Hello Friends 👋

In this episode, Shelly-Ann, Ben, and Gabriel discuss the Newborn Toolkit with Dr. Joy Lawn, Dr. Mbozu Sipalo, and Lauren Allison from the Newborn Toolkit Team. They highlight the importance of newborn care, the challenges faced in providing adequate care globally, and the development of the Newborn Toolkit to address these challenges.

Professor Joy Lawn, BMedSci, MB BS, MPH, PhD, FRCPCH, FMedSci

Professor of Maternal Reproductive and Child Health Epidemiology, London School of Hygiene and Tropical Medicine

Professor Joy Lawn is an African-born, British-trained paediatrician, neonatal doctor and perinatal epidemiologist with 30 years’ experience notably in sub-Saharan Africa including trials, complex evaluation of newborn and child health services, and epidemiological burden estimates for WHO and UNICEF. Her main contributions to global health have been developing the evidence-base to measure and reduce the global burden of 2.3 million neonatal deaths, 2 million stillbirths, and 15 million preterm births, including informing Sustainable Development Goal targets. She has published >350 peer-reviewed papers with a H-index of >110, including leading several Lancet series and UN reports, with wide media and policy uptake. She has been in the top 1% cited scientists since 2017. She is a champion for equitable and diverse research leadership, and health services.

Lauren Allison, BSc, MSc

Lauren Allison is a paediatric and neonatal nurse from Canada. She is one of the Knowledge

Management leads for the Implementation Toolkit for Small and Sick Newborn Care and a Research Assistant at the London School of Hygiene and Tropical Medicine. She is actively involved in scaling the Newborn Toolkit and building a community of practice of implementers for small and sick newborn care in French-speaking contexts globally.

Dr Mbozu Sipalo MBChB, PGdip, MSc

Mbozu Sipalo is a medical doctor from Zambia working in the newborn health space and one of the

Knowledge Management leads for the Implementation Toolkit for Small and Sick Newborn Care and a

Research Assistant at the London School of Hygiene and Tropical Medicine. She is part of the editorial

team for the Newborn Toolkit and is actively involved in building a community of practice for the small

and sick newborn care for developing contexts.

Newborn Toolkit Link: https://newborntoolkit.org/toolkit

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The transcript of today's episode can be found below 👇

Shelly-Ann Dakarai (00:00.909)

Hello everyone, we are back with another episode of the Global Neonatal Podcast and today I have Gabriel and Ben joining me as co-hosts. How are you guys doing today?

Gabriel (00:10.234)

Pretty good. Thank you for having me here. I'm very excited to hear a bit more about what's brewing. So very, very happy to be here. Thank you.

Ben Courchia MD (00:21.23)

Yeah, I'm very excited to be here as well. Thank you, Shelly Ann, and very excited to learn more about the newborn toolkit with you guys.

Shelly-Ann Dakarai (00:28.565)

Yes, same here. So today we are joined by three members of the Newborn Toolkit team. We have Dr. Mbozu Sipalo, Lauren Allison, and Professor Joy Lawn. And in the interest of time, I will just provide brief intros to our guests, but we will have their more extensive bios on our show notes. Dr. Mbozu Sipalo is a medical doctor from Zambia and a research assistant at the London School of Hygiene and Tropical Medicine. She is part of the editorial team for the Newborn Toolkit and also one of the...

knowledge management needs for the toolkit. Lauren Allison is a pediatric and neonatal nurse from Canada and a research assistant at the London School of Hygiene and Tropical Medicine. Lauren also is one of the knowledge management needs for the newborn toolkit and is involved with scaling the toolkit in the French speaking context globally. And last but not least, Professor Joy Lawn is an African born British trained pediatrician.

neonatal doctor and perinatal epidemiologist with 30 years of experience, notably in sub-Saharan Africa. Her main contributions to global health have been developing the evidence base to measure and reduce the global burden of 2.3 million neonatal deaths, 2 million still births, and 15 million preterm births, including in form and sustainable developmental goal targets. Dr. Lon is a professor at the London School of Hygiene and Tropical Medicine.

and on the editorial and health system building block teams of the Newborn Toolkit. And Mbozu, Lauren, Joy, welcome to the podcast. We are so excited to have you and hear all about what you're working on.

Joy Lawn (02:01.159)

Delighted. Thanks, Shelly Ann.

Lauren Allison (02:04.261)

Thank you.

Mbozu Sipalo (02:04.269)

Thank you, glad to be here.

Shelly-Ann Dakarai (02:07.349)

Alright, so before we delve into it...

Gabriel (02:08.042)

I can start just, I just want to say I'm so impressed right now. I'm so, so like, I'm like, I'm already like, wow, like everything that's been done.

