CORE Spring Meeting

25th April 2013

Lily Kak on behalf of the GNAP team

Lily Kak, USAID (on behalf of the GNAP team)Core Spring MeetingApril 26, 2013

What is the Global Newborn Action Plan?

• Global plan for country action linked to Every Woman Every Child, and to A Promise Renewed

• Global partnership with multiple organizations including:– Country governments– United Nations – NGOs– Universities and Professional organizations– Donors and foundations

2

Timeline• Global consultation (started in Johannesburg): April – October 2013• Launch of plan: November 2013:

Source: 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 2011 www.childinfo.org , UN MMR estimates 2012

Global progress for reducing maternal, newborn and child deaths has accelerated with the MDGs

Average rate reduction 1990-2010

Maternal mortality ratio 4.2%

Mortality for children 1- 59 months

2.5%

Neonatal mortality (<1 month) 1.8%

At least 30%

slower for

newborn

survival3

19902000

20102012

20142016

20182020

20222024

20262028

20302032

20340

10

20

30

40

50

60

70

80

90

100U5M current trajectory: ARR 2.5%• MDG 4 achieved in 2035• 4 million deaths annually in 2035

U5M ARR 5.2% • 2 million deaths by 2035 • Every country reaches

20/1000 Many countries below 15/1000

MDG 4

6 m deaths in 2011

The trajectory of newborn deaths is flat compared to under-five trajectory and goal of 20/1000 by 2035

Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

NMR current trajectory of ARR 2.2%

4

Mortality rate (per 1,000 live births)

9.6 mm deaths in 2000

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

20222024

20262028

20302032

20340

5

10

15

20

25

30

35

Year

Neo

nata

l mor

talit

y ra

te (p

er 1

,000

live

bir

ths)

NMR target of 10 by 2035ARR: 3.2%

NMR target of 5 by 2035ARR: 6.0%

Current trajectoryNMR in 2035: 13

ARR: 2.2%

We need to bend the curve to end preventable neonatal deaths by 2035 What is plausible? NMR = 5 or 7 or 9 or 10?

-1 0 1 2 3 4 5 6 7

-2

-1

0

1

2

3

4

5

6

7

EGYPT

IRAN

IRAQMOROC.

BOLIV.

BRAZIL

MEXICO

P.N.G.

CAMBODIA

INDONESIA

CHINA

DPRKLAOS

PHILIPPINES VIET NAM

AZERB.

KYRGYZ

TURK

UZBEKISTAN

BANGLADESH

BHUT.

INDIA

NEPAL

PAKISTAN

BOTSWANA

C.A.R.

DRC

ERITREA

ETHIOPIA

MADAG.

MALAWI

RWANDA

SENEGAL

SOMALIA

S. AFRICA

SWAZI.

TANZ.

ZIMBABWE

SubSaharan Africa

Southern Asia

MidEast/ North Africa

LAC

East Asia/ Pacific

Central & E.Europe/ Ind. States

Observed Annual Reduction in NMR (2011)Requ

ired

Annu

al R

educ

tion

in N

MR

to R

each

10

by 2

035

LIBERIA

*Bubble size = # newborn deaths 2011

Many countries need to dramatically accelerate progress to achieve 10 by 35, many others will not be challenged by it (you’re on track if you’re on or below the line)

Bending the curve: looking back, looking forward

Looking back: period of learning • 2005: Newborn Lancet series• January 2011: World Health Assembly Resolution• June 2012: Child Survival Call to Action/A

Promise Renewed• April 2013: Global Newborn Conference

Looking forward: poised for scale and impact• Nov 2013: Global Newborn Action Plan Launch• National rollout of newborn programs

8

3 reasons why the past does not have to be our future for newborn survival….

1. We know the causes

2. We have high impact interventions that integrate within health systems

3. We know it can be done as some low income countries are succeeding

Looking forward: poised for scale and impact

1

2

3

43%

We now know why newborns dieCHANGE 1

Source: Liu et al. 2012. Global, regional and national causes of child mortality in 2000-2010:. The Lancet. DOI:10.1016/SO140-60560-1.

3 million

9

Global causes of child deaths for 2010

717,200

713,000

1,077,800Preterm complications

Intrapartum events

Neonatal infection

Newborn deaths invisible in global estimates until 2005 – now visible

We can reduce the main causes of deathNewborn Survival Solutions – 3 by 2, Plus 1

Preterm birth1. Preterm labor management including antenatal corticosteroids*2. Care including Kangaroo mother care, essential newborn care

Birth complications (and intrapartum stillbirths)3. Prevention with obstetric care *4. Care - essential newborn care, resuscitation*

Neonatal infections5. Prevention, essential care, breastfeeding, Chlorhexidine *6. Case management of neonatal sepsis *

Keep healthy newborns healthy7. Essential newborn care

1

2

3

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

CHANGE

2

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

Plus 1

MDG 4 MDG 5 Neonatal mortality rateAnnual Rate of Reduction:

2000-2010

Rwanda Progressing 6.2%

Bangladesh 4.0%

Nepal 3.6%

Malawi Progressing 3.5%

Some countries are “bending the curve” for newborn survival

Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7

CHANGE

3

GNAP emerging themes

1. Happy Birth Day! Focus on care around birth, saving women and stillbirths as well as newborns

2. Mother and baby belong together, and it is critical for midwives and caregivers to be empowered to care for baby as well as mother

3. Highly cost-effective interventions work for the 3 main causes of newborn death and can be scaled up - some countries have halved newborn deaths in 20 yrs

4. Quality of care matters and saves lives and reduces disability

5. Stronger health systems are crucial and saving newborn babies is the most sensitive marker of a health system that works

6. Families and communities are key to mobilise change for their newborns

Ending preventable newborn deaths: GNAP Strategic Approaches

1. Leadership and political commitment: country and global

2. Focus on high impact interventions

3. Move towards universal coverage of essential maternal and newborn care

4. Address the gap in quality of care

5. Create a supportive environment

6. Ensure mutual accountability

Challenge: What game-changing action can you take?

Three actions:1. Increase birth notification 2. Increase home-based postnatal care coverage3. Change social norms about newborn death

Pvt. company NGO

Partnership for Three Actions

#Newborn2013 #GlobalNewbornAction