Introducing improvements in health care.

Malawi’s emergency program for resources Humans Malawi has had a medical school only since the 1990s and therefore suffers from a chronic shortage of doctors, nurses and other specialized professionals, a situation exacerbated by the brain drain and AIDS. A health services survey carried out in 2003 indicated that out of about 617 health services in the country, only 10

percent met the requirements for providing essential health services according to the criterion of service availability and staff qualification levels. After the government launched the Package Essential Health in 2004, it became evident that improving staffing levels is the biggest challenge to overcome to implement that package. The government and partners then created a human resources program to: • Improve incentives for staff recruitment and maintenance through the offer of top salaries

Expand the capacity of internal training

temporarily using international doctors and nurse tutors Obtain international technical assistance to improve the capacity and management skills and create the system for monitoring and evaluating the flow of human resourcesSource: Adapted from reference29166 Opportunities for newborns born in AfricaFORMAR – Produce more professionals, especially specialized professionals

  • introducing improvements in health care.Increase the capacity of training schools, which may require recourse to private educational institutions. Áfricado Sul, for example, is planning to hand over to
  • NGOs and private education organizations accredited by the Health Directorate, the training of thousands of skilled
  • health workers. The Health Directorate also defined, in a rigorous manner, what are the expected results of these competencies, which are based on a standardized training curriculum.

It is necessary to accelerate these deformation initiatives to resolve the human resources crisis. Promote North-South partnerships for training health professionals quickly. childcare, or abroad Increase budgetary funds to save lives – in order to solve the human resources crisis in Africa, a significant increase in budgetary funds for health is requiredRETER – Retain professionals  Improve wages and terms and conditions of employment contracts •

Improve staff motivation through incentives and job dissatisfaction (prestige, wages, working conditions, promotion, performance-based pay) 31 • Provide HIV prevention services and care and support and treat infected workers • Allow work hours flexible working conditions for families and HIV positive people. BOX IV.6 The second care revolution primary health care – an opportunity for

SMNIA first primary health care

revolution ended with the 1978 Alma Ata Declaration, which provided health care for all in the year 2000 through primary health care as the primary vehicle and focusing on maternal health and Infantile (SMI). Many reasons contributed to this vehicle failing, including the lack of concentration sustained in it, due to the fact that global health policy was later oriented towards the eradication of diseases. In addition,

introducing improvements in health care.TCS was assigned multiple tasks, but they were subject to little or no monitoring, or even little or no pay. Despite the massive wave of workers who have been trained, there are few careful assessments published. After a series of vertical programs, including the ongoing polio eradication, the intense HIV-related activities, malaria and tuberculosis have come to occupy a prominent place in health services, and attentions are now moving towards the acceptance of MNCH services as the main pillar of health care.

  • Communities and TCS are being looked at again as vital agents forIn sub-Saharan Africa, the human resources crisis has accelerated the speed of policy changes in the
  • sense of the TCS; Ethiopia, for example, is training 30,000 community-based Health Extension

Workers to dedicate themselves exclusively to MNCH, malaria and HIV.36 Kenya, Ghana and South Africa are planning national programs for TCS . Nigeria is also improving the capacity of Community Health Extension Workers with a curriculum that includes life saving skills within the MNCH. However, a search for available literature to guide policies reveals that there are no studies on the impact of these measures.

Most evaluations refer to the process

and not to the impact, and many refer to programs of special interest, such as increased coverage of insecticide-treated mosquito nets, the vaccineMANTER – Making better use of available workers • Using good management techniques, such as a clear description of tasks, matching skills to tasks, and balancing competencies in the nude ma team3

  • introducing improvements in health care.Ensure specialized and stimulating monitoring of personnel • Replace personnel to reflect the patterns of their use and fill priority jobs; prepare budgets for subsistence allowances that compensate the weight of rural
  • jobs • Increase efficiency by improving the skills of existing staff through in-service courses and distance learning courses. In South Africa, for example, an innovative
  • method that used a distance learning package helped to improve the skills of more than 30,000 midwives and cost about $ 5 per person.32; 33 •

Teamwork to support and delegate tasks, appropriate policies and legislation, such as, for example, Mozambique, where surgical assistants can perform cesarean hysterectomies.34 In Ghana, nursing assistants perform many of the simplest tasks, thus allowing nurses and midwives to focus on more specialized tasks • To explore the best possible use of TCS to bring health care as close as possible to the populations.

The current “second revolution in primary health care” (Box IV.6) in Africa provides an opportunity to incorporate health interventions. High-impact MNCH in TCS tasks and training personnel in several countries – but it is necessary to learn from the first revolution primary health care.35 Donons sa chance à chaque nouveau-né de l’Afrique 167IV against measles, or the eradication of the Guinea worm, for example.

Few publications discuss the evaluation of the processes of MNCH services, such as the promotion of breastfeeding and nutrition, and no text was found that referred to integrated child health or MNCH programs, although these programs are being improved. In several African countries there are programs such as the Accelerated Program for Child Survival, conducted by UNICEF and financed by the Canadian International Development Agency,

Instrument for calculating child health

All of these instruments require information to be introduced in the calculations, especially those related to the type of interventions that it was chosen, and those related to basic coverage and the broader final coverage, to epidemiological and demographic data, information on the health system (number of installations of services and human resources) local prices of medicines and salaries.

Some of these instruments contain prices for drugs and presumed salaries in cases where this type of information does not exist locally. We are continuing work to harmonize these instruments. TABLE IV.2 Summary of some relevant program instruments that include cost calculations WHO costsCalculate operating costs for varying coverage levels for interventions selected for child survival

Can be used in medium term planning

at national and national levels sub-national as soon as the strategy is conceivedOnly for child health, but subject to expansionCurrently not including system costs or general costsCosts and resources (human resources, facilities, medicines and materials, equipment) Spreadsheets in EXCEL Very simple to use and can be built with support, in a few weeksObjectiveUsageCompetitiveness of SME Competencies

  • Calculation of Reproductive Health Costs UNFPACalculate costs of exploration and / or improvement of servicesCan be used to finance and
  • create budgets for existing sector strategies and plans (eg. oRoteiro) at country level or district level Reproductive and maternal health Costs of activities
  • and improvements to the health system (training, equipment, referral system, etc.) Costs of providing an essential package of productive health interventions

(family planning, ANC and childbirth assistance, COE, managements IST / HIV) EXCEL spreadsheets Very simple to use and can be built with support in a few weeks Marginal budget for foreigners (Uments (UNICEF, World Bank, WHO) Compare the expected number of lives saved with the marginal costs of interventions with varying coverage levels, as an objective of overcoming the main supply and demand bottlenecks that oppose increased coverage.