Mbozu Sipalo (02:13.965)

Hehehe

Lauren Allison (02:16.701)

Yes.

Ben Courchia MD (02:18.214)

Gabriel, you cannot be starstruck. You need to conduct this interview. So settle down.

Mbozu Sipalo (02:19.085)

Hehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe hehehehehe hehehe hehehe he he he he he he he he he he he he he he he he he he

Shelly-Ann Dakarai (02:22.558)

I know.

Gabriel (02:22.95)

I want everyone to hear that this next hour is going to be one of the most, you know, valuable hour of your day because I know that for me it's going to be. I already know what I'm going to learn so much. So anyway, sorry for cutting you, Shelly Ann. Go for it.

Lauren Allison (02:23.102)

Yeah.

Shelly-Ann Dakarai (02:38.539)

No, this is great. I agree. I am super excited as well. So yeah, so as I was.

Lauren Allison (02:39.207)

Thank you.

Joy Lawn (02:43.035)

We're just so happy you guys are doing fantastic work on newborn health and this focus on newborns where most are born and most die is just really important.

Shelly-Ann Dakarai (02:57.453)

So before we delve deep into the newborn toolkit, I just wanted to get our listeners a sense of kind of what brought you guys into the neonatal medicine space to start. What were your motivations there? And then what got you from the path of being in neonatal medicine to the London School of Tropical Medicine and being on the newborn toolkit team?

Joy Lawn (03:21.675)

Berser, Lauren, you want to kick off first?

Shelly-Ann Dakarai (03:21.769)

I guess I will say let's start with, yeah, I was going to say let's start. Go ahead, Lauren.

Mbozu Sipalo (03:24.397)

I was handing over the fresh talking stage to you, Joy.

Joy Lawn (03:34.367)

Well, quick pressy, my biggest qualification is that I should have been a newborn death in Uganda.

Joy Lawn (03:44.527)

Well, I came late to realizing how important that was, you know, I think really shapes what we want for every newborn everywhere. And then I jumped around the world a bit, did neonates in the UK, worked in Ghana on a local wage as a neonatologist, did some work in the US at CDC on neonatal epi. And then...

had a very exciting 10 years with Save the Children kind of at the beginning of the global newborn health journey where Gates Foundation was really the only funder. And we were able to, you know, both work across lots of countries in Africa and Asia on the evidence, especially actually at what could be done at home, because at that stage, most of us were at home and on the global side. Yeah, and now being a fake academic at the London School for the last 10 years.

Yeah, of which the most exciting part is the team. So it's just such a delight and a pleasure to have people like Mbozu and Lauren and be working with people across Africa. So let me pass to them.

Mbozu Sipalo (04:53.005)

Lauren, you're on to go next.

Lauren Allison (04:57.221)

Sure. Yeah, so I studied nursing in Canada, and I've always kind of had a passion for working in pediatrics and neonatal care. I did pediatric emergency and then neonatal intensive care in Canada. But I found that I really kind of enjoy looking at things from more of a systems approach. So I found that the newborn toolkit really kind of brought that approach to the table. So looking at all the different factors to kind of what makes up a strong foundation for newborn care.

kind of what brought me into the more global sphere and then with that there's also the levels of having the language barriers. So really passionate about kind of finding more solutions and working to address and bridge that gap with the language barriers globally. So yeah.

Mbozu Sipalo (05:44.333)

Yeah, I'm originally from Zambia. Like, I don't know if Shelly Anne mentioned this, but that's home. But my medicine started in Russia. And then I went to do my internship in Zambia. And whilst in Zambia, I ended up working in the NICU. And that's where I did a postgraduate diploma in neonatology under the great supervision of our neonatologist, Dr. Kapemba.

Lauren Allison (05:44.913)

Yeah, I'm crazy.

Mbozu Sipalo (06:11.629)

And the thing that struck me there were the high neonatal deaths on the ward and just the fact that they could be, they could be avoided. And it really struck me as a problem that I would want to be part of, not just in the clinical sense, but also outside of the walls of the hospital. So that led me to do a masters in global health policy in Edinburgh. And then whilst there, I was just thinking of a way that I could get, again, get out of.

that bubble of the NICU Zambia, like what can I do? Where can I get involved to have a bigger impact? And somehow Oral led to London School of Hygiene Medicine. And that was through a colleague who worked at the school as well and linked me to this great team. And who else can be better to work under than Professor Joy Law? So it's just been quite a serendipitous path. And I'm looking forward to.

Lauren Allison (06:46.994)

Thank you.

Thank you.

