Department of Pediatrics, All India Institute of Medical Sciences Ansari Nagar, New Delhi, India
Recommendations of the consultationN
Countries in South East Asia Region within the framework of Millennium Development Goals to reduce under five and infant mortality rates should identify specific goals for reduction in neonatal mortality rates. This reduction in NMR should be about 50% of the 1990 levels by the year 2015. It requires positioning of neonatal health within the ongoing maternal child health programs in the countries. A serious consideration should be given to call the existing MCH programs as Maternal Newborn Child Health (MNCH) programs.
An enabling national policy is required to support countrywide implementation of an evidence-based essential neonatal health care programme supported by the existing referral institutions at the same time, the current ongoing interventions directed towards improvement of health and social status of future mothers; family planning; pregnancy and delivery care; child and adolescent health and development programs are to be intensified and sustained because they also influence directly or indirectly the determinants of newborn health, survival and development.
Advocacy at the highest political level amongst partners and stakeholders is needed at all level to recognize that improved neonatal health is the key to healthy start to life and is therefore, fundamental to human well being, development and socio-economic progress. Governments, partners and stakeholders should advocate mobilization of additional new resources to improve neonatal health and at the same time ensure efficient utilization of available resources while ensuring full accountability. The existing regional should be used as entry point for high level advocacy. Partners and stakeholders should collaborate and coordinate the advocacy efforts in a synchronized manner.
Strategies should take into account different scenarios of neonatal mortality and health system capacity that exists in disparate national and sub national settings. Strategy should provide different options, which the countries can adopt based on different scenarios prevailing in the respective countries, districts and provinces as regards neonatal mortality, skilled birth attendance and health system. Country strategy is the basis for development of programme and plans of action. Steps should be taken by the partners, and stakeholders in collaboration with the countries to prepare regional strategic framework for adaptation and use in the countries of the region. The strategy of scenario based stratified approach with phasing in can be widely used even in resource poor settings with weak health infrastructure.
Mainstreaming of neonatal health is urgently required within and outside the health sector. Neonatal health and survival depends on contribution from and co-operation between maternal/ reproductive health and child survival and public health, nutrition, family planning programs in the health sector. Outside the health sector, education, rural and urban development, planning, finance, women’s welfare, law and education ministries can contributes substantially to neonatal health.
Partnerships are required to tap the existing untapped resources for improving neonatal health. The vast potential of families and communities; governments, NGO’s, stakeholders; corporate sector; professional bodies; academia; developmental partners and UN organizations can be realized through establishing and sustaining partnerships built on the foundations of common goals, commitment and trust. A Regional partner’s forum should be formed to support country partnerships and maintain linkages with global mechanisms. Regional partners forum can effectively use inter-country mechanisms to support the countries.
Registration of births and deaths should be universalized. Include reporting of stillbirths in compulsory registration and recording of age at death. If possible, birth weight information should be a part of the vital registration. Key indicators for neonatal health should be developed and agreed by consensus. These indicators are to be included in routine recording and reporting systems. This data will be useful in supportive supervision and to provide feedback to improve the skills and performance of health care providers.
Initiate and strengthen national surveys and national health and management information system by including indicators like still births, early and late neonatal deaths exclusive breast feeding rates at 1 months and 6 months, early initiation of breast feeding, number of post natal visits and birth weight. This will help in generating disaggregated data needed for elaborating strategies, and for preparing plans. In countries where Macros Demographic and Health surveys (DHS) surveys are not done, the existing health and management information system should be strengthened to respond to the needs of national neonatal health care programs.
Strengthen neonatal care being implemented as a part of maternal and child health within the life course approach e.g. making pregnancy safer and IMCI. In the strengthening process, capacity development is important. It includes training, skills development, logistics, supportive supervision and follow-up.
Research related to neonatal health and survival should be accorded a high priority. Community based operational research to provide innovations for programme implementation is an urgent need. Selected hospital-based studies to generate evidence, which has policy implications need to be supported. Quality of research must be ensured through involvement of professional bodies, research institutions, WHO Collaborating Centres and developmental partners. Comparability of data is to be ensured by adopting internationally agreed standards and indicators.