1. The Opportunity and the Challenge Delivering More for Mothers and Newborns on the Day of Birth Koki Agarwal, M.D. Dr. PH Director Maternal and Child Survival Program / Jhpiego, USA

2. Outline Why focus on the day of birth? Opportunities for achieving better care on the day of birth Challenges for delivering integrated services for mother and newborn Aligning with global initiatives

3. When do Newborns Die?

4. Source: Ronsmans and Koblinsky 2006 Percentage

5. Almost half of all newborn occur on the day of birth Source: 2005 Lancet Every Newborn Series When Do Newborn Deaths Occur?

6. Birth is the Time of Greatest Risk of Death and Disability for Mothers and Newborns Photo Credit: John Healey /ACCESS 40% of all maternal and newborn deaths occur within 24 hours of birth 1.2 million intrapartum stillbirths 1 million neonatal deaths 113,000 maternal deaths Day of Birth… Source: Lancet Every Newborn: progress, priorities, and potential beyond survival

7. The Opportunity: Better Care on the Day of Birth Pregnancy Focused ANC IPTp GBV screening Immunizations Messages on danger signs for mother and newborn Messages on healthy life conditions Emergency & delivery plans FP counseling Post abortion care Management of preterm labor Day of Birth Infection prevention Respectful care at birth Effective labor care AMSTL Immediate newborn care Neonatal resuscitation Immediate postnatal care Vacuum extraction Early postnatal care Management of PPH Early detection and management of complications PPFP Postnatal Essential newborn care Management of newborn and maternal sepsis KMC Nutrition messages FP counseling and services: IUD & implants Messages on health life conditions Immunizations Messages on danger signs for mother and newborn Emergency plan

8. Challenges for Achieving: Better Care on the Day of Birth Vertical policy, programming, measurement, and funding (e.g. ENAP, EPMM) Poor alignment of maternal and newborn interventions Compartmentalized provider training/capacity-building strategies Photo Credit: Karen Kasmauski/MCSP

9. Local Realities: Access Photo Credits: MCSP/MCHIP

10. Where the Rubber Hits the Road Local Realities Photo Credits: MCSP/MCHIP

12. Photo Credits: Jhpiego

13. Bringing the pieces together: Opportunities To Improve Care on the Day of Birth Better Health Outcomes ANC PNC Better Care on the Day of Birth CommoditiesQuality Improvement MeasurementCapacity- building Health Systems Strengthening

14. WHO Quality of Care Framework for Childbirth Source: BJOG 2015

15. Maternal and Child Survival Program (MCSP) Well Positioned to Strengthen Day of Birth Services for Mothers and Newborns

16. MCSP’s Commitment to Implementing at Scale Strengthening local health systems (e.g. district) Integrated capacity building Ensuring commodities for mothers and newborns Continuous measurement of core DoB indicators Delivery of high-impact maternal & newborn interventions Supporting health workers and managers Photo Credit: Kate Holt/MCSP Continuous quality improvement to achieve effective, safe and people-centered care for mothers, newborns and families around the day of birth

17. Moving the Needle on the Day of Birth: MCSP working in 22 of USAID 24 priority countries Commitment to continuous shared learning across countries Contextual learning from Bangladesh, Pakistan and Tanzania

18. Thank You Learn more at: www.mcsprogram.org Twitter.com/MCSPglobal Facebook.com/MCSPglobal

19. For more information, please visit www.mcsprogram.org This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. facebook.com/MCSPglobal twitter.com/MCSPglobal