Nigeria Every Newborn Action Plan

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Federal Ministryof HealthNIGERIA EVERY NEWBORNACTION PLANA Plan To End PreventableNewborn Deaths in Nigeriaa

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FEDERALMINISTRY OFHEALTHNIGERIAEVERY NEWBORNACTION PLANA Plan To End PreventableNewborn Deaths in Nigeria

Suggested citation: Federal Ministry of Health. Nigeria Every Newborn Action Plan: A plan to end preventable newborn deathsin Nigeria. Abuja: Federal Ministry of Health; 2016.Cover photo credit: Jane Hahn, Save the Children, 2011. Federal Ministry of HealthDesign by Inis Communication – www.iniscommunication.com

CONTENTSForeword 2Acknowledgements 3Acronyms 4Executive Summary 51.0 Introduction 61.1 Development of the Nigeria Every Newborn Action Plan 61.2 Overview of the Nigeria Every Newborn Action Plan 61.3 The Global Picture 72.0 The State of Nigeria’s Newborns 82.1 Newborn Mortality Trends and Disparities 82.2 Causes of Neonatal Mortality 92.3 Stillbirths 102.4 The Maternal and Newborn Health Continuum of Care 102.5 Country Policies, Strategies, and Programmes to Promote NewbornHealth in Nigeria 123.0 Bottleneck Analysis 174.0 Nigeria Every Newborn Action Plan 184.1 Vision, Goals, and Targets 184.2 Guiding Principles 204.3 The Intervention Package 204.4 Strategic Objectives 224.5 Priority Activities within the 10 Key Areas of the Nigerian Health System 245.0 Management of NiENAP Actions 305.1 Oversight 305.2 Monitoring and Evaluation 306.0 The Way Forward 327.0 Appendices 36Appendix 1: Summary of coverage indicators in the Nigeria DHS 2013 36Appendix 2 39Appendix 3 40Appendix 4. Bottleneck analysis 41Appendix 5: Indicators for consideration for NiENAP 43References List of contributors 4447

FOREWORDEach year in Nigeria over seven million babies areborn, of whom 240,000 die during their first monthof life. Despite our gains for child survival wherebythe under-five child mortality has decreased from91 deaths per 1,000 live births in 1990 to 43 deathsper 1,000 live births in 2015, available data showsthat the decline for newborn deaths has been muchslower. Neonatal deaths now account for 32 percentof all under-five child deaths. Most of these deathsare caused by complications related to prematurity,birth asphyxia and infections. This trend requires anaccelerated response to achieve remarkable reduction in under-five mortality rate.The Newborn Situational Analysis reports of 2009and 2011, as well as the “Bottleneck analysis on neonatal health” of 2013, culminated in the Nigerialaunch of “Call to action on Newborn health” at thefirst National Newborn Health Conference in 2014.This call to action provided the framework for thedevelopment of the Nigeria Every Newborn ActionPlan (NiENAP).The NiENAP lays out a vision to end preventablestillbirths and newborn deaths by accelerating progress and scaling up evidence- based high-impact andcost effective interventions.The plan is guided by theprinciples of country-leadership, integration, accountability, equity, human rights, innovation and research.This blue print outlines our commitment as government and stakeholders to repositioning newbornhealth as we implement approaches that impact onthe lives of newborns for improved health outcome.I therefore call on all, partners, civil society groups,donors, the private sector and other stakeholders towork with government at all levels in implementingthis plan. We must ensure that our babies not onlybreathe, but they must also “survive, thrive and transform” in order to reach their full potentials.Prof. Isaac F. Adewole, FAS, FSPSP, DSC (HONS).Honourable Minister of HealthNovember, 20162

