Count Every Newborn: A Five-year Measurement Improvement Roadmap to Address Gaps in Tracking Impact, Coverage, and Quality of Care

Session: Every Newborn Action Plan (ENAP): A Multi-Partner Measurement Improvement Roadmap

Presenter: Joy Lawn, London School of Hygiene and Tropical Medicine
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Background: Every Newborn Action Plan (ENAP) developed national targets, for less than 12 neonatal deaths and stillbirths per 1000 births by 2030, with a resolution at World Health Assembly 2014. To track progress, urgent data improvements are required, with milestones by 2010 including validated coverage indicators and institutionalisation of data collection, impact data collection through civil registration and vital statistics (CVRS), minimum perinatal dataset and perinatal mortality audit tools. This paper describes the work of ENAP’s metrics group and multiple stakeholders to prioritise and select indicators and develop a systematic measurement improvement roadmap.

Methodology: In 2014, ENAP listed 10 core (plus additional) indicators prioritised from a list of 120 through systematic grading according to relevance to ENAP and data availability. Since then the indicators have been mapped, with identification of measurement gaps, research questions set. Through multi-partner planning processes including a WHO Technical meeting, December 2014, the measurement improvement roadmap was refined.

Results: Core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well-defined, focus is needed to improve data quantity and quality. Indicators for newborns at risk or with complications or disability mainly lack indicator definitions or data. Coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content of care provided at these contact points and quality of care. The most major gap is for coverage for specific treatment indicators, related to some of the highest impact interventions.

Conclusion: The measurement improvement roadmap outlines actions to improve data quantity, quality and use working with existing global networks, such as INDEPTH and All India Institute of Medical Science (AIIMS), and centres of excellence in three high burden countries. Real change requires intentional transfer of leadership to countries with the greatest disease burden.