early essential newborn care progress findings of the independent review group on eenc 21 september,...
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Early Essential Newborn Care Progress
Findings of the Independent Review Group on EENC
21 September, 2015Tokyo, Japan
Workshop on Validation of EENC Progress 12 – 13 August, 2015 (Manila)
• Four independent reviewers representing the fields of neonatology, obstetrics and gynaecology, and midwifery
• Convened for 2 days to: Validate EENC monitoring
and evaluation data from 8 priority countries
Validate WHO progress in supporting EENC introduction & scale-up
Advise on indicators and information use for EENC
Process of validation
• Independent reviewers worked in pairs: each pair reviewed four countries
• Examined data for each indicator and supporting documentation provided by countries to validate
• When data was not validated, provided queries and advice for countries
• Reviewed and validated WHO actions to support countries as a group
• WHO regional and country offices did not participate in the process (were available only to clarify any queries)
Outcome of validation exercise: Country reports
Outcome of validation exercise:EENC country profiles
EENC Data: General Findings
• All countries submitted data for review
• Priority countries have made impressive progress and taken concrete steps to introduce and scale up EENC
• Incomplete data and data inconsistencies are most commonly noted for indicators of EENC implementation and hospital impact as these require new data collection methods.
Benchmarks: Data Availability & ValidationBenchmark (July 2015) KHM CHN LAO MNG PNG PHL SLB VNM
Newborn situation analysis Yes Yes Yes Yes Yes Yes No Yes
EENC Action Plan costed Partial Yes Yes Yes Partial Partial No Partial
Implementation Plan funded Yes Partial Yes Yes Yes Yes Yes Yes
EENC technical working group formed
Yes Yes Yes Yes Partial Partial Yes Partial
Full-time EENC/newborn MOH focal person identified
Yes No Partial No Yes Yes Yes Yes
EENC stakeholder group organized to engage political leaders and champions
No Partial Yes No No Yes Yes Yes
Clinical Protocol adapted Partial No Partial Yes Partial Yes No Partial
Consensus-building workshop Yes No Yes Yes No Yes No No
Mechanisms established to ensure professional associations support EENC
No No Yes Partial Yes Yes No No
EENC interventions included in pre-service curricula
No data
No data Partial Partial Partial Partial Partial No
data
Validated Not validated due to lack of supporting documentation
Country Progress with EENC: Benchmarks
EENC in pre-service curricula
Mechanisms for professional associations' support
Consensus-building workshop
Clinical Protocol adapted
EENC stakeholder group
Full time EENC focal person
EENC technical working group
Implementation Plan funded
EENC Action Plan costed
Newborn health situation analysis
0 2 4 6 8 10
5
1
4
1
1
3
1
4
3
4
2
4
5
5
7
3
7
Achieved Partially achieved # of countries
Roll-out of EENC Indicators: Data Availability & ValidationIndicator (July 2015) KHM CHN LAO MNG PNG PHL SLB VNM
Proportion of delivery centres that have begun EENC coaching Partial
No data
Yes Yes Yes Partial Yes Partial
Staff who received EENC coaching Partial Yes Yes Yes Partial Partial Partial
Proportion of delivery centres using a quality improvement approach Yes Yes Yes Yes Partial Yes Partial
Proportion of delivery centres receiving at least 3 EENC support visits Yes Yes Yes Yes Partial Yes Partial
Proportion of delivery centres with running water, clean & functional toilets Partial No data Yes Partial Yes Partial Partial
Proportion of newborns receiving immediate STS of adequate duration Partial Partial Yes Partial Yes Partial Partial
Proportion of newborns receiving early EBF Partial Partial Yes Partial Yes Partial Partial
Proportion of delivery centres with no stock-outs of key medicines for EENC Partial
No data
Yes Partial Yes Partial Partial
Proportion of delivery centres with no stock-outs of commodities for EENC Partial Yes Partial Yes No data Partial
Validated Not validated due to low coverage of data/lack of supporting documentationRoll-out indicators are stratified by health facility level.Yes = data provided at all health facility levels, Partial = data provided for some levels
Country Progress with EENC: Roll-out• All countries providing data are scaling EENC through
coaching: At least 21 national, 64 regional and provincial, 266 first-level
referral and 56 primary facilities have begun EENC coaching Over 50% of delivery facilities have done coaching in
Cambodia, Mongolia & Philippines A total of 9 943 staff providing delivery and newborn services in
the priority countries have been coached in EENC
• Wide range of clinical EENC practice performance, coverage of: Immediate skin-to-skin is 63%, but only 32% of newborns
completed the first breastfeed before separation Early & exclusive breastfeeding ranges from 15% - 87%
Hospital Impact Indicators: Data Availability & ValidationIndicator KHM CHN LAO MNG PNG PHL SLB VNM
Premature deliveries 24 – 34 weeks receiving AN steroids No data
No data
No dataNo data
No dataPartial
No dataNo data
Premature newborns receiving KMC Partial Partial Partial
NICU admission rate Partial Partial Yes Partial Partial Partial Partial
Proportion of newborns born premature by gestational age Partial
No dataYes Partial Partial
No dataPartial
