Indicators to Monitor and Evaluate Newborn Care

Deborah Sitrin on behalf of the Newborn Indicators Technical Working Group

Global Newborn Health Conference Johannesburg, South Africa April 2013

Overview of Newborn Indicators TWG

Formed in 2008 in response to:
Growing interest in newborn health (eg, MDG4) Limited data on newborn health Lack of consensus on indicators to measure newborn health Opportunities to collect data (eg, DHS revisions)

Representation from multiple stakeholders

MICS, DHS, WHO, USAID, NGOs, etc

Aims:
1. 2. Reach consensus on key indicators Advocate for inclusion in major surveys and routine health systems

Initial areas of focus:

Household Surveys: Postnatal contact and content, Newborn care behaviors/ practices Facility assessments: Preparedness for newborn care

Contributions to Date
Standardization of measurement of postnatal contact
Collect for ALL births Within 2 years of survey Ask about contact for women and babies separately

Comparable data on postnatal contact in DHS & MICS4 Consensus on:

Indicators of newborn care behaviors/practices & postnatal care content for household surveys (optional DHS/MICS module) Indicators of newborn services for health facility assessments

MEASURE DHSs Service Provision Assessment (SPA) revised to include additional newborn information

Recommended Indicators for Household Surveys

Recently added to major national surveys (DHS, MICS)
Postnatal contact for women within 2 days after birth (all births) Postnatal contact for newborns within 2 days after birth (all births) Note: there are other long-standing newborn related indicators: skilled birth attendance, C-section, breastfeeding initiation, etc.

Recommended indicators for optional newborn module

Drying after birth Delayed bathing Cord cut with a clean instrument (home births only)

Indicators recommended for further testing

Skin-to-skin contact Nothing (harmful) applied to cord Postnatal care content (signal functions)

PNC Signal Functions

Consensus on 4 signal functions for PNC for baby to capture through household surveys
o Checked cord o Counseled on danger signs for the newborn o Assessed temperature of the newborn o Counseled on breastfeeding

Working with maternal health community on signal functions for PNC check for mother

Recommended Indicators for Health Facility Assessments

Overview
Purpose: minimum list of indicators to rapidly assess newborn care services for all level of facilities Can be used as stand-alone or integrate into broader HFAs Most questions in recent SPA

20 core indicators + 2 optional indicators

Service availability (5 indicators) Equipment & supplies (11 indicators) Documentation (1 indicator) Trained staff (2 indicators) Supervision (1 indicator)

Next steps
Dissemination
Reference sheets with evidence base and guidance on questions, tabulation plans, etc Work with partners to use and test indicators Sharing online:

http://www.healthynewbornnetwork.org/page/newborn-indicators Routine health system data (eg, HMIS)

Develop recommended indicators, tools and guidance

Develop indicators and test metrics for key newborn interventions

Kangaroo Mother Care Asphyxia management Sepsis management

Look for opportunities to validate indicators