Regional-National Networks for Newborn-Perinatal Health

CAH-SEARO

South East Asia Regional Neonatal Perinatal Database

Background…

Aim

To Establish A SEAR Network for generating information on neonatal/perinatal health in the Region

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

Methodology

 • •

Identification of network institutions

Nodal center: WHO CC, AIIMS, New Delhi 5 other Centers of Excellence in different countries

Country Bangladesh Indonesia Center

Bangabandhu Sheikh Mujib Medical University, Dhaka Gadjah Mada University, Yogyakarta

Principal Investigators

Prof. M. Shahidullah Dr. Ekawaty Haksari

Nepal Sri Lanka Thailand India

Tribhovan University, Kathmandu Prof. Prakash Shreshtha DeSoysa Hospital for Women, University of Colombo, Colombo Queen Sirikt National Institute of Child Health, Bangkok AIIMS, New Delhi Dr. Ishani Rodrigo Dr. Uraiwan Chotigaet Dr V K Paul and Dr A K Deorari

Regional Network

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

Salient findings from the database

SEAR- NPD IGME data Referral centers vs. whole country data!

Lancet 2010

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

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

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

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’

Regional Meeting: Participation

• Bangladesh • Bhutan • India • Indonesia • Myanmar • Maldives • Nepal • Sri Lanka • Timor Leste

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.

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

• • • • • • •

Develop National Networks: Attributes of National Coordination Center:

Has proven capacity newborn care in academics, education, training and research in newborn health - Handles a large volume of deliveries and patient load with NICU offering tertiary level Has significant experience and has goodwill professional colleagues in the country Has capacity to provide leadership and human resource available among - Has a team of experts 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

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

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

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 mobilization

Standard Treatment Protocols for common newborn conditions in small hospitals

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

Evidence based

Consistent with existing WHO Guidelines: • Pocket Book (Blue) • Pink Book (IMPAC series) • Recent Guidelines and updates by WHO

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

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

Follow up

• • •

National Networks

Health: Progress – Bangladesh – Myanmar – Nepal – Sri Lanka for Neonatal / Perinatal

Standard Treatment Protocols

for Newborn Conditions: Peer Review complete

Use of ICT for training healthcare providers