08182017Headline:

Family Healthy “Check Up” 2013: The Health of Mother and Baby

This is the second post in the six-part Family Health “Check Up” 2103 series which provides a window into the ways in which we think about our Family Health strategy, at the foundation. Follow @gatesfoundation and @gdarmsta on Twitter to join the conversation. The Millennium Development Goals (MDG) 4 & 5 have focused the world on child and maternal survival, with a wake-up call that while improvements have been made, many countries will not reach the targeted reductions for maternal and child mortality. Poor communities are lagging behind. An even starker wake-up call is that newborn survival and health—those first 28 days after birth—is lagging even further behind in progress, and that MDG 4 cannot be achieved without greatly accelerated progress in improving newborn health. The good news is that research has brought a better understanding of the causes of newborn mortality and interventions for care of the newborn, to increase the likelihood of survival and healthy development.

The Maternal Newborn and Child Health (MNCH) team has identified some important lessons from analyses of global and national trends in mortality reduction, cause specific mortality and intervention coverage, and from experience in program implementation. Based on this learning, we have adjusted our MNCH strategy to keep the focus of our investments on the most critical conditions and issues. A few of those adjustments are highlighted here.

While we need to continue to ensure that children under-five are prevented from, and treated for pneumonia, malaria and diarrhea, we also need to pay more attention to preterm babies.

Preterm birth is now the second leading cause of under-five deaths. While we need to continue to ensure that children under-five are prevented from, and treated for pneumonia, malaria and diarrhea, we also need to pay more attention to preterm babies. A preterm infant—born before 37 weeks of gestation—has a diminished chance of survival, particularly if born in low-income countries. Preterm babies who do survive can also experience serious short- and long-term health problems throughout their lives, particularly neuro-developmental impairments.

Last year, our Preventing Preterm Birth Initiative became fully operational. This initiative, through our partner the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), supports research aimed at identifying mechanisms and exploring approaches to prevent preterm birth.

The second prong of our preterm focus is scaling up known solutions for care of the preterm baby. We aim to substantially up our game in this area over the coming year through actions to scale-up life-saving interventions such as Kangaroo Mother Care and antenatal corticosteroids, a treatment given to pregnant women with threatened preterm labor to speed up lung maturation in the baby while in utero.

Chlorhexidine, used for umbilical cord cleansing for reducing newborn mortality due to infection, has made significant progress over the past year, both in research of its efficacy and the changing policy environment. As more studies prove the efficacy and acceptability of this low-cost simple intervention, it is becoming more prominent as an option for newborn care.

Take the state of Sokoto in northern Nigeria as an example. The state government has granted regulatory approval for the use of chlorhexidine for cleansing of the newborn umbilical cord in their state. This move shows local government commitment to using an evidence-based approach to improve the chance of newborn survival and their willingness to be innovative. This commitment has led to action as babies began to receive chlorhexidine cord treatment this month. This decision has been praised at the national level by the Minister of State for Health, encouraging other state governments to mirror these efforts.

On the policy side, we are placing more emphasis on country-level efforts to use evidence and advocacy to engage in policy dialogue. These efforts focus on increasing adoption, implementation and scale-up of essential interventions, commodities and practices at the country level. One example of this shift is in Ethiopia, where greater policy engagement by a number of partners led to a major policy breakthrough by the government to allow frontline health workers to provide neonatal sepsis care, including administration of antibiotics by injection, at the community level. This brings this life-saving treatment closer to the newborn infants who need it.

Frontline health workers are key to our MNCH strategy, as the providers who have first contact with women, children and their families. The Ananya project in Bihar, India is focused on scaling up the most promising approaches to women’s and children’s health, and early results are encouraging. Data from household surveys last year provide indications of improvements in outreach by frontline health workers and in key behaviors by families. More women are getting antenatal and postnatal newborn care, more children are getting immunized and have better nutrition, and more women are using a form of modern contraception. Progress is still slow, but unmistakable and seemingly gaining in momentum.

Another important trend that we are observing is the increase globally in the number of women having facility-based deliveries; although there are still differences in facility-based birth rates within regions and countries. While we continue to support efforts to ensure that more women have access to a skilled attendant at birth and to life-saving commodities and emergency care if necessary, we need to place more emphasis on assuring that quality of care is provided at health facilities, to respond to the increasing demand for those services. We need to identify effective strategies and define our role, to improve the quality of intrapartum care at facilities, with a better understanding of barriers and facilitators to effective intrapartum and immediate maternal and newborn care. The increased focus on intrapartum and postnatal care brings together maternal and neonatal health efforts and is an important adjustment to our MNCH strategy.

While we continue to support efforts to ensure that more women have access to a skilled attendant at birth and to life-saving commodities and emergency care if necessary, we need to place more emphasis on assuring that quality of care is provided at health facilities, to respond to the increasing demand for those services.

The MNCH team continues to invest in key maternal and neonatal conditions with an integrated approach, recognizing that integrated approaches can maximize the benefits of targeted interventions. The windows of opportunity of antenatal, intrapartum and postnatal care offer entry points to integration and accelerated progress on maternal, reproductive, neonatal, and child health and nutrition, leading to mortality reduction and improved child development.

These strategic adjustments are based on our analysis of data generated from our investments in monitoring and evaluation, utilizing process, intermediate and outcome indicators. Even with adjustments in priorities and actions, we continue to assess progress and analyze gaps along the pathway from inputs to outcomes. We will strive to improve the robustness of our measurments, get more and better intervention coverage rates, especially for neonatal health, and tighten the feed-back loop from monitoring and evaluation to adjustments — on an ongoing basis.

How do you measure progress in your programs? Which indicators are truly helpful to guide adjustments? Which indicators are not?

What Next?

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