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GLOBAL NEWBORN HEALTH CONFERENCE

15-18 April 2013


SESSION 3E-1
 BACKGROUND

 KEY COMMUNITY/HOME-BASED PROGRAMS

 SELECTION OF THE INTERVENTIONS AND


APPROACHES

 SUCCESSES/IMPACT ON NEWBORN HEALTH


Evolution of mortality rates Major causes of neonatal
mortality in Sénégal

11%
Prematurity
13%
49% Asphyxia

Pneumonia

27%
Sepsis
Status of current service Number of Geographic Comments
delivery health districts coverage
offering the
services (N=76)
Comprehensive care of mother
and newborn in the health Accessibility and quality of care
facilities (Focused ANC, BeMOC 76 100% must be improved
and CeMOC)

Management of neonatal In the referal facilities


infection 76 100%

Resuscitation of the newborn Training of trainers conducted in


(ENC / AMTSL + HBB) November 2012. Roll out plan
developed.

Family Planning (FP) Uptake still low- due to socio-


76 100% cultural barriers/social norms, lack
of the continuum of service
Kangaroo mother care 24 32% Not offered in all health facilities
Promotion of C-IMCI key
practices 72 95%

implementation of newborn home


Community component of care in few villages. Scale up plan
comprehensive care of mother being developed based on lessons
4 5%
and newborn learned from the pilot phase
(generation of local evidence)
100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
ANC at least 1 ANC at least 4 Protected at IPTp for Skilled Early Ever breastfed Exclusive DTP1 DTP3 Fully ITN use by
birth from malaria attendant at breasfeeding breastfeeding immunized under-five
tetanus birth children

Pregnancy New born and infant feeding Child health outreach


 Type of interventions
◦ Promotion of key family practices: early and exclusive
breast feeding, hand washing, use of nets, recognition
of danger signs and timely health care seeking

◦ Follow up the pregnant woman and the newborn

◦ Home visits for the pregnant women, mother and


newborn child since 2011
 Identify pregnant women to promote ANC, birth preparedness,
facility based deliveries, exclusive breast feeding and family
planning
 Encourage early postnatal facility visits for both mothers and
newborns.
 Conduct postnatal home visits of the mother-baby pair: care of the
umbilical cord, temperature management, care of the low birth
weight baby and identification of danger signs and referral for
care;
 Implementation approaches
◦ Bajenu Gox Program:
 sponsorship and leadership in the service of
maternal, neonatal and child health
◦ Grandmothers approach:
 peer education to act on social norms
◦ Solidarity circle for pregnant women:
 mutual aid, assistance and support
◦ Community mobilization
◦ Home visits
 There are three main cadres of community
health workers:
◦ Agents de Santé Communautaire (ASC)
◦ Matrones
◦ Relais communautaires
 Incentives:
◦ ASCs and Matrones: volunteer, incentives from mark
up on drugs and/or non monetary incentives
(bicycles, t-shirts etc);
◦ Relais communautaire : volunteer too; modest and
irregular financial and non financial incentives during
special events (meetings, social mobilization and
campaigns etc)
 At the end of 2012 there were:
◦ 13,959 CHWs, including 2,907 ASCs, 4,680
matrones, and 6,372 relais.
◦ 1,759 health huts and 1,474 community sites in the
14 regions and 72/76 districts
 Equipment and supplies provided:
◦ Partners support: UNICEF, OMS
◦ Kit/materials:
 Timer
 Thermomter
 Balance salter (5kg)
 Cartes conseils, regidtres, fiches mere/bebe, fiche de
reference
 Bag
 Use of routine indicators
◦ Lack for decision making at the local level
◦ Integration of the data from the community level in
the health system information

 Monitoring, supervision and reporting


◦ CHWs are an integral part of the health systems and
work under the direct supervision, support and
oversight of nurses and midwives;
◦ Data managment tools used by the CHW
◦ Data collection and reporting are doing regulary
with the NGOs support
The choice of the key family practices and
implementation strategies depended on:
 the epidemiological context,
 the specific district needs (coverage of key
interventions) and existing implementation
capacity;
 the socio-cultural practices/social norms
 the geographic conditions( within or beyond
5 km radius
 Commitment of the MoH to improve the
newborn health program –
 National appropriation of the approach:
◦ Newborn home care extension plan elaborated;
◦ Pool of trainers available;
◦ Adaptation of the OMS /UNICEF generic tools
 At the health facility and district level
◦ Better status of the CHW
◦ Increase the use of the services
◦ Introduction of kangourou mother care at the
community level