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Mary Kinney, Save the ChildrenWith support from author team of Small & Sick Newborn report (previous parent engagement chapter) and Save the Children colleagues
Session: Roles and responsibilities across the range of care givers
The power of partnership: health care providers, parents, families, communities and systems
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5 reasons parents, families and communities are essential partners with the health care system
1. Inextricable link between mother and baby2. Men have a unique and critical role3. Parental involvement benefits the newborn and the parents4. Parents and families need to be prepared for discharge5. Communities and families need to support parents throughout the
process
Social Ecological Framework for strengthening the partnership with parents, families and communities
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Kangaroo Mother Care: Example of roles in partnership from Saving Newborn Lives work in Malawi
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Situation in Malawi• Higher burden:
• 18% of live births occurring before 37 completedweeks of pregnancy.
• 1/3 of newborn deaths results from directcomplications of prematurity
• Slow implementation and uptake: KMC wasintroduced in Malawi in 1999 and then becamepart of policy in 2005 uptake has been slow.
• Major bottlenecks identified: Lack of space/supplies Shortage of appropriately competent health workers Lack of mobilization in the community to support mothers
providing KMC Lack of data on KMC
5
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Strategies level 1: infant-parent
Goal Parent-infant attachments
One challenge the traditional wrapper – chitenje – to keep the baby skin-to-skin is difficult
Potential Strategies Customized wrap
Implementation research in Malawi of customized KMC wrap found: • Mothers accepted the wrap and preferred it to traditional
chitenje• improved skin-to-skin practices while in facility KMC • Great variation between facilities• Feasibility of locally produced customized but needs more work
for sustainability• 2/3 of mothers willing to return wrap, use pre-used wrap or
purchase wrap
Access study report here: www.healthynewbornnetwork.org/resource/kmc-wrapper-study/
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Strategies level 2: Healthcare Professional –Parent-infantGoal Healthcare professional follow the principles of FCC
One challenge Healthcare providers do not know how to support mothers and families
Potential Strategies Quality improvement efforts with focus on mentorship
Access resources: www.healthynewbornnetwork.org/resource/from-invisibility-to-value-improving-quality-of-care-for-small-and-sick-newborns/
Neonatal deaths reduced from 15.5% to 9.5%
Lesson learned for sustainability: District ownership Standardized monitoring forms and participatory learning
through mentorship and QOC audits Client services are a key component of quality care Consistent monitoring, feedback and stakeholder
engagement Ideal quality improvement leader and mentor
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Strategies level 3: Healthcare system
GoalHealth system demonstrates organization-level value of FCC and provides leadership and resources to ensure consistent implementation
One challenge Lack of smart and dedicated spacePotential Strategies Design of units; increase space
The Thyolo District Hospital neonatal unit now has lifesaving equipment including a phototherapy machine, a Continuous positive airway pressure (CPAP) ventilator, a radiant warmer, and baby cots among other supplies.
Access resources: www.healthynewbornnetwork.org/resource/from-invisibility-to-value-improving-quality-of-care-for-small-and-sick-newborns/
Ntcheu Small Baby Unit Design model example
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Strategies level 4: community
Goal Parent-infant dyad have necessary community support
One challenge Communities do not value lives of small and preterm babies
Potential Strategies SBCC campaign around norms
Access resources: www.healthynewbornnetwork.org/resource/khanda-ndi-mphatso-a-baby-is-a-gift-evaluation-of-a-pilot-sbcc-campaign-to-shift-social-norms-care-practices-for-preterm-and-low-birthweight-babies/
Multi-channel intervention helped to address negative social norms around care of the newborn
Increased value for low birthweight and preterm babies and increased some of the promoted behaviours.
Community-based activities generated meaningful debate, discussion, and supportive action among communities and families including peer support among mothers
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Strategies level 5: societal & policy
Goal Societal policies, regulations, legislation One challenge Clear national guidance and policiesPotential Strategies Guideline and national policies
National KMC Guideline (2005)
National ENAP 2015
President commits to ENAP at UNGA 2015
More opportunities for scale up, resource mobilization and political commitment
World Prematurity Days2012-2015
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Main takeaways The survival and wellbeing of small and sick newborns require strong partnerships
between parents, healthcare professionals and communities. Parents make unique contributions across all levels of the framework as
caregivers and advocates and need support for engagement. Healthcare providers and the system leadership should adopt and promote
family-centered care principles and practices to work in partnership with parents to achieve the mutual goal of improved newborn and infant care and outcomes with support from healthcare managers.
Civil society and parent-led advocacy groups, in particular, play a key role in raising awareness, providing instrumental support and affecting policy change to better meet the needs of sick and small newborns and their families. Parent-led advocacy groups should be recognized and supported by the public and private sectors.
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Thank youAccess resources at:www.healthynewbornnetwork.org
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