Leadership and Learning

Global and Regional Leadership Role
MCHIP helped to shape the global technical agenda for the management of newborn birth asphyxia by working with USAID, the America Academy of Pediatrics (AAP), and other partners to operationalize the HHB Global Development Alliance (GDA). This GDA served as a platform to improve birth asphyxia management and to strengthen ENC in more than 40 countries. Through regional and country training events and direct implementation support, MCHIP contributed to the introduction and expansion of HBB in 23 countries . MCHIP assisted in translating of the English version of the HBB materials into French, Spanish and Arabic, which helped to facilitate the introduction and expansion of HBB into more countries.

As a result of the efforts of MCHIP and other Born Too Soon partners, the use of antenatal corticosteroids in low- and middle-income countries to improve survival of preterm births was brought to the forefront. Working in collaboration with professional associations and donors through the Survive and Thrive GDA, MCHIP developed a learning package for use at country level to facilitate knowledge and skills acquisition by service providers. The availability of these materials and MCHIP’s technical support to operationalize use of antenatal corticosteroids in countries significantly contributed to a reduction in newborn mortality from complications of preterm births.

Program Learning Achievements

  • MCHIP conducted an assessment of its postnatal care (PNC) home visits program in selected countries (Rwanda, Nigeria, Malawi, Bangladesh and Nepal) to identify program learning on the introduction and expansion of structured PNC home visits as recommended by WHO/UNICEF joint statement.  MCHIP has supported program implementation in all countries except Nepal. Results indicated that PNC home visits have increased in all five countries, but that visits within 48 hours for babies delivered at home are relatively low—possibly due to the multiple responsibilities assigned to community health workers (CHWs). Facility-based deliveries were also found to have increased in all five countries. Lessons learned identified from the program learning were shared at a global consultation hosted by WHO in 2012, with attendance from low- and middle-income countries and recommendations made on how to strengthen countries’ PNC home visits programs and improve coverage of early home visits.
  • To better understand implementation challenges and opportunities in the introduction and expansion of KMC services in sub-Saharan Africa, MCHIP supported an in-depth assessment of KMC services in four African countries (Rwanda, Mali, Malawi and Uganda) in collaboration with Save the Children’s Saving Newborn Lives program. MCHIP contributed to the expansion of KMC services in all countries except Uganda. Malawi had the most number of health facilities with KMC services (121), followed by 30, 17 and 7 in Rwanda, Uganda and Mali, respectively. The assessment identified the facilitators and barriers to KMC service implementation—information that will be useful as MCHIP works with partners to improve the quality of facility-based KMC services, and seeks to introduce the intervention to other countries.

How did MCHIP Newborn Health address equity?
MCHIP ensured that newborn health services are provided along the household-to-hospital continuum of care, as appropriate. For example, in Malawi, Ethiopia, Bangladesh, Zimbabwe and Mozambique, the Program worked with the MoH and partners to ensure newborns received ENC regardless of where they were born. Service providers at health facilities were trained in ENC and CHWs and to counsel and coach mothers in the community to practice ENC. In addition, MCHIP improved access to newborn health services in hard-to-reach areas. In Bangladesh, for example, the Program identified remote areas (including those cutoff from the main service delivery system due to flooding) and developed innovative delivery approaches to ensure access to lifesaving newborn health services. These included the provision of outreach services using chartered local boats, renovating family welfare centers, and recruiting paramedics for these centers to provide 24/7 maternal and newborn health services (including childbirth services).

How did MCHIP Newborn Health address scale?
The goal of MCHIP’s Newborn Health team was to scale-up proven interventions, and the Program designed its country programs with this goal in mind. As the main service provider and policymaker in countries where MCHIP worked—and with an existing service delivery platform at scale—the MoH was the key partner engaged to strengthen newborn health programs. MCHIP ensured that the MoH had a strong leadership role coordinating the national dialogue with key stakeholders and mobilizing resources to address newborn survival. The Program ensured that information on proven newborn interventions and effective delivery approaches along the household-to-hospital continuum of care (including lessons learned from other countries) were available during various national level meetings. MCHIP collaborated with the MoH and its implementing partners and donors to address the three main causes of newborn death by providing technical support to:

  • Develop overall program strategy and guidance;
  • Harmonize or develop both in-service and pre-service training materials;
  • Provide national level coordination;
  • Review and revise policies; and
  • Identify and address systems issues associated with the strengthening of existing interventions or the rolling out of new ones.

To ensure an effective coverage of selected newborn interventions, MCHIP aimed to establish an implementation foundation led by the MOH, and through which all current and future implementation partners could contribute. For example, despite the closure of MCHIP in Nigeria and Rwanda, the Program supported these Ministries to lay the foundation for KMC services in selected health facilities, which were expanded by these MoHs and their implementing partners.

How did MCHIP Newborn Health address community?
A number of studies have shown that various community interventions have significant impact in reducing the neonatal mortality rate. These interventions include structured PNC home visits by trained CHWs as recommended by the WHO/UNICEF joint statement, and discussion of maternal and newborn health issues by community groups (women’s groups in particular). MCHIP used both approaches to counsel and coach pregnant women, mothers and their families on key lifesaving newborn practices, including the importance of: receiving antenatal care; delivering with a skilled birth attendant; practicing immediate and exclusive breastfeeding; ensuring appropriate cord care; recognizing danger signs; and prompt care-seeking. MCHIP built community capacity to create an enabling environment to facilitate care-seeking for pregnant women, mothers and newborns such as the establishment of emergency funds and transportation system.  In Malawi, Bangladesh, Rwanda and  Nigeria, the Program worked with CHWs to visits pregnant women 2-3 times during the antenatal period and 2-4 times during the postnatal period, while building the capacity of community groups to improve the enabling environment for MoH practices and care-seeking.

How did MCHIP Newborn Health address quality?
Quality of care was an essential component of MCHIP’s newborn health programs. It begins with making sure the various equipment and supplies needed by service providers and CHWs are available prior to initiation of any training so that the health workers can put their refreshed or newly acquired knowledge and skills to use as soon as they return to their place of work. Another element of quality assurance is using competency-based learning materials and certifying that all trainees demonstrate the required competencies in the particular intervention area at the end of training. A checklist was used by trained supervisors (usually a joint team of MCHIP and MoH staff) during post-training follow-up visits to ascertain that services are being provided at the required standards. In Ethiopia, working with the maternal health team, the Jhpiego Standard-based Management and Recognition tool used mainly for BEmOC was adapted for newborn care.