Implementation of Enc

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THE EFFECTIVENESS OF THE IMPLEMENTATION OF ESSENTIAL NEWBORN CARE PROGRAM OF DEPARTMENT OF HEALTH IN EDUARDO L. JOSON
MEMORIAL HOSPITAL,
CABANATUAN CITY

CHAPTER I
THE PROBLEM AND ITS SETTING

INTRODUCTION
Neonatal stage is one of the most crucial stage for growth and development of an individual. In this stage of life, intensive care should be given to promote health of the newborn. From the time newborns are exposed to the outside environment, essential and utmost care must be rendered immediately to these delicate individuals. Evidence-based practices and care given will ensure and promote to the survival of the newborn. Approximately, there are four million global neonatal deaths occurring annually. Based on the statistics, Philippines is one of the 42 countries that account for the 90% of under-five mortality worldwide. 82,000 Filipino children under five years old die every year. 37% of them are newborn. Majority of them (3/4) die within the first two days of life, mostly due to stressful events or conditions during labor, delivery and immediate postpartum period. The current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country. Thus the need for a paradigm shifts from the prevailing standard procedures into the new protocol. (http://instantmami.blogspot.com/2010/04/doh-unang-yakap-campaign.html)

According to Duque (2009) childhood death rates in the country showed a downtrend from 1993 to 2003. The decline has slowed down in the last 10 years noted that under-five mortality rate decreased to only 32 per 1,000 live births in 2003—from 52 per 1,000 live births in 1988. Infant-mortality and child-death rates have also exhibited a similar trend over the same period.

The Department of Health (2009) launched the Essential Newborn Care program or the Unang Yakap Campaign under Administrative Order 2009-0025. This campaign aims to cut down infant mortality in the Philippines by at least half. The campaign employs Essential Newborn Care (ENC) Protocol as a strategy to improve the health of the newborn through interventions before conception, during pregnancy, at and soon after birth, and in the postnatal period. The Essential Newborn Care Protocol provides an evidence-based, low cost, low technology package of interventions that will save thousands of lives.

Former Health Secretary Francisco Duque III said that, "with the new protocol, the DOH expects a sharp cut in infant deaths to remove the Philippines from the list of 42 countries that account for 90 percent of global deaths among children below five years old." He also explained that the ENC Protocol focus on the first hours of life of the newborn The guidelines categorize procedures into time-bound, non time-bound and unnecessary procedures: Time bound procedures should be routinely performed first - immediate drying, skin-to-skin contact followed by clamping of the cord after one to three minutes, non-separation of the newborn from the mother and breastfeeding initiation.

Non time-bound intervention should only be done after the first full breastfeed. These are immunizations, eye care, Vitamin K administration and weighing. Washing must be postponed by at least 6 hours. The so-called unnecessary procedures include routine suctioning, routine separation of newborns for observations, administration of prelacteals like glucose, water formula and foot printing.

We’re launching this protocol in collaboration with the World Health Organization to help solve this newborn-mortality problem because if it is not reduced by at least half, the goal of reducing childhood mortality by two-thirds by 2015 will not be met,” he said Duque also noted that 50 percent of all neonatal and post neonatal deaths occur during the first two days of life, mainly caused by birth asphyxia (31...
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