ACKNOWLEDGEMENTSNigeria under-five mortality especially the neonatalmortality rate is unacceptably high, thus the development of the Nigeria Every Newborn Action Plan isa major milestone in the bid to end preventable stillbirths as well as newborn deaths.I wish to express sincere gratitude to individuals, academic institutions, professional associationsand development partners who contributed considerable time and efforts in the conception andbirth of this dream. Special thanks go to representatives of State Ministries of Health, the NigeriaSociety of Neonatal Medicine (NISONM), PediatricsAssociation of Nigeria (PAN), Society for Obstetricsand Gynecologists of Nigeria (SOGON) as well asthe National Association of Nigerian Nurse andMidwives (NANNM) for their hard work and technical inputs.I commend the unflinching suppor t of ourDevelopment Partners notably: Save the ChildrenInternational, MCSP, WHO, UNICEF, the HealthStrategy Delivery Fund, Health Strategy DeliveryFund and CHAI for the time and resources committed towards repositioning newborn health in Nigeriaby the development of this document.My sincere appreciation to the local and international Consultants, Dr Nkeiru Onuekwusi and ProfIndira Narayanan, funded by Save the Children; whoprovided technical guidance throughout the entireprocess of development of the plan.Finally, I will like to appreciate the Newborn branchteam, Child Health Division of the Departmentof Family Health under the leadership of Dr A.RAdeniran, for the drive, team spirit and concertedeffort demonstrated from planning to execution ofthe entire development process.Dr. (Mrs.) Adebimpe Adebiyi, mniDirector, Family Health DepartmentNovember, 20163

ACRONYMSAFRINESTAfrican Neonatal Sepsis TrialMPDSRMaternal and Perinatal DeathSurveillance and ResponseBEmOCBasic emergency obstetric and newborn careNiENAPNigeria Every Newborn Action PlanCEmOCComprehensive emergency obstetricand newborn careNHISNational Health Insurance SchemeCHEWCommunity health extension workerNHMISNational Health ManagementInformation SystemDHSDemographic and Health SurveyPHCPrimary healthcare centreENAPEvery Newborn Action PlanPRMNCAHFMOHFederal Ministry of HealthPartnership for Reproductive andMaternal, Newborn, Child, andAdolescent HealthFGONFederal Government of NigeriaHISHealth information systemIGMEInteragency Group for Child MortalityEstimationSBCCSocial and behaviour changecommunicationIMNCHIntegrated maternal, newborn andchild healthSDGSustainable Development GoalSMARTStandardized Monitoring andAssessment of Relief and TransitionsRMNCAH N Reproductive, maternal, newborn,child, and adolescent health andnutritionISSIntegrated Supportive SupervisionKMCKangaroo mother careSOMLSaving One Million LivesLGALocal government authority/areaSSHIPState-Supported Health InsuranceProgrammeMCHMaternal and child heathMDGMillennium Development GoalMICSMultiple Indicator Cluster SurveyMNCHMaternal, newborn and child heathMNHMaternal and newborn health4SURE-P MCH Subsidy Reinvestment andEmpowerment Programme forMaternal and Child HealthU5MRUnder five mortality rateWHOWorld Health Organization

