Postnatal Care Program Experience and Innovative Learning

Where it all began

PNC home visits can save newborn lives

Home-based PNC pilot: TBAs

Birth-preparedness package: FCHVs conducting home visits

PSBI management MINI project

CB-Postpartum care meeting Dhaka 2005• Most deliveries are at home &

most deaths are at home• Dearth of information on

effective integrated community-based postpartum care

• Immediate postpartum care that reaches into homes much needed

• Neither mothers nor providers appreciate the need for postpartum care

• Home visits: days 1, 3 and 7 (if possible)

• Promote breastfeeding, thermal care and hygiene, birth registration and vaccination

• Assess for danger signs and prompt medical care

• Identify and support newborns needing additional care (LBW, sick etc.)

https://www.who.int/maternal_child_adolescent/news_events/news/2009/09_07_08/en/

Bangladesh, Malawi, Nepal, Nigeria, Rwanda2012

• Enabling policy environment: strategies, implementation plans

• Development partners sharing and bearing bulk of implementation costs

• Challenging for CHWs to make household visits in most countries

• Early home visits – most difficult to achieve

• Quality of facility-based care increasingly important

http://www.healthynewbornnetwork.org/hnn-content/uploads/Postnatal-Care-Home-Visits-A-Review-of-the-Current-Status-of-Implementation-in-Five-countries-A.pdf

• First PNC contact within 24 hours of birth (home and facility)

• Timing of discharge from facility: 24 hours after birth

• Additional PNC contacts on days 3, 7-14 and 42

• Home visits for PNC: in the first week after birth

https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/

Postnatal home visitation: Lessons from country programs operating at scale 2016• Bangladesh, Ethiopia, Ghana, India, Indonesia, Malawi, Myanmar,

Nepal, Pakistan, Rwanda, Sri Lanka and Uganda

• Evidence of implementing at scale through government health service systems, maturity of implementation, availability of performance data and with diversity of models of implementation

• Experience in implementation were captured through document reviews, key informant interviews with policy makers, programmers and service providers

https://pubmed.ncbi.nlm.nih.gov/29977530/

Postnatal home visitation: Lessons from country programs operating at scale• Some countries responded to the Joint Statement by adopting the

schedule recommended

• Some others modified the recommended schedule

• Translating the JS from the policy level to the operations - a challenge

• Proportion of births happening in health facilities higher –opportunities for PNC

https://pubmed.ncbi.nlm.nih.gov/29977530/

Postnatal home visitation: Lessons from country programs operating at scale• Home deliveries with PNC within 48 hours of birth following home

birth <10%

• Country responses varied: some continued programming unchanged, some suspended attempts to provide PNHVs, and others modified their strategies for providing PNC

https://pubmed.ncbi.nlm.nih.gov/29977530/

Postnatal home visitation: Lessons from country programs operating at scale• Feasibility of implementation in the real world is key

• Context and local feasibility need to be considered when determining whether and how to use a strategy like PNHVs

https://pubmed.ncbi.nlm.nih.gov/29977530/

An innovative trial in Nuapada district, Odisha state of India

• Risk stratification to increase pre- and post-discharge PNC for mothers and their newborns

• Establishment of linkage between facility and family using text messages for CHWs and families

• Inputs:• improvement of pre-discharge postnatal care and

counseling

• pre-discharge screening

• mobile application linking facility to CHWs

• Improvement in content of home-based PNC

• monitoring and documentation

Odisha

Results: pre-discharge PNC

Results: pre-discharge PNC

Results: post-discharge PNC

Learning from the Nuapada risk-stratification pilot• Risk stratification helped to increase the attention to postnatal

mothers and newborns

• Linkages between facility and community providers go a big way in improving care for mothers and newborns at home

• Implementation research / feasibility testing designed pilots ensure system ownership and more likely of being taken up for scale

• Technology use is feasible in low resource settings and can help with communications and build linkages between facility, community and homes of postnatal mothers and newborns

Why do we need to focus on postnatal care?

Source: Countdown to 2030, Report 2017

Why the need to focus on postnatal care?

• Common platform for several RMNCAH interventions: postpartum family planning, maternal nutrition, breastfeeding, care of adolescent mothers and fathers, maternal mental health and wellbeing, early childhood development

• Equity and gender empowerment

• Mortality reduction

So what is needed?

• Demand creation: awareness of the critical importance of the postnatal period to improve survival and to ensure mothers and babies thrive

• Value of PNC: quality of care at facilities and linkages between care providers at all levels

• Human resources: facility and community levels – aware, motivated, skilled and supported

• Supplies and commodities: at facility and with community providers• Metrics: routine and survey data and use • Policies and contextualized strategies: national and sub-national

government ownership and context specific PNC home visits • Integration within services along the continuum of care and within reliable

and functioning health systems

https://pubmed.ncbi.nlm.nih.gov/29977530/

Thank you!