It can be used to guide the definition and phasing of priorities in the context of national or regional planning and policy dialogue. Maternal, newborn and child health, malaria, vaccinations, HIV / AIDS. activities and improvement s of the health system needed to overcome specific constraints for improving servicesCalculating the impact of the lives of mothers, newborns and saved children

Calculated costs (per capita) to extend coverage

of consensual SMNIC intervention packagesComparison of various interventions, service delivery methods and phasing options, with costs of improving the health system.The calculation sheets in EXCEL will be customized for application Technically complex, with a series of hypotheses, requires training and expertise to be used and time-consuming

African countries, the salaries and other incentives offered by ARV therapy programs have been much higher than those offered by other programs, which leads to the abandonment of staff. routine health services and slowing improvements in other high-impact interventions. Malawi has made a concerted attempt to create a comprehensive human resources plan (Box IV.5). A vast human resources plan is therefore essential and should include strategies for FORMING, HOLDING.30 BOX IV.

instrument for calculating child health

  • Essential Health Technology Package (PETS-EHTP) Planning human and material resources) necessary to provide aselected sets of health interventionsCan be used in the
  • detailed planning and logistics of a program that uses defined interventions Reproductive and child healthCurrently does not include system costs or general costs

Resources (materials and equipment, equipment, human resources and facilities) and logistics to provide a set of defined interventions in terms of user training and the use of the same software and interfaces with each user. reference15 with additional entries specific to UNFPAOportunities for newborns in Africa 1653th Step. Implementing interventions and improving the health system

Tanzania found that less than 10 percent of its basic obstetric care facilities met predicted standards, largely because no one could perform vacuum extraction. Consequently, national regulations are being revised to allow midwives to carry out that operation. It is very frequent that the difficulties of human resources are solved in a piecemeal manner that merely serves to prolong the existing crisis. For example: while promoting increased acceptance of antiretroviral therapy is crucial in many

Countries and programs that have achieved high service

coverage have focused on selected interventions and packages, rather than trying to do everything at the same time. Although there is a strong justification for fewer interventions, but high quality, the other ingredients of success are often lacking: leadership, management and effective use of the data necessary for decision making.

If there are already shortages of midwives, how is it possible that your time will be occupied primarily to perform specialized tasks such as childbirth assistance? Eliminating administrative tasks from midwifery functions can increase job satisfaction and efficiency. In some cases, this will require changes to legislation that support the delegation of responsibilities. In a recent survey of COE services, for example,

  • instrument for calculating child healthOver time, interventions that require greater specialization, and more expensive materials and products, can be added to essential packages. For
  • example: doing tests and treating pregnant women for asymptomatic urinary infections is based on the evidence, but it is more complex and expensive than
  • simple ANC interventions. However, as skills increase, or perhaps in referral services, this intervention can be added to the essential package.

When running a program, the essential questions to ask are:  What? Essential interventions • Where? At home or in a basic health service, depending on the intervention With what? Materials, products, equipment and medicines  Who? Who has the necessary skills and who is highlighted for this  When? Through an integrated service delivery strategy, during pregnancy, childbirth and the postnatal period

Global guidelines should be adapted at national level and include task aids for in-service training, monitoring and regulation. Regular audits are a powerful tool for improving quality.8Improving supplyWhere and with what? Infrastructure, materials, products and goods Despite the fact that assistance to newborns is often associated with advanced technologies,


Promote childbirth preparation

For more details on this analysis, see notes to the data in Section V. Calculating plan costs and filling the resource gap Countries that calculate the costs of specific NMES programs and then compare those costs with an estimated saved lives have longer chances of seeing more resources invested in MNCH. In addition, building consensus around an operational plan that has associated costs between sicontributes to enhancing government leadership and harmonizing partners with each other.

If all the resources of partners in a given country were harmonized or combined, thus allowing investments in MNCH and donors to respect the priorities of those countries, the progress would be TABLE IV.1 Ideas for phasing strategies in agreement with the reference TMNs and withMost occurred at home (33%) Moderate coverage (average 66%) Average 41% (20%)

Very limited services

Very low coverage Initiate systematic plans to increase the coverage of specialized assistance. The aim is to improve priority behaviors for families and coverage of local services., clean birth practices, demand health care & optimal newborn care practices. Consider providing additional care for LBP with routine postnatal home visits. Consider providing clean birth kits for home births.

  • Democratic Republic of Congo, Gambia, Guinea-Bissau, Lesotho, Liberia, Mali, Nigeria, Sierra Leone and Somalia.164 Opportunities for African infants much faster, and that would be in line with the founding principle of the Partnership for Maternal, Newborn and Child Health. An example of efficiency is the essential health package and the Malawi Roadmap, which generated additional funding from several donors afterwards costs have been calculated (See Box IV.3). In the programs, several instruments are used (see Box IV.2), some of them for the calculation of costs, others for carrying out programmatic planning more minimized and some others that calculate the costs and impacts on maternal, newborn and child health of some simulated coverage scenarios through different forms of service provision.26 Increase vaccination coverage with tetanus toxoid (at least two vaccinations during pregnancy), ANC, birth space interventions , IMCI, and routine Postnatal Control. Initiate systematic plans to increase
  • coverage of specialized personnel, COE, and neonatal care, at least in hospitals. Create an implementation plan for human resources, including assignment of tasks if appropriate,
  • finances, and materials and products to increase the coverage of specialized assistance, proximity services and assistance to families.