EXECUTIVE SUMMARYEach year in Nigeria over seven million babies areborn: 240,000 of these babies die in their first monthof life with 94,000 dying on the day of birth; in addition, there are nearly 314,000 stillbirths. While Nigeriahas made significant progress in decreasing childmortality, the country has not achieved MillenniumDevelopment Goal 4 for child survival, primarily dueto inadequate reduction of neonatal mortality. As theworld transitions to achieving sustainable development goals, it is clear that Nigeria must accelerateefforts to improve outcomes for its newborns.At the 2016 World Health Assembly, the FederalGovernment of Nigeria endorsed the GlobalStrategy for Women’s, Children’s, and Adolescents’Health, a roadmap for ending all preventable deathsof women, children, and adolescents within a generation. The global strategy includes the targets andobjectives of the global Every Newborn Action Plan,launched in 2014, and Ending Preventable MaternalMortality, launched in 2015.Inspired by these documents and its global commitments, this Nigeria Every Newborn Action Plan(NiENAP) sets forth specific actions necessary toachieve significant mortality and coverage targets by2030. It lays out the Nigeria’s vision of a country“with no preventable deaths of newborns and stillbirths, where every pregnancy is wanted, every birthcelebrated; and women, babies, and children survive,thrive, and reach their full potential.”Guided by the principles of country leadership, integration, accountability, equity, human rights, innovation,and research, the NiENAP presents a set of intervention packages aligned with the 10 key areas of theNational Health Policy 2016–2021.The interventionpackages follow a four-pronged approach of (1) promotion of facility-based deliveries at scale addressingequity issues, (2) strengthening of community-basedinterventions, (3) strengthening of facility readinessfor providing quality care for the newborn, and (4)provision of quality care for the newborn with focuson labour, birth, and immediate care after birth during the first week of life.Tracking progress towards achievement of the ambitious agenda laid out in the NiENAP is paramount.Thus, the document defines a set of preliminary,national-level milestones and steps taken to identifycore indicators that should be tracked to ascertainprogress toward meeting targets. The schedule forachieving key milestones and responsibility for tracking progress will be determined by the NationalSubcommittee on Newborn Health in consultationwith stakeholders.The NiENAP is a concerted effort towards translating Nigeria’s commitments into meaningful changefor newborns. The aim is that this document willserve as a framework for each of Nigeria’s 36 statesand Federal Capital Territory – in collaboration withmany stakeholders and partners – to develop theirown action plans, adapting the NiENAP as neededto their unique contexts.5

1.0 INTRODUCTIONIn the past two decades, Nigeria has made significant progress in reducing child mortality.1 However,the country has been unable to achieve MillenniumDevelopmental Goal 4 for child survival, primarily dueto the inadequate reduction in neonatal mortality.As the world transitions from the MillenniumDevelopment Goal (MDG) era to achieving sustainable development goals (SDGs), it has becomeincreasingly clear that Nigeria must accelerateefforts to improve outcomes for its newborns. Atthe World Health Assembly 2016, Nigeria committed to the Global Strategy for Women’s, Children’s,and Adolescents’ Health (A69/A/CONF./2), a roadmap for ending all preventable deaths of women,children, and adolescents within a generation.2,3 Theglobal strategy includes the targets and objectivesof the global Every Newborn Action Plan (ENAP),launched in 2014,4 and Ending Preventable MaternalMortality, launched in 2015.51.1 Development of the Nigeria EveryNewborn Action PlanNigeria’s commitment to newborns reflects theincreasing global interest in this extremely vulnerablegroup. In 2014, when the global ENAP was launchedand adopted as a World Health Assembly resolution,the Federal Government of Nigeria (FGON), in conjunction with key stakeholders, began adapting thisglobal drive into a Nigeria-specific plan.There were two sets of newborn situation analysisreports, in 2009 and 2011.6,7 A bottleneck analysis on newborn health was conducted in 2013 tounderstand the challenges around newborn healthin Nigeria and to articulate possible solutions.In October 2014, the Federal Ministry of Health(FMOH) organized the first National Newborn6Health Conference. During this meeting, the FMOHlaunched Nigeria’s “Call to Action” to save newbornlives.8, 9 With this came the special commitment todevelop this Nigeria Every Newborn Action Plan(NiENAP) as part of a concerted effort to end preventable neonatal deaths.All these actions formed the basis for the development of the NiENAP, which was achievedthrough a series of stakeholder engagements andthe engagement of both international and indigenous consultants.1.2 Overview of the Nigeria EveryNewborn Action PlanThe NiENAP lays out a vision and a plan for Nigeriato end preventable newborn deaths and stillbirths,accelerate progress, and scale up high-impact,cost-effective interventions. The NiENAP is a concerted effort towards translating commitments intomeaningful change for newborns. It will serve as aframework for Nigeria’s 36 states to develop theirown area-specific action plans.NiENAP is guided by the principles of country leadership, integration, accountability, equity, human rights,innovation, and research. It presents the intervention packages required for newborn health througha four-pronged approach of (1) promotion of facility-based deliveries at scale addressing equity issues,(2) strengthening of community-based interventions,(3) strengthening of facility readiness for providingquality care for the newborn, and (4) provision ofquality care for the newborn with focus on labour,birth, and immediate care after birth during the firstweek of life. Priority activities for newborn healthare located within the 10 key areas of the Nigerianhealth systems and align with the National HealthPolicy 2016–2021.10

