1. Regional-National Networks for Newborn-Perinatal Health WHO-SEARO

2. South East Asia Regional Neonatal Perinatal Database

3. Background… Regional Neonatal Perinatal Database ◦ To compile, analyze, and disseminate reliable data from countries of the Region ◦ Recommended by 2 WHO Regional meetings (1997 & 1998) South East Asia Regional Neonatal Perinatal Database (SEAR-NPD)

4. Aim Objectives To generate and disseminate prospectively collected data on neonatal-perinatal morbidity and mortality at the Network institutions To use the data generated for quality improvement of newborn care To Establish A SEAR Network for generating information on neonatal/perinatal health in the Region

5. Methodology  Identification of network institutions Nodal center: WHO CC, AIIMS, New Delhi 5 other Centers of Excellence in different countries CountryCenterPrincipal Investigators Bangladesh Bangabandhu Sheikh Mujib Medical University, Dhaka Prof. M. Shahidullah Indonesia Gadjah Mada University, Yogyakarta Dr. Ekawaty Haksari NepalTribhovan University, KathmanduProf. Prakash Shreshtha Sri Lanka DeSoysa Hospital for Women, University of Colombo, Colombo Dr. Ishani Rodrigo ThailandQueen Sirikt National Institute of Child Health, Bangkok Dr. Uraiwan Chotigaet IndiaAll India Institute of Medical Sciences, New Delhi Prof. V. K. Paul & Prof. A. K. Deorari

6. Methodology  Development of tools  PIs’ meeting  Data collection  Quality assurance  Data check and feedback  Mid-term meeting of PIs  Data analysis and drafting the final report

7. Salient findings from the database SEAR- NPD IGME data Lancet 2010 Referral centers vs. whole country data!

8. Gains Established a network of centers of excellence in the Region Engagement of local collaborators and colleagues to implement the program at each center Generation of data –for planning new research and for quality improvement

9. Recommended Next steps Network Institutions  To create network of institutions in countries  To use the data generated for quality improvement of newborn care Nodal center: Role  Facilitating each center to create the network  Help in developing software and data tools  Developing a common website for the network

10. Regional Network Meeting on Strengthening Newborn Health care, Education and Training Capacity, 22-25 March 2011, AIIMS, New Delhi, India

11. Regional Network Meeting: Objectives To strengthen the Regional Neonatal-Perinatal Network and promote National Networks for strengthening neonatal healthcare toward the attainment of MDG 4 To build collaboration and consensus on promoting evidence based newborn heath care, education and training in the member States and the Region To introduce technical updates on KMC and LBW feeding and introduce Newborn Learning Resource Materials for capacity building of health care providers To receive technical inputs the draft ‘Standard Treatment Protocols for Management of Newborn Problems in Small Hospitals’

12. Regional Meeting: Participation Bangladesh Bhutan India Indonesia Myanmar Maldives Nepal Sri Lanka Timor Leste

13. Regional Network Meeting: Recommendations 1.Regional-National Networks for Neonatal- Perinatal Health to contribute to newborn survival and health towards achievement of MDG 4 in the Region 2.Develop National Networks for Neonatal- Perinatal Health 3.Develop Standard Treatment Protocols for managing common newborn conditions in small hospitals.

14. Regional-National Networks: Functions Provide Advocacy for Policy / Strategy, increased investments Promote Database and Research Assist in Knowledge Management: Dissemination of / Exchange of / sharing of knowledge and experience Build Education and Training Capacity Support Quality assurance

15. Develop National Networks: Attributes of National Coordination Center: Has proven capacity in academics, education, training and research in newborn health - Handles a large volume of deliveries and patient load with NICU offering tertiary level newborn care Has significant experience and has goodwill among professional colleagues in the country Has capacity to provide leadership - Has a team of experts and human resource available Has proven track record of collaboration and contribution to national newborn programme Has stated mission and vision to promote public health approach for newborn health and has keen interest and inclination to lead such initiatives Facilitated by WHO Support of the Government

16. Role of ‘National Coordination Center’ Engagement with Regional Network Assist / lead development of National Network Coordinate the National Network Contribute to the technical functions of the Network in the country

17. Partners in the Country Institutions: Phased approach –Neonatal Units: Government Private –District / Sub-district Hospitals Professional Associations: –Doctors: Neonatology, Pediatrics, Perinatology, ObGy –Nurses and Midwives Development Partners: UN agencies and others Stewarded by Ministry of Health

18. Sustenance Government mandate Continued engagement with partners Resources Mobilization: –Leverage existing opportunities: Government, Agencies –National Coordination Center to coordinate with WHO and agencies for resource mobization

19. Standard Treatment Protocols for common newborn conditions in small hospitals

20. Application Small Hospitals that: Provide in-patient care to newborns – not necessarily in special care units Have MBBS doctors and nurses May or may not have Specialist Pediatrician Has necessary supplies and equipment Protocols would be applicable to higher level facilities with relevant additionalities

21. Evidence based Consistent with existing WHO Guidelines: Pocket Book (Blue) Pink Book (IMPAC series) Recent Guidelines and updates by WHO

22. Format Section 1. Flow Charts or Decision Making charts on identified conditions: –1-2 pages –Action oriented –Linkages with other relevant flow charts when applicable Section 2. Explanatory Notes for rationale of recommended actions for each condition Section 3. Guidance notes on procedures Annexure: Guidance note on how to organize the neonatal care services at the small hospital

23. Standard Treatment Protocols Dr Tunjung: Seizure, Hypoglycemia Dr Samana: Sepsis, Fluids, Anemia Dr Ekawaty: Sepsis, LBW feeding Dr Niyasha: Jaundice, sepsis, seizures Dr Shreshtha: Breathing difficulty, sepsis, jaundice Drs KIshwar, Shahidullah: Sepsis, Triage, post asphyxia Dr Azad Choudhary: LBW feeding, Referral Dr Virna: Jaundice, Seizures, Hypoglycemia Dr Aye Aye: Hypoglycemia, LBW feeding, post asphyxia

24. Follow up National Networks for Neonatal / Perinatal Health: Progress –Bangladesh –Nepal –Sri Lanka Standard Treatment Protocols for Newborn Conditions: Peer Review complete Use of ICT for training courses