Save the Children is focused on reducing newborn mortality globally. It has three main goals: 1. Getting newborn health on global and national agendas through research showing the major causes of newborn deaths and effective interventions. 2. Supporting country programs that have led to important declines in newborn mortality rates in places like Bangladesh, Bolivia, and Tanzania. 3. Continuing to scale up high-impact newborn interventions through health systems, strengthen implementation, and institutionalize newborn survival within countries and organizations.

1. Save the Children –
Saving Newborn Lives
What
we’ve
learned,
where
we’re
going
Australia
April
2013

2.
Outline
I. Background – Why Newborn Health?
II. Getting on Global & National Agendas –
SNL’s experience
III. Where now? - Priorities and Opportunities
for Achieving Impact at Scale

3. High income countries
~11 million births
Middle income countries
~34 million births
~40 million facility births~50 million births at home
135
million
live births
per year
2010
One
in
4
newborns
is
African
2035
One
in
3
will
be
African

4. Why are we focused on newborn survival?
Three killers –
prematurity,
asphyxia, and
infections -
account for 81% of
all neonatal deaths3.1
million
Sources: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010. UNICEF,
State
of
the
World's
Children,
2011.
Causes of death in children under-five in developing countries –
Newborn deaths are almost half of all deaths of children under five

5. 0
20
40
60
80
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
Source:
UN
Inter-­‐agency
Group
for
Child
Mortality
Es>ma>on,
Levels
and
Trends
in
Child
Mortality:
Report
2011;
UNICEF,
Required
Accelera>on
for
Child
Mortality
Reduc>on
beyond
2015,
2012;
team
analysis
SNL/Save
the
Children
team
analysis
for
NMR
projec>on
for
Call
for
Ac>on
mee>ng
Mortality
Rate
(deaths
/
1000
births)
20
35
Accelerated
U5MR
ARR
=
5.1%
Current
U5MR
ARR
=
2.2%
*
ARR
=
annual
rate
of
reduc>on
MDG
4
target
=
34
U5MR
Global
Progress
for
child
survival
U5MR
and
NMR
decline
1990-­‐2010,
projected
to
2035
15
Current
NMR
ARR
=
1.8%
If
1-­‐59
month
mortality
accelerates
further
but
neonatal
mortality
conKnues
on
same
trend
then
with
2
million
child
deaths
in
2035,
1.5
million
may
be
neonatal.

6. REGION
Neonatal
mortality
rate
Average
annual
change
1990-­‐2010
Africa
1.3%
East
Med
1.6%
Southeast
Asia
2.2%
Western
Pacific
4.2%
Americas
3.6%
Europe
3.6%
Maternal mortality ratio = 4.2%
1- 59 month mortality rate = 3%
Neonatal mortality rate = 1.8%
All 3 measures show increased progress since 2000
Source: Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-
ii28. Data sources: Oestergaard et al 2011 PLoS, UNICEF 2012 www.childinfo.org
2165
2085
2040
Mortality
average
annual
rate
of
reducKon
WHEN
WILL
REGIONS
REDUCE
NMR
TO
CURRENT
RATE
OF
HIGH
INCOME
COUNTRIES
(3
per
1000)?

7. • First major international program to focus on
newborn survival
• Supported key research on newborn
interventions in developing country settings
• Raised global and national awareness
SNL 1 (2000-2005)

8. • Large-scale research activities
• Programs in 18 countries
• Global advocacy and partnerships
• Established
communication
platforms including the
Healthy Newborn Network
SNL 2 (2006-2011)

9.
Outline
Getting on Global & National Agendas –
SNL’s experience:
• Intention
• Evidence
• Exposure
• Engagement

10. Infection
Management
RCT in Pakistan
Postnatal Care
Package OR in
Bangladesh
Integration of
newborn care RCT
in Uganda
Neonatal sepsis
management
through HEWs in
Ethiopia
Simplified
AntibioticTrial
Testing if simplified
antibiotic regimens
are effective
treatment for sepsis
Treatment failure
To modify global
policy
PNC Operations
Research
Testing existing cadres
providing home visits to
improve practices
Coverage & Practices
To inform MOH &
partners how to deliver
PNC in existing system
and scale up
UNEST
Testing community-based
package using volunteers
linked to the health
system
Coverage & Practices
To inform MOH how to
scale up newborn care
through health extension
volunteers
COMBINE
Testing govrn’t HEW’s
ability to identify and
treat probable severe
bacterial infection
NMR, Case Detection &
Practices
First study with NMR
end point in Africa;
providing input for GoE
decision on HEW role
in newborn care
OutcomesDescriptionInfluence
Evidence
to
inform
policy
and
program

11. Systematically Sharing Evidence

12. Exposure (beyond journal articles):
Evidence Summaries

13. Engagement:Translating Research & Data for Action
Regional
Opportunities for Africa’s Newborns
ASADI Science in Action
LAC Alliance
Global
Countdown to 2015
CHERG
LiST
UN Joint Statement on HomeVisits
National
Situation Analysis (15)
Data Profiles

