1. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation in selected African Countries Dr. Joseph de Graft-Johnson, MCHIP/Save the Children Newborn Team Leader

2. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Acknowledgments  Ministries of Health and staff of the study facilities in Ethiopia, Madagascar, Rwanda, and United Republic of Tanzania  Data collection teams in each country  Research team for MCHIP: Jim Ricca, Barbara Rawlins, Linda Bartlett, David Cantor, Patricia Gomez, Heather Rosen, Bob Bozsa  MCHIP\jhpiego headquarters and in-country staff, Tandem consulting (Madagascar) 2

3. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Presentation outline  Summary of the newborn sample  Newborn care equipment & supplies inventory findings  immediate newborn care findings  Neonatal resuscitation results  Conclusions

4. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Summary of newborn care sample  Surveyed 177 facilities in 4 countries; observed ~2500 deliveries and ANC consults, and interviewed ~600 health workers 4 SampleEthiopiaTanzaniaRwandaMada- gascar Total Facilities19527036177 -Hospital100%29%60%75%58% -Health Center/dispensary0%71%40%25%42% Observations 3188806046712473 -Deliveries1924892933481322 *Newborn care1154192253361095 -ANC consults1263913113231151 Health workers interviewed79206146140571 *Newborn health79202142132555

5. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Inventory of supplies for immediate newborn care (n=177) 5

6. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Inventory of supplies for management of newborn complications  54% of facilities had gentamycin and ampicillin with wide range by country (29-67%) 6

7. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Essential newborn care: from policy to practice 7 (1) SDGs covers all elements of ENC, data missing for Tanzania and Rwanda; (2) births attended by skilled attendants; (3) facilities stocked with cord ties, sterile scissors, towel/blanket (all 3); (4) personnel knowledgeable in immediate newborn care; (5) personnel received supervision within last 3 months

8. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Observation of immediate newborn care (n=1095)  24% of deliveries (range 17-40%) received all essential newborn care elements (*) (1) Ethiopia: cuts and ties/clamps cord, protecting newborn from blade or scissors

9. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Non-beneficial and un-indicated newborn care practices 9

10. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Health worker knowledge of immediate newborn care and management of complication (n=423) 10 * Values are mean score (1) no data for Madagascar; (2) n=555, written test for Ethiopia, simulation for Tanzania, Rwanda, Madagascar

11. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Newborn resuscitation simulations 11 (1) Simulation: drying, place on warm clean surface, head in slightly extended position, suction with bulb or catheter in mouth or nose (all items) (2) Ventilation: place correct size mask covering chin, moth and nose, squeeze bag with 2 fingers or hand – appropriately, ventilate at 40 breathes/min (all items) (3) Adjustment is any proper adjustment: check neck position, check seal, repeat suction, squeeze harder

12. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Management of Newborn Asphyxia 12 Itemn Percent Cases of resuscitation observed148 Type of treatment provided -Drying/wrapping130 88% -Position for resuscitation117 79% -Use of suction62 42% -Use of bag and mask69 47% -Ventilate with oxygen15 10% Outcome of newborn -Alive128 86% -Dead17 11%

13. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Conclusions Assumption that skilled birth attendance equal quality newborn care is obviously not true  There is need to improve the quality of newborn care for infants delivered at health facilities  A sizable percentage of health facilities have newborn resuscitation equipment but staff skills needs improvement  Countries are committed to make these improvements and all must play their part to make it happen

14. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011 Thank you! wwww.mchip.net Follow us on: