Early Essential Newborn Care Progress Findings of the Independent Review Group on EENC 21 September, 2015 Tokyo, 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 & Validation Benchmark (July 2015) KHMCHNLAOMNGPNGPHLSLBVNM Newborn situation analysis Yes NoYes EENC Action Plan costed PartialYes Partial NoPartial Implementation Plan funded YesPartialYes EENC technical working group formed Yes Partial YesPartial Full-time EENC/newborn MOH focal person identified YesNoPartialNoYes EENC stakeholder group organized to engage political leaders and champions NoPartialYesNo Yes Clinical Protocol adapted PartialNoPartialYesPartialYesNoPartial Consensus-building workshop YesNoYes NoYesNo Mechanisms established to ensure professional associations support EENC No YesPartialYes No EENC interventions included in pre-service curricula No data No data Partial No data Validated Not validated due to lack of supporting documentation

Country Progress with EENC: Benchmarks

Roll-out of EENC Indicators: Data Availability & Validation Indicator (July 2015) KHMCHNLAOMNGPNGPHLSLBVNM Proportion of delivery centres that have begun EENC coaching Partial No data Yes PartialYesPartial Staff who received EENC coaching PartialYes Partial Proportion of delivery centres using a quality improvement approach Yes PartialYesPartial Proportion of delivery centres receiving at least 3 EENC support visits Yes PartialYesPartial Proportion of delivery centres with running water, clean & functional toilets PartialNo dataYesPartialYesPartial Proportion of newborns receiving immediate STS of adequate duration Partial YesPartialYesPartial Proportion of newborns receiving early EBF Partial YesPartialYesPartial Proportion of delivery centres with no stock-outs of key medicines for EENC Partial No data YesPartialYesPartial Proportion of delivery centres with no stock-outs of commodities for EENC PartialYesPartialYesNo dataPartial Validated Not validated due to low coverage of data/lack of supporting documentation Roll-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 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 & Validation Indicator KHMCHNLAOMNGPNGPHLSLBVNM Premature deliveries 24 – 34 weeks receiving AN steroids No data Partial No data Premature newborns receiving KMC Partial NICU admission rate Partial YesPartial Proportion of newborns born premature by gestational age Partial No data YesPartial No data Partial Proportion of newborns born premature by birthweight PartialYesPartial Proportion of newborns with sepsis Partial YesPartial Proportion of newborns with birth asphyxia Partial YesPartial NMR stratified by gestational age Partial No data YesPartial No data Partial NMR stratifed by birthweight PartialYesPartial Premature case-fatality rate Partial YesPartial Sepsis case-fatality rate Partial YesPartial Birth asphyxia case-fatality rate Partial YesPartial Validated Not validated Hospital impact indicators are stratified by health facility level. Reported for 2014 & 2015 Yes = data provided at all health facility levels, Partial = data provided for some levels

Coverage Indicators: Data Availability & Validation Indicator KHMCHNLAOMNGPNGPHLSLBVNM % 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 % 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 data64%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 data93%41%99%53% No data % newborns receiving PNC within 2 days assessed and counselled on EBF and danger signs No data % newborns 0-28 days who are EBF 80%No data 80%90% 27% Validated Not validated as data not considered representative of population coverage

Country Progress with EENC: Coverage Indicators

Population Impact Indicators: Data Availability & Validation Indicator KHMCHNLAOMNGPNGPHLSLBVNM Neonatal mortality rate (per 1000 live births) Perinatal mortality rate (per 1000 LB) No data 5.5 No data 14.5 No data 22 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% 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 data 13% 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).