Can ENCC materials be used for pre-service and in-service health workers?

Yes , use the ENCC at a Glance guide for designing the course suited to your participants, and for facilitating trained and experience d participants or students with no newborn experience.

The materials can be used for face-to-face sessions or self-paced leaning.

How does ENCC fit with EENC (Early Essential Newborn Care)?

WHO WPRO EENC focuses on care given to a baby during delivery and the first days after birth, and use the clinical coaching approach to practice skills and improve quality of care, while ENCC focuses on the entire newborn period, and integrates demonstrations and practice , videos, simulations and clinical practices, accompanied by other activities. ENCC has incorporated EENC algorithms in EENC Clinical Practice Pocket Guide as job aids, as important references. Countries using EENC may choose to use sections of modules or specific modules to go into some subjects in more depth such as communication and respectful care or kangaroo mother care .

How does ENCC fit with the new Essential Childbirth Course (ECBC) from WHO?

The ENCC is part of the WHO Midwifery toolkit. The ECBC has a module on immediate newborn care and the ENCC is linked. The technical advisory groups and teams have worked very closely together to ensure compatibility and seamless transition between the two courses.

Can ENCC materials be used in humanitarian settings? What modifications are needed?

Yes. Prioritize gaps in health worker competencies and interventions that will save lives, reduce disabilities and promote healthy growth and development. Prioritize demonstrations and practice , simulations, clinical practice, counselling and safe referral. Ensure safety of participants and facilitators and no disruption of services . Review and share relevant videos in preparation and for review after educational updates. Essential newborn care is the same for newborns born in humanitarian settings. Adapt practical content if clean delivery kits are used , or if newborns delivery beds are not used (eg delivered on the ground).

Can the ENCC be used for community health workers (CHW)?

For each and every cadre that you will train in ENCC, review their roles and responsibilities and their scope of practice as defined by your Ministry of Health. If a CHW supports breastfeeding for example, then cover the breastfeeding modules. Conversely if a cadre is not allowed to carry out an intervention such as placing a nasogastric tube, then do not cover it. Map and review expected competencies of each and every cadre providing essential newborn care in your country.

What are the key differences between ENC 1 and HBB 2^nd Edition?

An overview of key updates to the ENC 1 Action Plan compared to the HBB 2^nd Edition Action plan are below, and click here to access a more comprehensive Summary of Changes document.

Grey Zone:

• Graphic includes addition of a birth companion and healthcare provider – highlights that this course has a family-centered focus and acknowledges the important role of the provider;
• Equipment list graphic moved to the top of the Action Plan – emphasizes the importance of being prepared for birth.

Green Zone

• Addition of “breathing well” to harmonize with WHO recommendations;
• Addition of “Give mother uterotonic” – acknowledges that often a single provider is taking care of mother and baby;
• Addition of “Continue skin-to-skin care” and “Help initiate breastfeeding” – the Green Zone now encompasses the full hour after birth.

Yellow Zone (The Golden Minute)

• Assessment of crying and breathing – addition of “breathing well” to harmonize with WHO recommendations;
• “Keep warm, Stimulate, Clear airway if needed” – deliberately moved “clear airway” to last position to remind providers that suctioning is only needed in certain circumstances;
• "Call for help” – moved to yellow zone to help ensure support arrives sooner;
• “Clamp and cut cord, Ventilate” – adjusted the order of these actions to align with WHO guidelines.

Cross-cutting Themes

• Addition of “Record and use data,” “Provide respectful care,” and “Prevent infection” on left side of the Action Plan – call attention to essential activities that health care providers must think about during every action step;
• Link graphics added to action steps involving the mother – these highlight the companion maternal care courses.

What are the key differences between ENC 2 and ECEB/ECSB?

An overview of key updates to the ENC 2 Action Plan compared to the ECEB and ECSB Action plans are below, and click here to access a more comprehensive Summary of Changes document.

