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This forecasting supplement, which complements a general guidance document Quantification of Health Commodities: A Guide to Forecasting and Supply Planning for Procurement, will assist program managers, service providers, and technical experts when conducting quantification of needs for priority reproductive, maternal, newborn, and child health medical products. It has been updated to include new products and recommendations from WHO.

This revision includes a significantly enhanced chapter on Postpartum Hemorrhage (PPH), along with improved forecasting algorithms and Excel-based tools—with and without examples—to better support country teams in quantifying priority RMNCH medical products, many of which are underutilized or newly recommended. 

Key Updates and Revisions: 

This latest version reflects 2023 World Health Organization (WHO) recommendations for PPH prevention, diagnosis and treatment, which emphasize two major changes: 

1. The routine, objective measurement of postpartum blood loss using tools such as calibrated drapes for timely detection of PPH. 
2. The use of a standardized care bundle that includes uterine massage, administration of uterotonic and tranexamic acid (TXA), IV fluids, genital tract examination, and escalation of care where necessary. 

To align with these updated recommendations and enhance usability, the following changes have been made: 

• PPH chapter fully updated to include: 
  • Calibrated drapes for blood loss detection 
  • TXA along with other uterotonics for PPH treatment  
  • Heat stable carbetocin as an alternative for prevention of PPH
• Forecasting algorithms, tools (templates), and tools with examples are updated to incorporate template for the forecasting of calibrated drapes, heat stable carbetocin with other uterotonics for prevention of PPH, and the use of TXA with other uterotonics for PPH treatment. 

These updates are intended to strengthen the country and partner teams’ ability to produce accurate and actionable forecasts, contributing to improved availability of lifesaving RMNCH commodities at all levels of care. 

NEST360 is an international alliance united to end preventable newborn deaths in African hospitals. The alliance works to deliver a package of technologies and services that enable local governments to save newborn lives, improve newborn outcomes, and empower the medical workforce for the future. There are a number of resources available to support clinicians, engineers and administrators to implement an evidence-based model for sustainable, high-quality hospital-based newborn care in limited resource settings, including clinical and technical resources, technology resources, implementation resources, and COVID-19 related resources.

Overview

The KMC implementation strategy targets a broad audience. These include policy-makers and programme managers at national, regional and local levels, government and nongovernmental organizations working in the area of maternal and newborn care, global and national professional associations, public and private hospital management at all levels of care, and facility- and community-based maternal and infant care providers.

The purpose of developing the implementation strategy is to:

• guide countries in implementing KMC for all preterm or LBW infants, both well and sick, as the foundation of small and/or sick newborn care at different levels of care in the facility and community, according to their specific health system and cultural or social contexts;
• enunciate the programmatic principles for implementing KMC as an integral component of small and/or sick newborn care and the ways and means to achieve them.

Summary

Implementation of KMC is central to achievement of the SDGs for the survival, health and well-being of preterm or LBW infants, both well and sick, through its successful scale-up at all levels of facility care and in the community. Based on the new evidence on successful scale-up of KMC in programmatic settings from several countries, complemented by the joint wisdom and experience of global stakeholders, this implementation strategy is intended to guide the way forward for universal coverage of KMC for all preterm or LBW infants, both well and sick. This implementation strategy is meant to inspire a renewed vision in which mothers and infants are kept and cared for together from birth, and where parents and families play a central role in the care of their infants, thus humanizing health care.

Highlights

Achieving KMC implementation at scale requires:

• A system-wide perspective and structural changes to place mothers and infants at the center of care by keeping and caring for them together after birth
• A commitment by political and program leadership to implement KMC as the foundation of small and/or sick newborn care
• A dedicated budget for implementing KMC as part of small and/or sick newborn care in national maternal, newborn and child health programs
• Developing and implementing a monitoring and evaluation framework to track progress.

How to Use

KMC has been shown to be an essential intervention superior to standard radiant warmer/incubator care in all settings. All countries, irrespective of their income setting and resource availability, should adapt this strategy to their health system contexts to realize the full impact of KMC in improving the survival, health and well-being of mothers and preterm or LBW infants alike.

Summary

The purpose of this document is to put forward the joint position and vision of an expert, global, multi-stakeholder working group on implementing KMC for all preterm or LBW infants as the foundation for small and/or sick newborn care within maternal, newborn and child health programs, and spur collaborative global action. Reversing the long-standing inequities in health care will require prolonged efforts; the scale-up of KMC as an essential service for all mothers and their preterm or LBW infants as a critical component of universal health coverage can serve as the key starting point.

