An Action Plan To End Preventable Deaths #EveryNewborn EVERY NEWBORN

An Action Plan To End Preventable Deaths

#EveryNewborn

EVERY NEWBORN

www.everynewborn.org #EveryNewborn

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

Every Newborn Series5 papers, 6 comments

55 authors from 18+ countries

60+ partner organizations

Published May 2014

www.thelancet.com/series/everynewborn

Every Newborn Action Plan

Based on the evidence from the Series

Co-led by UNICEF & WHO

World Health Assembly 2014 resolution

Over 300 experts consulted

60+ partner organization

Launched 30th June 2014

40+ commitments to EWEC

Building from evidence to action


This is where we get the biggest bang for our buck. - Kim Dixon, Co-Chair ENAP, UNICEF

Our efforts have meaning only if those who are born today can enjoy them. - Cyril Ramaphosa, Deputy Vice President of South Africa

Progress is still too slow, especially for newborns. Today we launch the Every to speed up our response and save more lives. - Ban Ki-Moon, UN Secretary General

Graça Machel and other world leaders launched the Every Newborn action planPartners Forum, South Africa, June 2014

Newborn was a gap. The World Health Assembly agreed and passed ENAP.- Margaret Chan, World Health Organization

This plan demonstrates that together we can achieve the vision of 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 – Graça Machel

EVERY NEWBORNCommitments

www.lancet/series/everynewbornwww.everynewborn.org

#EveryNewborn

World Health Assembly Resolution194 member states endorsed the Every Newborn Action Plan in May 2014

Now 40 new commitments, largest collection since launch of Every Woman, Every Child in 2010


A roadmap for change in countries…

A platform for harmonized action by all partners…

Sets out a clear vision with mortality goals, strategic objectives, innovative actions within the continuum of care

Supported by new evidence

Inputs from more than 2,000 individuals

A movement for greater action and accountability…

The Every Newborn Action Plan: building a movement


• Huge burden, yet huge potential for rapid change with high impact, feasible interventions

• Country demand for guidance and action to accelerate progress towards MDGs 4 and 5, universal health coverage, and towards ending preventable deaths among women and children

• For greater effectiveness we must accelerate and harmonize global response and link to existing initiatives for reproductive, maternal, child and adolescent health care.

More than 3 million babies and women could be saved

each year through investing in quality care around the time of birth.

Photo credit: Save the Children

Why Every Newborn?


We’ve made significant progress toward MDGs

4 & 5, but newborn survival is lagging behind

Source: Adapted from Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: UNICEF 2012 www.childinfo.org, WHO MMR estimates 2014* Maternal mortality ratio annual rate reduction 1990-2013

Average annual rate reduction 1990-2012

Maternal mortality ratio* 2.6%

Children aged 1- 59 months 3.4%

Neonatal mortality (newborn, first 4 weeks after birth)

2.1%

Stillbirths (last 3 months of pregnancy)

1.0%(1995-2009)

At least 40% slower for newborn survival and slower still for stillbirths

http://www.childinfo.org/


Data source: Cause of death - WHO. Global Health Observatory http://www.who.int/gho/child_health/en/index.html); Child deaths - UN Inter-agency Group for Child Mortality Estimates. Levels and Trends in Child Mortality. Report 2013; Stillbirths - Lawn et al The Lancet stillbirth series 2011. 377 (9775) p1448 – 1463

8

3 main killers to address: 1. Preterm birth

2. Birth complications

3. Neonatal infections

Two-thirds of neonatal deaths

are preventable

Causes of under five deaths 44% are from neonatal causes

http://www.who.int/gho/child_health/en/index.html




Preterm birth

• Preterm labor management including antenatal corticosteroids*

• Care including Kangaroo mother care, essential newborn care

Birth complications

(and intrapartum stillbirths)

• Prevention with obstetric care *• Essential newborn care, and

resuscitation*

Neonatal infections

• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*

• Case management of neonatal sepsis *

1

2

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

Over two-thirds of newborn deaths preventable – actionable now without intensive care

3

We have the knowledge and tools to reduce the main causes of death

There are proven interventions within RMNCH continuum of care

Source: Adapted from The Lancet Every Newborn Series

Source: Special analysis detailed in The Lancet Every Newborn Series (Bhutta et al 2014)The lives of nearly 3 million babies and women could be saved each year with high coverage of quality care around birth and care for small and

sick babies

Care around birth gives a triple return on investments by reducing maternal and

newborn deaths and stillbirths


The vision for Every Newborn Action Plan

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.

Vision statement


NEW NEONATAL MORTALITY GOALUnless we greatly accelerate newborn survival efforts, goal to end preventable child deaths by

2035 unreachable

Source: Special analysis detailed in The Lancet Every Newborn Series based on country and official online consultations and using neonatal mortality rate data from the UN Inter-agency Group for Child Mortality Estimation 2013 .