Improve the links between communities and services and promote their participation. Basic coverage of essential interventions increased by 20%. About 171,000 newborn lives were saved in 13 sub-Saharan African countries. delivery (Average% of partosnos services) * Pre-NatalAssistência specialized control childbirth

(Coberturamédia of ATP) * & neonatal obstetric care deemergênciaControlo After NatalPrincípios to dasmetas ofaseamento coberturapara of the próximos2-3 anosFamília eComunidade -examples of deintrodução maisrápida melhoriasServiços of saúdede proximidadee basic level -examples of faster introduction of improvements24-hour clinical and hospital assistance

Examples of faster introduction

of improvementsPrinciples for the medium termLives saved in the 12 countries with very high TMN (> 45) that progress through 4 phases of reducing TMNM with increasing coverage of essential packages Coverage and functions of the system Priorities introducing improvements in the first 2-3 years Medium-term investments Saved livesDefinition of mortality TMN> 45

which generated additional funding from several donors afterwards costs have been calculated (See Box IV.3). In the programs, several instruments are used (see Box IV.2), some of them for the calculation of costs, others for carrying out programmatic planning more minimized and some others that calculate the costs and impacts on maternal, newborn and child health of some simulated coverage scenarios through different forms of service provision.26

  • Democratic Republic of Congo, Gambia, Guinea-Bissau, Lesotho, Liberia, Mali, Nigeria, Sierra Leone and Somalia.164 Opportunities for African infants much faster, and that would be in line with the founding principle of the Partnership for Maternal, Newborn and Child Health. An example of efficiency is the essential health package and the Malawi Roadmap, which generated additional funding from several donors afterwards costs have been calculated (See Box IV.3). In the programs, several instruments are used (see Box IV.2), some of them for the calculation of costs, others for carrying out programmatic planning more minimized and some others that calculate the costs and impacts on maternal, newborn and child health of some simulated coverage scenarios through different forms of service provision.26 Opportunities for newborns in Africa 163IV designed to save the lives of newborns using existing programs, of capacity and the health systemCombination home / health service (48%) Moderate to high coverage (average 77%) Medium 50% (ATP
  • 18%) Moderate coverage, scarce access and unaffordable costsLow coverageAiming for faster increases in specialized care coverage.Continue to increase the coverage of services
  • for the modification of family behaviors and proximity services

Promote the demand for specialized care and optimal neonatal care practices. Considering additional care for infants with LBW through routine postnatal home consultationsIncreasing coverage and quality of CPN, IMCI and routine Postnatal ControlIncreasing the number of specialized birth attendance, COEfunctional and neonatal care in district and sub-district hospitalsImplementar plans to increase coverage of specialized personnel, especially in places where it is difficult to work.

Draw up guidelines, provide training, supervise and create Monitoring and Evaluation instruments 20% increase in coverage of essential interventions Approximately 280,000 newborn lives savedMost in a health service (65%) High coverage, but there are inequalities (average 82%) Average 85% ( ATP 9%) Moderate to high coverage, variable quality, inequalities remain Moderate coverageAiming for universal coverage of services for the modification of family behavior, proximity services and specialized assistance

Promoting healthy home behaviors

Democratic Republic of Congo, Gambia, Guinea-Bissau, Lesotho, Liberia, Mali, Nigeria, Sierra Leone and Somalia.164 Opportunities for African infants much faster, and that would be in line with the founding principle of the Partnership for Maternal, Newborn and Child Health. An example of efficiency is the essential health package and the Malawi Roadmap,

and the desire to seek health careAiming for universal coverage of high CPN quality, for IMCI and for quality Post-Natal Control Ensuring universal coverage of specialized childbirth care, COE, and neonatal care in peripheral servicesImprove the quality of obstetric and neonatal care and carry out audits on maternal and newborn deaths, and on stillbirths.Resolve residual inequalities (socioeconomic, geographic, rural / tribal, etc.).

Democratic Republic of Congo, Gambia, Guinea-Bissau, Lesotho, Liberia, Mali, Nigeria, Sierra Leone and Somalia.164 Opportunities for African infants much faster, and that would be in line with the founding principle of the Partnership for Maternal, Newborn and Child Health. An example of efficiency is the essential health package and the Malawi Roadmap, which generated additional funding from several donors afterwards costs have been calculated (See Box IV.3). In the programs, several instruments are used (see Box IV.2), some of them for the calculation of costs, others for carrying out programmatic planning more minimized and some others that calculate the costs and impacts on maternal, newborn and child health of some simulated coverage scenarios through different forms of service provision.26

  • Prepare services for full coverage of neonatal intensive care 20% increase in coverage of essential interventions About 355,000 lives of newborns saved Almost exclusively in a health service (98%)
  • High coverage (average 98%) Average 98% (NA) Universal coverageHigh coverageEnsure equality and promote better quality
  • health carePromote healthy home behaviors and the desire to seek health careAim for universal coverage of high quality

ANC, and for routine Postnatal Control Ensuring universal coverage of specialized birth care, COE, and neonatal carePonder creation of a regionalized referral systemProvide long-term follow-up assistance to babies with serious complications 90% increase in coverage of essential interventionsAbout 409,000 newborn lives savedTMN 30-44 TMN 15-29 TMN> 15Source:

Adapté des références23; 26 * Based on IDS analyzes as described and in reference23. For details on the lives saved, see Section V for notes on data contained in an analysis of Sub-Saharan Africa that used the hypotheses and models described in the series by The Lancet magazine on newborn survival24; 27. 12 countries in Africa with a TMN greater than 45 per 1,000 live births are Angola, Central African Republic,


Provide essential care to the newborn

Specialist assistants are able to perform resuscitation. born with well-defined vaccinations and messages on malaria prevention would also allow a wide audience to be reached in a short time. In Africa, maternal death audits have been well publicized and practiced, especially through the WHO “Beyondthe Numbers” program, audits that help program planners to produce the right kind of information needed to prevent maternal deaths.

19 Where women have died or were on the verge of death, there are usually many stillbirths associated with this and deaths of newborns. Audits of maternal deaths could include an analysis of fetal and neonatal deaths, as the deficiencies of the system that lead to maternal and newborn deaths are often the same. Stage to address the main gaps in the provision of health care as noted in

Continuing health care in African

Sections II and III , and as can be seen from country data on  countries’ profiles in Section V, in most countries health service gaps include: • Low coverage of specialized care and COE, particularly for poor and rural communities (VideSection III, chapter 3) • Low coverage of Postnatal Control and little concrete knowledge about the quality of services provided at home and services (See Section III, chapter 4) •

  • Systematic attribution of powers to the community for implementation changes in behavior and possible community interventions, especially specialized
  • childbirth care. Specialized assistance during childbirth is a well-defined package, the improvement of which will be achieved more effectively if carried
  • out by the services.20 This package has a high impact to save the lives of mothers and babies and to prevent stillbirths.

It is true that it requires a constant effort to bring services closer to families, to train and retain more midwives and more obstetricians in services, and to empower communities to demand quality services and have access to them. To achieve universal coverage in Sub-Saharan Africa, approximately 180,000 more partners are needed in the next ten years.21 This increase in human resources will require immediate planning, investment and concerted actions.

This is a long-term solution, and although resolving the problem requires provisional plans to be made, these should not be made at the expense of future investments in specialized health care.22 Postnatal Control and community-based packages are not as well defined as other packages, and much of the information comes from Asia and has to be adapted, tested and refined in different parts of Africa. In addition, the staffing of health personnel available at community level in African countries is much more unstable than in Asia.