Highlights

• Kangaroo mother care (KMC) is an intervention that enables the mother to take a central role in her own and her newborn’s care, thereby ensuring the power stays with the mother, and health workers support and respond to the mother’s and newborn’s needs.
• It humanizes maternal and newborn care by empowering and involving those who care most for the infant, rather than focusing predominantly on technological solutions.
• KMC can serve as a starting point for broader health-system redesign and service delivery transformation for maternal and newborn care, and a model of what can be accomplished when relevant stakeholders are empowered to play the roles naturally entrusted to them in the care of their newborns.

How to Use

Operationalizing this concept can serve as a strong foundation of highly efficient health systems that are rooted in the communities they serve and focus not only on preventing and treating illness but also on improving well-being and quality of life.

This article in BMJ Global Health argues that as new evidence-based interventions emerge and are included in the global recommendations to improve health and well-being of pregnant populations, the global maternal newborn health community must ensure that their introduction and implementation takes local context into account and employs an inclusive, equitable, health systems approach with a continuous learning agenda.

In 2022, the World Health Organization (WHO) updated the routine ultrasound recommendation originally published in the 2016 WHO recommendations on antenatal care for a positive pregnancy experience. This technical brief from MOMENTUM Country and Global Leadership describes the re-affirmed WHO recommendation on routine antenatal ultrasound examination and outlines policy and program implications for translating this recommendation into action at the country level.

The following is intended to assist decision-makers in analyzing a country’s current situation. This will assist in making a decision about whether to introduce/ scale up OB U/S services and ultimately in developing an implementation plan for introducing OB U/S.

Column 1 outlines factors that will need to be considered – Review the factors that are listed. As you review them, delete any that are not relevant to your country situation and add any factors you think need to be considered when introducing U/S into your country.

Column 2 provides checklists to guide a situational analysis as well as make decisions on how to introduce U/S – Review the items listed and check any boxes that apply to your country context. If necessary, add additional items to assist in developing an implementation plan.

Column 3 provides a space to outline action items/activities to introduction into the health system – Review the situational analysis/decisions made and then write action items/activities that will ensure a sustainable and efficient introduction.

“Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain.

The results of this new clinical trial published in May 2021 provide evidence in support of starting KMC immediately after birth, a clear message that keeping mothers and babies together helps babies to survive and thrive.

Key Findings

• Starting KMC immediately after birth in newborns with birthweight of 1000 grams to 1799 grams has the potential to save up to 150,000 more lives each year (a further increase in survival of 25%), compared with the current recommendation of starting it only once a baby is stable.
• Mother-Newborn Intensive Care Units will be critical to support the mother, or a surrogate, in providing this immediate, ongoing skin-to-skin contact from birth.

Understanding of the lifesaving benefits of KMC for babies born early or small and its continued importance during the COVID-19 pandemic are further strengthened with this new evidence on the benefits of starting the intervention immediately after birth. Among preterm or low birthweight infants, KMC has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%.

Evidence from this updated 2020 Cochrane review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. Treatment with antenatal corticosteroids reduces the risk of perinatal death, neonatal death and RDS and probably reduces the risk of IVH. 

This review (of 27 randomized trials including 11,272 women and 11,925 neonates) assessed the effect of administering a course of corticosteroids to women prior to anticipated preterm birth (before 37 weeks) on fetal and neonatal morbidity and mortality, maternal morbidity and mortality, and childhood development later in life. Evidence supports the continued use of a single course of ACS to accelerate fetal lung maturation in women at risk of preterm birth to reduce the risk of serious respiratory illness and death in neonates in low- and middle-income countries.

Neonatal outcomes from this analysis found:

• Reduced risk of perinatal death (numbers of stillbirths and babies dying in the first 28 days of life)
• Reduced risk of early neonatal death (numbers of babies dying in the first 28 days of life)
• Reduced risk of severe respiratory distress at 24 hours after birth
• Minor effect on babies’ birth weight

In 2015, the World Health Organization (WHO) recommended that antenatal glucocorticoids should be used only under certain conditions, including the accurate assessment of gestational age, imminent preterm birth, the absence of maternal infection, and adequate care for childbirth and preterm newborns. The guideline panel and an expert panel that was subsequently convened by the WHO identified the conduct of efficacy trials in hospitals in low-resource countries as a research priority in order to resolve this controversy and guide clinicians and policymakers on the use of antenatal glucocorticoids. We conducted the WHO ACTION-I (Antenatal Corticosteroids for Improving Outcomes in Preterm Newborns) trial, a randomized trial to assess the safety and efficacy of dexamethasone in women in hospitals in low-resource countries who were at risk for early preterm birth.

 The Action 1 trial found that among women in low-resource countries at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection.