Learning from South Korea’s development experience

노트 : This report was published in December 2011 in the KOICA Journal for International Development Assistance, Vol.

Reaching the every newborn national 2020 milestones: country progress, plans and moving forward

The day of birth and the first 28-days of life - the neonatal period – are the most vulnerable time for a child’s survival and health. Neonatal deaths as a share of under-five deaths declined more slowly than other under-five deaths during the Millennium Development Goal period (1990 to 2015), a period that saw a great drop in under-five mortality. Newborn deaths now account for 45 percent of under-five deaths globally, up from 40 percent in 1990. Moreover, half of all stillborn babies begin labour alive but die before birth. Beyond survival, the health of each child and adolescent of the Sustainable Development Goals (SDG) period begins with a healthy mother, a healthy birth and good health in the critical first days of life. Country leadership has been critical to strengthen engagement, action and partner harmonization efforts toward the implementation of the Every Newborn Action Plan which targets the reduction of the neonatal mortality rate (NMR) to 12 or fewer per 1,000 live births and stillbirths to 12 or fewer per 1,000 births in all countries by 2030. In doing so, we also improve the care provided to all mothers and their children. The Every Newborn targets are echoed in the Every Woman Every Child (EWEC) Global Strategy for Women’s, Children’s and Adolescents’ Health (2015- 2030). The neonatal target is SDG Goal 3.2, and is closely linked to SDG 3.1 for ending preventable maternal mortality. As the SDG era is underway, many countries are revising their relevant plans, policies and programmes. To reach these targets to end preventable deaths [1] and ensure available, accessible and quality care, the Every Newborn National Milestones by 2020 which track the processes of country ownership and action are fundamental. A simple Tracking Tool was developed by maternal and newborn health partners to annually measure progress or lack thereof on the eight national milestones. The Every Newborn Tracking Tool was adopted by 51 countries in 2016, up significantly from 18 countries in 2015. This increase was enabled by preparatory work and follow-up after the UN interagency meetings with 37 countries in the Middle East and North Africa, and West and Central Africa in 2016. These forums provided the opportunity for country teams with high burdens of preventable mortality to understand the strategic objectives, milestones and recommended actions of the Every Newborn Action Plan, and learn about best practices and formulate their follow-up action plans. This exercise helped to identify gaps and prioritize action, and along with the inclusion of the NMR target as an SDG Indicator, and the NMR and Stillbirth Reduction targets as Global Strategy Indicators, has accelerated country actions. To further support countries, a regional task force was agreed on for the West and Central Africa region, in light of high newborn mortality and stillbirths in most countries in the region and a need for concerted action by partners. Overall, by January 2017: • Forty-eight countries and territories have strengthened maternal and newborn components of their reproductive, maternal, newborn, child and adolescent health (RMNCAH) plans, and 40 countries have set NMR targets. In addition, 16 countries have developed subnational plans and 21 countries have completed the costing of their national plans. • Nineteen of the 20 countries with the highest burden of newborn mortality have completed a newborn action plan or strengthened the newborn component in their RMNCAH plan. • Fifteen of the 20 countries with the highest rates of newborn mortality have similarly strengthened their plans. Our in-depth look at those 51 countries and territories that completed the Every Newborn Tracking Tool found: • Forty-one countries report having a national quality improvement programme and 30 of these have a specific focus on maternal and newborn care. • Forty-five countries report having health workers at appropriate levels of care authorized to administer life-saving interventions and commodities. • Thirty-four countries have adopted legislation or policies on the notification of maternal death within 24 hours. • Thirty countries have a human resource strategy for skilled attendants at birth and 18 countries have a strategy for retention of these cadres. • Twenty-three countries have included all the seven essential medical products and technologies in their National Essential Medicines List. • A Maternal Death Surveillance and Review mechanism is in place for 44 countries. • Twenty-three countries have started perinatal death reviews. • Thirty-four countries have a national health insurance scheme/policy for free maternal and newborn services including care for sick newborns. • Eighteen countries have developed a national communication strategy on newborn survival and 28 countries have a community engagement or social mobilization strategy for maternal and newborn health. • Only ten countries have established a stillbirth reduction target. • Small and sick newborns remain a critical focus for action, in terms of addressing both the causes of preterm birth and ensure quality of care for mothers and newborns in the time around birth and postnatal period. • National Health Monitoring Information Systems and data collection need improvement. Of the global efforts to support country work, it is particularly worth mentioning two: quality of care, and data collection. Greater momentum was achieved toward improving the quality of care with the launch in Malawi in February 2017 of a Network for Improving Quality of Care for Maternal, Newborn and Child Health which fosters cross-country exchange and planning with nine first-wave countries. Additionally, large-scale quality improvement learning activities are progressing through regional leadership in South and Southeast Asia and the Pacific region, including a regional quality improvement learning hub and extensive coaching and mentoring in facilities. The urgent need for improved national data was one of the main messages during the development of the Every Newborn Action Plan, specifically the need for programmatically relevant data to drive coverage, and also understand the equity and quality gaps. Guidance and tools for audit and response for perinatal mortality were released and piloted by WHO in 2016; “Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths” and partners are supporting countries with implementation. The ENAP Measurement Improvement Plan, developed in 2015, provides an ambitious, multi-country, multi-partner approach to improving data gathering by 2020 and progress has been made, notably the following: (a) coverage of care indicators have been defined for selected interventions and are being validated through a three-country study to observe 20,000 births; (b) service readiness for the small and sick newborn is a major measurement gap and a situation analysis on who cares for the small and sick newborn as well as a survey of practitioners around the world will help to define levels of care and support the development of new WHO guidance in 2018 to improve the quality of care for small and sick newborns. The INDEPTH network, with leadership from Makerere University, Uganda, are working with 5 country sites to compare different survey methods for pregnancy outcomes in a study of 70,000 births. The Demographic Health Survey, UNICEF (Multiple Indicator Cluster Surveys), and the Centre for Disease Control are working together closely on this. Moreover, the harmonization of newborn and maternal metrics has been improved through the establishment of MoNITOR (Maternal and Newborn Information for Tracking Outcomes and Results), with six-monthly meetings hosted by WHO. To accelerate progress, countries need additional support with updating their Health Management Information Systems (HMIS) with key indicators, including quality of care indicators, as well as exposure to innovations in data collection and use. The ambitious goals for maternal and newborn survival and well being can only be met with the consistent and harmonized support of partners. A joint Results Framework was endorsed by partners that sets forth key activities for 2017 and 2018 and partners are rallying behind this one work plan (Every Newborn Results Framework 2017-2018 [2] ). Available, accessible, acceptable and quality maternal and newborn care is the foundation for good health at all life stages for everyone, everywhere. Achieving the goals and targets set out in the SDGs and the EWEC Global Strategy for Women’s, Children’s and Adolescents’ Health is underpinned by achieving the Every Newborn 2020 Milestones

