization of training manuals for facility-based

and community health workers (e.g: IMNC, CBMNC,

CM, iCCM) helped to bring focus and standardization

Key messages


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6. Community mobilization assisted in raisingawareness of newborn health problems andpromoting collective action in addressing thenewborn problems

7. Improvements in newborn health possible despitelow health worker density (3.3 per 10,000population)

8. Task shifting of key life-saving MNH services to

nurses, midwives and community health workers,coupled with supportive supervision andmentorship

Key Messages

F O i i


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Future Opportunities

High level Policy makers attention to address preterm

birth

Political will

Presidential Initiative on Maternal Health & Safe

Motherhood promotes interdisciplinary approach

which includes local traditional leaders

Inclusion of Newborn health indicators into the HMIS

will increase attention on the progress of newborn care

Everyone campaign launched in 2010 provides anongoing advocacy forum to advance newborn health

integration , implementation and funding


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Challenges

Human resource

Data management and use

Sustainability

Conflicting priorities

Resources for maternal andnewborn health inadequate

Mwansambo: Scaling-Up National Newborn Programs in Malawi

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