1.3 The Global PictureThe world has witnessed remarkable improvementsin maternal and child survival since 1990. Yet thisis still an unfinished agenda, as many countries didnot reach their targets for child and maternal survival, and inequities within countries remain. Globally,neonatal deaths decreased from 5.1 million in 1990to 2.7 million in 2015.11 However, the reduction inneonatal mortality has been less (47 percent) thanthat of under-five mortality (58 percent). Aroundthree-quarters of neonatal deaths take place in thefirst week of life, many on the first day.12 To achievethe desired impact with the SDGs, it is essential forevery country to address neonatal mortality, focusing on the first week of life and especially the day ofbirth. Perhaps the even more challenging issue is theneed for 63 countries – including Nigeria – to accelerate the rate of reduction of these deaths to achievethe SDG target of a neonatal mortality rate of 12 orfewer deaths per 1000 live births by 2030.137

2.0 THE STATE OF NIGERIA’S NEWBORNSNigeria is situated in West Africa. It occupies approximately 923,768 sq. kilometres of land and sharesborders with Republic of Benin in the West, Chadand Cameroon in the East, and Niger in the North,while in the south it lies on the Gulf of Guinea onthe Atlantic Coast. Nigeria is a federal constitutionalrepublic comprising of 36 states and a Federal CapitalTerritory, grouped into six geopolitical zones: northcentral, north east, north west, south east, southsouth, and south west. There are 774 constitutionally recognized local government areas and six areacouncils (of the Federal Capital Territory).The country is the most populous nation in Africa and theseventh most populous in the world with an estimated population of 182.2 million in 2015.Nigeria, with an estimated 45,000 maternal deathsannually and a maternal mortality ratio of 576 deathsper 100,000 live births in 2013.19Each year in Nigeria over seven million babies areborn, of whom 240,000 die during their first monthof life with 94,000 on the day of birth.14 Accordingto the latest Nigeria Demographic and HealthSurvey (DHS), the neonatal mortality rate was 37per 1000 live births in 2013.15 In addition, there arenearly 314,000 stillbirths.16 Given its large population, Nigeria has a high burden of newborn deathsand stillbirths.17, 18 Maternal mortality is also high inNeonatal mortality rates vary by socioeconomiccharacteristics such as wealth, maternal education,geographic zone of residence, and place of residence. The inequities are captured in figure 2 andare greater in rural than urban areas, in the northwest zone than the south-south zone, and amonguneducated mothers than mothers with more thansecondary education.2.1 Newborn Mortality Trends andDisparitiesChildhood mortality, including newborn deaths,remains high and the rate of reduction is slow.Figure 1 shows the changes in the three components of childhood mortality rates from 1990 to2015. Using the global mortality estimates, the annualrate of reduction for neonatal mortality was slower(1.5 percent per year) than for post-neonatal under-5mortality (2.7 percent per year).20Figure 1. Changes in childhood mortality, 1990 to 2015Under-five mortality rate (UN IGME)Under -five mortality rate (DHS/MICS)Infant mortality rate (UN IGME)Infant mortality rate (DHS/MICS)Neonatal mortality rate (UN IGME)Neonatal mortality rate (DHS/MICS)Mortality per 1000 live 102015Source: UN Interagency Group for Child Mortality Estimation (IGME) mortality estimates, accessed 2016; Demographic and Health Survey (DHS 1999, 2003, 2008, 2013) andMultiple Indicator Cluster Survey (MICS 2008, 2011).8