Mbozu Sipalo (07:09.773)

where all this leads me going forward. And glad to be here again.

Gabriel (07:18.518)

Can I ask a question? You know, like for everyone that's listening, you have to go on the website of the Newborn Toolkit. I just want to see like, it's so amazing what has been built. The content is incredible.

Ben Courchia MD (07:32.182)

But Gabriel, before we even invite people on the Newborn Toolkit, I was wondering if maybe, Joy, can you tell us a little bit what is the Newborn Toolkit and what are its goals and how did that initiative even begin as well?

Gabriel (07:34.523)

Yeah.

Gabriel (07:48.518)

The dream.

Joy Lawn (07:48.883)

Yeah, thank you, Ben. Yeah. So, you know, I think we're at an amazing point in history. You know, when the global newborn health journey started, most births were at home and we were really struggling, you know, what could be done at home. Now, more than 80 percent of the world's births are in facilities and most countries in the world now have a target for newborn survival.

And to meet that target, they have to get their neonatal mortality rate to less than 12. And the only way to do that is to provide higher quality neonatal care. And, you know, maybe not the full NICU, as most of your listeners will be thinking about. We need a core package, which at least has ventilation support, CPAP for newborns and the other.

core components of what WHO called Level 2 care. The challenge with that is across most of the world, we don't have that. You know, I've spent most of my life working in clinical settings across Africa. It's often a small room off Labor Ward, you know, maybe one nurse, none at night, limited equipment, which has mostly been donated. So countries have got this big target. And for the first time we have

really political level leadership. I was in Tanzania two weeks with presidential level attention for this. And then what happens is everybody's reinventing the wheel. Man, we have so many education materials, device lists, this, that, the other. So the newborn toolkit was this principle of collectively we can go faster together. And to go faster together, yes, we need the kind of one

Joy Lawn (09:44.263)

But I think as both Lauren and Mbozu said, it's also beyond the walls of the newborn ward. If we're going to change data systems, it's not just on the newborn ward. If we're going to change money, man, it's not just on the newborn ward. So what the toolkit is trying to do is to put together tools, learning, and the community to go faster together, not to be reinventing the wheel to share where we're at.

and to do that more together in support of what WHO is saying. But WHO gives us the what. The real challenge is the how. So we're trying to share the how. And it's just such a pleasure. And Bozo and Lauren have been transformative in the time they've been working on this. But I just appeal to all of your listeners. We're actually at a point where learning from.

high income countries where we're de-intensifying neonatal care, we're bringing women into the NICU, we're trying to reduce the number of machines, actually our world's a meeting. How do we share both ways and a way that learns both ways? And how do we do that, you know, to be able to go faster together? And we really need you and we welcome your inputs on it.

Shelly-Ann Dakarai (11:03.029)

So it seems like the Newborn Toolkit is what you would call a potentially, quotation marks, a one-stop shop for a bunch of different resources to help providers caring for newborns globally. Can you give us a little bit more detail as to what it encompasses, the different spokes on the wheel as it were?

and what that is for our listeners. So for somebody who's never heard of it before, if they were to go and try to look at this toolkit, what is it really about? What does it help them do?

Joy Lawn (11:41.215)

Yeah, so I think a critical part here is that it's really looking for sustainable systems change. So for those, you know, who have worked with WHO guidelines before, a lot of things are organized by the so-called health system building blocks, you know, money, space, staff, medical supplies and devices.

The toolkit is organized in support of WHO. That gives us the what, you know, which interventions do we need in this package and keeping that small enough. If we start to add in, you know, very more expensive things, for example, surfactant, we may, you know, mean that the package becomes even more complicated than it is for, you know, small incremental games. So we're looking at.

the Level 2 Small and Sick Newborn Care WHO guidelines, and then 10 core components, which are mostly systems change. We want people just to be able to land and find one thing if you're looking for it. But also, if you want them to say, you know, I have a problem with hospital-acquired infections. How do I work through that? Or I actually want to change my space a bit. Or I want to make the case for more nurses. Then we're trying to provide that.

And maybe I could pass to Mbozu because what Mbozu has led brilliantly in many ways over the last year is building a community also around regular webinars. So we share learning. Mbozu, maybe you could talk a bit about how the community works.

Mbozu Sipalo (13:20.685)

Thank you, Joy, for that lovely summary. So like Joy briefly described, the newborn toolkit is organized by the 10, now organized by the 10 WHO units of core components. And they're all beautifully described on the website. So just to bring out one, we have an infrastructure health system building block or core component.

and we usually have webinars on the

Mbozu Sipalo (13:56.365)

So for example, if we have a webinar on infrastructure, we'll reach out to different experts in low middle income context, primarily in Africa for now, and get them to join the webinar and speak on the webinar and just explain the implementation learning and the experience of building a proper infrastructure system in small signal bond care in their setting. And in that way, we're...

trying to promote learning across different settings and have people get to know that these are the things other countries are doing, and they can also equally do something similar. So that's just one of the ways that we're building a community of practice through the webinars that we have. We're hopefully going to have more than 10 of them next year on the 10 components, including infection prevention and control.

