How has the LAC Neonatal Alliance contributed to scale-up of newborn interventions at country level in the region?

Goldy Mazia, MD, MPH Coordinator - LAC Neonatal Alliance Newborn Health Advisor - MCHIP/PATH Global Newborn Health Conference Johannesburg, South Africa April 15th, 2013

Variations in NMR in LAC

40
37 37 37

21-30

10-20

<9

30
NMR (per 1,0000 LB)
27 26 26 25 24 24 22

20

19

19

19

18

18

17

16

15 11

10

10

9 7 6 4

0
SU R PA R HO N JA M EC U CO L BL Z EL S M EX AR G VE N UR U CO R CH I CU B US A CA N Y A PE R DO R L I G U BO BR NI C HA

Source: Levels and Trends in Child Mortality Report 2012 (UNICEF, WHO, World Bank, UN)

NMR Reduction Estimates 1990-2011

80
66 66 59

57

57

Percentage NMR rediuction

56

56

56

60

55 50 50 48

NMR 37 NMR 19
47 46 46 45 42 42 41 40 37 36 32

NMR 37

NMR 37

40

NMR 23
32

22

20

0
S PE R M EX EC U CU B BL Z BR A DO R UR U HO N AR G NI C VE N G U A PA R CH I CO L JA M BO L CR O DO M PA N G U Y HA I T& T EL

Source: Levels and Trends in Child Mortality Report 2012 (UNICEF, WHO, World Bank, UN)

Disparities in Neonatal Mortality in LAC

The LAC region is diverse (20 countries/391 ethnic groups)
Average indicators HIDE DISPARITIES between and within countries (i.e. Cuba and Chiles NMR is 5/1000 LB; Haits NMR is 31 and Bolivias is 27/ 1000 LB) Limited access to health services by rural, displaced, and indigenous populations contributes to inequities (i.e. in Bolivia: Potoss NMR is 52, while Santa Cruzs is 17/1000 LB) NMR in the poorest quintiles is double than in richest

Causes of Mortality in Children under 5 in the Americas - 2010

2nd cause of death In children under 5

5
Source: WHO, Lancet May 2012

Proportion of premature births in the Americas

14

12
10 8 6 4 2 0
Total More Developed Less developed developed

6.1% 33-36 w

12.5
9.6 7.5

8.8

8.1

9.1

10.6 7.9

6.7

LAC

Central America

North America

South America

Caribbean

6
Source: P Duran, PAHO/WHO, 2012

Skilled Birth Attendants and NMR

100 80 60 40 20 0
Skilled attendant at delivery Neonatal deaths

50 40 30 20 10 0

Africa
Source: WHO estimates 2000

Asia

Latin America & the Caribbean

More developed regions

Country Haiti Chile Dom Rep*

NMR 31 5 23

MMR 523 12 159

SBA 26 99.9 98

Neonatal deaths per 1000 live births

Skilled attendant at delivery (%)

Breastfeeding in the Americas

Exclusive breastfeeding months Lactancia Exclusiva <<66meses
Repblica Dominicana 2007 EEUU 2005* El Salvador 2002-2003 7.8 Exclusive 12 24 29.7 30.6 36 40.7 46.7

breastfeeding 0-1 m: 20%!!

Honduras 2005
Nicaragua 2006-2007 MUNDO EN DESARROLLO 2006 (UNICEF) Hait 2005 Colombia 2005 Bolivia 2003 Per 2004-2006 0 10 20

53.6
62.8 30 40 50 60 70

Source: Fort A., Macro International, 2007

The burden of fetal deaths

Stillbirths are commonly not counted in national information systems, and are often misclassified

It is estimated that there were 97,000 stillbirths in LAC in 2009 (8,7/1000 LB)

The LAC Neonatal Alliance

10

Mission of the Alliance

To promote neonatal health in LAC within the continuum of reproductive, maternal, and child health, through inter-agency efforts To promote policies and programs based on scientific evidence, with a specific focus on the most vulnerable populations

Members of the LAC Neonatal Alliance

Strategic Areas
Create a favorable environment Strengthen health systems and improve access to health services for the mother, the newborn, and the child Promote community-based interventions Develop and strengthen surveillance, monitoring, and evaluation systems to assess progress

Highlights

MOU with regional professional associations (September 2009), and increasing memberships

Shared annual work plan and budget with clear responsibilities for each member
National Alliances Sub-Regional Forums (Nicaragua/Paraguay; Peru/Barbados) Positive PAHO mid-term evaluation of Regional Strategy and Action Plan (March 2013)

Achievements
Regional Strategy and Action Plan- Resolution CD48.R4 of PAHOs Directing Council Website to share information and experiences on evidence-based interventions (www.alianzaneonatal.org) Neonatal health indicators through an expert consultative process Member of the Commission on Information and Accountability for Women and Childrens Health (WHO/PAHO) and the UN Commission on Commodities for Neonatal Resuscitation and Chlorhexidine Technical assistance to countries for development and implementation of newborn work plans and strengthening of National Alliances

HBB Scale-up in LAC through Alliance efforts

Mxico and Central America (El Salvador, Honduras, Nicaragua, Guatemala) South America: Colombia (nationalintegrated with IMNCI), Ecuador, Per Caribbean: English- speaking Caribbean, and Dominican Republic (national) Muchos otros

LAC KMC Network

Created in December 2011 in the Dominican Republic (1st regional meeting) Supported by the Neonatal Alliance and the Colombian KMC Foundation 10 countries: Paraguay, Bolivia, Ecuador, Per, Colombia, El Salvador, Honduras, Guatemala, Nicaragua, Dominican Republic Community of practice Second regional meeting planned for June 2013
17

Challenges
Small and decreasing funding for the region Newborn health again disappearing from regional agenda Funding for national alliances Limited national budgets for newborn health

18

www.alianzaneonatal.org (healthynewbornnetwork.org)

Many thanks