BANGLADESH CASE STUDY: NEWB O RN H EA LTH FR O M I NCEPTI ON TO NATI O NAL STR ATEGY A ND

I MPLEMENTATIO N PLA N

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

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NMR Trend NMR Target % Newborn death Expon. (NMR Trend )

67%

Bangladesh Demographic and Health Survey 1993, 1997, 2000, 2004, 2007 2011, 2014, 2017

NMR TREND AND TARGET: BANGLADESH

KEY PARTNERS FOR NEWBORN

MOH&FW

International NGOs

Save the Children

Professional Associations

BPA,BNF,BPS,OGSB

UN Agencies

WHO,UNICEF

Media

Academia, Research

Organization

Icddr,b

Private Sector

Implementing Partners:• Saving Newborn Lives:

District Implementation model for CNCP

• USAID’s MaMoniproject: Strengthening health systems for effective scale up

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): i i i40-iii56. For data sources: See full paper

National Newborn Health Program

Established

Research to definethe problem of

Neonatal mortality

Policy, strategiesand implementation

at scale

Projahnmo cluster randomized controlled trial

(2001-2005)

Community-based research on newborn health services and

practices (2002-2004)

Community-based postnatal care study

(2009-2010)

Helping Babies Breathe Pilot Study (2010)

Draft Health, Population and Nutrition Sector

Development Program (2011-2016)

National NeonatalHealth Strategy and

Guideline (2009)

National Newborn Situation

Analysis (2001)

Maternal MortalitySurvey 2001, 2010

Demographic Health Surveys

2000, 2004, 2007, 2011

Formative research conducted on newborn care practices (2002)

Key newborn intervention tested

Policy Adoption. Included 4 key

Newborn interventions in 2012

GOB develop and implement a model

program CNCP for national scale-up at Kushtia by SNL,

SCI 2012

Adopted and implemented by other large program

APR Declaration

National Newborn Action Plan integrated in different OPs of 4th

HPNSP in 2016

SCANU scale up plan integrated in OP for all district with budget

allocation in 2018

BENAP indicators integrated in national MIS system in 2017

All priority newborn intervention scaled up in 2017

Detail NNHP costed Implementation Plan 2019-2022

developed in 2019

Commitment and Promise Renewed to “Child Survival

Call to Action”2012, in Washington, D.C

NTWC on NBH starts functioning

National Sensitization meeting of policy makers and

participation at Global newborn event

NTWC recommended for 4 key newborn interventions for

national scale up

NNHP-Implementation committee and steering committee become

functional in 2017

Zero draft of NNHS 2020-2030 developed in 2017

Roll out of CNCP by MaMoni HSS in 4 districts

NEWBORN HEALTH JOURNEY (2000-2020) IN BANGLADESH

DEVELOPMENT OF COMPREHENSIVE NEWBORN CARE PACKAGE (CNCP)

Interventions in CNCP: • SBCC for promotion of

o Healthy MNH behavior and care seeking

• Care for all newborn o Immediate and Essential newborn

care including application of CHX NB cord

o Postnatal care

• Care for sick newborn and newborn with complicationso Resuscitation (HBB)

o PSBI Management

o Kangaroo Mother Care

• Care for prevention of preterm complication o Use of Antenatal Corticosteroid

Background:• In 2013 GoB declared its commitment for

Ending Preventable Child and newborn Deaths and identified a set of evidence based newborn health interventions to achieve its commitments.

• Later the MOH, DGHS and DGFP decided to develop a Comprehensive Newborn Care Package (CNCP) and to demonstrate in a pure public health settings with the technical and catalytic support of SNL program of Save the Children.

DEMONSTRATION OF DISTRICT IMPLEMENTATION MODEL BY SAVING NEWBORN LIVES

Program inputs supply side:• 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 MNH Behavior and Proper Care seeking • Health System Contacts• Community Engagement• Multi-Sectoral Engagement• Media Campaign (Local and

National)CNCP training packages

Supplies for newborn interventions

Establishing Routine Monitoring System

Job aids

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

• 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

NNHP in 4th HPNSP

Integration of NBH Indicators and Dashboard in National HMIS

DGHS: Line Director Program Manager

DPM

Admin Finance

DPM Newborn Health

DPM Monitoring & Data Quality

DPMCoordination &

Logistics

DPMTraining &

Child Injury

Division- DirectorDistrict - CS

Upazila - UHFPOUnion – MO & Paramedics

Community – CHCP & Field Staff

DGFPDGNM

DPs Professional Associations

Other OPs

CBHCNNSHSMMISBHE

MOH&FW: NNHP-Steering CommitteeNNHP-Implementation Coordination Committee

National Technical Working Committee

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.

Bay of Bengal

MYANMAR

RANGAMATI

SYLHET

TANGAIL

BOGRA

BANDARBAN

KHULNA

PABNA

COMILLA

DINAJPUR

NAOGAON

MYMENSINGH

SUNAMGANJ

CHITTAGONG

JESSORE

SATKHIRA

HABIGANJ

RAJSHAHI

RANGPUR

NETRAKONA

NATORESIRAJGANJ

DHAKA

BAGERHAT

KURIGRAM

FARIDPUR

NOAKHALI

FENI

KUSHTIA

JAMALPUR

MAULVIBAZAR

GAZIPUR

GAIBANDHA

KISHOREGANJ

JHENAIDAH

KHAGRACHHARI

COX'S BAZAR

NILPHAMARI

NAWABGANJ

SHERPUR

NARAIL

RAJBARI

THAKURGAON

GOPALGANJ

MAGURA

MANIKGANJ

BARISAL

BRAHAMANBARIA

NARSINGDI

PANCHAGARH

SHARIATPURMADARIPUR

LAKSHMIPUR

CHUADANGA

LALMONIRHAT

JOYPURHAT

MUNSHIGANJ

PATUAKHALI

MEHERPUR

PIROJPUR

BARGUNA

NARAYANGANJ

JHALOKATI

CHADPUR

BHOLA

USAID’s MaMoni/SCI also supports 2 SCANUs at DGFP facilities and one at private facility

USAID’s MaMoni/SCI supporting functionality of 8 SCANUs

• Total 48 SCANUs established (30 by UNICEF, 10 by SDF, 1 by JICA and 1 by USAID’s MaMoni/SCI

• Plan for SCANU in remaining 17 district by 2022: SCI will support establishment of 3 SCANUs

SCALE UP PLAN OF SCANU IN 64 DISTRICTS

BANGLADESH PROGRESS ON ENAP MILESTONES 2015-2020

• Costed Bangladesh ENAP developed in 2015, which guided the MOHFW to incorporate allpriority 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 theNational Quality Improvement Secretariat with necessary strategic, M&E framework andguidelines.

• Health workforce developed with new deployment and huge capacity developmentprogramme 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 withengagement of Community Groups centering around >14,000 Community Clinics fordemand 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 andpolicy adoption for scale-up: Managing young infants with sepsis, 7.1% chlorhexidine cordcleansing, Quantitative/Qualitative study on SCANU services etc. Results and findingswere shared with Policy stakeholders in the National Newborn Health conference 2019

LESSONS LEARNED

• Integration of NBH interventions into existingservice delivery platforms for MNCH

• Effectiveness of scale up depends largely onthe strength of implementation

• Institutionalization of the interventionspossible when scale up done through healthsystems platforms

• Strong partnerships critical to achieve scale -private sector, NGOs, professionalassociations, 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