And Lauren can speak on the hopefully French-led webinars as well. And in all of that, our goal is just to have more of a community around the small signal born care for low- and middle-income countries, and for them to also lead on the webinars, to input, to send us, and to communicate with us on what they want to talk about so that it's a two-way learning platform, and not just

a one-way thing where we're the ones who are leading on the conversation.

Shelly-Ann Dakarai (15:30.113)

Lauren, did you want to talk a little bit about the French initiative?

Lauren Allison (15:38.577)

So in 2023, in May this year, we launched the French newborn toolkit, and this was done at the International Maternally-Born Child Health Conference. So that took place in South Africa.

So we're really excited to kind of bring this platform in French. So just share a quick stat here. So data from 2022 from the UN Interagency Group for Child Mortality Estimation showed that 13 of the top 30 highest newborn mortality rates were actually in French-speaking contexts. So there is quite a high burden within those settings. And we found that as well that in terms of

translation of French resources in French. The availability and the speed at which these documents are often translated is slower. So things will come out in English first and it'll take a bit of time to come out in French. So we really wanted to kind of highlight a platform where all those resources could be put in one place and it kind of takes away that gap for implementers to find and locate those resources.

So yeah, we're really excited to launch that and it's still growing. So we have over 200 resources, tools and readings in French now, but we are very much still kind of building on this work and we look forward to collaboration and feedback from French implementers working in those settings as well.

Ben Courchia MD (17:00.162)

So you launched the French version of the Newborn Toolkit in an English speaking African country. Is that what you're saying?

Joy Lawn (17:08.712)

Also in Bamako and in fact, yeah, but really important. Senegal is the highest French-speaking country user group and there's some really dynamic doctors there who have led it. I think, you know, we really look, I know you have French users to amplify that and we're very

Mbozu Sipalo (17:13.58)

Thanks for watching!

Mbozu Sipalo (17:18.893)

Thank you.

Joy Lawn (17:34.367)

one of the few foundations that really focus on French speaking areas. One shocking other link is that many of these French speaking countries are also the most challenging humanitarian settings. And looking at the news recently, it's such a clear reminder of there's nothing more vulnerable than a pre-term baby when there's a conflict.

Yeah, so if people would like to do a launch in a French speaking country, please do let us know. Lauren is your...

Ben Courchia MD (18:06.874)

I was just teasing about the fact that she said it was announced in South Africa, which I thought was kind of funny. But of course, it has tremendous ramifications.

Joy Lawn (18:17.403)

Yeah, it was a meeting with several thousand people and there were fewer French-speaking people than there should have been there. So I think it's a reflection, you know, global meetings, global translation and where people are, it's missing out.

Ben Courchia MD (18:32.429)

Yes, Gabriel.

Gabriel (18:33.85)

Well, I just find it's great. I'm obviously very biased to French because I'm the voice with Ben on the French incubator. But I think that this outlines how it's so important to reach out as a community of the world to everyone around, you know? And so I'm just wondering, is there a plan to eventually even expand that to go to other languages? Some that might be like Spanish, Portuguese, or even I would say local languages to try to adopt that.

I mean, there's so many great resources and I'm wondering if there's, you know, in the near future, the hope to expand this initiative beyond, you know, like, I guess Africa, but also like in some other countries in Asia and South America that may need these kinds of resources.

Joy Lawn (19:23.135)

Okay, well, it's so important. In fact, in low and middle income countries, the most common using country is India and the biggest contributor of resources also is India. So I think Asia very strong and the French speaking part really critical. The Spanish speaking part we're going to try next year and we would welcome insight and ideas.

from your team just to reflect that a lot of this is a labor of love and done on the side of other grants and specific inputs and trying to make it happen. So we really need collective community ideas and ways to make that work more.

Joy Lawn (20:17.831)

I think we have 11 languages with tools, right? 700 tools in 11 languages. So you can search by language. The gap is the website content and then the webinars. So live translation is not cheap. Especially if you want people who don't garble your neonatal technical terms.

Mbozu Sipalo (20:42.285)

Gabriel, if you know some funders we should reach out to, just let us know. That would be great to have more people fund the toolkit. So yeah, please do reach out.

Gabriel (20:51.384)

Of course.

