Transcript Introduction Planning Scale-up Ongoing advocacy

Better Cord Care Saves Babies' Lives:
Mapping Chlorhexidine Introduction
and Implementation
Examples from Madagascar, Nepal and Nigeria
Moving along the chlorhexidine implementation trajectory:
Planning to scale-up
Services
Products
Governance
Planning
Introduction
Scale-up
• Analyze existing environment, human
resources, and systems
• Determine needs and priorities
• Advocate to ensure buy-in for introduction
• Engage stakeholders in working group
• Prepare implementation “roadmap”
• Identify success metrics and establish
monitoring &evaluation system
• Get policy approval for introduction
• Amend the essential drug list to include
chlorhexidine
• Convene working group to
coordinate implementation of
plan
• Establish governance platform,
including lines of accountability
• Develop guidelines and
procedures to ensure adherence
• Increase public awareness in the
introduction of chlorhexidine
• Explore feasibility of and
resources for scale-up
• Decentralize decision making
to facilitate innovations and
system improvement
• Publish experiences and
proven strategies
• Plan for national/subnational
reviews
• Facilitate study exchanges
• Design supply chain system
• Identify supplier base
• Identify customer needs through client
acceptability study
• Develop manufacturing specifications,
quantify needs, and procure product
• Strengthen supply chain system,
building capacity of staff to
manage products
• Strengthen local supplier base
• Link suppliers and other
stakeholders with information
about demand
• Quantity, procure, and manage
products
• Revise supply chain system,
and build capacity of staff and
supervisors nationally
• Link local and external
suppliers with new programs
• Quantity, procure, and manage
products
• Design system for delivering services
• Train service providers
• Mobilize beneficiaries/community
representatives
• Strengthen service delivery
system, building capacity of staff
• Generate provider/client demand
• Assess client satisfaction
• Revise service delivery system,
and build capacity of staff and
supervisors
• Integrate chlorhexidine into
existing work plans and
programs (i.e., MNCH)
Ongoing advocacy
Madagascar: Planning for introduction (1)
Background and context for pilot
introduction
•
•
•
Baseline study conducted, which
identifies information on current cord
care practices
Pilot planned to introduce
chlorhexidine gel in Mahabo district
(Western region)
Chlorhexidine will be integrated into
on-going program managing
childhood illness and providing family
planning and other services
Newborns
like this child
in Mahabo
will soon be
protected
from sepsis
when
chlorhexidine
is available in
the district.
Steps in planning for pilot introduction
1
Technical working group established to
provide coordination of pilot activities
(MOH provides overall technical
leadership/coordination)
2
Product acceptability study and field
testing of product name, logo packaging,
and design (PSI)
3
Conduct trainings for health workers
(MCHIP) and community health workers
(CHW) (JSI)
4
Procure Chlorhexidine from manufacturer
in Nepal (JSI)
5
Monitor the intervention at the
community level (JSI)
Madagascar: Moving towards implementation (2)
Steps in implementation
First CHWs training, September 2013
Job aid for CHWs
1
Conduct official launch of project in Mahabo
2
Lobby and raise awareness of Chlorhexidine
at regional and local levels
3
Train health workers and CHWs
4
Train referral providers
5
Adapt data collection tools (e.g., register,
report form, booklet)
6 Put in place a field supervisor to oversee
CHWs with NGOs implementing partners
7
Conduct quarterly field monitoring and
annual assessment
8
Integrate misoprostol - chlorhexidine for
community based service provision
On-going: Assessing the feasibility of scale-up
Nigeria: Introduction of chlorhexidine in Sokoto
The context for introduction: Profile for
Sokoto & Bauchi States
Indicators
Bauchi
Sokoto
Nigeria
Fertility rate
8.1
8.7
5.7
ANC
Coverage
50%
14%
60%
Home
Delivery
87%
95%
62%
Skilled Birth
Attendance
13%
5%
No One at
Birth
34%
25%
Steps in introducing chlorhexidine in
Sokoto
1
Conducted research to understand current
practices, receptiveness, and user preferences
2
Undertook state and national advocacy/policy
efforts to support Sokoto State Gov’t to launch
chlorhexidine program
35%
3
Added chlorhexidine to essential drug list at
federal, state, and local government level
19%
4
Designed and strengthened systems to deliver
services and products
• Brief 244 Ward Development Committees
(WDC) in Sokoto
• Train 440 community volunteers & 1220 drug
keepers within 6 months
• Incorporate into routine monitoring system
5
Procured chlorhexidine gel (4%) from Nepal;
simultaneously built capacity for local production
After 12 months: 9.33% coverage in Sokoto
Target @ 80% coverage
Sokoto introduction efforts result in:
• Government and community making a firm
commitment to scale-up
• 13 of 36 States being ready to introduce
chlorhexidine
References: National Demography & Health Survey (NDHS) 2008; Nigeria Bureau of Statistics, 2012; TSHIP Reports
Nepal: Achieving coverage at scale
Background and context
•
•
•
Preliminary studies on efficacy of product
and community acceptability (gel versus
Aqueous), show preference for gel
Pilot study in 4 districts to determine
coverage and compliance in Nepal context
proves successful
In 2011, Government of Nepal approves use
of 4% chlorhexidine as part of essential
newborn care
Scale-up plan and progress
Scale-up plan aims to bring chlorhexidine to
newborns in at least 63 of 73 districts in over 3
years (2011 – 2013). Progress shown below:
Activities required for scale-up
1 Incorporate chlorhexidine into essential
newborn care related program and packages
2 Train all service providers and community
health volunteers
3 Include chlorhexidine in essential drug list
and multi-year procurement plans
4 Involve private sector to ensure quality
supply of product
5 Undertake BCC activities
6 Include chlorhexidine activities in routine
health management information system
7 Engage active involvement of stakeholders
throughout implementation process
8 Conduct advocacy at different level and
forums (professional societies and
conferences)