Source: Special analysis detailed in The Lancet Every Newborn Series based on country and official online consultations and using stillbirth rate data from The Lancet Stillbirth Series (Cousens S et al Lancet 2011)

NEW goal for stillbirths


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

Maternal mortality goal links with newborn action

National target: no country should have an MMR over 140 deaths per 100,000 livebirths by 2030

Global target: Reduce global MMR to less than 70 maternal deaths per 100,000 live births by 2030.

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


What to do differently?Every Newborn’s guiding principles

Country leadership

Good governance, community

participation, partner alignment

IntegrationIntegrated service

delivery, continuum of care, programme

coordination

EquityUniversal coverage, closing the equity

gap

Human rightsPrinciples, standards

AccountabilityTransparency,

oversight

InnovationInterventions,

delivery approaches, technologies


What to do differently?Every Newborn’s Five strategic objectives

1. Strengthen and invest in care during labour, birth and the first day and week of life

2. Improve the quality of maternal and newborn care

3. Reach every woman and every newborn; reduce inequities

4. Harness the power of parents, families and communities

5. Count every newborn – measurement, tracking and accountability

Health Sector Strategic & Investment Plan

Integrated National RMNCH Plan

Increasing access and use of FP

Ending preventable

newborn deaths

Ending preventable deaths from

pneumonia and diarrhoea (GAPPD)

Ending preventable

maternal deaths

Every Newborn prioritizes focus on birth within existing national strategies and plans; not a new

stand alone plan


Every Newborn’s impact framework


How will we track progress?Every Newborn milestones

Every Newborn sets out concrete and measurable global and national level milestones from now to 2020, coverage targets to

2025 and mortality goals to 2035


Source: Lancet Every Newborn series, paper 5

EVERY NEWBORN MILESTONESEvery Mother, Every Newborn Quality Improvement Initiative

Reach every women and every newborn

with high quality facility-based care for

women and babies around the time of

birth, also strengthening the linkages

with communities

Co-led by WHO, UNICEF and UNFPA to

build on and accelerate existing work

including:

• global standards to reach every mother and

newborn with high-quality care

• quality improvement methodologies

• accreditation approaches


EVERY NEWBORN MILESTONES: Monitoring framework and metrics

Impact

1. Maternal Mortality Ratio

2. Stillbirth Rate

3. Neonatal Mortality Rate

Coverage: Care for all mothers & newborns

4. Skilled attendant at birth

5. Early postnatal care for mothers & babies 6. Exclusive breast feeding to 6 months

Coverage:Complications & extra care

7. Antenatal corticosteroid use

8. Newborn resuscitation

9. Kangaroo mother care & feeding support10. Treatment of neonatal sepsis

Improving & using the

data including

programmatic coverage is

crucial for acceleration

& accountabilit

y


Potential for major change in countries

• Progress is possible – targets getting traction Neonatal survival unfinished agenda, stillbirths still missing, but

count for families Synergies of newborn survival with demographic transition Country consultations and ownership over 1 yr process

• Programmatic focus is clear and evidence-based Time around birth, triple return on investment Priority attention to small babies to reduce deaths, disability and

risk of non communicable diseases (NCDs) Urgent improvements for programmatic coverage data

• Partnerships and alliances UN leadership Maternal alliances especially re service delivery eg “Every

Mother, Every Newborn quality improvement package” Civil society advocacy to change social norms


The partnerships forged during the development process for ENAP will work together on three main streams of activities:

1. Country implementation: to identify and respond to technical support needs to ensure that the proposed strategies and evidence are translated into action

2. Advocacy: to strengthen and track maternal and newborn health advocacy efforts globally and in countries.

3. Data and metrics: to improve and institutionalize metrics to track coverage and impact based on the goals and targets of the ENAP and the five strategic objectives

Next stepsEvery Newborn movement


Country launch events for the Lancet Every Newborn Series and/or a national newborn action plan

Implementation of national newborn action plans

Global and national tracking of benchmarks, milestones and outcomes

Annual reporting to World Health Assembly

Support and promote key advocacy moments such as World Prematurity Day (November 17th). A calendar of upcoming events are available at www.everynewborn.org

Next stepsEvery Newborn opportunities for action

What are you doing for Every Newborn? Let us know [email protected]

Stay updated by visiting www.everynewborn.org

mailto:[email protected]

We are building a movement…

BE PART OF THE ACTION

For more information

visit www.everynewborn.org #EveryNewborn

http://www.everynewborn.org/


ADDITIONAL SLIDES


5 things to do differently

Investment for impact

Good governance, community

participation, partner alignment

Integrated Plans

Integrated service delivery, continuum

of care, coordination

Implementation & Innovation

Address health system bottlenecks, EMEN QI

initiative

Indicators & metrics

Targets in post 2015Measurement of

progress and impact

Intentional leadership

developmentCountry ledxx



Could save 2 million lives a year by closing this quality gapParticular focus on health workers especially midwives

