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!