1. Helping Babies Breathe annual meeting Prof Bogale Worku Washington DC July 17/ 2012 3

2. Data sources: Updated from Opportunities for Africa’s Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 datawww.childmortality.org Ethiopia’s Progress to meet MDG 4. 2000 EDHS48/1000 2005 EDHS38/1000 2010 EDHS37/1000, SBA <10% Target?25/1000 According to 2008 National EmONC assessment, 66 % of HCs did not have a resuscitation bag and mask.

3. National scale up strategy of HBB in Ethiopia Govt ownership with extensive collaboration among all maternal, newborn and child health partners HBB is integrated in existing and new trainings and programs: – NBC training /Newborn corner, – NICU nurse training, – CEmONC / BEmONC, – PMTCT, – ICCM, New IMNCI – Pre-service training for midwifes – Others

4. National scale up strategy cont. Rollout strategy for Ethiopia – Champions and high level advocacy – Government coordination with all MNCH partners – Master level TOT for trainers and supervisors of existing MNCH training programs – UNICEF making available resuscitation equipment and for both training and service – No specific budget needed as the program is rolled out through integration though existing programs

5. TOT Addis Ababa

7. Evaluation - Newborn Corner The newborn corner is an initiative to address gaps in preventing newborn morbidity and mortality by ensuring standard newborn care immediately after birth in health facilities. Piloting in 100 facilities by EPS in collaboration with FMoH and UNICEF 354 HW including MDs, HOs, midwifes and clinical nurses 3 days on ENC, HBB, KMC and sepsis management providing supplies and clinical mentoring post training.

8. The newborn corner Trained personnel to care for the baby A warm and clean surface Essential newborn resuscitation equipments

9. Evaluation - Results Baseline and end line assessment in 60 facilities looking at knowledge, skills and availability of basic resuscitation equipment

10. The newborn corner

11. Comparison % health workers skill on neonatal resuscitation on base line and end line survey

12. Number of newborn with asphyxia (one month in 60 health facilities ) Number of deliveries Still birth(%) Number of babies not breathing at birth and required resuscitation (%) Survived After resuscitation Case fatality from PNA 8080453(5.6)212 (2.6)180 (84.9)32 (17.77)

14. Results to date in Ethiopia Carders trained on HBB by 31 June 2012 Health workers7 295 HEWs20 050 Total27 345 Bag and mask distributed by 31 April 2012 Health centers354 Hospitals50 Total 404 out of 3000 HF (13,5%) Resuscitation equipment available 8 000, plus an additional 10 000 to arrive shortly in Ethiopia. In addition 2 000 NeoNatalie training dolls are available in Ethiopia for HBB training.

15. Quality improvement process Neonatal registration book in place Supportive supervision and clinical mentoring post-training Guidelines and protocols for newborn resuscitation is being under development Quarterly / annual review meetings planned

16. Lessons learned Integration has been a successful way to quickly train and orient a large number of health workers and community health workers (HEWs) on HBB in Ethiopia. Having a strong governmental leadership with close collaboration among partners is the only way to make changes to newborn survival in a large country with limited funding sources. Making training material and resuscitation equipment available has helped the HBB rollout. Early data shows that the training on HBB among HWs has improved their skills.

17. However… Still only around 10% of deliveries are conducted in health facilities, and only 1% of the HEW have the opportunity to conduct deliveries. Data on newborns not yet systematically collected as current HMIS does not fully address NB issues

18. Acknowledgements FMoH UNICEF WHO ICAP – Ethiopia

20. Thank you