“Every Mother Every Newborn” quality initiative

First opportunity is the QUALITY gap for facility births



1990 1998 2006 2014 2022 2030 2038 2046 2054 2062 2070 2078 2086 2094 2102 2110 2118 21260

5

10

15

20

25

30

35

40

45

50

55

Neo

nat

al m

ort

alit

y ra

te (

per

1,0

00 li

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irth

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Sub-Saharan AfricaYear: 2124

Southern AsiaYear: 2103

South-East AsiaYear: 2070

Latin America/CaribbeanYear: 2043

Eastern AsiaYear: 2028

North Africa/West AsiaYear: 2051

Caucasus/Central AsiaYear: 2062

Years for each region to reach NMR of 3 = industrialized countries current averageBy projecting regional average rate of reduction 2000-2011


When will every newborn have the same survival chance as newborns in the richest countries?

NMR 1

110 YEARS FOR AFRICAN NEWBORNS…Nearly 3 times longer than this change took rich countries, despite new interventions


Movement with a planWho has been involved?

Alliance: 50+ global partners on Advisory group;

Steering team and management group (led by WHO & UNICF)

ENAP presented and discussed at many global meetings in 2013 including Women Deliver, AU MNCH, IPA, and NYC mtg

Countries: 17 country consultations between April-September 2013

2 regional workshops

Completed bottleneck analyses conducted in 10 countries

Official WHO consultation: More than 300 official comments including +40 member states,

professional associations, academics, NGOs, individuals

Action plan discussed and endorsed at the 67th World Health Assembly

AU MNCH conference

The ENAP is a road map for change and platform for action. It includes: • A vision and objectives• New mortality targets for ending preventable maternal and newborn deaths

and stillbirths by 2035. • Five strategic objectives• Framework for success including global and national milestones and coverage

goals

Every Newborn action plan – a global consensus on practical actions

More than 3 million babies and women could be saved

each year through investing in quality care around the time of birth.

• Based on the evidence from The Lancet Every Newborn Series

• Co-led by UNICEF & WHO with support from 60+ partner organizations

• Consultation and involvement of countries– 17 country consultations between April-September 2013 and two

regional workshops– Completed bottleneck analyses conducted in 10 countries– More than 300 official comments including +40 member states,

professional associations, academics, NGOs, individuals

• Action plan discussed and endorsed at the 67th World Health Assembly

• Officially launched 30th June 2014 at the Partners Forum, South Africa

• 40+ new commitments to Every Woman, Every Child

Every Newborn action plan - process


Building a movementStrategic use of key moments

xWHO World Health

Assembly

The end of MDGs brings new clarity about what is left behind on the agenda – newborns, adolescents

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=DTzi1OJ4jSSBtM&tbnid=oA4qJKYYHnYzRM:&ved=0CAUQjRw&url=http://www.who.int/pmnch/media/news/2012/preterm_birth_report/&ei=ZVqjUo68G-S50QWu_oDwBw&bvm=bv.57752919,d.bGQ&psig=AFQjCNHD4iHUP-Kykolt5WduE9ZsPKQSVw&ust=1386523473641648

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=RXuzuolMkxztkM&tbnid=_CKAlKKGkqJNkM:&ved=0CAUQjRw&url=http://www.healthynewbornnetwork.org/event/2013-global-newborn-health-conference&ei=01ajUtjSEdGN0wWjg4GACQ&bvm=bv.57752919,d.ZGU&psig=AFQjCNFkYsgg6k5-OWZyZKbvPjXi4LvseQ&ust=1386522640138528

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=t4Udpy3hk8UVBM&tbnid=WXDk4_Av1pSaKM:&ved=0CAUQjRw&url=http://unicefchallenge.wordpress.com/&ei=XVyjUuPeJKal0AWZoICICQ&bvm=bv.57752919,d.bGQ&psig=AFQjCNHCSjoHDJET8P_f3-N4FF49YNkDpw&ust=1386524044519968

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=F8W0kVegGxfu4M&tbnid=DT-6c4eRf_VOKM:&ved=0CAUQjRw&url=http://www.kosherfrugal.com/2013/11/world-prematurity-day-2013.html&ei=hFijUoWnCK-Z0QWJ7oCoCQ&bvm=bv.57752919,d.bGQ&psig=AFQjCNEeRtxZ09PORCMN7ZOCurH2fsurjA&ust=1386522831775433

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An Action Plan To End Preventable Deaths #EveryNewborn EVERY NEWBORN