Joy Lawn (20:57.275)

Never miss a trick, Mbozu.

Shelly-Ann Dakarai (20:57.621)

I was... So thanks for that good overview of what the toolkit entails. Can you give us any stories of how it's been implemented to date of maybe any countries that have used it well or successfully?

Joy Lawn (21:16.595)

Maybe I can make a couple of comments and then Lauren may talk on the French side. So the African Neonatal Association, which is really exciting, new organization, just a couple of years old, but has members in 40 countries. We have a memorandum of understanding with them. And for example, the president of the African Neonatal Association, the wonderful Dr Alex Stevenson, has been using the

the toolkit with his ward team kind of working through things as a way for them to look and get their own ideas. In Malawi, where there are 27 districts, 37 NINET units, they posted QR codes next to CPAP machines with simple tips and a video on how to just to up. Up.

use on specific things on the toolkit. And then, you know, I would say that and as I mentioned about infrastructure and floor plans earlier. So there's been this kind of train where India had a neonatal floor plan that got adapted in several African countries that now has a great one in Tanzania that's been used in Uganda now as an adaptation. And I think that kind of South-South sharing.

would be hard to happen, I think, without the toolkit. And maybe Lauren, do you want to have any ideas or suggestions, especially on the French side, where I think we're really, really trying?

Lauren Allison (22:54.233)

Yeah, so I think we're really trying to kind of build up the user base of the French toolkit side. So we've had kind of several French countries, we've seen increased usage over the past year within those settings. So just a shout out, we've seen from Burundi, Benin.

Mali, we're trying to grow kind of more within those settings as well. But we also did have a recent essay contest as well that we're able to highlight some of the usages of the toolkit, which is really fantastic to see for more of the frontline implementers. So I'll just mention one of our winners was two midwives from Burundi, and they kind of were able to use the toolkit to highlight different examples of how they could implement direct kangaroo mother care within their settings and

using the toolkit as a way to support implementation of those spaces within their hospital. So it really kind of took into factor the family-centered care approach, but also considering infrastructure and how to engage the leadership and governance of their hospital to implement this within their setting. So we do want to see kind of more of that in action. It's great to kind of have those feedback stories from our mentors who are working in those settings, but it's definitely something we're continuing to work to grow moving forward.

Ben Courchia MD (24:07.574)

Joy, I have an additional question on this topic. I think you guys are trying to do, it's interesting to me, you're trying to do something so of such magnitude with a tool that is, whose simplicity is so elegant. It's 10 aspects and it's so well streamlined. How do you guys know how to address?

the priorities of the various stakeholders that you're trying to help? And how do you direct what the focus will be placed on? Is this something that is reviewed by a committee or are you taking in direct feedback from people on the ground to decide what the direction the Newborn Toolkit needs to take to address the needs of your partners?

Joy Lawn (24:59.195)

Professor Ben can tell why you were asked to mark the essays. Very important question. Because this is a web platform with content on it, which could just be flat. So I think that the two big ways that happens that was co-designed with 300 implementers across lots of disciplines like architects.

biomedical engineers and lab people and so on, with a focus on low and middle income countries are not all from the neonatal ward. We're looking for this systems change beyond the ward. So I love that you think it's simple. I think we do find that especially for people who are at the coalface, they feel like it's more complicated. So I think that's a good insight.

Ben Courchia MD (25:49.522)

I would, yeah, I mean, when I mean simple, I really say this in the most elogious terms because you could expect when we're describing the problem of implementing neonatal services in low resource setting, that you would end up on a very complex platform with lots of pages and things that you don't understand, but you'll go and it's so well done. There are 10 items. The categories are broad enough, but not too broad that you're not really sure what you're talking about. And so I think that's...

to have achieved this level of simplicity all the while really reaching your objectives is tremendous. And so...

Joy Lawn (26:27.207)

Then I can die happy. You know, I think it was user design. We know that user design is critical. So if you'd seen how the toolkit emblem started, it was like nothing like that. Actually, the engineers really helped us with that. And then I think, you know, what you were saying about how do we know what to flag and what to answer, I think that is what Mbozu said, which is really critical. This is not a one way where we're like, we're collecting everything and

dumping it on a website. We're really having people co-design and listening all the time. I spend most of my time in low and middle income countries and working with endless both Africans and Asians. I think we're failing, Gabriel, you're right, with Latin America at the moment. And we've learned a lot from China too.

