Dr. Ashish K.C. SNL Nepal Program Manager: Save the Children's Saving - - PowerPoint PPT Presentation

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 Nepal Child Mortality in Nepal

50 79 118 39 64 91 33 52 64 25 50 75 100 125 Neonatal Mortality Infant Mortality Under Five Mortality NFHS1996 NDHS2001 NDHS2006

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

4 8 4 4 7 8 1 9 3 5 2 4 2 5 3 8 5 9 6 4 3 2 5

10 20 30 40 50 60 70 80 90 100

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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 Newborn
• 4. Extra community-based care for low birth weight babies
• 5. Extra community-based care for hypothermic babies
• 6. Community-based care of newborn sepsis
• 7. 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 elem ents

• 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 activity

District Planning Meeting Community Health Worker training Health facility level training Female Community Health Volunteer Village Development Committee orientation Mother'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

Thank you