02000200520102015202020252030YearFIG 22. Disparities in neonatal 0Post-secondarySecondaryPrimaryNoneSouth WestSouth SouthSouth EastNorth WestNorth East1995North Central150100501990Residence0Under-five mortality rate (UN nesMortality per 1000 live births250Under -five mortality rate (DHS/MICS)30Infant mortality37 rate (UN IGME)Infant mortality rate (DHS/MICS)39Neonatal mortality rate (UN IGME)45Neonatal mortality rate 01035RuralUrban443402020154060Neonatal mortality (deaths per 1,000 live births)Source: Nigeria DHS 2013.2.2 Causes of Neonatal MortalityThe major causes of neonatal mortality in Nigeriainclude complications of preterm birth, adverse intrapartum events, including birth asphyxia, and neonatalinfections including sepsis, pneumonia, and tetanus21(figure 3).Figure 3. Causes of child and neonatal mortalityFIG 3Other (post-neonatal),17%FIGPreterm birthcomplications, 31%Meningitis, 3%Injuries, 5%8Measles, 1%AIDS, 3%Strategic objective 1: Strengthen and32%Neonatal14%during labour, birth, andinvestMalaria,in carethe first day and week of lifeGovernance & stewardshipIntrapartum-relatedcomplications, 31%Health servicesSepis, 16%Diarrhoea (postStrategicobjectiveneonatal),10% 2: Improve theHealth financeHuman Resources 4 Healthquality of maternal and newbornPneumoniacare(post-neo-natal), 10%FIG 660Strategic objective 3:Data source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE)Reach every woman and everynewborn to reduce inequitiesStrategic objective 4:Medicines, vaccines & other tech2015 data.unicef.orgHealth infrastructureHealth information system9

Prematurity is primarily a predisposing condition,and except in cases of extreme immaturity bordering on viability, death is mainly due to complications,accounting for nearly a third of all neonatal deaths.Preterm babies’ risk of death is 12 times higher thanthat for full-term babies; premature babies also havean increased risk of disability.22Adverse intra-partum events including birth asphyxiaaccount for about 31 percent of neonatal deaths inNigeria. This cause frequently has a direct link to quality of care during childbirth.Infections including sepsis, pneumonia, tetanus, andmeningitis result in over 26 percent of neonataldeaths. Some complications of prematurity are alsorelated to infections. Infections may contribute to agreater extent to neonatal mortality than estimatedby the World Health Organization (WHO). A socialand verbal autopsy report carried out in Nigeria in2014 showed sepsis as the leading cause of neonataldeath (31.5 percent).23Though usually benign or physiologic, neonatal jaundice can complicate prematurity and neonatal sepsisand result in mortality and morbidity. While mostcases of neonatal jaundice are preventable, casescontinue to occur regularly in Nigeria.2.3 StillbirthsNigeria has a high stillbirth rate (42.9 per 1000 totalbirths in 2015).24 Over half of stillbirths occur inlabour and childbirth (fresh stillbirths) and are mostlypreventable through quality intrapartum care. Otherstillbirths are primarily related to adverse maternalissues that cause intrauterine deaths at various periods earlier during pregnancy (macerated stillbirths).Fresh stillbirths have a special link to neonatal death.Some are actually early neonatal deaths that havebeen wrongly classified as stillbirths. For this reason,WHO recommends that all fresh stillbirths should besubjected to neonatal resuscitation.25 Additionally, inevaluating intervention programmes to reduce neonatal mortality, the numbers of stillbirths, notablyfresh stillbirths, should always be taken into accountalong with neonatal deaths.102.4 The Maternal and NewbornHealth Continuum of CareUniversal coverage of essential maternal and newborn health (MNH) services could prevent overtwo thirds of newborn deaths in Nigeria, but coverage remains very low across the continuum of carefor women’s and children’s health. Figure 4 indicates the coverage of some of the practices showinglow coverage rates and the lack of any significantimprovement over the last 10 years (appendix 1).26Of special concern is the low and unchanged level offacility deliveries and skilled birth attendance.In Nigeria, health services are rendered through bothpublic and private sectors with primary healthcarebeing a foremost priority. However, the availabilityof services does not equate to quality of care, andthere have been considerable challenges, includingdisruption of services. Even though the private sector plays an important role, it is poorly integratedwithin the country’s health system. Other challengesinclude the distance to be covered to reach the facilities, especially in rural areas, the cost of services, thepoor quality of care, inadequate implementation ofthe standard guidelines, and the attitudes of healthworkers.27The proportion of women not receiving any antenatal care (ANC) is high, especially in the northernzones. Only 38 percent of women across Nigeriadeliver in a health facility, and a similar proportion arereceiving a postnatal care (PNC) check in the twodays after birth. Only a quarter of women reportthat they initiated breastfeeding within the first hourafter birth. Exclusive breastfeeding rates are low andare showing no signs of improvement. Overall 55percent of currently married women use a moderncontraceptive method.Inequities in coverage and quality of care at birth areextreme. Rural and less educated women are lesslikely than others to attend ANC, have assistancefrom a skilled health provider during delivery, and givebirth in a health facility. Even where the majority ofbirths take place in a facility and with a skilled attendant, the quality of care remains low and outcomesfor mothers and babies are poor.

