The Nepal Community-Based Newborn Care Package (CB-NCP) Dr. Ashish K.C. SNL Nepal Program Manager: Save the Children's Saving Newborn Lives (SNL) Program, September 1, 2010
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 Death per 1000 118 125 91 100 79 64 64 75 NFHS1996 52 50 NDHS2001 39 50 NDHS2006 33 25 0 Neonatal Infant Mortality Under Five Mortality Mortality
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 100 9 6 8 5 90 7 8 80 70 60 5 3 4 8 4 4 50 4 3 3 5 40 2 4 30 2 5 1 9 20 10 2 0 h n e e n g r n g n a g e r t o t o n r n o e n a a r h o i i i h i i i t i r c t b d t d t k b o a a o a e e e e l w t r z t m z c a e e n e a r i i e a t n f f n n e s a t o n u i a u t t m n D n e s t s l m a o m e a a a e r e f d t a v t e m m r e l o n p c n e e r a r A i p i b r b t r e c n a p s a s u t i t y e e u l c e n a s a e l v m n r l o t l s v a a i A d a a s e m a i e E n t t t u g a e n p e u l t l n l M i a s c e T i e m k n o t c x n s S a a P E a P o M t r i P t V n o C
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 Clean delivery, hygienic cord care, thermal care, breastfeeding, identification of LBW babies, recognition and management of sick newborns and appropriate care-seeking 2. Institutional delivery and/or delivery by a Skilled Birth Attendant
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 Health facility level training FCHV activity Village Development Committee orientation Mother's group meeting Female Community Community Health Worker training Health Volunteer
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
Comparison of validation study with Baseline – Newborn Treatment - Findings show encouraging trends for care-seeking and management Indicator Baseline Study Validation Study 22.0% 31.1% Child had any danger sign 86.9% 94.1% Child seen by health provider 1.7% 37.4% Given Cotrim from any provider* NA 32.8% Given Gentamycin from any provider* Sick child taken to FCHV first* 0.0% 14.6% NA 77.8% Received Cotrim from FCHV NA 40.7% Referred by FCHV, given Gentamycin *- 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
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