Before deforming new staff

of health professionals at any level, an extremely careful assessment of their sustainability should be carried out. Table IV.1 presents ideas for phasing strategies according to the standard TMN and the capacity of health systems. In the place with the highest mortality rate, where the TMN is greater than 45 per 1,000 live births, most births162

continuing health care in AfricanOpportunities for Africa’s newborns occur at home, and although specialized assistance is scarce (33 percent), coverage by traditional birth attendants is even lower (20 percent) .23 More than half of births occur without any assistance. The World Health Report, 2005, describes this reality as a “state of massive deprivation” .21 In these locations, more than half of neonatal deaths are due to infections, including tetanus.23

Rapid decreases in TMN are possible with tetanus toxoid vaccination and with healthy behaviors at home.According to a new analysis made for this publication based on methodology used in the series of The Lancet on the survival of newborns, 24 the level of community and families could be avoided up to one third of neonatal deaths if human resources and specialized health care in health services were strengthened.

If policy makers and program managers

do not already start working to build a better health system, especially through improvements in specialized health care, the opportunity for more substantial progress to save the lives of mothers, newborns will be lost. births and children.The places in the middle of the table, with TMN values ​​between 30 to 44 and 15 to 29, are what the World Health Report 2005 describes as “marginalized” .

  • continuing health care in African21 Because they have more assets, urban populations in these countries have access to specialized assistance, but the poor and other marginalized populations do not. The
  • solution lies in ending the bottlenecks that are opposed to improving services. At lower levels of TMN, there may still be great inequalities in coverage, especially with regard to
  • very different interventions. In these situations, attention should focus on improving the quality of health care provided and the longer-term results related to physical disabilities.

If the 12 countries in Africa with the highest mortality rates started with the community level and proximity services, while reinforcing more complex clinical care packages, and making progress by introducing phased improvements through three gradual increases of 20 percent coverage, so that it reaches 90 percent of all essential interventions, so even with only the first 20 percent increment , about 171 000 newborns’ lives could be saved annually.

Half of African newborn deaths preventable through essential interventions (409,000 out of 800,000) occur in these 12 countries with high mortality (Table IV.2). The additional operating costs for phase 1 of the interventions in these 12 countries are estimated at 0.12 billion dollars, increasing from 0.22 billion to 90 percent coverage, a phase in which three quarters of the cost consists of providing care


The causes of neonatal deaths

SMNI data for policy dialogue, programming and advocacy are contained in the 46 country profiles presented at the end of this publication.causing regular revenues from fees previously charged to be lost. Therefore, careful assessment and a phased strategy of abolishing the fees are required.10 Some African countries have recently abolished moderating rates or modified policies to try to lessen their effect on the poor.

In addition, applying models that provide data on economic losses due to morbidity and mortality, such as PowerPoint presentations on the protection of maternal health (REDUCE) and newborn health (ALIVE!), Can help to relate these events to general national development.BOX IV.4 Assessment of neonatal health status in the context of MNCH Task 1: describe the state of neonatal health in the context of MNCH

Report on the fundamental outcomes

MNCH, such as Maternal Mortality Rates-TMM , the Mortality Rates of Children under 5 years-TMCM5, and the Neonatal Mortality Rates-TMN, rates of stillbirths,  and the rates of low birth weight (LBW). Disaggregate key indicators of results by geographic region, ethnic group and income quintile to determine which populations are under-served Task 2: analyze the coverage and quality of essential interventions

  • Report on the fundamental outcomes Coverage of MNCH packages, essential interventions and the quality of health care Cheers. Disaggregate fundamental indicators of results by geographic region, ethnic group and income quintile to determine which are
  • the poorly served populations  Integration between different health service delivery sites or programs. Domestic behaviors and cultural practices • Continue to
  • analyze the reasons for low coverage (supply and demand) 1.Evaluate the obstacles that hamper the provision of health services

Access (long distances, limited transport, geographical issues of the land) – Human resources (lack of qualified personnel due to brain drain and / or absenteeism) – Materials and products (poor supply chain management, break in the cold chain), – Quality of health care provided (lack of standards or lack of knowledge of standards, or low motivation) 2.Assess the obstacles that hinder the search for health care- Knowledge of the danger signs of newborn illnesses, or maternal complications

Degree of ac eitability (compare the profiles of users and non-users, considering distance and cultural and other barriers) – Accessibility in terms of costs (moderating fees, ineffective exemptions, hidden or “under the table” costs) Task 3: Review policies, current commitment and opportunities • Plans and objectives of relevance to policies, such as the Roadmap, the Child Survival framework, health sector reform

Current expenditure on health

government and key partners in interventions essentials of SMNIT Task 4: Synthesize the strengths and weaknesses of the health system • Possibilities to save children in good time • Important gaps in the provision of services related to certain packages, or to certain ethnic or socio-economic groupsSource: Adapted from reference18On the other hand, identify and working with them to convey MNCH messages and data can help accelerate the introduction of and changes.

Current expenditure on healthIn West Africa, the First Ladies (the women of the presidents) have been very active supporters of the struggle to improve maternal and neonatal health.17 In Mauritania, the First Lady used data and information generated by the REDUCE model to promote causes to sensitize policy makers, community leaders and general population for the magnitude of maternal and neonatal mortality. This attitude has intensified the actions of the government and civil society to improve MNCH in the country.

  • In Burkina Faso, the promotion of this cause at a high level resulted in increased funding for MNCH and reduced the value of moderating fees for cesarean sections (see
  • Box IV.3). As soon as a situation analysis is completed (Box IV.4 ) it is important to define or review national level targets for neonatal health.

To achieve the 4th MDG objective, it makes more sense, from the point of view of programs and policies, to analyze TMCM5 and TMN than to analyze TMCM5 and the infant mortality rate. (TMI). Data availability is the same and there are generally few differences in trends or solutions for TMCM5 and TMI, whereas TMCM5 and TMN tend to differ in the rate of change and potential solutions, as stated in Section I.

For newborns in Africa

1612th Step. Create, adopt and finance an IV national plan inserted in existing policiesCreate an integrated operational plan focused on filling the gaps in ongoing health care Often, strategies to solve the problem of newborn deaths already exist in multiple maternal and child health plans and programs , as described in Section II, and the programs and packages covered in Section III.

