1. Challenges, Bottlenecks and Solutions to Scaling-up Newborn Care in Cameroun AU Maternal, Child and Newborn Conference 1-3 August, 2013 Johannesburg, South Africa Dr Martina L. Baye MD,MPH Technical Advisor, MOH GENAP Advisory Group Member

2. Outline of the presentation BACKGROUND 1.The GENAP Advisory Group 2.Regional GENAP Consultation in Dakar, 9-11 July 2013 3.Overview of the standard bottleneck analysis (BNA) tool MAJOR BOTTLENECKS AND SOLUTIONS TO SCALE-UP NEWBORN CARE IN CAMEROUN 1.Country profile 2.Summary of identified bottlenecks and solutions 3.Opportunities

3. BACKGROUND

4. THE GENAP ADVISORY GROUP Purpose: provides strategic guidance on the GENAP development process (e.g to review draft documents, support global, regional, and national GENAP consultations) advocates for the GENAP to help generate a strong, coordinated global, regional and national platform for this effort. Composition: Key constituencies with expertise and/or interest in investing in global newborn health; Country representatives from Africa (Cameroun, Ghana, Nigeria, and Uganda), Asia, Latin America/Caribbean, the Middle East and Mediterranean. Funding agencies, professional associations, the private sector, non-governmental organizations and civil society.

5. REGIONAL CONSULTATION ON “EVERY NEWBORN ACTION PLAN ” Dakar, 9-11 July 2013 Main purpose: to promote coordinated efforts among key country stakeholders focusing on newborn care to identify what needs to happen to scale-up evidence-based interventions to address preventable newborn deaths in the West and Central African region. Specific objectives: To provide a forum for countries to identify their bottlenecks and solutions to accelerate the scale up of newborn programmes To provide a forum for high level consultation to review and provide input to the global Every Newborn draft document Participants: Representatives from 8 countries (Government, Midwives, Pediatricians, NGOs, UN, etc) Outcomes: Country bottlenecks identified, country follow-up plans to accelerate in-country actions on MNH; Inputs on the GENAP

6. Overview of the standard BNA tool Divided into 2 sections: Section I includes questions to assess bottlenecks to scale-up newborn health programmes in general Section II is sub-divided into 9 sub-sections. Each section includes questions to assess bottlenecks to scale-up each of the 9 critical maternal and newborn interventions Each section also includes a chapter on solutions and strategies to address identified challenges/barriers

7. Overview of the standard BNA tool Health system building blocksCritical maternal and newborn health interventions 1.Leadership and governance 2.Health financing 3.Health work force 4.Essential medical products and technologies 5.Health services delivery 6.Health information system 7.Community ownership and participation 1.Management of pre-term birth - focus on antenatal corticosteroids 2.Skilled care at birth - focus on the use of the partograph 3.Basic Emergency Obstetric Care - focus on assisted vaginal delivery 4.Comprehensive Emergency Obstetric Care - focus on caesarean section 5.Basic Newborn Care - focus on cleanliness including cord care, warmth, and feeding 6.Neonatal resuscitation 7.Kangaroo mother care - focus on skin to skin, breastfeeding and feeding support for premature and small babies 8.Treatment of severe infections - focus on using injectable antibiotics 9.Inpatient supportive care for sick and small newborns - focus on IV fluids/feeding support and safe oxygen

8. Situation Analysis of MNH in Cameroun

9. COUNTRY PROFILE Population : 20 386 799 in 2012 (RGPH ) Expected Deliveries : 940206 NMR 31 per 1000 LB IMR 62 per 1000 LB Surface Area : 475 650 Km² Economic growth: 4.4% in 2012 (Economic Perspectives in Africa) Poverty rate 40% in 2007 (ECAM, 2007) GNI = $ 1,400/Capita in 2012 (CEMAC, 2013 ) Regions : 10 Health districts : 191 and > 3000 Health facilities

10. Trends in Maternal Mortality

11. EQUITY PROFILE : Analysis of Regional disparities

12. Coverage of Key MNH interventions Data Source: DHS

13. 1.Roadmap for the reduction of maternal and neonatal mortality 2006-2015; 2.CARMMA plan 2011-2013; 3.RH Strategic plan 2010-2015 : revision ongoing, RMNCH Strategic plan 2014- 2020 Key MNH Strategies Supporting MNH in Cameroun

14. Bottlenecks and solutions to scale-up newborn care in Cameroun

15. BOTTLENECKS AND SOLUTIONS PRIORITY BOTTLENECKSSTRATEGIES AND SOLUTIONS LEADERSHIP AND GOVERNANCE Newborn health not recognized as a specific issue Advocacy and Awareness: policy makers, gynecologists, pediatricians, all stakeholders in the newborn health field Inclusion of neonatal health in the pre-service training curriculum on RMNCH HEALTH FINANCING Existence of financial barriers to access maternal and newborn care No specific mention of the newborn in new funding allocations for healthcare delivery Subsidies/ free care for newborns in health facilities Allocation of funding specific to the newborn for the supply of care services

16. BOTTLENECKS AND SOLUTIONS PRIORITY BOTTLENECKSSTRATEGIES AND SOLUTIONS HEALTH WORKFORCE Insufficient staff trained for newborn care (pediatricians, obstetricians, midwives, nurses) Recruitment of staff (pediatricians, obstetricians, midwives, nurses) Incentives for staff to stay in hard-to-reach stations Continuous training of staff based on identified needs and a functioning supervisory system ESSENTIAL MEDICAL PRODUCTS AND TECHNOLOGIES Absence of certain newborn drugs and supplies in national system of essential medicines and in facilities Frequent drug and commodity stock outs Drafting of the newborn essential drugs and equipment list by level of care Scaling up of obstetric kits by including relevant newborn drugs Training / retraining providers and pharmacy personnel to handle inventory management

17. BOTTLENECKS AND SOLUTIONS PRIORITY BOTTLENECKSSTRATEGIES AND SOLUTIONS HEALTH SERVICE DELIVERY Outdated documents on norms and standards for RMNCH Revision of norms and RMNCH standards with an emphasis on newborn care Scale up Kangaroo Mother care Implementation of quality control systems HEALTH INFORMATION SYSTEMS Lack of key information on newborn health Lack of adequate tools Multiplicity of tools Update tools for data collection and data entry to include information on newborns Integrating newborn indicators into existing data collection tools Make recovery of data a functional tool COMMUNITY OWNERSHIP AND PARTNERSHIP Poor community involvement and participation Recruit and train CHW selected by communities CHWs to provide services for newborn and maternal health

18. OPPORTUNITIES Political will – setting up of a specific multisectoral program for reduction of maternal, neonatal and child mortality; Plan for Reproductive, Maternal, Neonatal and Child Health 2014 -2020 underway; Functional multi-sectoral Mother and Child Technical coordination platform; Setting up of nutrition program Commitment of Professional Associations – Pediatricians, Obstetricians and midwives Decentralization