PROD Reference number: 195                 

Reform option

Home Based Newborn Care, SEARCH, Gadchiroli, Maharashtra



Subject area

Community participation.
  

Objective

Home based newborn care to reduce newborn mortality and morbidity.
 
Summary
Background:
Gadchiroli district in Maharashtra state, tribal in nature, is very poor both educationally and economically. Female literacy rate in 1991 in the Gadchiroli was 28.9% as compared to 52.3% in Maharashtra. Although Government health services exists in the district following the pattern for tribal region, they suffer from various problems such as staff absenteeism, poor motivation of the staff and poor supervision of the workers. In a study based on prospectively observed 763 mothers and neonates in 39 villages of Gadchiroli during 1995-96, it was observed that health service delivery in the region was so poor that in the area where around 54% of the neonates needed medical attention, only 2.6% were able to receive medical attention and 0.4% were managed to get hospitalised.

Actions:
Society for Education, Action and Research in Community Health (SEARCH) was founded in 1986 as a non-governmental organisation. Based on baseline observational data, tools for Home Based Neonatal Care (HBNC) were developed. The services are provided through the Community Health worker (CHW) who is a local resident woman of the community, has strong willingness to work in the area and is able to read and write. Women with 5 to ten years of schooling are preferred. The tools for HBNC include:

1)Community sensitisations: Through health education of mothers and grand mothers, sensitisation about care of the newborn was generated by the Community Health Worker (CHW) called Arogyadoot and Trained Birth Attendant (TBA). Health education was conducted in following manner:·
Group Health education through audio visual and group games·
To individual mothers, by home visits- twice during pregnancy and once on the second day after delivery.
To mothers of high-risk neonates.

2) Listing of the pregnant women: CHW regularly makes home visits and maintains updated list of the eligible women (women who can become pregnant) in the community for future follow up. Through bimonthly visits she identifies the pregnant women and registers them.

3) Immediate charge of the newborn baby: Newborn babies are taken under care by the CHW in collaboration with TBA. (Please see the reference section for detail: Intervention in the home based management of the new borne).

CHWs are well trained in identifying birth asphyxia and high-risk babies (premature and low birth weight and babies with breast feeding problems) and their management at home. Through various experimental studies a simple and validated method of screening of neonates at high risk was devised by SEARCH for these field level workers. CHW and TBA are also trained in various health education messages like promotion of the exclusive breast feeding, maintenance of hygiene and care of the neonate to prevent death due to sepsis.
(Please see the reference section for detail: Intervention for the home based management of the neonatal sepsis and diagnosis and management of asphyxia by Village Health Worker).

For immunisation services CHWs refer the women to nearby PHC. Otherwise there is no formal links with government health facilities and patients are referred there as per need.

4) Field supervision: Twice in a month by a doctor or a nurse. The supervisor visits each CHW twice a month and ensures that he visits the neonate at least once during the neonatal period.

Results:
Aceivements are reflected in various indicators:
(1)Low Birth Weight : 4.9 percent in 1996-03 as compared to 11.3percent in 1995-96.
(2)Pre term Babies: decreased to 10.1 percent in 1996-03 from 33.3percent in 1995-96
(3)Sepsis: Reduced to 6.9percent in 1996-03 from 18.5 percent in 1995-96.
(4)Asphyxia : reduced to 20.2percent in 1996-03 from 38.5 percent in 1995-96
(5)Neonatal mortality rate: 70 percent reduction in 2001-2003 as compared to control area.
(6)Infant Mortality rate: 57 percent reduction in 2001-03 as compared to control area
 
Cost The training costs per CHW is INR 5368 Equipment and CHW kit cost is INR 3936 Recurring cost per village INR 7040 as in 2001-2003.
Place Gadchiroli district, Maharashtra.
Time to set up One year (1995-96).
Advantages Community mobilization: Awareness among community is raised and are mobilized to take care of pregnant women and new born baby.

Propoor: Home based care with the help of community health workers is pro poor strategy where cost and trained man power is a constraint.

Culturally sensitive: Home based care promotes those practices, which are culturally acceptable and traditionally sound.

Home based care: Raising the capacity of the mothers to look after her new born baby and provision of immediate care to the babies who have no access to medical care through doctors or institutional facilities.

Timely care: Early identification of the highrisk new born babies and timely care.
Challenges Selection and training of the CHWs: Identifying a women worker who can minimally read and write and can learn basic skill to handle the new born immediately after delivery is a difficult process where female illiteracy is very high.

Provision of supportive supervision: With limited staff field level supportive supervision to the CHWs is a tricky task.

Process intensive intervention: Basic interventions need to learn right from diagnosing the sick babies to applying various basic care.

Sustaining motivation of workers: To maintain the continuation of work by community health worker it is important to keep up the motivation level of CHW.
Prerequisites Familiarity with the community.
Who needs to
be consulted		 Local communities.Local TBAs.
PROD links   *
Sustainability Scheme is self sustainable technically because of the fact that services are delivered by the identified local resident and she is given training to identify the high risk neonates and manage them at home. However supervision and financial support are needed.
Chances of Replication The strategy has been devised through various field-based trials. It has already been proved replicable through NGOs (ANKUR project for replication of HBNC over a population of 88,000 in 7 sites(Rural, Tribal and Urban slum) through 7 different NGOs. It has been accepted as one of the components of duties of ASHA under the National rural Health Mission of India.
Comments In States where resources are scares and new born babies are dying due to ignorance, illiteracy of the mother and non availability of the basic care at the time of birth and medical care due to non accessibility of institutional facilities - Home based newbornl care through trained community worker is the alternative.
References
Links to Images
* HBNC-Asphyxia.jpg

* HBNC-sepsis.jpg

* HBNC-Health edu.jpg

Links to Documents
* Interventions in the home based management of new borne-AB-anu.doc

* Interventions for Home Based managt of neonatal sepsis-AB-anu.doc

* Diagnosis and management of Asphyxia by the VHW-AB-anu.doc

Further material available on request

Click here to request the item(s) below through email/ post

Low Birth Weight and Preterm Neonates: Can they be managed at home by mother and a trained village health worker? Journal of perinatology, Vol 25 Supplementary 1 March 2005, page S72-S81.

Neonates in Gadchiroli: Field trial of home based neonatal care in rural India (i993-2003). Journal of perinatology, Vol 25 Supplementary 1 March 2005.

Home Based maternal and neonatal care, SEARCH Gadchiroli, India.

Contact for further information Dr. Abhay Bhang
Director,
Society for Education, Action and Research in Community Health (SEARCH)
Shodh Gram,
PO & District Gadchiroli,
Maharashtra
PIN: 442605.
E mail: search@satyam.net.in
Tel: 07138-255407
Fax: 07132-233403
Submitted by: Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, New Delhi, Oct 2006.
    

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