An Action Plan To End Preventable Deaths #EveryNewborn EVERY NEWBORN

#EveryNewborn Main funders: Bill & Melinda Gates Foundation, USAID, Children’s Investment Fund Foundation Every Newborn Series 5 papers, 6 comments 55 authors from 18+ countries 60+ partner organizations Published May Every Newborn Action Plan Based on the evidence from the Series Co-led by UNICEF & WHO World Health Assembly 2014 resolution Over 300 experts consulted 60+ partner organization Launched 30 th June commitments to EWEC Building from evidence to action

#EveryNewborn This is where we get the biggest bang for our buck. - Kim Dixon, Co-Chair ENAP, UNICEF Our efforts have meaning only if those who are born today can enjoy them. - Cyril Ramaphosa, Deputy Vice President of South Africa Progress is still too slow, especially for newborns. Today we launch the Every to speed up our response and save more lives. - Ban Ki-Moon, UN Secretary General Graça Machel and other world leaders launched the Every Newborn action plan Partners Forum, South Africa, June 2014 Newborn was a gap. The World Health Assembly agreed and passed ENAP. - Margaret Chan, World Health Organization This plan demonstrates that together we can achieve the vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential – Graça Machel

EVERY NEWBORN Commitments #EveryNewborn World Health Assembly Resolution 194 member states endorsed the Every Newborn Action Plan in May 2014 Now 40 new commitments, largest collection since launch of Every Woman, Every Child in 2010

#EveryNewborn A roadmap for change in countries… A platform for harmonized action by all partners…  Sets out a clear vision with mortality goals, strategic objectives, innovative actions within the continuum of care  Supported by new evidence  Inputs from more than 2,000 individuals  A movement for greater action and accountability… The Every Newborn Action Plan: building a movement

#EveryNewborn Huge burden, yet huge potential for rapid change with high impact, feasible interventions Country demand for guidance and action to accelerate progress towards MDGs 4 and 5, universal health coverage, and towards ending preventable deaths among women and children For greater effectiveness we must accelerate and harmonize global response and link to existing initiatives for reproductive, maternal, child and adolescent health care. More than 3 million babies and women could be saved each year through investing in quality care around the time of birth. Photo credit: Save the Children Why Every Newborn?

#EveryNewborn We’ve made significant progress toward MDGs 4 & 5, but newborn survival is lagging behind Source: Adapted from Lawn J,E. et al Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: UNICEF WHO MMR estimates 2014www.childinfo.org * Maternal mortality ratio annual rate reduction Average annual rate reduction Maternal mortality ratio*2.6% Children aged months3.4% Neonatal mortality (newborn, first 4 weeks after birth) 2.1% Stillbirths (last 3 months of pregnancy) 1.0% ( ) At least 40% slower for newborn survival and slower still for stillbirths

#EveryNewborn Data source: Cause of death - WHO. Global Health Observatory ex.html); Child deaths - UN Inter-agency Group for Child Mortality Estimates. Levels and Trends in Child Mortality. Report 2013; Stillbirths - Lawn et al The Lancet stillbirth series (9775) p1448 – ex.html 8 3 main killers to address: 1.Preterm birth 2.Birth complications 3.Neonatal infections 3 main killers to address: 1.Preterm birth 2.Birth complications 3.Neonatal infections Two-thirds of neonatal deaths are preventable Two-thirds of neonatal deaths are preventable Causes of under five deaths 44% are from neonatal causes

#EveryNewborn Preterm birth Preterm labor management including antenatal corticosteroids* Care including Kangaroo mother care, essential newborn care Birth complications (and intrapartum stillbirths) Prevention with obstetric care * Essential newborn care, and resuscitation* Neonatal infections Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate* Case management of neonatal sepsis * 1 2 * Prioritised by the UN Commission on Life Saving Commodities for Women and Children Over two-thirds of newborn deaths preventable – actionable now without intensive care 3 We have the knowledge and tools to reduce the main causes of death

There are proven interventions within RMNCH continuum of care Source: Adapted from The Lancet Every Newborn Series

Source: Special analysis detailed in The Lancet Every Newborn Series (Bhutta et al 2014) The lives of nearly 3 million babies and women could be saved each year with high coverage of quality care around birth and care for small and sick babies Care around birth gives a triple return on investments by reducing maternal and newborn deaths and stillbirths

#EveryNewborn The vision for Every Newborn Action Plan A world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Vision statement

#EveryNewborn NEW NEONATAL MORTALITY GOAL Unless we greatly accelerate newborn survival efforts, goal to end preventable child deaths by 2035 unreachable Source: Special analysis detailed in The Lancet Every Newborn Series based on country and official online consultations and using neonatal mortality rate data from the UN Inter-agency Group for Child Mortality Estimation 2013.