Raising awareness of metabolic syndrome in people treated with typical long-acting Injectable antipsychotic medications

This paper details an action research study that was carried out with nurses and patients in a community mental health service in Ireland. People with mental illnesses who receive antipsychotic medications have excess mortality which is two to three times higher than the general population, shortening their life expectancy of 20 -30 years. An action research methodology was specifically chosen to enact two cycles of action used in this study assisted in examining metabolic risk in patient’s receiving long acting typical injectable antipsychotic medication. This methodology was practical because it identified the people i.e. the patients and the nurses who could help to improve it and, this study was consciousness raising and allowed practice transformation to occur. Two action cycles took place and was led by with community mental health nurses (n=8) and patients who participated (n=45). The first cycle of action was obtaining metabolic screening data of the patient’s metabolic markers. Metabolic screening of risk factors utilized NCEP ATP III criteria [1]. The second cycle of action involved obtaining a second round of screening data on the patient’s metabolic markers to determine if there was an improved health status. At baseline, fourteen patients 31% met the criteria for metabolic syndrome. At the 2nd screening metabolic screening just eight patients 17 % met the criteria for metabolic syndrome. Action research has assisted nurses and patients to identify the problem and subsequently to develop a way forward that was aimed towards changing and improving the physical health and wellbeing of the patients. By engaging in this meaningful activity, the nurses became catalysts in empowering others to bring about real change and that is now improving the lives of patients with severe mental illness, who badly need it

The Korean experience within the context of development cooperation effectiveness

행사명 : 2011The 5th Seoul ODA International Conference

What’s in a name? Unpacking ‘Community Blank’ terminology in reproductive, maternal, newborn and child health: a scoping review

