Innovation in reducing neonatal death using Chlorhexidine in Nepal- a case study

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Saving Lives at Birth a Grand Challenge for Development

• This is three year project to scale up use of Chlorhexidine at national level

• The project aim to reduce neo-natal death cased by infection by using Chlorhexidine immediate after cord cutting

• This in one of the innovation project under USAID health , science and technology.

1991 1996 2001 2006 2011 20150

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60

80

100

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160

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153

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6154

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10279

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4846

34

46 5039 33

3316*

Under five mortality rateInfant mortality rateNeonatal mortality rate

The Nepal Context- Child Mortality

Source: NDHS&NHSP*3

Marked decline in infant and child mortality

Less improvement with neonatal mortality and no change from 2006-2011

Se-vere in-

fec-tions42%

Injury

Birth As-

phyxia

Pre term/LBW

Congenital Anomaly

Other

3 – 4 children die every hour

63% of deliveries occur at home

Child birth considered an impure and dirty process

Expansion of community-based neonatal care program

Promote institutional delivery and Skilled Birth Attendant

Nepal Context – Policy

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Strategies to reduce neonatal mortality

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Nepal policy for CHX used

• Chlorhexidine will be applied to each newborn irrespective of facility and home birth.

• Nepal is using single dose resume immediate after cord cutting as a part of essential newborn care followed by clean and dry cord care practices.

• CHX is not stand alone program it is integral part of essential newborn care.

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Why Nepal Accepted Chlorhexidine Cord CareAddressing a problem with high population health burdenEfficacy

Low cost

Simplicity

Safety

Acceptability

Low regulatory requirements

Health system compatibility

Scalability

Commercial viability

2007• 1st consultative meeting in Nepal

2008-09

• Non-inferiority trial of CHX gel compared to aqueous

• Gel versus aqueous community acceptability study

2009-11• Pilot program in four districts

Nepal: A Living University for Chlorhexidine Cord Care

2009-11

• Coverage and compliance study• CHX international meeting at Banke,

Nepalgunj• Approval from MoHP for national level

scale up• Government of Nepal with strong support of

JSI and other partners working together to scale up at national level

Nepal: A living university for Chlorhexidine cord care

2012 Onwards

• Providing technical and product Supply to neighboring Asian and several African countries for doing formative work and preparing to pilot

• Providing a learning platform to many international visitors

• Providing technical support to other implementing partners

Nepal: A Living University for Chlorhexidine Cord Care

Completed and Active Districts: 41Planned: Entire Country (75 districts)

Impact

14Success through Integration

Chlorhexidine integration into

ongoing programs

Community-based programs

Health Facility Delivery

Skilled Birth Attendant Training

Misoprostol Program

Chlorhexidine integration into

ongoing programs

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Key to Program Success in Nepal

Benefit of conducting the first RCT in Nepal

Government leadership since inception of the program

Local manufacturer (Lomus Pharmaceutical) producing a good-quality product

Partners and professional organisation involvement since beginning to scaling up

Nepal – member of global Chlorhexidine working group

Supply of 7.1%w/v Chlorhexidine in Nepal

3 gram of 7.1% Chlorhexidine digluconate gel tube - Nepali brand name Kawach.

Pictorial instruction inside box.

Current price is Rs.18 ($0.23) for Government.

Supply is ensured through the government logistics supply system.

Job aid to counsel mother

Doll as a Interpersonal Communication Tool

Ensuring Sustainability

Chlorhexidine added in Essential Drug List of Nepal

Chlorhexidine cord care is a part of an essential newborn care

Government of Nepal included Chlorhexidine procurement in multi-year procurement plan

Included in routine health information system for recording and reporting

Thank you