Sodzi Sodzi-Tettey: Improving newborn health: Opportunities & Challenges

Have the fortunes of Ghana’s newborn changed since Ghana’s newborn strategy and action plan was launched last year? Dr Isabella Sagoe-Moses, the National Child Health Coordinator, might have some answers worth listening to!

To be sure, the strategy ambitiously targeted the impact in both communities and health facilities; mainly reducing the current newborn death every 15 minutes and the 40 per cent of deaths among children under five attributable to the newborns.

In a wide ranging interview, Dr Sagoe-Moses assessed the various interventions rolled out, their impact, existing opportunities and the challenges. 

Assessment of Interventions

Regional focal persons for newborns have been appointed in all regions. Their roles include the coordination of newborn-related activities in line with the policy at the regional level, mobilisation of resources and ensuring that newborn care stays high on the agenda through advocacy.

Secondly, training guidelines for Community-Based-Agents have been developed.

These guidelines provide a step-by-step guide for training community health officers & nurses, and community volunteers on the conduct of home visits. Home visits are currently organised around five home visits – two during pregnancy and three in the immediate post-partum/newborn period.

 This new training guide guides health providers in their interaction with the newborn, its mother and the immediate family. Health providers are expected to promote facility delivery, educate on maternal and newborn danger signs and ensure prompt referral of all sick newborns for appropriate care.

To increase the visibility of the newborn, indicators specific to the newborn are currently being tracked,  e.g. some quality indicators that enable verification of the care that was provided to all newborns in the facility.

For instance, was cord care provided? Was a baby born with breathing difficulties, resuscitated or not? Also as a data-related intervention, a Score Card for Reproductive Maternal Newborn and Child Health has been developed. This score card shows the performance of all regions and districts across priority reproductive, maternal, newborn and child health (RMNCH) indicators.

Dr Sagoe-Moses spoke about two important medicines that have been recommended by the strategy: Chlorhexidine and antenatal Corticosteroids.

Chlorhexidine is recommended by the World Health Organisation (WHO) for use in cord care to prevent the development of infections. There is thus a gradual move in Ghana to replace the current more widespread practice of cleaning the cord with methylated spirit with Chlorhexidine.

Corticosteroids have long been used by doctors/obstetricians working in secondary and tertiary level facilities to help the lungs of the premature baby to mature quickly, thereby improving survival. This happens when corticosteroids are administered to the pregnant mother at risk of preterm delivery. Currently, efforts are underway to declassify corticosteroids such that they can be administered at lower levels in the light of evidence that it can be safely administered by midwives, and makes a difference when administered not as a stand along intervention but in conjunction with other system-wide improvement interventions.

Both medicines are currently before the National Drug Procurement programme for inclusion in the Essential Medicines List. The expectation is that this will automatically place both essential medicines under health insurance cover, thus making them more available and more affordable.

To promote quality improvement initiatives, tools for conducting peer review of health facilities and other integrated supervisory tools have been updated to include specific newborn sections.

Similar to current mandatory maternal mortality audits recommended by the health system, a tool for conducting perinatal mortality audit is being developed. In addition, maternal and newborn quality of care standards have been drafted for implementation.

To support advocacy, communication, social mobilisation and community-based interventions, a new website has been developed; www.ghanahealthservice.org.

The newborn strategy advocates public private partnerships and already, some private companies are lending their support. Eni Foundation, an oil company in the Western Region, is currently supporting newborn data collection and use in addition to improving basic obstetric services and research.

PZ Cussons has expressed interest in supporting the provision of Kangaroo Mother Care (KMC) services for the preterm and low birth weight babies. Roche, a pharmaceutical company, is keen to support the implementation of Vitamin K administration after birth as advocated by the policy.

Dr Sagoe-Moses is quick to acknowledge the support from the Ghanaian media and national newborn champions such as Ms Gifty Anti, Dr Joyce Aryee, the Chief Imam, hip-life musician Sarkodiee and the Deputy Minister of the Eastern Region, Madam Mavis Ama Frimpong.

Results
From 1993, all the five Demographic Health Surveys conducted indicate clearly that access to antenatal services has consistently increased from 86 per cent  in 1993 to 97 per cent  in 2014. Similarly, skilled assistance at delivery has also consistently improved from 44 per cent  in 1993 to 74 per cent  in 2014. Within this context, it is also observed that relative to the infant and overall under- five age groups, there is stagnation in the newborn age group although the 2014 GDHS recorded marginal declines.

If 97 per cent  of pregnant women are seeking antenatal care, 74 per cent  of women deliver under the care of skilled personnel, and if 78 per cent  of women receive post-natal care within two days of delivery, but still newborn outcomes are reportedly stagnating, then it would be difficult for health workers to continue to point to non-care seeking, rather than poor facility-based quality of care, as the root cause of poor newborn outcomes.

 In Dr Sagoe-Moses’s words, “Clearly, the pregnant women are coming to us and, therefore, it is time for us to focus on the gaps in the quality of care provided in the health facilities.” Perhaps, doing this will also entail identifying the root causes of why over 20 per cent  of women who seek antenatal care regularly, do not deliver under the care of skilled personnel, for one reason or the other.

Hopefully, with a clearly mapped out newborn implementation plan and the various health partners aligned to this plan for a true national coverage of high impact interventions, and with more reliable funding from government, it will be possible by 2017 to see the impact at scale that the newborn strategy and action plan envisages.

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