  • For newborns in AfricaIt is possible that countries already have multiple operational plans in place; in Tanzania, for example, there is a strategy for health sector reform, the Roadmap, the
  • MNCH plan and a Sector Plan for Poverty Alleviation, as well as specific plans such as the Program Extended Vaccination (VAP), and the prevention of malaria and HIV,
  • all of them interconnected with MNCH. A fragmented strategic plan aimed only at newborn health workers would consume the time and energy needed for action.

Therefore, what is needed is to create practical operational links between existing plans and the activities to be carried out (for example, health sector reform, the Roadmap, and the MNCH) to accelerate progress towards improving high-impact interventions, with phased targets. coverage and ensuring continuous health care without gaps. Identifying and correcting the problem of missed opportunities in the health system As has been pointed out throughout this publication,

there are many possibilities to reduce the number of newborn deaths through continuing health care programs and packages. therefore, by adding, adapting or improving interventions connected with an existing package, relatively high coverage will be achieved quickly. Notable examples include adapting the IMCI to include assistance to sick newborns in the first week of life and ensuring that all

Deliveries and assistance for children

In view of the potentially catastrophic costs to pay for emergency obstetric services, the governments of Zambia and Burundi joined in 2006 at least twelve other sub-Saharan African countries that have a regime of total or partial exemptions from parental fees for newborns and for children. Zambia has completely abolished fees, while Burundi has instituted exemptions for caesarean under 5 years old.

In Section V, in each of the country profiles, information on the moderating fees for MNCH services is shown.FIGURE IV.1 In many African countries, it is families who bear the costs of healthCreate an Operational Plan and take actionThe effective plans that lead the implementation of demanding political actions and also good governance. With good policies, but without ownership, investment of time, money and energy is unlikely to continue the actions.

With good policies

but bad governance, actionsthey may be misdirected and a better health system cannot be built over time, or inequalities may increase. An effective participatory process should reach consensus through a phased operational plan and catalyze the integration of MNCH services by bringing together health services. maternal and child health, as well as malaria, HIV and others. To be effective, two parallel and interdependent processes need to be involved (Figure IV.2).

  • A participatory political process that identifies and engages key stakeholders, promoting a facilitating policy environment and resulting in agreement on
  • the resources needed for implementation should include the following main stakeholders: stakeholders – In principle, this group should include the group of national or local
  • broad-based partnerships that integrate MNCH services, headed by the national government and that includes the relevant elements of the

Ministry of Health for MNCH and those of other ministries, relevant partners and donors , non-governmental organizations (NGOs) and groups promoting the interests of women. This method facilitates the acceptance of a planonational for MNCH services and the harmonization of donations and other financial inputs that encourage the construction of a stronger national health system that over time manages to meet the needs of MNCH services.

Nuclear group – Name become a team and given terms of reference to carry out a situation analysis. It is important that this team includes individuals with extensive experience and competence in programs, policies and data handling, as well as representatives from various districts with MNCH services. Source: Reference3. For more information on out-of-pocket expenses and other financial indicators, see country profiles and notes to data, in Section V0% 20% 40% 60% 80% 100% Percentage of out-of-pocket fees on health expenses

Opportunities for newborns

born in Africa 159IVFIGURE IV.2 Description of the process for creating and implementing an operational strategy and planA process for creating a strategic and operational plan that uses data to work systematically and in the following way, all steps of the program management cycle : Step 1. Conducting, in the context of MNCH services, an analysis of the situation regarding the health of newborns2nd Step.

With good policies

  • Create, approve and finance a national strategic plan included in existing national plans and policies3rd Step.
  • Implement interventions and improve the health system4th Step. Monitor the process and evaluate the results, costs,
  • and financial inputs. These steps can be adapted to each specific country or location,

depending on the state of the existing NMES planning process.For example, if the Roadmap is already an active governance document, the priority may be an integrated operational plan for improving newborn health services that links, in a phased implementation plan, the Roadmap, the Integrated Care Strategy for Childhood Illness. (IMCI), and other relevant existing policies. Steps 1 and 2 would therefore be less important and would fundamentally ensure that there are no major gaps or flaws when reviewing the content of existing policies.

It will be useful to set a deadline for completing each step, and for completing the report. On the CD accompanying this publication there is a situation analysis guide and some other guides, still in the form of an outline, to help carry out the work along all these steps. This material is being used in a series of workshops to help teams in each country advance the process of improving the health of newborns in their countries.

15 Furthermore, the CD contains some examples

Of national situation analyzes and plans. Source: Adapted reference16 DEFENSESDECAUSEASINTERINTERESESIdentification of a core group (preferably using or reinforcing an existing group) to guide the creation of the newborn health strategy and a broader representative groupAssessment of technical resources and other resources necessary for the creation of strategies by the core groupCreation of the strategy project under the leadership of the nuclear group: Step 1:

  • Carry out a situation analysis on newborn health in the context of the MNCH Step 2: Create, adopt and finance a national strategic plan (Draw up a
  • list of interventions according to their priority, placing them on packages and executing them in phases) Meeting to reach consensus
  • with a g wide group of stakeholders to present and complete the draft strategy and operational plan.Disclosure of the plan3th Step:

Implement interventions and improve the health system4th Step: Control the process and evaluate the results160 Opportunities for Africa’s newborns1st Step. Conducting a situation analysis on neonatal health in the context of MNCH and defining national goals for the reduction of TMN in view of the goals of the ODMAs evidence-based information not only reinforce policies and programs, but also promote dialogue around the cause defense.

Equal data can be used differently for different audiences. Often, mortality rates alone are not enough to influence policy makers, but modifying rates to present them in the form of the number of deaths per year or per day helps to convert the statistics from abstract concepts to the reality of the day. postpone. It is difficult to ignore the fact that a quarter of a million babies in Nigeria die every year, for example.


Where women and their families are not spectators.

Madagascar has a strong tradition of community involvement and effective community-based programs. For more information on TMN, GNI per capita and other indicators used in this box, see Section V for country profiles and notes on the data. Donons sa chance à chaque nouveau-né de l’Afrique 157What are the factors driving IVprogressions to save lives? All countries differ from each other, but there are four themes shared by countries that are making progress in MNCH and which are the ABCs of progress:

Responsible leadership : in many of these countries, it is an consistent and responsible leadership and good management of resources that guides the way forward and the actions to be taken. Good leadership not only maximizes teamwork in a country, state or organization, but also attracts investment from outside sources. The Paris Declaration on aid effectiveness established the fundamental principle of being the government that leads and that partners have to respect it. three principles: ”4 • A national plan

A coordinating mechanism

A monitoring and evaluation mechanismHow to link national policies with district measures: almost all of these countries have documents on poverty reduction strategies and health sector reform plans. There is often a gap between strategic planning at national level and measures taken at district level. Tanzania has created an instrument that allows districts to allocate funds from local budgets according to certain identified categories of diseases most present in the places concerned,

  • A coordinating mechanismwhich have increased spending on child survival that are associated with steady increases in coverage of essential interventions. Empowerment of the community and
  • families: many of the health care provided to mothers and newborns take place at home, where women and their
  • families are not spectators. If empowered, they can be part of the solution to save lives and promote healthy behaviors.