Health research & developmentStrategic objective 5: Count everynewborn through measurement,program tracking, and accountabilityHealth promotion, community ownershipFIG 4 4.newFigureCoverage of select practices across the continuum of care that can influence neonatal outcomesContraceptive prevalence rate(any modern method)6755Antenatal care(1 or more visits)58Antenatal care(4 or more visits)45Tetanus toxoid vaccine(2 or more doses)456051483938Skilled birth attendanceDHS 20083536Facility birthsBreastfeeding within 1 hour33Postnatal care within 2 days(mother)DHS 2013383840Postnatal care within 2 days(newborn)314Exclusive breastfeeding( 1 month)2002620406080100Coverage (%)Source: Nigeria DHS 2013.implementation of national Maternal and PerinatalDeath Surveillance and Response, described in moredetail in the next section.Infrastructure662003 NDHS63DELIVERY AT HOMETheresignificant infrastructure challenges, includ2013areNDHSing inadequate quality of roads, lack of electricity andpiped-in water, and insufficient medical equipmentand supplies. These may contribute to the lack oftheir utilization and the low numbers of facility births.Geographic information system data on the facilitiesexist, but need standardization and harmonization.To37 help address the situation, the National Health Act39has specified that 15 percent of the Basic Healthcare45ProvisionFund should be made available to help45maintain the infrastructure.30 This will be particularlyimportant if facility births are to be promoted.2008 NDHSThe importance of documenting births and deaths iswidely recognized. Civil registration systems providethe basis for individual legal identity and subsequent eligibility for state-proffered services. TheyFIG 10also allow countries to identify their most pressinghealth issues. InNigeria, although it is compulsoryHIGHEST30to register birthsand deaths, but compliance is limFOURTHMIDDLEited; most newbornbabies who die and almost allSECONDstillbirths have no death certificate. In March 2016,LOWESTthe National Council on Health reinforced the needMORETHAN SECONDARYtoregisterall births appropriately. Recognition30ofSECONDARYthe need for better death surveillance led to the34PRIMARYNO EDUCATIONSouth WestSouth South62Based on an FMoH survey carried out in December2011, there are 34,173 health facilities across the36 states and the Federal Capital Territory. Amongthese 30,098 (88 percent) are primary healthcare(PHC) facilities, 3,992 (12 percent) are secondaryfacilities, and 83 ( 1 percent) are tertiary facilities.More than 66 percent of the facilities are government owned.28, 29Coverage (%)FIG 9Prevention of infection during and after childbirth,100 extremely important, is rarely documented orwhilemonitored.In view of the high occurrence of home90birthsandtheneed to avoid infections, the FGON80providesthrough the FMOH clean home delivery70kits 60(Mama Kits). In addition, use of 4 percent chlorhexidine gel has been approved for cord care by50the FMOH at the community as well as 36facility levels,354033and implementation is planned at scale. In 2013, 3630percent of families applied something to the umbili20cal cordat birth – most commonly oil or methylated10 Women with secondary education were morespirits.likely0to apply something to the cord than less eduDELIVERY AT HEALTH FACILITYcated women.4244393211

