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  1. 1. Introduction
    1. 1.0 Overview
    2. 1.1 What is the Purpose of the Field Guide
    3. 1.2 Who is the Field Guide intended for?
    4. 1.3 How is the Field Guide organized?
  2. 2. Background
    1. 2.0 Overview
    2. 2.1 Humanitarian Settings Across the Globe
      1. 2.1.1 Challenges to Newborn Health Service Delivery
    3. 2.2 Newborn Health: Epidemiology
      1. 2.2.1 Global burden of newborn mortality
      2. 2.2.2 Principal causes of neonatal deaths
  3. 3. Newborn Health Services
    1. 3.0 Overview
    2. 3.1 General Principles and Considerations
      1. 3.1.1 The Continuum of Care Across the Lifecourse
      2. 3.1.2 Levels of Care
    3. 3.2 Essential Newborn Care
    4. 3.3 Newborn Care at Household/Community Level
      1. 3.3.1 During the Antenatal Period
      2. 3.3.2 Intrapartum and essential newborn care
      3. 3.3.3 Postnatal care
    5. 3.4 Newborn Care at Primary Care Facilities
      1. 3.4.1 Antenatal care
      2. 3.4.2 Intrapartum and essential newborn care
      3. 3.4.3 Postnatal care
    6. 3.5 Newborn Care at Hospitals
      1. 3.5.1 Antenatal care
      2. 3.5.2 Intrapartum and essential newborn care
      3. 3.5.3 Postnatal care
    7. 3.6 Additional Considerations for Preventing and Managing Principal Causes of Neonatal Deaths
      1. 3.6.1 Prematurity/Low Birth Weight (LBW)
      2. 3.6.2 Newborn Infections
      3. 3.6.3 Intrapartum Complications
  4. 4. Strategic Considerations
    1. 4.0 Overview
    2. 4.1 Mainstreaming newborn health in humanitarian coordination
      1. 4.1.1 Incorporate questions about newborn health services within a rapid health assessment
      2. 4.1.2 Advocate for the inclusion and prioritisation of newborn health in humanitarian response plans
    3. 4.2 Conducting a situational analysis
      1. 4.2.1 Examine national policies and protocols relevant to newborn health
      2. 4.2.2 Examine existing clinical guidelines, key messages/ BCC materials, tools and training materials
      3. 4.2.3 Assess resource availability: facilities, supplies and staff
    4. 4.3 Developing an inclusive and unified response strategy
      1. 4.3.1 Prioritizing newborn interventions
      2. 4.3.2 Update and distribute clinical guidelines and protocols
      3. 4.3.3 Develop and collate needs based staff training materials
      4. 4.3.4 Procure and distribute essential medicines and supplies
      5. 4.3.5 Ensure quality improvement and respectful care
      6. 4.3.6 Develop proposals to secure additional funding
    5. 4.4 Developing and implementing a monitoring and evaluation (M&E) plan
      1. 4.4.1 Compromised data flow and routine information systems
  5. 5. Program Implementation Considerations
    1. 5.0 Overview
    2. 5.1 Developing and disseminating key messages/behavior change communication (BCC) materials
    3. 5.2 Developing a referral system
      1. 5.2.1 When referral is not feasible
    4. 5.3 Home visits for mothers and babies
    5. 5.4 Procuring newborn care supply kits
    6. 5.5 Managing newborn deaths in crisis settings
      1. 5.5.1 Support for neonatal loss
      2. 5.5.2 Documenting neonatal loss
  6. 6. Annexes
    1. 6.1 Annex 1: Newborn health services summary tables by levels of care
      1. 6.1.1 Annex 1A
      2. 6.1.2 Annex 1B
      3. 6.1.3 Annex 1C
    2. 6.2 Annex 2: Doses of Common Drugs for Neonates
    3. 6.3 Annex 3: Advanced Care for Very Sick Newborns
    4. 6.4 Annex 4: Tools to Support Neonatal Referrals
      1. 6.4.1 Annex 4A: When to Refer a Newborn to the Hospital
      2. 6.4.2 Annex 4B: Job Aid: Transporting the Sick Newborn
      3. 6.4.3 Annex 4C: Sample Referral Note
    5. 6.5 Annex 5: Newborn Kits for Humanitarian Settings
    6. 6.6 Annex 6: Indicators
      1. 6.6.1 Annex 6A: Newborn Health Indicators for Routine Data Systems
      2. 6.6.2 Annex 6B: List of Indicators and Questions to Measure Facility Capacity to Provide Key Newborn Health Services
Newborn Field Guide

4.1 Mainstreaming newborn health in humanitarian coordination

Photo credits: UNICEF/NYHQ2014-1932/Anmar

Working with governmental, humanitarian and development partners in productive, cooperative partnerships is critical to a practical and comprehensive humanitarian response. When a crisis warranting a response occurs, humanitarian agencies immediately establish a coordination system to facilitate cooperation and avoid duplication of efforts. This coordination system is based on an internationally agreed framework that includes designated lead agencies, in collaboration with the relevant government agencies, to coordinate each sector of humanitarian action.[1] For example, WHOabbreviation and the Ministry of Health lead the health sector/cluster, and UNICEFabbreviation and the Ministry of Health lead the nutrition sector/cluster. WHOabbreviation and the Ministry of Health, as heads of the health sector/cluster, are ultimately accountable for ensuring the provision of newborn care.