In Senegal, a neonatal health committee has been created whose action is aimed at health services and also the community. This committee creates and strengthens links between those two realities of society and involves key partners at national and regional levels. In one area, a project supported by the BASICS organization, improved health services through the training of health professionals, stimulating monitoring, and the provision of basic equipment.

Counseling through community health workers (TCS) and volunteers and semi-skilled service workers has also improved. Simultaneously with the use of the media, these communication strategies resulted in an improvement in family behaviors, such as preparing for childbirth or saving money for emergencies (from 44 percent to 78 percent), drying the baby right after birth. childbirth, when he is born at home (from 54 per cent to 73 per cent),

Initiation of breastfeeding

in the first hour after childbirth (from 60 per cent to 78 per cent), and avoiding pre-dairy foods (from 39 per cent to 71 percent) .5 Demonstrated commitment to: • Create and encourage policies to support the 4th and 5th MDG objectives and increase coverage of essential MNCH interventions and packages. Both the Roadmap and the Regional Framework for Child Survival pay the utmost attention to increasing the coverage of essential interventions.

  • Initiation of breastfeedingIn the 5 and 10 year plans, constant and consistent attention must be paid to essential MNCH packages in order to achieve universal coverage, especially with regard
  • to the packages that raise the most difficulties. • Maximize the potential of human resources, including the use of
  • community staff when appropriate. In order to improve specialized assistance, it is very important that there is a permanent commitment to increasing the capacities of human resources.

The International Federation of Gynecologists and Obstetricians (FIGO) supported the establishment of links between professional associations in developing countries and those in developed countries to improve the capacity and improve the quality of health care. From Uganda we have a success story, in which two districts were able to demonstrate that COE was needed and did so by improving the quality of services and stimulating demand in communities.6 (See Section II, Box II.5)

Measure progress and link the data obtained with the decision-making process, always considering equal criteria in monitoring and in the evaluation of efforts to improve services. Some countries have used new methods to use the available data and promote accountability by the authorities. Every year, for example, Uganda newspapers publish a table of all districts that will show progress in health and education and other key indicators.

South Africa has instituted a confidential

national survey on maternal deaths7 and also has a process to analyze neonatal deaths and their causes.8 • Mobilize resources to protect the poor. Mobilizing resources to protect the poor and move towards a more egalitarian health system requires a very careful analysis of moderator rates. Even with better supplies and improvements in service quality, moderator fees reduce the use of health services.9;

  • South Africa has instituted a confidential10 Moderator fees paid by service users make some essential health care, such as hysterectomy, prohibitively expensive. An analysis comparing the costs of maternal
  • “near death” cases and the associated obstetric costs made in Ghana and Benin, concluded that the cost of this care can be so high that it reaches up to one third of a family’s annual income.11
  • Figure IV.1 shows the estimated percentage of expenses with moderating fees in health services in 44 countries.

In most158 Opportunities for newborns in Africized countries in southern Africa, less than 20 percent of health expenditures refer to out-of-pocket fees, largely due to the existence of better social security systems in these countries. However, the 17 countries with the highest spending on moderating fees are located in the poorest African sub-region, in West and Central Africa, with 40 to 80 percent of health expenditure to be paid directly by families.

Various analyzes suggest that exemptions from moderating fees based on socio-economic status are very difficult to implement12; 13 and that exemptions based on demographic data (eg age, pregnancy) may be more effective.10; 14 Abolishing moderating fees can greatly increase demand services and overburden the system,


Reductions in the mortality rate of children under five

Some countries, such as Tanzania, Malawi and Ethiopia, have recently shown spectacular , according to IDS data. There are also other countries making steady progress in reducing that rate and simultaneously in the rate neonatal mortality (TMN) and maternal mortality rate, as is the case in Eritrea. (See Section I, figure I.2). Normally, we expect low-income countries to have high mortality rates, and while this is often true, there are some positive surprises.

Box IV.3 shows a graph comparing TMNs with Gross National Income (GNI) per capita. We would like to take a closer look at countries that stand out positively, countries that have progressed towards lower neonatal mortality rates, despite their low GNI per capita. We highlight these countries – Eritrea, Malawi, Burkina Faso, Tanzania, Uganda and Madagascar – to demonstrate that good news can come from Africa.

These countries are progressing

from very high NMR and mortality rates for children under 5 years old, lower parataxes and, in many cases, to lower maternal mortality ratios. In some cases, measuring TMN may be difficult, but despite this, what can we learn from your experiences so far? BOX IV.3 Despite their scarce wealth, some African countries are making progress: neonatal mortality rate versus

These countries are progressing

  • National Income Gross (GNI) per capita102 03 04 05 06 070 $ 0 $ 1 000 $ 2 000 $ 3 000 $ 4 000 $ 5 000RNB per capita in dollarsMascar macawalaMalawiTa z â iarq a FasoU d aEritrea
  • TMN per 1000 live beings156 Opportunities for the newly born – born in AfricaThere are many factors that can
  • contribute to improvements in neonatal health.

However, for each of these countries with a lower TMN (31 per 1,000 live births or less) and also a low GNI per capita (less than $ 500 per year), it is worth pointing out certain fundamental realities that are likely related to these successes. The chart also contains indicators on the progress of these countries towards fulfilling Abuja commitments to spend at least 15 percent of the state’s general budget on health.

An important warning is that Demographic and Health Surveys (SDI) tend to underestimate neonatal deaths, so the true TMN in some of these countries is probably higher. Eritrea: (TMN = 24, GNI per capita = 180 dollars, progress towards of Abuja commitments = 5.6%) Despite being one of the poorest countries in the world, placed 157th out of 173 countries on the UNDP Human Development Index, and despite the difficulties of wars and famines, Eritrea has achieved extraordinary successes in this regard regards the health of children.

