Bangladesh Case Study: Newborn Health from Inception to National Strategy and Implementation Plan
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BANGLADESH CASE STUDY: NEWBORN HEALTH FROM INCEPTION TO NATIONAL STRATEGY AND IMPLEMENTATION PLAN Professor Mohammod Shahidullah Chairman, Department of Neonatology, BSMMU, President,Bangladesh Medical and Dental Council, Chairperson, National Technical Working Committee, NBH Chairman, National Technical Advisory Committee forCOVID-19Response PRESENTATION OUTLINE • NMR Trend and Target • Government Led Partnership • What was done • Current Status of Newborn Programming • Lessons Learned • Future Directions NMR TREND AND TARGET: BANGLADESH 55 52 100% 48 50 90% 42 45 41 80% 37 67% in U5 40 70% 35 32 61% 28 60% death 30 57% 50% 25 60% 22 47% 40% 20 42% 45% 16 39% 30% deaths 15 19 10 20% 12 5 10% 0 0% Neonatal Mortality Neonatal Mortality Rate/1000Live Birth 1990 1995 2000 2005 2010 2015 2020 2025 2030 Year contribution % of newborn NMR Trend NMR Target % Newborn death Expon. (NMR Trend ) Bangladesh Demographic and Health Survey 1993, 1997, 2000, 2004, 2007 2011, 2014, 2017 KEY PARTNERS FOR NEWBORN International Implementing Partners: NGOs • Saving Newborn Lives: Save the Children District Implementation model for CNCP Professional • USAID’s MaMoni Private Sector Associations Strengthening BPA,BNF,BPS,OGSB project: health systems for effective scale up MOH&FW Academia, Research UN Agencies Organization WHO,UNICEF Icddr,b Media NEWBORN HEALTH JOURNEY (2000-2020) IN BANGLADESH Research to define Policy, strategies Key newborn National Newborn the problem of and implementation intervention tested APR Declaration Health Program Neonatal mortality at scale Established Projahnmo cluster Draft Health, Population and Policy Adoption. National Newborn Action Plan National Newborn randomized controlled trial Nutrition Sector th Included 4 key integrated in different OPs of 4 Situation (2001-2005) Development Program HPNSP in 2016 Newborn interventions in Analysis (2001) (2011-2016) 2012 Community-based National Neonatal NNHP-Implementation committee research on newborn Health Strategy and and steering committee become Maternal Mortality health services and GOB develop and functional in 2017 Guideline (2009) implement a model Survey 2001, 2010 practices (2002-2004) Commitment and Promise program CNCP for national All priority newborn intervention scale-up at Kushtiaby SNL, Demographic Health Community-based Renewed to “Child Survival scaled up in 2017 Call to Action” SCI 2012 Surveys postnatal care study 2012, in Washington, D.C BENAP indicators integrated in 2000, 2004, 2007, 2011 (2009-2010) Roll out of CNCP by national MIS system in 2017 National Sensitization MaMoni HSS in 4 districts Formative research Helping Babies Breathe meeting of policy makers and SCANU scale up plan integrated in conducted on newborn Pilot Study (2010) participation at Global Adopted and implemented OP for all district with budget care practices (2002) newborn event by other large program allocation in 2018 NTWC on NBH starts Detail NNHP costed functioning Implementation Plan 2019-2022 NTWC recommended for 4 key developed in 2019 newborn interventions for national scale up Zero draft of NNHS 2020-2030 developed in 2017 Source: Modified from Rubayet et al. 2012. Newborn Survival in Bangladesh: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii40-iii56. For data sources: See full paper DEVELOPMENT OF COMPREHENSIVE NEWBORN CARE PACKAGE (CNCP) Background: Interventions in CNCP: • In 2013 GoB declared its commitment for • SBCC for promotion of Ending Preventable Child and newborn o Healthy MNH behavior and care Deaths and identified a set of evidence seeking based newborn health interventions to • Care for all newborn achieve its commitments. o Immediate and Essential newborn care including application of CHX NB cord • Later the MOH, DGHS and DGFP decided to o Postnatal care develop a Comprehensive Newborn Care • Care for sick newborn and newborn Package (CNCP) and to demonstrate in a with complications pure public health settings with the technical o Resuscitation (HBB) and catalytic support of SNL program of Save o PSBI Management the Children. o Kangaroo Mother Care • Care for prevention of preterm complication o Use of Antenatal Corticosteroid DEMONSTRATION OF DISTRICT IMPLEMENTATION MODEL BY SAVING NEWBORN LIVES Supplies for newborn Program inputs supply side: interventions • Capacity building and skill retention • Ensure availability of supplies • Establishing Routine Monitoring System • Strengthen supervision and mentoring support for quality improvement Programmatic Inputs: Demand Side: SBCC Approaches: Promoting Healthy Job aids MNH Behavior and Proper Care seeking Establishing Routine Monitoring System • Health System Contacts • Community Engagement • Multi-Sectoral Engagement • Media Campaign (Local