In developing countries, many newborns pass away because they are exposed to germs that cause serious infection. In fact, about a quarter of all newborn deaths are due to infections. However, an antiseptic called chlorhexidine (CHX) has been proven very effective in preventing newborn sepsis. Last week, a group of program managers gathered in Washington, D.C. to discuss country progress in introducing and scaling up the use of CHX, and the way forward. I was honored to be part of this group.
In Nepal, Johns Hopkins School of Public Health performed a trial that showed a 24% reduction in newborn mortality when CHX was used. Yet, “the trials would have gone nowhere if we weren’t working concurrently on how to deliver the product, how to engage industry, and what would convince governments to use the product,” explained Neal Brandes of USAID who moderated the four-person panel.
As the first panelist, I shared my experience working on the Chlorhexidine ‘Navi’ Care Program in Nepal, managed by USAID through the Saving Lives at Birth Grand Challenge. Based on pilot work in four districts, in late 2011 the government of Nepal approved incorporating use of CHX as part of essential newborn care. Country-wide scale-up is now underway, supported by JSI. It’s very important to me that we share this promising approach with other countries, so our project is sharing training manuals, videos, and other resources. I have also traveled to Nigeria to support the introduction of CHX there.
While the use of CHX is in the national scale-up phase in Nepal, Nigeria is making strides in the initial introduction of CHX through the USAID-funded Targeted States High Impact Project (TSHIP) led by JSI’s Nosa Orobaton. In partnership with the Nigerian Ministry of Health, TSHIP has conducted acceptability research, trained nearly 2,500 community-based health volunteers, and has facilitated the Sokoto government in the purchase of CHX with its own funds. Nosa emphasized the importance of framing the situation for decisionmakers. “Leaders knew how much a cow cost, so we translated the cost of CHX into number of cattle, and they perceived it as more affordable.”
In Madagascar, plans are moving ahead for a pilot program to introduce the use of CHX for umbilical cord care. As Steve Hodgins of Save the Children explained, JSI’s USAID-supported Madagascar community-based integrated health program, MAHEFA, is working as a member of a Technical Working Group that includes the Ministry of Health, PSI, MCHIP, and UNICEF. Steve Hodgins, who helped develop JSI’s CNCP program spoke briefly on important issues that program developers should be keeping in mind from the beginning to help ensure that – beyond the introduction phase, there will be strong ongoing program implementation.
Trish Coffey of PATH introduced the issues of supply and demand as well as product profile. Trish explained the impact of product type—gel or liquid—and presentation—spray, pre-moistened towelette, color, scent—on the product’s uptake, ease of distribution, pricing, and regulatory pathway. “One way to encourage affordable and available supply is to establish local production at the country level,” Trish described.
I do hope that the use of CHX continues to advance, and the CHX Technical Working Group, for which PATH is the secretariat, is a very good forum to share experiences. Trish encouraged all of us in the field to visit the website housed by Healthy Newborn Network.
I am very excited to continue to share our experiences from Nepal and to spread to other countries this simple but promising approach for saving the lives of newborns.