#EveryNewborn Source: Special analysis detailed in The Lancet Every Newborn Series based on country and official online consultations and using stillbirth rate data from The Lancet Stillbirth Series (Cousens S et al Lancet 2011) NEW goal for stillbirths

#EveryNewborn Lancet GH Sept 2013 : The Lancet Global Health 2013; 1:e176-e177 (DOI: /S X(13) )The Lancet Global Health 2013; 1:e176-e177 Maternal mortality goal links with newborn action National target: no country should have an MMR over 140 deaths per 100,000 livebirths by 2030 Global target: Reduce global MMR to less than 70 maternal deaths per 100,000 live births by National target: no country should have an MMR over 140 deaths per 100,000 livebirths by 2030 Global target: Reduce global MMR to less than 70 maternal deaths per 100,000 live births by 2030.

#EveryNewborn What to do differently? Every Newborn’s guiding principles Country leadership Good governance, community participation, partner alignment Integration Integrated service delivery, continuum of care, programme coordination Equity Universal coverage, closing the equity gap Human rights Principles, standards Accountability Transparency, oversight Innovation Interventions, delivery approaches, technologies

#EveryNewborn What to do differently? Every Newborn’s Five strategic objectives 1.Strengthen and invest in care during labour, birth and the first day and week of life 2.Improve the quality of maternal and newborn care 3.Reach every woman and every newborn; reduce inequities 4.Harness the power of parents, families and communities 5.Count every newborn – measurement, tracking and accountability

Health Sector Strategic & Investment Plan Integrated National RMNCH Plan Increasing access and use of FP Ending preventable newborn deaths Ending preventable deaths from pneumonia and diarrhoea (GAPPD) Ending preventable maternal deaths Every Newborn prioritizes focus on birth within existing national strategies and plans; not a new stand alone plan

#EveryNewborn Every Newborn’s impact framework

#EveryNewborn How will we track progress? Every Newborn milestones Every Newborn sets out concrete and measurable global and national level milestones from now to 2020, coverage targets to 2025 and mortality goals to 2035

#EveryNewborn Source: Lancet Every Newborn series, paper 5 EVERY NEWBORN MILESTONES Every Mother, Every Newborn Quality Improvement Initiative  Reach every women and every newborn with high quality facility-based care for women and babies around the time of birth, also strengthening the linkages with communities  Co-led by WHO, UNICEF and UNFPA to build on and accelerate existing work including: global standards to reach every mother and newborn with high-quality care quality improvement methodologies accreditation approaches

#EveryNewborn EVERY NEWBORN MILESTONES: Monitoring framework and metrics Impact 1. Maternal Mortality Ratio 2. Stillbirth Rate 3. Neonatal Mortality Rate Coverage: Care for all mothers & newborns 4. Skilled attendant at birth 5. Early postnatal care for mothers & babies 6. Exclusive breast feeding to 6 months Coverage: Complications & extra care 7. Antenatal corticosteroid use 8. Newborn resuscitation 9. Kangaroo mother care & feeding support 10. Treatment of neonatal sepsis Improving & using the data including programmatic coverage is crucial for acceleration & accountability

#EveryNewborn Potential for major change in countries Progress is possible – targets getting traction  Neonatal survival unfinished agenda, stillbirths still missing, but count for families  Synergies of newborn survival with demographic transition  Country consultations and ownership over 1 yr process Programmatic focus is clear and evidence-based  Time around birth, triple return on investment  Priority attention to small babies to reduce deaths, disability and risk of non communicable diseases (NCDs)  Urgent improvements for programmatic coverage data Partnerships and alliances  UN leadership  Maternal alliances especially re service delivery eg “Every Mother, Every Newborn quality improvement package”  Civil society advocacy to change social norms