Introduction: Engaging the community as actors within reproductive, maternal, newborn and child health (RMNCH) programmes (referred to as ‘community blank’) has seen increased implementation in recent years. While evidence suggests these approaches are effective, terminology (such as ‘community engagement,’ ‘community participation,’ ‘community mobilisation,’ and ‘social accountability’) is often used interchangeably across published literature, contributing to a lack of conceptual clarity in practice. The purpose of this review was to describe and clarify varying uses of these terms in the literature by documenting what authors and implementers report they are doing when they use these terms. Methods: Seven academic databases (PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Global Health), two grey literature databases (OAIster, OpenGrey) and relevant organisation websites were searched for documents that described ‘community blank’ terms in RMNCH interventions. Eligibility criteria included being published between 1975 and 1 October 2021 and reports or studies detailing the activities used in ‘community blank.’ Results: A total of 9779 unique documents were retrieved and screened, with 173 included for analysis. Twenty-four distinct ‘community blank’ terms were used across the documents, falling into 11 broader terms. Use of these terms was distributed across time and all six WHO regions, with ‘community mobilisation’, ‘community engagement’ and ‘community participation’ being the most frequently used terms. While 48 unique activities were described, only 25 activities were mentioned more than twice and 19 of these were attributed to at least three different ‘community blank’ terms. Conclusion: Across the literature, there is inconsistency in the usage of ‘community blank’ terms for RMNCH. There is an observed interchangeable use of terms and a lack of descriptions of these terms provided in the literature. There is a need for RMNCH researchers and practitioners to clarify the descriptions reported and improve the documentation of ‘community blank’ implementation. This can contribute to a better sharing of learning within and across communities and to bringing evidence-based practices to scale. Efforts to improve reporting can be supported with the use of standardised monitoring and evaluation processes and indicators. Therefore, it is recommended that future research endeavours clarify the operational definitions of ‘community blank’ and improve the documentation of its implementation.University College DublinWorld Health Organizatio

Facilitators of co-leadership for quality care.

Olive Cocoman and colleagues argue that national leadership for quality of care requires working in a co-leadership model such that quality and programme units have equal standing and clearly defined individual roles and responsibilitie

Strengthening the policy, implementation, and accountability environment for quality care: experiences from quality of care network countries

Despite global commitment to universal health coverage with quality, poor quality of care (QOC) continues to impact health outcomes for mothers and newborns, especially in low-and-middle income countries. Although there is much experience from small-scale projects, without a long-term perspective it is unclear how to implement quality of care effectively and consistently for impact. In 2017, ten countries together with the WHO and a coalition of partners established the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network). The Network agreed to pursue four strategic objectives—Leadership, Action, Learning and Accountability (LALA) for QOC. This paper describes, analyses and reflects on what has worked and some of the challenges faced in implementation of the LALA framework. The implementation of the LALA framework has served as a catalyst to develop an enabling environment for QOC in the Network countries through strengthening the policy, implementation, accountability and community engagement for quality care. Developing an enabling health system environment takes time, but it is possible and shows results. The implementation shows that health systems continue to face persistent challenges such as capacities to quickly scale up changes across subnational levels, limited workforce capability to implement quality improvement consistently and gaps in quality of relevant data. The implementation has also highlighted the need to develop new mechanisms for community engagement and learning systems that inform scaling up of good QOC practices across programmes and levels of care. Moving forward, the Network countries will build on the experiences and lessons learned and continue to strengthen the implementation of LALA strategic objectives for impact. We hope the Network experience will encourage other countries and partners to adopt the Network implementation model to enable delivery of quality care for everyone, everywhere, and actively collaborate and contribute to the QOC global learning network

Recognizing the evidence and changing practice on injection sites Intramuscular injections: a review of best practice for mental health nurses Intramuscular injections: a review of best practice for mental health nurses

This paper reviews practice in the area of intramuscular (IM) injection administration, an everyday activity for many nurses in clinical practice. The authors address administration of neuroleptic depot drugs within the adult mental health environment and examine the evidence base for this practice. A historical overview of injection practices and use of the dorsogluteal site is given, followed by more contemporary evidence on the benefits of using the ventrogluteal, deltoid and thigh sites. The authors point out that despite being a very commonplace nursing activity, there is a dearth of researchbased guidelines for nurses in this area. A quantity of published papers and nursing texts on injection sites and techniques were assessed to evaluate their quality and relevance and their overall benefit to improving clinical practice. Much of the literature available was in the form of opinion pieces without a sound research/evidence base. There appears, however, to be enough consensual evidence to form an evidence-based clinical guideline for the administration of IM injections. The review of the available evidence, albeit at times contradictory, is presented along with a discussion of the implications for nurses