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

Thank you