#EveryNewborn The partnerships forged during the development process for ENAP will work together on three main streams of activities: 1.Country implementation: to identify and respond to technical support needs to ensure that the proposed strategies and evidence are translated into action 2.Advocacy: to strengthen and track maternal and newborn health advocacy efforts globally and in countries. 3.Data and metrics: to improve and institutionalize metrics to track coverage and impact based on the goals and targets of the ENAP and the five strategic objectives Next steps Every Newborn movement

#EveryNewborn  Country launch events for the Lancet Every Newborn Series and/or a national newborn action plan  Implementation of national newborn action plans  Global and national tracking of benchmarks, milestones and outcomes  Annual reporting to World Health Assembly  Support and promote key advocacy moments such as World Prematurity Day (November 17 th ). A calendar of upcoming events are available at Next steps Every Newborn opportunities for action What are you doing for Every Newborn? Let us know Stay updated by visiting What are you doing for Every Newborn? Let us know Stay updated by visiting

We are building a movement… BE PART OF THE ACTION For more information visit #EveryNewborn

#EveryNewborn ADDITIONAL SLIDES

#EveryNewborn 5 things to do differently Investment for impact Good governance, community participation, partner alignment Integrated Plans Integrated service delivery, continuum of care, coordination Implementation & Innovation Address health system bottlenecks, EMEN QI initiative Indicators & metrics Targets in post 2015 Measurement of progress and impact Intentional leadership development Country ledxx Source: Lancet Every Newborn series, paper 3

#EveryNewborn Could save 2 million lives a year by closing this quality gap Particular focus on health workers especially midwives “Every Mother Every Newborn” quality initiative First opportunity is the QUALITY gap for facility births Source: Lancet Every Newborn series, paper 3

#EveryNewborn Sub-Saharan Africa Year: 2124 Southern Asia Year: 2103 South-East Asia Year: 2070 Latin America/Caribbean Year: 2043 Eastern Asia Year: 2028 North Africa/West Asia Year: 2051 Caucasus/Central Asia Year: 2062 Years for each region to reach NMR of 3 = industrialized countries current average By projecting regional average rate of reduction Source: Lancet Every Newborn series, paper 2 When will every newborn have the same survival chance as newborns in the richest countries? NMR YEARS FOR AFRICAN NEWBORNS… Nearly 3 times longer than this change took rich countries, despite new interventions

#EveryNewborn Movement with a plan Who has been involved?  Alliance:  50+ global partners on Advisory group;  Steering team and management group (led by WHO & UNICF)  ENAP presented and discussed at many global meetings in 2013 including Women Deliver, AU MNCH, IPA, and NYC mtg  Countries:  17 country consultations between April-September 2013  2 regional workshops  Completed bottleneck analyses conducted in 10 countries  Official WHO consultation:  More than 300 official comments including +40 member states, professional associations, academics, NGOs, individuals  Action plan discussed and endorsed at the 67 th World Health Assembly AU MNCH conference

The ENAP is a road map for change and platform for action. It includes: A vision and objectives New mortality targets for ending preventable maternal and newborn deaths and stillbirths by Five strategic objectives Framework for success including global and national milestones and coverage goals Every Newborn action plan – a global consensus on practical actions More than 3 million babies and women could be saved each year through investing in quality care around the time of birth.

Based on the evidence from The Lancet Every Newborn Series Co-led by UNICEF & WHO with support from 60+ partner organizations Consultation and involvement of countries – 17 country consultations between April-September 2013 and two regional workshops – Completed bottleneck analyses conducted in 10 countries – More than 300 official comments including +40 member states, professional associations, academics, NGOs, individuals Action plan discussed and endorsed at the 67th World Health Assembly Officially launched 30th June 2014 at the Partners Forum, South Africa 40+ new commitments to Every Woman, Every Child Every Newborn action plan - process

#EveryNewborn Building a movement Strategic use of key moments x WHO World Health Assembly The end of MDGs brings new clarity about what is left behind on the agenda – newborns, adolescents