and National) CNCP training packages NATIONAL NEWBORN HEALTH PROGRAM • All newborn interventions incorporated into the National Newborn Health Program (NNHP) • Incorporate in different Operation Plans (OPs) of 4th HPNSP program (2017-2022) • Bangladesh Government decided to scale-up CNCP NNHP in 4th HPNSP • Procurement and distribution of commodities • Indicators included in the MIS, dashboard created on DHIS 2 • Monitoring and review of progress • Comprehensive Newborn Care Package for capacity-building • National newborn health campaign • Engagement of partners and stakeholders • Engagement of private sector and social marketing Integration of NBH Indicators and Dashboard in National HMIS MOH&FW: NNHP-Steering Committee NNHP-Implementation Coordination Committee National Technical Working Committee Other OPs DGHS: Line Director Program Manager DGFP CBHC DGNM NNS DPs HSM DPM DPM DPM DPM DPM Newborn Professional MIS Monitoring & Coordination & Training & Admin Finance Health Associations BHE Data Quality Logistics Child Injury Division- Director District - CS Upazila - UHFPO Union – MO & Paramedics Community – CHCP & Field Staff CURRENT STATUS OF NEWBORN PROGRAMMING • CNCP scaled up in all 64 districts. • KMC scaled up in all 64 district in 192 facilities. • ACS service is available in 14 public Medical college hospital and 63 district hospitals. • Total 48 SCANU established. SCALE UP PLAN OF SCANU IN 64 DISTRICTS PANCHAGARH NILPHAMARI THAKURGAON LALMONIRHAT KURIGRAM • Total 48 SCANUs established (30 by UNICEF, 10 by SDF, 1 by JICA and 1 DINAJPUR RANGPUR by USAID’s MaMoni/SCI GAIBANDHA • Plan for SCANU in remaining 17 district by 2022: SCI will support JOYPURHAT SHERPUR establishment of 3 SCANUs NAOGAON SUNAMGANJ SYLHET JAMALPUR NETRAKONA BOGRA NAWABGANJ MYMENSINGH RAJSHAHI MAULVIBAZAR SIRAJGANJ HABIGANJ NATORE TANGAIL KISHOREGANJ USAID’s MaMoni/SCI also supports 2 SCANUs at DGFP facilities and one at private facility GAZIPUR PABNA NARSINGDI KUSHTIA BRAHAMANBARIA MEHERPUR MANIKGANJ DHAKA RAJBARI NARAYANGANJ CHUADANGA FARIDPUR MUNSHIGANJ JHENAIDAH MAGURA COMILLA CHADPUR SHARIATPUR MADARIPUR NARAIL KHAGRACHHARI JESSORE GOPALGANJ FENI RANGAMATI LAKSHMIPUR BARISAL NOAKHALI KHULNA JHALOKATI SATKHIRA BAGERHAT CHITTAGONG PIROJPUR BHOLA PATUAKHALI BARGUNA BANDARBAN Bay of Bengal COX'S BAZAR USAID’s MaMoni/SCI supporting functionality of 8 SCANUs MYANMAR BANGLADESH PROGRESS ON ENAP MILESTONES 2015-2020 • Costed Bangladesh ENAP developed in 2015, which guided the MOHFW to incorporate all priority newborn interventions in it’s Operational Plan and scale-up nationwide. • District learning models for QI scaled-up in 17 districts under the strategic guidance of the National Quality Improvement Secretariat with necessary strategic, M&E framework and guidelines. • Health workforce developed with new deployment and huge capacity development programme on maternal and newborn care ✓ >16,000 health Workers trained on Essential, Small and sick-newborn care ✓ Midwifery cadre introduced with 1183 midwives deployed since 2018 in 378 facilities • National communication strategy and materials on MNCH developed and National newborn health campaign implemented. Community participation model developed with engagement of Community Groups centering around >14,000 Community Clinics for demand creation and uptake of essential MNH care • All Newborn and quality indicators for MNH were incorporated in national MIS system (DHIS 2) • Implementation researches were conducted for in-country evidence generation and policy adoption for scale-up: Managing young infants with sepsis, 7.1% chlorhexidine cord cleansing, Quantitative/Qualitative study on SCANU services etc. Results and findings were shared with Policy stakeholders in the National Newborn Health conference 2019 LESSONS LEARNED • Integration of NBH interventions into existing service delivery platforms for MNCH • Effectiveness of scale up depends largely on the strength of implementation • Institutionalization of the interventions possible when scale up done through health systems platforms • Strong partnerships critical to achieve scale - private sector, NGOs, professional associations, NGOs FUTURE DIRECTIONS • Access to high priority intervention/most essential care in HTR areas • Quality MNH services (Standard, Adherence to SOPs) • Demonstrate model with private sector engagement in NB care • Regional institutional hub for training and mentoring established for MNH care transform the Medical Colleges as training institution • Provision for separate indoor facilities for treatment of sick newborns who don’t need admission at SCANU. • Country wide reporting on Maternal and newborn data both from public and private facilities • Monitoring of NB progress through MIS data analysis (national and local) and action plan • Accreditation/certification process in place for public and private facilities THANK YOU.