Grey Zone

• Graphic includes addition of birth companion and healthcare provider – highlights this course has a family-centered focus and acknowledges the important role of the provider;
• Risk factors are included with assessment findings to classify and make a plan of care;
• Vitamin K dosage guidance is 1mg – simplified, no longer weight dependent;
• Recognition of Danger Signs can occur at any time after birth;
• Action Plan begins at 60 minutes after birth – ENC 1 covers first hour.

Green Zone (Routine)

• Routine care eligibility criteria include weight, temperature, feeding behavior, assessment findings, and risk factors;
• Reassess for discharge emphasizes use of discharge criteria;
• Advise about home care emphasizes making links to follow-up care in the home and community.

Yellow Zone (Intermediate)

• Treat risk of infection highlights that a stable baby with risk for infection can be treated with antibiotics without separation from mother;
• Reassess emphasizes repeated cycles of assessment during the facility stay to adjust the treatment plan;
• Discharge based on assessment criteria;
• Strengthened family preparation for discharge and links to follow-up care in the community are essential after immediate care.

Red Zone (Advanced)

• Antibiotic administration is linked with core Danger Signs to avoid over-use;
• Temperature changed to >38.0 rather than >37.5 as a Danger Sign to better correlate with risk of infection.

Cross-cutting Themes

• ECEB + ECSB steps combined into one course and Action Plan;
• Addition of “Record and use data,” “Provide respectful care,” and “Prevent infection” on left side of Action Plan – call attention to essential activities that healthcare providers must think about during every action step;
• Link graphics added to action steps involving the mother – these highlight the companion maternal care courses.

What if facilities and skilled personnel are available for more advanced resuscitation than what is taught in ENCC?

How does the ENCC algorithm fit with the Neonatal Resuscitation Program (NRP) or Neonatal Life Support (NLS) program?

For advanced resuscitation, follow up-to-date National guidelines. Advanced resuscitation will be included in WHO Small or Sick Newborn Care Course training materials, which are currently under development. WHO Neonatal resuscitation guidelines will be reviewed and updated in 2023-4.

How can skills and performance be maintained?

Learners are encouraged to practice with their peers. Skills corners should be made available for staff and students including those working weekends and night shifts. A compilation of additional simulations can be found in the course materials for maintaining and developing skills and performance.

Are the videos translated into other languages?

The Global Health Media videos are already available in a large number of languages. Check the Global Health Media Project site https://globalhealthmedia.org/videos/. If the video you require is not available, ask for permission and follow the recommended process (see ENCC Plan, Adapt and Facilitate Guide)

Many videos can have subtitles in several languages.

How can print files and specifications for the materials be obtained so that materials can be printed locally for a face-to-face training?

All the ENCC materials can be downloaded from the WHO website and can be flexibly reviewed and used using smartphones, tablets, and laptops.

Print specifications are provided on the resources page.

Is there a certification process for ENCC?

Countries and organizations running ENCC courses will be responsible for ensuring quality and fidelity of the courses supported. There are pre- and post- tests and assessments that can be used for both participants and facilitators and to decide if they need further support to reach defined standards of performance. Ministries of Health should decide any certification process.

What is ENC Now! ?

ENC Now! is a digital training program for remote facilitation of the WHO Essential Newborn Care course ENC1 and 2, It is designed to provide creative solutions for supporting healthcare workers and maintaining educational continuity when meeting face-to-face is difficult. To provide immediate access to education, the American Academy of Pediatrics (AAP) and Laerdal Global Health (LGH) joined together to develop a digital solution for training and changing practices of healthcare workers who care for mothers and newborn babies – Essential Newborn Care (ENC) Now! Please visit the ENC Now! page

Are there outcome measures that are recommended to use in quality improvement activities and program evaluation?

WHO and partners have been working closely to develop indicators to measure coverage, quality of care and outcomes.

WHO has also updating a set of indicators using health facility data. Check the Analysis and use of health facility data: guidance for RMNCAH programme managers document for the details of indicators. These indicators can be used for ENCC quality improvement sessions.

Please give us feedback

We value your feedback to improve the materials through periodic review and updating. Send any feedback to mncah@who.int with ENCC 2nd edition in the subject line.