Proportion of newborns born premature by birthweight Partial Yes Partial Partial Partial
Proportion of newborns with sepsis Partial Partial Yes Partial Partial Partial Partial
Proportion of newborns with birth asphyxia Partial Partial Partial Yes Partial Partial Partial Partial
NMR stratified by gestational age Partial
No data
No dataYes Partial Partial
No data
Partial
NMR stratifed by birthweight Partial Yes Partial Partial PartialPremature case-fatality rate Partial Partial Yes Partial Partial Partial
Sepsis case-fatality rate Partial Partial Yes Partial Partial Partial
Birth asphyxia case-fatality rate Partial Partial Yes Partial Partial Partial
Validated Not validatedHospital impact indicators are stratified by health facility level. Reported for 2014 & 2015Yes = data provided at all health facility levels, Partial = data provided for some levels
Coverage Indicators: Data Availability & ValidationIndicator KHM CHN LAO MNG PNG PHL SLB VNM
% live births attended by skilled health personnel 89% 99.8% 42% 98.9% 53% 73% 88% 93%
% live births that take place at health facilities 83% 99.5% 38% 98%
No data
61% 90% 92%
% live births delivered by C-section 3% 35% 4% 23% 9% 6% 20%% live rural births delivered by C-section
2% 29% 2% 18% 8% 5.9% 16%
% newborns dried after birth
No data
No data
No data No data
No data
No dataNo data No data% newborns with delayed bath after birth
% newborns receiving STS 64%% newborns breastfed within one hour of birth 66% 39% 93% 50% 75% 40%
% newborns not receiving a prelacteal feed 81% 77% No data 64% 94% 38%% live births with a reported birth weight 72% 43% 99% 80% 81% 93% % women receiving PNC within two days of birth 88% 94% 40% 95% 72% 18%
No data% newborns receiving PNC within two days of birth No data 93% 41% 99% 53%
No data% newborns receiving PNC within 2 days assessed and counselled on EBF and danger signs
No data No data No data No data No data
% newborns 0-28 days who are EBF 80% No data No data No data 80% 90% 90% 27%
Validated Not validated as data not considered representative of population coverage
Country Progress with EENC: Coverage Indicators
Skilled birth at-tendance
Facility delivery rate Caesarean section rate
0
20
40
60
80
100
8983
3
99.8 99.5
3542
38
4
98.9 98
23
53
73
61
9
88 90
6
93 92
20
KHM
CHN
LAO
MNG
PNG
PHL
SLB
VTN
Perc
enta
ge
No data PNG
No data PNG
Country Progress with EENC: Coverage Indicators
Newborns not receiving a prelacteal feed
Newborns breastfed within 1 hour of birth
Newborns exclusively breastfed 0 -28 days
0
20
40
60
80
100
81
66
8077
39
64
50
9094
75
90
38 40
27
93
80 KHM
LAO
MNG
PNG
PHL
SLB
VTN
Perc
enta
ge
No data
MNG &
PNG
No data PNG
No data Lao & MNG
Population Impact Indicators: Data Availability & ValidationIndicator KHM CHN LAO MNG PNG PHL SLB VNM
Neonatal mortality rate(per 1000 live births)
18 6.3 29 10 24 13 13 13
Perinatal mortality rate(per 1000 LB)
No data 5.5 No
data 14.5
No data
22 No data
No data
Proportional causes of NN death: • Sepsis• Tetanus• Birth asphyxia• Pre-term birth• Congenital anomalies
No
data
1.7%0.1%25%33%19%
19%-
32%27%8%
3.8%0%
12.5%34.0%9.9%
17%-
23%32%17%
18%-
27%27%20%
7%
-13%36%24%
Low birth weight rate (<2500g) 8% 6.2% 15% 4.4% 21% 13% 5%Pre-term birth rate(< 37 weeks)
No data 7.5% No
dataNo
data 13% No data
No data
Validated Not validated as data not considered representative of population coverage
WHO Actions to Support EENC: Findings• The Regional Action Plan specifies
indicators to track WHO, UNICEF & partner support to countries
• Data were available for 71% (18/24) of indicators
• Of these indicators, 56% (10/18) were validated
• Several indicators need to be more clearly defined to track support and measure progress in countries more effectively
Conclusions of the Independent Review Group
• Validation of EENC M&E data is essential for tracking progress and supporting implementation.
• Scale-up of EENC has begun in priority countries through coaching, quality improvement and monitoring and evaluation
• Hospital impact data are not yet incorporated into routine systems in any country, and show many gaps & inconsistencies
Conclusions of the Independent Review Group (2)
• All countries routinely track population coverage and impact measures for newborn health. However, indicators on immediate newborn care are often not included in population-based surveys
• Most indicators in the EENC M&E framework are accurate, precise, measureable and programmatically relevant for EENC
• Many activities in the Regional Action Plan have been initiated or completed. Definitions and programmatic relevance of some indicators for tracking Regional progress with EENC are not clear.
Recommendations of the Independent Review Group
Member States may consider:• Standardizing hospital indicators and incorporating
them into routine hospital reporting systems.
• Conducting Annual EENC Implementation Reviews and using data for planning and tracking progress.
• Using country data to review programme successes and areas needing attention, and to identify priorities for further scale-up and financing.
Recommendations of the Independent Review Group (2)
WHO should: • Support member states to institutionalize M&E for
EENC, including for: (1) incorporating newborn care practices in surveys, (2) supporting use of data for monitoring and
planning, and (3) developing systems for hospital impact data.
• Make EENC data validations followed by Member State meetings a routine process (e.g. biannual).