The constant reductions in the mortality rates

Of children under 5 years old that have been seen in this country have already been highlighted in Section I. How are these results being achieved? Firstly, through a strong commitment to children’s health at all levels, and secondly, because there is no corruption in Eritrea and there is strong donor collaboration, which multiplies the impact that limited resources could have. Eritrea was one of the first African countries to be certified for having eliminated neonatal tetanus

The constant reductions in the mortality ratesDespite these successes, difficulties remain. The coverage rate of women who give birth to specialized care, for example – only 28 percent – is still low, while the TMM is moderately high, with a value of 630 per 100 000. The Eritrean National Roadmap was created to solve the problem of its high TMM and innovative methods to solve the human resources crisis in the country are being explored. Uganda: (TMN = 32, GNI per capita = $ 270,

Progress towards Abuja commitments = 9.1%) In Uganda, the current Health Sector Strategic Plan II includes a Maternal Health Cluster and Infantile, to which a sub-group dedicated to newborn health was recently added. The objective is to improve and expand essential interventions and reach the poor. In addition, every year the results of the districts in terms of health are published in national newspapers, thus promoting the accountability of the authorities.

That families previously paid for cesarean hysterectomies.

Burkina Faso: (TMN = 31 , GNI per capita = $ 360, Progress towards Abuja commitments = 10.6%) Recent high-level actions in Burkina Faso to combat maternal and newborn deaths through the REDUCE advocacy tool , resulted in an 11 percent increase in government funding for maternal and newborn health. These actions also resulted in the publication of legislation designed to reduce from $ 120 to a maximum of $ 20 the amounts

  • That families previously paid for cesarean hysterectomies.Tanzania: (NMR = 32, GNI per capita = $ 330, Progress towards commitments de Abuja = 14.9%) The Government of Tanzania has shown a constant
  • commitment to invest in health and to decentralize decision making regarding health spending based on district priorities. At this time, district health teams
  • allocate budget funds based on local charges and the coverage of some high-impact interventions has increased.

The National Roadmap is being created and it is giving even more emphasis to the health of newborns. Malawi: (TMN = 27, GNI per capita = $ 170, Progress towards Abuja commitments = 9.7%) If there are doubts about the accuracy of TMN’s calculations in the country’s most recent IDS, Malawi has undoubtedly made progress in reducing child deaths, as described in Section I. Many factors can contribute to this progress, although there are few obvious increases coverage of the most essential interventions over the same period of time.

Health sector reform in Malawi has been a participatory process that has resulted in a national consensus on the essential health package and an increase in investment in the sector. led to greater collaboration between the Ministry of Health and donors. Two donors invested an additional US $ 40 million after the costs of the National Roadmap were calculated. The level of commitment to the Roadmap is demonstrated by the fact that it will be launched by the President. Madagascar: (TMN = 32,

GNI per capita = $ 300, Progress towards Abuja commitments = 8.0%) A recent review of the Framework National Medium Term Expenditure provided an opportunity to integrate newborn health into the current MNCH plan, especially as the latest IDS revealed that the percentage of children under five in the postnatal period increased. Attention goes to family planning, prenatal control and community strategies, as well as solving the problem of human resource limitations for specialized health care and obstetric emergency.

Improve the provision of quality health care

To mothers and newborns, as well as access, including family planning services, and ensuring easy access to the services provided, from the user’s point of view. Improve the referral system. Improve the planning and district management of maternal and neonatal health care and also family planning services Strive for an increase in the commitment of the authorities and the increased resources.

Promote and boost partnershipsObjective 2 Improve the capacity of individuals, families and communities to improve maternal and neonatal health. Promote continued health care, from housing to hospitals. Empower the community to define, seek and access specialized assistance by mobilizing community resourcesMonitoring, evaluation and accountability

Cont roll out the progress

At national and regional level, of the adoption and adaptation of the Roadmap • Monitor the mobilization of resources and the commitment of partners in implementing the Roadmap  Create selected indicators for the different levels of health care and services to be provided , with phased implementation154 Opportunities for Africa’s Newborns

Cont roll out the progressPhases of the development of the National Roadmap for Sub-Saharan Africa, from 2003 to July 2006Regional strategy for children’s survivalIn 2005, the African Union, concerned about the lack of progress towards the 4th objective MDGs for child survival, launched a call for an accelerated child survival strategy that was supported by WHO Member States at the 56th Regional Committee in August 2006.

WHO, UNICEF and the World Bank are currently converting this strategy into a framework of joint implementation, to be submitted to the approval of the Heads of State of the African Union. IV.2 The African regional framework for the survival of children Priority areas. The structure created by UNICEF, WHO and the World Bank in partnership with the African Union, allows for a consensus on the importance of continuing MNCH care, health systems and financing, as well as essential interventions.

Priority areas include assistance

To newborns and connection with assistance to mothers, and involves specialized assistance during pregnancy and childbirth, Post-Natal Control and improved assistance in the community and in basic and referral health services. Other priorities include the feeding of infants and children in early childhood, and nutritional supplements with micronutrients, vaccinations, malaria prevention, management of common diseases, PMTCT and assistance to children exposed to or infected with HIV.

Broad Sector Approach, (SWAp) (“SectorWide Approach”) that has promoted a rapid increase in donor investment at the national health sector level. Some African countries are making progress to save newborn lives. Although the news from Africa is often negative, there are huge differences between African countries and within each, and there are examples of successes.

  • Priority areas include assistanceImplementation. The implementation plan describes the methods of providing services and the phasing required to achieve universal coverage through partnerships,
  • accountability, clear definition of the roles to be played and monitoring and evaluation. To be included in measure packages and to implement interventions, three ways of
  • providing services are proposed, which include health care in communities, proximity services and clinical assistance at the level of basic health services and units. dereferencing.

These three forms are: community-based and family-oriented services, programmable services targeted at the general population, and individual-oriented clinical services. The three phases of integration begin with the implementation of the small-scale minimum package, the resolution of limitations to improve services, and the subsequent addition of other interventions in the extended package.

The aim is to achieve maximum coverage with the complete package of interventions. Arguments in favor of investment. The arguments in favor of investment detail the estimated impact of achieving fundamental goals related to neonatal mortality and children under five years of age, while also analyzing the costs incurred with interventions and the improvement of health systems. Respecting the governmental perspective, the inputs will consist of a combination of global support and financing schemes composed of nationally owned funds.

