1. Research to Advocacy, Policy, and Action Evidence for effectiveness of interventions in newborn care at district level Evidence for effectiveness of interventions in newborn care at district level Presented by: Nguyen Van Hai Saving Newborn Lives (SNL), Save the Children, Vietnam August, 2010

5. Key indicators at baseline Source: *Reports from neonatal death screening in Thanh Hoa, March 2007 1,876 1,078 Number of delivery per year 24 30 Home delivery rate (%) 76 70 Delivery in health facility (%) 19.4* 21.9* Neonatal death rate (%o) 22 17 Number of communes 141,436 85,227 Population Ngoc Lac (2006) Nhu Thanh (2006) Indicators

6. Result Framework Goal : Reduced neonatal mortality in selected intervention sites Strategic Objective: To improve use of key practices and services that protect and promote the health of newborns through the intervention package IR 1 Increased access to and availability of key services, equipment, and supplies for newborn health at all levels IR 2 Increased quality of essential newborn care and complications management at all district and communal levels of care IR 3 Improved knowledge, skills, and home care practices for newborns at household and community levels, and increased demand for newborn care services IR 4 Strengthened management, social support, and enabling environment for newborn survival in the intervention sites

9. Preliminary results [1] No records of newborn care and complications were available at district hospitals. It was, therefore, assumed that almost all newborns with complications were referred to higher level for treatment. 3 34 N/A N/A Request to go home 2 13 N/A [1] N/A Dead 32 (15%) 79 (9%) N/A N/A Referred to higher level 178 767 N/A N/A Cured Treatment outcomes 215 867 N/A N/A # Newborn admission to district newborn care unit Nhu Thanh Ngoc Lac Nhu Thanh Ngoc Lac Preliminary results (2008-2009) Pre-intervention (2006) Indicator

10. Preliminary results (cont’) Some key indicators as a result from both institution and community-based interventions 87.9% 92.4% 76.1% 70% Institution delivery - Ngoc Lac - Nhu Thanh 12.1% 7.7% 23.9% 30% Home delivery - Ngoc Lac - Nhu Thanh 9% 15% 95% (25%)* 98% (24%)* Referral rate - Ngoc Lac - Nhu Thanh 14.8‰ 8.4 ‰ 19.4‰ 21.9 ‰ Neonatal death - Ngoc Lac - Nhu Thanh Preliminary result (2009) Pre-intervention (2006) Key indicators

11. NEWBORN CARE UNIT AT DISTRICT HOSPITAL: INNOVATIVE APPROACH Increased opportunities of investments/revenue Improved quality of neonatal care for the hospital Regain competence of district health workers in complications Take advantage of available human resources Avoid wasting human resources Contribute to improved newborn health/reduced neonatal death Benefits for Hospital District Newborn Care Unit Place credit to hospital when seeking care Reduced non-medical costs for patients Convenient for patients when seeking care Benefit for community Reduced patient load at higher levels of care Better management of information system Bridge to other health facilities /technical support to lower level Benefits for the health sector

12. Listen to what hospital managers say! Dr. Nguyen Van Phung, Director of Nhu Thanh District Hospital “ The techniques of resuscitation have improved much. Other skills like place stomach sonde ..are also advanced . This NBC Unit has changed the face and service provision of this hospital. More patients come, that means more revenue we collect.” Dr. Pham Van Xuan, Director of Ngoc Lac General District Hospital “ So far, never before have we had such a professional contingent of staff. The techniques of taking blood vein, place endorcheal tube are very quick and skilled. I hope the province can replicate this model of NBC Unit.”