Care for Newborns with Specific Interventions: Validating Coverage Metrics With a Focus on Facility-Based Health Management Information Systems

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: To achieve the Every Newborn Action Plan (ENAP) national targets of <12 neonatal deaths and stillbirths per 1000 births by 2030, ambitious plans are needed to improve data on coverage of perinatal and newborn interventions, especially for newborns at risk or with complications requiring specific treatment. ENAP metrics group prioritised indicators and developed a systematic measurement improvement roadmap.

Methodology: A matrix of more than 100 indicators were graded in a multi-stage process based on importance for ENAP and data availability. Of the resultant 10 indicators, 4 coverage indicators were mapped by task teams, linking to existing technical workings groups, and priorities identified to improve measurement at scale. Consultations were held throughout.

Results: Five of the ENAP core indicators are for measurement of the coverage of specific high impact treatment interventions for newborns at risk or with complications: antenatal corticosteroids, neonatal resuscitation, treatment of severe neonatal infections, kangaroo mother care and an additional indicator, chlorhexidine cord cleansing. All of these interventions have major data gaps and lack standard indicator definitions. Measuring the population in need (for the denominator) is especially challenging. Apart from KMC and CHX, data are unlike to be feasible to collect through maternal recall in household surveys.  Process indicators are presented to use now, with coverage indicator definitions proposed for testing. Facility-based validation will be undertaken in three countries (Bangladesh, Ghana and Tanzania).

Conclusion: The ENAP Measurement Improvement Roadmap (2015-2020) outlines actions needed to test, validate and institutionalise the proposed coverage indicators. The facility-based nature of these high-impact interventions for newborns presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys, and linking to centres of excellence in Africa and Asia.