2.5 Country Policies, Strategies, andProgrammes to Promote NewbornHealth in NigeriaNewborn health has always been linked to bothmaternal health and child health, but its visibility hasremained low. With rising attention that high neonatal mortality was one of the major reasons forNigeria not achieving MDG 4,31 the number ofpolicies, programmes, and activities to improve newborn survival either directly or through improvingmaternal health has increased. Table 1 lists key policies/strategies, programmes, and activities relatedto newborn health in the past decade. The first andsecond editions of the Nigeria Newborn SituationAnalysis Report in 2009 and 2011 drew attentionto the status of newborn health in the country andproposed various actions to improve newborn survival and health. 32,33Table 1. Policies/strategies, programmes and activities to promote newborn health:Milestones in the evolution of newborn health in the last decadeInitiativesWhenPurpose/DescriptionPolicies, Strategies, Guidelines, PlansEssential Equipment List2005, Revisionon-going 2016To present a standard list of equipment needed for optimal delivery ofservice by each level of service delivery in Nigeria.Child Health Policy2006, revisionon-goingTo provide framework for planning, management, delivery andsupervision of services to address the critical problems affecting childcare in the target group.Integrated Maternal,Newborn and Child Health(IMNCH) Strategy2007, revisionon-goingTo provide policy direction and guidance to the different levels ofgovernment to formulate more in-depth operational/implementationplans for an integrated maternal, neonatal and child health (IMNCH)programmeWard Minimum Health carepackage (2007 – 2012)2007To provide a standard reference for the setting of priorities anddevelopment of plans for the provision of quality PHC with scarceresources. The WMHCP targets the grass root for the delivery of aminimum set of primary health care interventions needed to meetthe basic health requirements of a majority of Nigerians, resultingin substantial reduction in morbidity and mortality and contributingsignificantly to achieving “Health for All” and the MDGs at a costgovernment and its Partners can afford. It outlines broad strategiesto be utilized, main objectives to be achieved and a time frame for theestablishment of the minimum package in wards across the country.Essential Newborn CareCourseAdopted 2008,HarmonizedMarch 2016To provide an ENCC package with a combination of documentedevidences about Newborn health in Nigeria and global best practices toensure provision of a full range of updated, evidence-based interventionsand standards that will enable health care workers to give high qualitycare during childbirth and postnatal period considering the needs of thenewborn baby. The ENCC package conveys the national recommendedstandards for use at all levels of health care deliveryCommunication forBehaviour and SocialChange on MNCH2009, revisionon-goingTo guide effective implementation of communication for behaviour andsocial change for IMNCH in the areas of health education, communityengagement, advocacy and service improvement at the Federal, State,LGA and community levelsNewborn health in thecontext of IMNCH (SituationAnalysis Report)2009To provide a road map for all stakeholders delivering survivalinterventions for newborn health in the context of maternal and childhealth in this country.12

InitiativesWhenPurpose/DescriptionPolicies, Strategies, Guidelines, PlansNational Essential MedicineList5th revision2010, 6th 2016To streamline the drugs deployed in the healthcaredelivery system of the country by providing a reference standard for alllevels of health care towards ensuring good drug supply managementas all drugs to be procured by the public health facilities for theenhancement of quality of health care services.National Strategic HealthDevelopment plan I(2010-2015)2010To serve

1.1 Development of the Nigeria Every Newborn Action Plan 6 1.2 Overview of the Nigeria Every Newborn Action Plan 6 1.3 The Global Picture 7 2.0 The State of Nigeria's Newborns 8 2.1 Newborn Mortality Trends and Disparities 8 2.2 Causes of Neonatal Mortality 9 2.3 Stillbirths 10 2.4 The Maternal and Newborn Health Continuum of Care 10

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