So I think what matters and what it takes. And then I do think an important principle in, there's a sociopolitical scientist called Jeremy Schiffman who looks at what makes things a global priority. I think it's also the affected people. So parents and their voices, as well as the kind of politicians and having that in the system is really critical. And then other factors that make things work are that kind of two-way.

you know, having your feet in the field while you're also hearing the kind of global, the global waffle space, you know, that the global policy is utterly critical to have standard agreed things to do. But the real challenge for people is how to and the how to comes from the field and it comes from another saying that I absolutely love, which is the best ideas come from meeting of unlike minds. So, you know, often we mix with

people who are the same as us, speak, you know, same discipline, same language, nice neonatal people, we're all too nice, that's another problem maybe we have. So I think we would love to hear from your listeners on what works, what their suggestions are. And I do think another point on the political priority for newborn health is that this professor, Jeremy Schiffman has officially told the neonatal community, we are too nice.

Joy Lawn (28:48.175)

So I have worked all over Africa where the AIDS community are able to get action. And it's not that we want less for AIDS, but man, we need more for newborns.

Gabriel (28:59.826)

Totally. Yeah, for sure. You know, I saw, I love the fact that you have a whole section dedicated to family-centered care. I find we even struggle in our own settings to be better at integrating families and providing family-centered care. And I love that you see in that like the parent power that you mentioned on the website. So I'd love to hear more on the perspective of how you push forward.

Joy Lawn (29:00.111)

Manon.

Gabriel (29:28.794)

this concept in these units as a vehicle of change, as a power to really improve outcomes of newborns. And from an outsider perspective, it just seems to make so much sense. But I can see how much there must be also challenges and, you know, a lot of work to be done on the ground for that to be adopted. Would love to hear the perspective of you three on that.

Joy Lawn (29:56.347)

And Bozo you're nodding, you want to comment on that?

Mbozu Sipalo (30:03.661)

Yes, I just wanted to just say that that's a big one because like the basic NICU doesn't accommodate parents. It accommodates one bedside with the neonate and quite a small space. So even like where I was working, which is the tertiary hospital in Lusaka, the university teaching hospital, NICU.

has a, I think a bed capacity, our actual capacity should be less than 50, but then on the ground there'll be more than 100 babies at a time. So that alone limits that family-centered approach because you can only have one parent per coat. So it all starts with how we're planning these NICUs, like what is the government saying about how much space should be allocated to newborn babies and that well.

and how much space should be given to that parent who should be able to be there all the time, not just two hourly feeds or three hourly feeds. So those are the big questions that need to be solved and the planners and the policymakers and the people making decisions around the caring of the NUB when at the infrastructure level really need to redesign and

just restructure their minds on just the importance of having families there taking care of the babies. And that helps as well with the nursing care in our setting, because if it's one nurse for 15 babies and parents are not there, it just naturally means that the care that those babies receive won't be optimal. So the more the parents are there, the better the babies will be cared for. And yeah, so now we all get to speed with that and pushing the money for that.

the better our babies will be cared for in those hospitals and clinical settings.

Joy Lawn (32:02.607)

And Gabriel, just thanks for noticing too that we deliberately put the family, the woman and the rest of the family at the center and at the heart. And I think it's easy to draw that on a figure and think about it. But as Mbozu says, it's a big pivot. I think in our favor is the new evidence on immediate and early KMC, Kangaroo Mother Care, and that this is the best for every baby everywhere.

I would reflect having just been in Sweden and Karolinska and went to what looked like a six star hotel to me with you know side rooms for women and everybody else and you know amazing monitoring and one-to-one nursing and so on. I was like oh my goodness and so in fact you know the Scandi countries are leading the way and putting the money in and I think it gets back to our point about

we're being too nice. It should be unacceptable to have units where we're not thinking about the woman. Expecting her to be there and express and come in and out and sit on a bench and not have somewhere to shower, that should become unacceptable. It's not that we should make her an intervention for the kangaroo mother care. If we're going to do that, we need to then say then for the woman.

and for the family and for the nurses, we absolutely need to say here's a minimum standard for space and what we do. We're so used to like just doing charity, let's have a little room off here, have one great big long flex, one plug, whole bunch of donated equipment. I think and I've done that, I've been part of that problem for 20 years. I really think we need to shift our mindset for the sake of the women and the babies. And it's also better for nurses and doctors.

cramped room where you are doing wardrobes and you find babies who have, you know, three per incubator on one side and people haven't even been able to, you know, do the right thing.

Gabriel (34:19.014)

Thank you for this insight. Sorry, go for it, shall we?

Shelly-Ann Dakarai (34:23.721)

No, I was going to say, what do you think it would take for us to become less nice about requiring more of institutions? Do you have any thoughts as to how we might proceed down that path?

Joy Lawn (34:30.116)

Yeah.