At the beginning of a humanitarian response, the health sector/cluster should identify an organization to lead the SRHabbreviation, including MNHabbreviation, response. This can be any national or international NGO or UNabbreviation agency that has the capacity to effectively lead the SRMNH response in collaboration with the Ministry of Health. The nominated agency immediately dedicates a fulltime SRHabbreviation coordinator for a minimum of three to six months to provide operational and technical support to the health partners. This coordinator convenes the SRHabbreviation working group, operating under the health cluster/sector, and facilitates coordinated planning to ensure the prioritization of SRHabbreviation care and effective provision of MISPabbreviation services.

Box 4.1: Engaging local and international development partners

Establishing respectful partnerships with development agencies that were working in-country before the crisis is important for an effective response. These agencies can include international, national and community-based organizations, women’s groups, faith-based agencies, and other advocacy and service delivery organizations working on MNHabbreviation. Partnering with development actors is useful because they can provide deeper understanding of the local context and culture, which can help inform the design of a more appropriate response. These agencies can also help identify pre-existing resources and capacities, and provide insights into which communities are most in need of assistance. Development agencies may not be familiar with the humanitarian coordination system. When feasible, support these organizations, particularly local groups, to meaningfully participate in the SRHabbreviation working group meetings. Linking with the national ENAPabbreviation, where in place, may also be useful.

4.1.1 Incorporate questions about newborn health services within a rapid health assessment

At the onset of a humanitarian response, the health sector/cluster will undertake RHAabbreviation. In addition to assessing service availability, the health sector/cluster’s RHAabbreviation provides an estimation of the population needing services, thus forming the basis for service development and implementation. For this reason, integrating questions into the health sector/cluster’s RHAabbreviation about newborn health care and about the population requiring newborn health services is critical (Box 4.3).

  • Work with the health sector/cluster to ensure that the RHAabbreviation includes these questions and basic population estimates. For example, ensure that MNHabbreviation-related figures included in the RHAabbreviation comprise:
    • the total population prior to the crisis;
    • the total number of the affected population;
    • the number of women of childbearing age, pregnant women and newborns within this population; the number of deliveries per month;
    • demographic indicators about the MNHabbreviation status of the affected population prior to the crisis such as the maternal and newborn mortality ratios, stillbirth rates, the total fertility rate, crude birth rate, contraceptive prevalence, and percentage of births with a skilled attendant and/or facility-based births.[2]
    • Pre-crisis MDPSR data (if possible and available)
    • Pre-crisis country ENAPabbreviation/SRMNCAHabbreviation plans (if possible and available)
  • Review the RHAabbreviation to ensure that the assessment process is gender sensitive, involving men and women from the affected community as assessors and translators whenever possible. This ensures that information collected is accurate, up-to-date and actionable, and that acceptance and ownership of the assessment results are maximized.

4.1.2 Advocate for the inclusion and prioritisation of newborn health in humanitarian response plans

Although newborn health services are part of the MISP, humanitarian health actors may not prioritize them. Advocacy and inter-agency coordination are key to ensuring that newborn health is adequately addressed.

  • Participate in the SRHabbreviation working group meetings and, where necessary, advocate to include newborn care issues (integrated with maternal health) on the agenda.
  • Work with the SRHabbreviation coordinator to task the working group with identifying priority newborn health services and coordinating with the broader group of governmental, development and humanitarian responders in the country to ensure that MNHabbreviation services are integrated into the humanitarian response.
  • Determine which government ministries, UNabbreviation agencies, INGOs and local NGOs are working in SRHabbreviation care: these agencies and staff will be essential partners to advocate and integrate newborn health services within the humanitarian response (Box 4.1).
  • Ensure government and other partners are appropriately vetted to establish legitimacy.
  • Identify and engage government programs and international and local initiatives that pre-date the crisis, as well as humanitarian agencies that enter at the onset of, or immediately after, a crisis response.
Box 4.2: Leveraging the field guide to improve newborn care practices in South Sudan

In 2016, interagency partners monitored the rollout of the Field Guide in South Sudan and, after six months, held a newborn health technical workshop to share lessons learned and generate feedback on how to address bottlenecks to service delivery. The workshop was co-hosted by the Ministry of Health and UNICEFabbreviation, and the SRHabbreviation Working Group members as well as other humanitarian and development actors were invited. By bringing together key partners from across the development-humanitarian continuum and ensuring leadership by the government, the workshop helped facilitate the development of a Every Newborn Action Plan (ENAP) for the country. South Sudan’s ENAPabbreviation has led to the development of a newborn service package under the main health funding mechanism in the country. The National Community Health Strategy has also been revised to incorporate community-based newborn interventions.

Note: For further information, please see Sami S, Amsalu R, Dimiti A, et al,. An analytic perspective of a mixed methods study during humanitarian crises in South Sudan: translating facility- and community-based newborn guidelines into practice. Conflict and Health. 2021. doi: 10.1186/s13031-021-00339-8

Notes


Abbreviations

  1. These sectors may also be called clusters, depending on the context of the crisis. For more information about the humanitarian coordination system, see https://www.humanitarianresponse.info/en/about-clusters/what-is-the-cluster-approach. ↩︎

  2. Inter-agency Working Group on Reproductive Health in Crises. Inter-agency Field Manual on Sexual and Reproductive Health in Humanitarian Settings. 2018. ↩︎