14. Engagement
at
Country
Level
(Nepal):
Catalysing
naKonal
policy
change
through
partnership
Source:
Pradhan
YV
et
al.
2012.
Newborn
survival
in
Nepal:
a
decade
of
change
and
future
implica>ons.
Health
Policy
and
Planning
27(Suppl.
3):iii57–iii71.
Saving
Newborn
Lives
1
Saving
Newborn
Lives
2

15. 0 5 10 15 20 25
Bangladesh
Malawi
Nepal
Pakistan
Uganda
Tanzania
Ethiopia
Mali
Bolivia
Achieved
Partially achieved
Not achieved
Missing
0 5 10 15 20 25
Bangladesh
Malawi
Nepal
Pakistan
Uganda
Tanzania
Ethiopia
Mali
Bolivia
2000 2010
Source:
Moran
AC
et
al.
2012.
Benchmarks
to
measure
readiness
to
integrate
and
scale
up
newborn
survival
interven>ons.
Health
Policy
and
Planning.
27(Suppl.
3):
iii29-­‐ii39.
Engagement
–
Catalyzing
Change
in
Countries:
27
Benchmarks
of
scale-­‐up
readiness
for
newborn
care

16. Some SNL-assisted countries have made
important progress
1990-2010 Changes in Newborn Mortality
• Bangladesh: 51% decline
• Bolivia: 41% decline
• Indonesia: 45% decline
• Malawi: 39% decline
• Tanzania: 35% decline
Levels
&
Trends
in
Child
Mortality
–
Report
2010
UN
Inter-­‐agency
Group
for
Child
Mortality
EsJmaJon

17.
Outline
Where now? - Priorities and Opportunities for
Achieving Impact at Scale

18. At Global Level –
• Increased political commitment and resources
• Increased participation by key organizations
• “Need to see it actually done at scale”
At Country Level –
• Newborn programs taken to scale through health systems
• Increased resources
• Responding to increasing rates of facility births
• Improving families’ expectations, care, & care-seeking
for newborns
• Adequate indicators and monitoring
2011-2 SNL Evaluation conclusions:
What remains to be done

19. SNL 3
• Success (“3 + 1”) =
Ø High impact newborn interventions are effectively
delivered and used at national scale in selected
countries;
Ø Learning and evidence is documented, shared, and
used within and outside SNL-assisted countries;
Ø Partnerships committed to newborn survival & health are
expanded;
•
5
years,
$40
million
+
Ø Newborn survival and health are institutionalized within
countries and key partners

20. Scaling up newborn interventions through health care systems
and programs - a systematic & measurable approach
“EffecKve
coverage”
Scale-­‐up
readiness
Capacity
to
implement:
-­‐
Trained
workers
-­‐
CommodiKes
-­‐
Guidelines
&
standards
Strength
of
implementaKon:
-­‐
Availability
-­‐
Quality
-­‐
Accessibility
Social
&
behavioral
change
Community
&
home
care:
-­‐
PrevenKve
pracKces
Community
&
home
care:
-­‐
Problem
recogniKon
-­‐
Appropriate
care-­‐seeking
Champions
Government
Officials
&
Parliamentarians
Health
Sector
Managers
&
Health
Workers
Civil
Society
OrganizaKons
Community
Leaders

21. What the Evaluation taught us about achieving
impact at scale (“Spheres of Influence”)

22. What the Evaluation taught us about achieving
impact at scale (“Spheres of Influence”)

23. What the Evaluation taught us about achieving
impact at scale (“Spheres of Influence”)

24. Opportunities for global & regional influence
24
• Research priority setting and tracking (with WHO)
- Identify opportunities from WHO priority list
- Connect with the community – “Sign up” for topics
• Participate in knowledge exchange / communities of practice
• Promote evidence-based interventions and effective delivery
approaches
• Participate in regional / global movements for newborn health
– Child Survival Call to Action (“Promise Renewed”)
– “Global Newborn Action Plan”
• UN Commission on Life-Saving Commodities
– Participate in situation analyses and/or national planning for newborn
commodities

25. 2013 – A tipping point for newborns?
25
April May September
Global Newborn Health Conference
(UNICEF / USAID / SNL / WHO)
State of theWorld’s Mothers report
(Mother’s day)
Women Deliver
Conference
The MDG 4 & 5
Investment Framework
(to be presented at UNGA)
Global Moments
Global Movements
U.N. Commission on Life-Saving
Commodities for Women’s & Children
The “Promise Renewed” Call to Action for
ending preventable child deaths by 2035
Post-MDG deliberations - an opportunity and a threat
November (?)
Launch Global Newborn
Action Plan

26. Much to do…
- We look forward to
working together
to make it happen.
- Thanks
www.healthynewbornnetwork.org