Joy Lawn (34:38.32)

Well, I mean, we love to be nice, don't we? I mean, we should still be nice and we have to be a team together. I think we also need to put families at the front, both mothers and fathers, and their voice needs to be enabled so this isn't acceptable. We got a sustainable development goal for newborn survival globally.

Ben Courchia MD (34:41.79)

In 90 seconds or less please.

Joy Lawn (35:02.559)

probably because of US parents, because we learned from the HIV movement. So yeah, but we definitely need to also use the data. Shouldn't just be emotional. It's not just that it's a tragedy of 2.3 million deaths. Most of those are preventable. We have in our hands what to do and we need to be noisier about getting it.

Shelly-Ann Dakarai (35:29.037)

Thanks for that perspective. I did want to ask kind of piggybacking on what Ben had asked earlier about, talking about all that has to go into this toolkit. There's a lot that has to go into make it simple, like you explained. But one of the things I wanted to ask to hear your perspective again is, sometimes when we're working with many teams in just one institution, things can take a long time to make progress. But this toolkit really has

a plethora of collaborating organizations and individuals. So I'm curious as to if you have any words of advice or maybe can speak to how you guys were able to make such progress at scale and speed when having to include so many different organizations and hear from different organizations and different perspectives and different needs and kind of put all those things together. How?

How does one work with so many to then have a unified front moving forward and to be able to do it quickly and at scale?

Joy Lawn (36:38.399)

Maybe I'll try and answer quickly on the principle. The principle is to partner and not compete. So often people compete with each other. We really want this to be everybody's baby. We deliberately brought it out before it was perfect. It'll never be perfect. And we want people to input. We want to hear from you.

And then we have an expert advisory group, EAT, our joke to keep us happy in 2020, which come from all these different professional groups and so on. But of course, there are competing voices in that, and we also have quite a limited budget and opportunities. So I think it's also the reality of Kim Bozo and Lauren and others being out there.

I don't know, do you guys want to comment you're doing drop-in sessions and webinars and emails and competitions?

Lauren Allison (37:40.573)

Yeah, I think too, even just promoting what other people are doing well within the field in newborn health. So if there's things that we find that other groups are doing, so PMNCH actually released like a digital advocacy hub recently. And that's a great platform for, you know, connecting people within the field. So really elevating, I think, other people working in the newborn health space to kind of work collectively towards the same goal, I think, is crucial. And you only have so much funds and time to kind of work towards this goal.

So that's something we're really trying to do as well through the webinars, like sharing stories of different implementers working in different settings on topics and how those stories can kind of be amplified to different settings. So definitely sharing stories I think is one of the bigger ways we've been trying to speed up that progress.

Mbozu Sipalo (38:27.789)

And just to add on to Lauren, we're always looking for more people to partner with in the small and signal-borne care, low-middle-income context. So that's our main thing to highlight, again, what Joy mentioned, that it's all about working together so that we can move faster together. And so the No-Born Toolkit is that platform where we want to work together with organizations because the main goal is improving.

newborn care in middle-income countries and we need to work together for that. So yeah, that's just one of the main goals of the Newborn Toolkit to be this collaborative platform.

Gabriel (39:10.874)

I know we're getting close to an hour, but I'm so amazed about everything you built and so much dedication. And I'm wondering, you know, moving forward, there's so much we talk about the maternal health and the newborn health and how there's so much interlink between themselves. And so is there a hope or a plan to eventually even expand it further to try to optimize and be the advocate?

of these moms, of these mothers, of these pregnant individuals that need the support of the global community to eventually also lead to this improvement in neonatal outcomes. And so what are the next steps and is that something that's already part of the big plan to really start engaging with midwives on the ground, physician and nurses on the grounds for this whole maternal health aspect?

to the new needle and newborn outcomes.

Joy Lawn (40:10.739)

Thank you, Gabriel. And so important, the woman is not just an intervention for the baby, but we want her own rights and health. Just want to reflect that, you know, very important goals for maternal mortality reduction, neonatal mortality reduction, and also stillbirths that get lost. That on the maternal side, there's been about 40.

years of focus on this, you know, more focus needed, but there are actually a plethora of sites that have focused on this and, you know, many policy documents and a much longer history. So we don't want to compete with that. I think for the neonatal side, it's still newborn. So the concept for global newborn health is 20 years.

first Lancet series in 2005, you know, up until then was not really something that people were thinking about or acting on. And the concept for neonatal care, you know, the initial focus was doing very simple things at home. So the concept for hospital neonatal care is less than five years. It's only three years that countries have had targets for this. So with

wanting really to fill a gap. This was a gap on the how-to. And I think it's already quite complicated. We have one of the 10 core components is linkage to maternal care. And then I would reflect to that even if we were to do maternal care perfectly, which we would love to do, you are still going to have a lot of preterm babies. The preterm estimates which we published in

Joy Lawn (41:57.075)

So absolutely the maternal stuff needs to be done. And particularly intrapartum care for neonatal hypoxia would make a massive difference for stillbirths as well as neonatal deaths. But we are still going to have small and sick newborns and we still have a big survival gap. And this toolkit is really focused on that niche while linking.

