1. Status and Preparedness of the Kenya health System to Support Critically ill neonates R Nyamai NCAHu 07 Feb 2014

2. Scope of Presentation Magnitude of problem in Target Population The interventions aimed at better outcomes for neonates The health System-Kenyan Context Policy environment The health system performance for neonatal care

3. Maternal and Child Mortality in kenya- KDHS 2008 Maternal mortality is 488/100,000 live births Neonatal mortality is 31/1000 live births Infant mortality is 52/1000live births Under five mortality is 74/1000 live births

4. Trends in under fives and infant mortality from 1990-2008-9 - Kenya

5. Kenya Health System organization Gazeted names KEPH Standards Current Proposed National Referral Hospital Level 6Tier 4 Provincial General Hospitals Level 5Tier 3 District HospitalsLevel 4Tier 3 Sub-district HospitalsLevel 4Tier 3 Health CentresLevel 3Tier 2 DispensariesLevel 2Tier 2 CommunityLevel 1Tier 1

7. The Health System-Kenya context Human resources Medical products and other technologies Finance Service delivery Health information System Leadership and governance

8. High Impact Interventions targeted at Neonates Hand washing with soap by caregiver Newborn temperature management Early initiation and EBF Antibiotics for neonatal infections Newborn resuscitation Antenatal steroids ARV prophylaxis

9. Priority High Impact Interventions for neonates by Level of Care, and Intervention Area Community-L1 (Tier 1) Newborn temperature management Hand washing with soap by caregiver Early initiation and EBF Level 2;3;4 (tier 2 and 3) Hand washing with soap by caregiver Temperature management Antibiotics for neonatal infections Newborn resuscitation ARV prophylaxis

10. Policy environment

11. Guidelines Mother child Booklet Integrated Community case Mangement Manual Integrated Management of Childhood Illness (IMCI) Guide for healthcare workers August, 2012 Edition Ministry of Health Basic Paediatric Protocols for ages up to 5 years July 2013 GOK Clinical Management and Refferal Guidelines 2009 Managing Newborn Problems WHO A guide guied for doctors Nurses and midwives Pocket Book of Hospital Care for children WHO

12. Case management of the small young infant Integrated Management of Childhood Illnes iCCM IMCI ETAT+

13. The 6 major steps in IMCI Case Management approach 1.Assessment 2.Classification 3.Identify Treatment 4.Treat the child 5.Counsel the mother 6.Follow Up care

14. Sick Young Infant Assessment at the community Watch for signs often found in sick young babies and refer

15. Classification at the outpatient Make decision on severity of illness Colour coded triage system Pink-Admission or pre-refferal treatment Yellow-Specific medical Treatment and adcice Green- not serous, mostly no drugs needed, advice mother

16. System Readiness for Neonatal Care KDHSs KSPA surveys Rapid assssment Targeted supervision

17. Safe Delivery KDHS 2008 43% of Births are conducted in a health Facility 56% of births take place at Home

18. KSPA survey 2010 Weighing the newborn, Rooming in, vit A to were well practiced across the facilities Newborn respiratory support available in 92%of Hospitals New born respiratory Support available in 7 out of 10 facilities offering delivery services External heat source was available in 67%of Hospitals

19. Facility Readiness 17 level 4 and five Hospitals rapid survey 64% of the NBU nursing staff had inadequate knowledge to resuscitate a newborn baby Although 88% of the facilities had a resuscitation tray ready for immediate use, only 41% of facilities had an up to date resuscitation tray check list Only 11 hospitals had sterile delivery packs for inpatient mothers

21. Findings from Hospital reforms supervision 200920102012 %Hospital with at least two rooms for admitting sick neonate and preterm 274766 % of PGHs with 10 functional incubators2685100 % of hospitals with at least one oxygen source in the newborn unit 4686.3100 % of hospital with basic paediatric protocols immediately available at clinical area 388096

22. Challenges in Scaling up Health Systems Challenges  Human resources- numbers, skills, attitude,  Health Financing  Reliable Data  Referrals  Commodity security  Governance  gaps at community level service delivery Access  Geographic, Financial, Cultural  Low male involvement Multi-sectoral challenges  Infrastructure, safe water, status of women

23. Thank you

26. Neonatal contribution to underfive mortality in Kenya 26,000 babies die per yr in the first month