Online Program

Better cord care saves babies' lives: Mapping chlorhexidine program introduction and implementation

Monday, November 4, 2013

Carmit Keddem, MA, John Snow, Inc., Boston, MA
Mary A. Carnell, MD MPH, Center for Maternal, Newborn & Child Health, John Snow Inc., Arlington, VA
Sandee Minovi, MA, International Health, JSI Research and Training Institute, Inc, Arlington, VA
Robin Houston, John Snow, Inc., Boston, MA
Goli Lamiri, MBBS, DTM&H, MPH, Targeted States High Impact Project, Sokoto, Nigeria
Chlorhexidine (CHX) is an antiseptic that, when administrated to the umbilical stump after delivery, can drastically mitigate the risk of infection and mortality in newborns. CHX use at delivery is particularly effective in resource-limited settings, where high rates of neonatal mortality are linked to home births and poor hygiene. In a short amount of time, this safe, low-cost intervention has demonstrated impact on newborn mortality, receiving global recognition and interest. Several countries are now revisiting their policies and looking for ways to add CHX to the array of maternal and neonatal interventions.

Successful introduction and scale-up of a CHX program that assures high quality service, requires a multi-pronged approach that emphasizes strengthening systems, policies, and services, supported by ongoing advocacy. This presentation provides a visual map that illustrates the issues and activities countries must address at each step in the CHX progression: planning, introduction, and national scale-up. It will guide country policymakers and program managers along the implementation pathway, including: creating sustainable markets, supplying CHX, generating demand among clients and providers, and incorporating CHX into existing maternal and neonatal service delivery. The presentation will demonstrate this pathway by sharing recent experiences from three countries currently in different phases of implementation: Madagascar, which has decided to introduce CHX and is in the initial planning stages; Nigeria, which has started introducing CHX in one state, and is working to develop a local supply market; and Nepal, which is the first country working to achieve CHX coverage at scale.

Learning Areas:

Planning of health education strategies, interventions, and programs

Learning Objectives:
Identify the range of issues decision makers and program managers must address to launch chlorhexidine (CHX) within country maternal/newborn/child/health service delivery programs. Define the steps country programs must go through to introduce CHX successfully and to take implementation to scale. Cite examples of how programs in Nepal, Nigeria, and Madagascar have used evidence, engaged partners, and allocated human resources to move beyond, or even skip, the pilot phase and implement CHX initiatives at scale.

Keyword(s): Child Health, Infant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked for over 19 years experience in public health both at national, regional and international levels. I have worked specifically on health system strengthening, maternal, newborn and child survival initiatives which include immunization, surveillance systems development and monitoring. I have participated in developing various in-country policy initiatives. I have been involved in health systems performance assessments and have managed sub-national programmes and projects fulfilling the attendant reporting and knowledge management requirements creditably.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.