Gabriel (42:23.77)

Very impressive. I think this is making a big difference. And I'm so amazed because, you know, we do our little road in our local environments. But my feeling is that the kind of work that you do and the kind of commitment that you bring is really changed the world of tomorrow for all these babies. So thank you for that.

Joy Lawn (42:47.879)

Well, I think everyone can be part of that. You know, 134 millions born over a year and they should all be able to get more of a chance.

Shelly-Ann Dakarai (42:59.777)

Well, we certainly have enjoyed having you guys here and learning a lot about the Newborn Toolkit. And as we wrap up, how can folks connect with the toolkit? Where should they go? And if they have suggestions or comments or just want to be more involved, how can they do so?

Mbozu Sipalo (43:19.821)

All right, so firstly, our website has a lovely submission link where you can reach out to us through the website itself that's related to any small and signal-borne care news or small and signal-borne care resources that you'd like added to the website. So the website itself is a platform that invites collaboration from everyone else. But also, you can reach out to us individually.

Through the link on the website, we can easily reach out to whoever is interested in inputting into the newborn toolkit. Also, we have a monthly newsletter where we highlight small and sick newborn care news globally. And that's a brilliant way to tap into the newborn toolkit activities and just small and sick newborn care news in general. And we invite people to also share their resources with us so that we can highlight it.

on the newsletter monthly to get it just become that one stop shop for small signal bond caring news for the low middle income context. Lauren can add on if I've missed anything but those are some of our big ticket items in terms of reaching out to the newborn to get.

Lauren Allison (44:40.049)

That's great. Thanks, Mbozu. I think also check out our webinars. So we have some scheduled for next year. So stay tuned. We'll be announcing those topics shortly. But again, if there's any topics that your listeners are interested in or hearing about, or if there's connections you can reach out to, we'd love to hear your thoughts on that as well.

Joy Lawn (45:00.987)

And also multi-channel, join on LinkedIn, whatever your favorite one is, LinkedIn. X, I can still barely bear to say that, but anyway. And also Facebook, Mbozu has led a Facebook page, which doesn't have that many on it. We'd love to have you guys join on that.

Mbozu Sipalo (45:11.437)

Hehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe

Shelly-Ann Dakarai (45:21.977)

Okay, great. Well, we'll certainly put a link to the website and any of your social media handles on the episode show notes for those who may be interested. So I don't know if Ben or Gabriel, if you guys have anything else to add or to ask while we wrap up.

Ben Courchia MD (45:40.194)

No, this was phenomenal and we're hoping that the launch of the global Neonatal podcast on the incubator channel is going to feature the team from the newborn toolkit more frequently and highlight some of the work that you guys are doing. So obviously stay tuned for more on that.

Gabriel (45:58.43)

Shelly Ann, Ben, thank you so much for inviting me. That was very enlightening. And thank you Joy Lauren and Mbozu for sharing all this with us and everyone listening. That's been really a wonderful and phenomenal time.

Shelly-Ann Dakarai (45:58.637)

Yes.

Shelly-Ann Dakarai (46:15.469)

All right, well, yes.

Joy Lawn (46:15.519)

Such a privilege. Thank you.

Lauren Allison (46:17.478)

Thank you.

Mbozu Sipalo (46:19.213)

Thank you so much. This has been very delightful and nice to just share ideas and get to speak with you guys as well.

Shelly-Ann Dakarai (46:27.555)

for you.

Joy Lawn (46:27.679)

We've got some absolutely fantastic heroes on the ground as well, if you would like some other people for the podcast. And trying to diversify, I've managed to get some of them on Lancet profiles. We all need to sing about these people more.

Shelly-Ann Dakarai (46:34.165)

Absolutely. Yes.

Ben Courchia MD (46:42.03)

We're going to speak off air in very shortly, Troy. Give us a second. Ha ha.

Lauren Allison (46:43.869)

I'm sorry.

Shelly-Ann Dakarai (46:44.169)

Yes. And give us that list. Yes, certainly. So, yes, thank you again for coming on and letting us learn more about the Newborn Toolkit. And thanks everyone for listening. And until next time, we will see you again. Bye.

Mbozu Sipalo (46:45.197)

Hehehehe