Opportunities for Africa’s Newborns

Source: updated data from the WHO Regional Office for Africa, up to October 2006, complemented by UNFPA. At present, the monitoring measures have only detected data until the launch date. The measures that have yet to be detected are being analyzed. Development phase (July 2006) Orientation (presentation to the Ministry of Sa de, re niãoc with the interested parties and with the task orce) Pla e am to (creation and adoption of the Roadmap) D e esa and mobilization of resources (loop of the Roadmap) Op

  • Opportunities for Africa's Newborns155Health Sector Reform IVEThese two regional structures are based on standard models that can be adapted, financed, and then implemented in countries, not in the “vacuum”, but in the global
  • context of health sector reform . A reform of this sector ranged from some decentralized decision-making processes to a definite plan to
  • remodel the health sector based on an essential package on which agreement and external annual reviews were reached.

The health sector reform process makes it possible to improve certain essential, highly effective and viable MNCH interventions. If these interventions are part of the national health package and are related to objectives and budget lines subject to a regular review procedure, then the first reforms that are carried out are likely to be those related to national ownership, sustainability and responsibility. Several African countries now have a sub-committee included in their health plan’s

NMES services, which focuses its activities on the 4th and 5th MDG targets. Uganda, for example, recently added a subcommittee to the maternal and child health cluster. This sub-committee was charged with making recommendations for improving newborn care included in the national health sector’s strategic plan. In Malawi, the government and its partners have joined forces to create and fund an essential health package linked to the

Essential health care for every mother and baby

In AfricaDoyin Oluwole, Khama Rogo, Mickey Chopra, Genevieve Begkoyian, Joy LawnIV152 Opportunities for Africa’s NewbornsIntroductionEvery year, 1.16 million babies die in Africa. However, about 800,000 newborn lives could be saved, and a similar number of maternal and child deaths could be spared if essential interventions reached 90 per cent of women and babies. Many of these interventions are already part of the health policies of almost all African countries, inserted in programs that already exist in continuous health care and have implementation strategies already in place.

The cost of implementing policies

is affordable and represents approximately another $ 1.39 per capita than is already being spent.1 The reason why so many babies and so many mothers and children die each year is not a lack of knowledge or policies, but it is rather our collective inability to implement these interventions, to achieve high coverage and to reach the poor. A recent focus of attention on the issue of regional slow progress towards the 4th objective of the Millennium

  • The cost of implementing policiesDevelopment Goals (child survival) and the 5th objective ( especially in Africa, has caused greater attention to be paid to improving essential interventions for maternal, newborn and child health (MNCH). Progress is
  • hampered by cross-cutting difficulties, some of which go beyond the scope of newborn health and even of SMNI.
  • These limitations are well described2 particularly with regard to human resources for health crisis situations and the difficulties in financing health care on a continent where governments

16 countries spend less than $ 5 per capita on health, and those in 11 other countries spend less. $ 10 per capita.3 This section will describe important regional policy frameworks, highlighting specific opportunities to save newborns’ lives, and how to address their health can be a catalyst for their integration into MNCH. Good news arrives from Africa, which is why we highlight some countries that are making progress towards lower neonatal mortality rates (TMN), despite their low Gross Domestic Product (GDP), and we analyze principles that can serve as a lesson.

The final part of the Section analyzes policy measures and programs to accelerate actions, including the resolution of the issue of human resources and SMNI financing. There are commitments made to regional policies. Africa does not suffer from a lack of policies. There are many fundamental policies in place, both general, such as health sector reform, and specific, such as the prevention of mother-to-child vertical HIV transmission (PMTCT).

To reduce the number of maternal

neonatal and child deaths, and accelerate the actions that will lead to the fulfillment of the 4th and 5th Millennium Development Goals, there are two main regional political frameworks, both created under the African Union’s aegis: • The Roadmap for accelerating progress towards the Millennium Development Goals for maternal and child health in Africa – “Roadmap” (Box IV.1)

Regional Task Force for Maternal, Newborn and Child HealthWhat is new? • Highlight for the inseparable pair made up of the mother and the newborn -born. Consensus on plans for the next decade, including long-term commitment and opportunities to take advantage of the resources of all partners. Focus on two levels to have a significant effect: specialized assistance in health services and demand creation at community level.

To reduce the number of maternal

  • The Regional Strategy for Child Survival (Box IV.2) The common thread of these two frameworks is the newborn. The health of newborns can represent the “bridge” that
  • connects maternal health with children’s health, but which is easily lost sight of in the midst of actions that strive solely for one goal or another and for its implementation.
  • Ideally, these political frameworks will be based on a single vision of NMES,

both in each country and at the regional level. The constitution of the MNCH African Regional Task Force, with the secretariat located in the WHO African regional office, is a measure that fills us with hope to achieve that objective (see Introduction, page 4). The Roadmap for accelerating progress towards the 4th and of the 5th objectives of the ODMem Africa The Roadmap resulted in the establishment of an unprecedented pace of acceptance of policies in all countries, with at least 35 countries starting the process within 2 years.

In many countries, the process was participatory

and multisectoral (Box IV.1). In several countries there has been a very high commitment – in some cases the President himself chaired the national launch of the process. The Roadmap promotes an approach to health care that deals with both supply and demand, by closely monitoring events from home to continued health care in the hospital. (See Section II).

Special attention to emergency obstetric health care and newborns, highlighting specialized care as a process through which a mother and baby are provided with adequate assistance during labor, delivery and delivery. postnatal period, regardless of where the birth takes placeProcess and strategies: Objective 1 Provide special assistance specialized during pregnancy, childbirth and throughout the postnatal period.

  • In many countries, the process was participatoryThe real test of success will come when you determine whether coverage of essential interventions and packages, especially specialized health care and emergency obstetric care (COE), has increased over the next few years. While
  • supply-side problems such as a lack of human resources, infrastructure and medicines are widely accepted, measures
  • to increase demand are not well defined in many countries, and the empowerment of the community, as well as information for behavior change, these actions are rarely systematically implemented.

At the moment, most of the national Roadmaps have not yet adequately valued interventions based on evidence that are possible at the community level, especially in relation to newborns. Opportunities for Africa’s Newborns 153TH BOX IV.1 African Roadmap for Accelerating Progress towards the MDGs on Maternal and Newborn Health In 2003, the meeting of the African Regional Task Force on Reproductive Health called on all partners to birth and implement a

Roadmap to accelerate the reduction of maternal and neonatal mortality in Africa, thus proposing the fulfillment of the 4th and 5th MDG objectives. The guiding principles of the Roadmap are: 1. Staged and evidence-based planning and implementation at national level2. Methodology centered on health systems and focused on reducing injustices and inequities3. Partnerships with clear definition of roles to play and respective responsibilities, transparency and accountability, under the direction of the