Dr. Ashish K.C. - healthynewbornnetwork.org Presentation...... Core Interventions 1. Effective...
Transcript of Dr. Ashish K.C. - healthynewbornnetwork.org Presentation...... Core Interventions 1. Effective...
The Nepal Community-Based Newborn Care Package (CB-NCP)
SNL Nepal Program Manager: Save the Children's Saving Newborn Lives (SNL) Program, September 1, 2010
Dr. Ashish K.C.
Table of content
• Background to newborn health status
• Community Based Newborn Care Package
• Design of Community Based Newborn Care Package
Program
• Preliminary results of CB-NCP program
• Integration of Newborn Program into Safe motherhood
and Child health programs
Child Mortality in NepalChild Mortality in Nepal
50
79
118
39
64
91
33
5264
0
25
50
75
100
125
NeonatalMortality
Infant Mortality Under FiveMortality
NFHS1996NDHS2001NDHS2006
Death per 1000
Direct causes of neonatal deaths (Hospital and community based data)
Infection
Birth asphyxia/trauma
Pre-maturity/ LBW
Hypothermia
Coverage of maternal, newborn and child health interventions
48 44
78
19
35
24
2
53
8596
43
25
0102030405060708090
100
Contra
ceptiv
e prev
alance
rate
Antena
tal ca
re
Tetanus
immun
izatio
n
Skilled
atten
dant a
t birt
h
Early b
reast
feeding
Postna
tal ca
re to m
other
Postna
tal ca
re to new
born
Exclusiv
e brea
st fee
ding
Measle
s immun
izatio
n
Vitamin A
supple
mentat
ion
Manag
emen
t of D
iarro
hea
Pneumonia
care
seek
ing
Policy in place for newborn health
• National safe motherhood and Neonatal Long Term Plan-2006-2017• National Neonatal Health Strategy-2004• Nepal Health Sector Plan-2011-2015
Rationale for Community Based-Newborn Care Package
• Reaching mothers and newborns EARLY is critical to reducing mortality
• Mothers need to be identified when they become pregnant and followed-up through delivery and the neonatal period
• Community-based strategies for improving home care practices will be more effective
Program Design
• CB-NCP is a program designed to deliver a set of newborn care interventions (package) within health service system and integrate the best practices into maternal and child health policies and programs for scale up.
Program Objective• To prevent and manage newborn infection• To prevent and manage hypothermia & LBW babies• To manage post delivery asphyxia• To develop an effective system of referral of sick newborns
CB-NCP – Core Interventions
1. Effective newborn care practices in the home at the time of delivery and in the newborn period
2. Institutional delivery and/or delivery by a Skilled Birth Attendant
Clean delivery, hygienic cord care, thermal care, breastfeeding, identification of LBW babies, recognition and management of
sick newborns and appropriate care-seeking
CB-NCP – Core interventions
3. Postnatal home visit to Newborn4. Extra community-based care for low birth weight babies5. Extra community-based care for hypothermic babies6. Community-based care of newborn sepsis7. Community-based care of asphyxia
CB-NCP – Development of the Approach• Collaboration between Ministry of Health and Population,
partner organizations and district staff• Essential package of evidence-based newborn
interventions defined by a technical working group – 2007• Development of materials and guidelines - 2008• Selection of 10 early implementation districts
CB-NCP – Main elements
• Community-based surveillance to identify pregnant women, births and newborn deaths
• Home visits by trained Female Community Health Volunteer (FCHV) to provide essential newborn care, to recognize and treat sick newborns and to ensure referral when necessary
• Care and referral of sick newborns by Community Health Workers• Health education for mothers and caretakers – using counseling, MG
meetings and other channels• Community-based monitoring and use of data for planning
CB-NCP implementation activityDistrict Planning Meeting
Community Health Worker training
Health facility level training
Female Community Health Volunteer
Village Development Committee orientationMother's group meeting
FCHV activity
Comparison with Baseline –
Newborn Services with the validation study-
Results show improvements from baseline for newborns reached by FCHVs
Indicator Baseline Study Validation Study
Delivered at health facility 31.5% 66.3%FCHV present at home delivery 15.5% 27.7%CDK used at home delivery 33.9% 52.7%Skin-to-skin contact at birth* 15.6% 71.4%Breastfed within 1 hour of birth* 68.8% 87.5%Weighed within 3 days (home births) <1% 89.4%PNC visit from FCHV within 3 days** 3.3% 46.2%*Data represent home births in which FCHV was present; **Refers to PNC checks after discharge/initial attendant left
- Findings show encouraging trends for care-seeking and management
Comparison of validation study with Baseline – Newborn Treatment
Indicator Baseline Study Validation Study
Child had any danger sign 22.0% 31.1%Child seen by health provider 86.9% 94.1%Given Cotrim from any provider* 1.7% 37.4%Given Gentamycin from any provider* NA 32.8%Sick child taken to FCHV first* 0.0% 14.6%Received Cotrim from FCHV NA 77.8%Referred by FCHV, given Gentamycin NA 40.7%*- Denominator is among those who sought care
Impression from Mid-term review of CB-NCP
- Overall, monitoring data from FCHVs appear quite reliable for most indicators
- Monitoring and verification data suggest positive trends for newborns reached by FCHV
- Tracking and achieving high coverage of registration of pregnant women and births is vital to CB-NCP success!!
Next Steps for Community Based Newborn Care Package- Scaling up
• Gradual scale up of CB-NCP through out the country by 2014 with quality implementation to sustain the high coverage of intervention
Next Steps for Community Based Newborn Care Package- Integration into existing safe motherhood and IMCI program
• Integration at the service delivery mode• Integration at the training of health workers and volunteers• Integration at monitoring and supervision of safe motherhood, newborn
and IMCI program