THE MARCH OF CARE FOR NEWBORN UMBILICAL CORD IN NIGERIA Using Advocacy to Launch and Move of Chlorhexidine

7.1% Digluconate Gel Use for Newborn Cord Care to

Scale: 2012-2014

Nosa Orobaton MD, DrPH, MBA

Olayinka Umar-Farouk, MD, MBA

February 11 2015

REMEMBER THIS

Chlorhexidine, powerful,

impactful, for health

system improvements

Government role across value

chain is critical

Public-private partnerships

matter

Trust-based community

demand is foundation for

local market

Proactive, comprehensive

forecasting is key to prevent

shortages

NIGERIA: CONTEXT

Second highest newborn deaths

globally at 276,000 in 2014*

Infections cause 1 in 3 newborn

deaths

Nationally, two in three babies delivered at

home without skilled assistance

In some states, over four in five babies

delivered at home

1 in 4 non-institutional births apply

potentially harmful substances to umbilical

cord

* Lancet Newborn Series, 2014

STRATEGIC CONSIDERATIONS

Multi-pronged, co-

reinforcing, organic

approach

Clear national

leadership &

Commitment

Direct implementation in 2

States generates local

experience

Network of Public-Private Actors to

Fast-track Local Manufacture

Study Tour of 30 States to Sokoto State for firsthand view of community-based program

Chlorxy-G Brand, Manufactured in Nigeria. Launched in March

2014

AT NATIONAL LEVEL

Strong national leadership

Nigeria co-chair of UNCoLSC

Strong, proactive drug

regulatory agency

Open innovation space to test

program approaches

Chlorhexidine 7.1% Digluconate

included in Essential Drug List

AT STATE & COMMUNITY LEVEL

Launched in Sokoto &

and Bauchi States

CHX & misoprostol

twinned

Govt used own funds to

buy both commodities

CHX and misoprostol added to

work of community-based health

volunteer system

Both states decide to implement

metrics-based program at scale

Newborns as Percent of Expected Births Reached with Chlorhexidine Gel in Sokoto State, Nigeria April-Dec 2013 N=36,404

99.7% survived the

neonatal period.

More than 3 in 4

newborns had died

prior to or around

birth.

Source: http://office.microsoft.com/en-us/excel-help/present-your-data-in-a-column-chart-HA010218663.aspx

Newborn Deaths By Reported Timing in Cohort of 36,404 Who Rcvd CHX in Sokoto State, Nigeria, April-December 2013 (N=124)

SPREADING THE MESSAGE

PROGRESS: MARKET FORMATION

Pace of growth reflect national

commitment and the use of an

integrated community-

manufacturer-regulator-buyer

platform.

Activity January

2014

January

2015

National Policy No Yes

Number of States at

Sokoto CHX Study

Tour

0/37 30/37*

Approved Local

CHX Producing

Firms

0 2

CHX Locally

Manufactured

No Yes

Number of CHX

Tubes Annual

Production Capacity

0 20 million

(one firm

only)

Number of States

with CHX in Use

0 8

LOCAL MANUFACTURE

10

6

3 2

1

PRIVATE NIGERIAN PHARMACEUTICAL FIRMS

THAT ENTERED IN CHLORHEXIDINE 7.1%

DIGLUCONATE GEL MANUFACTURE AS OF

DECEMBER 2014

ONE MILLION UNIT MARK MET IN DECEMBER 2014

Source: http://office.microsoft.com/en-us/excel-help/present-your-data-in-a-column-chart-HA010218663.aspx

0

200000

400000

600000

800000

1000000

1200000

Cumulative Trends in the Known Quantities of Chlorhexidine 7.1 Digluconate Gel Ordered

by/for 8 Nigerian State Governments and Fed Govt 2012-2014

LESSONS: DEMAND SIDE

LESSONS: SUPPLY SIDE

Proactive, responsive

National Drug

Regulatory Agency

Public-Private Partners

Network as Incubator

accelerated drug

development process

Integrated community-to-

manufacturer-buyer learning

platform

Federal system created open

innovation space for early

movers to adopt

LOOKING AHEAD Government role across value

chain is critical

Think sustainability upfront

Proactive, comprehensive

forecasting by government is

key to prevent shortages

Public-private partnerships

matter

Align entry into OTC market with

demand creation process to increase

commodity security, availability

Short, 10 minutes Film: Watch it on Youtube Introduction of CHX-Miso in Nigeria: https://www.youtube.com/watch?v=ts1-9soXbZ8