1. The hidden problem of neonatal health 2. A home – based solution 3. Can it be replicated ? 4. New research studies.

Hidden Child Mortality in Maharashtra ( 1998 – 2000 )

WHAT REDUCED THE NMR? 1. HIGH COVERAGE AND QUALITY OF CARE. 2. CHANGE IN MOTHERS’ BELIEFS AND BEHAVIOURS. 3. REDUCED INCIDENCE OF MORBIDITIES. 4. REDUCED CASE FATALITY IN MAIN MORBIDITIES.

ANKUR PROJECT 2001 – 2005 SEARCH, Gadchiroli, India Supported by the SNL Initiative

AIM of The Project To develop and test the methods of expanding the HBNC approach from SEARCH to 7 selected NGOs in Maharashtra, as the initial step in demonstrating its generalisability for incorporating it into health policies and programmes on a broader scale.

ANKUR Project Study Design It is a multi-site intervention trial with before-after comparison.

Transfer of Motivation

A. Training package * Training of VHWs * Training of TBAs * Training of trainers/supervisors

Training without hospital : Community Class room Simulations Audio-Visuals / aids

Training evaluation in Ankur ( February 2003 ) 92 VHWs 14 trainer / supervisors

Conclusions : The training package, including the method of selection of VHWs, training strategy and training methods and material were highly effective and acceptable.

B. Health education material

Ankur Utsav Convocation of VHWs Certificates conferred by the Health secretary of India

Monitoring the interventions: Monthly MIS established 3 monthly review Corrective decisions Interventions started. What next?

Pregnant women who received health educations

Home deliveries attended by VHW

First Breast Feed % Neonates First breast feed

E. RESEARCH STUDIES 4 studies

2.Is HBNC accompanied by replacement mortality ? Did PNMR increase when NMR declined? 10 years experience in Gadchiroli.

YearLive BirthsNMRPNMR – % change Control area YearLive BirthsNMRPNMR – % change Intervention area

Conclusion: No replacement mortality occurred when the HBNC was accompanied by 1. Care of high risk infants in second month. 2. Case management of pneumonia in 1 to 59 months children.

4. Time inputs necessary for providing HBNC

Problem: How much workload will be added to a health worker’s current job if HBNC is added ? VHW Supervisor

Extrapolation to Government set-up ICDS worker (per village) Time spent on new/additional tasks in HBNC : 65.4 minutes per day Supervisory role: ANM (per 5000 population) Time spent on new/additional tasks in HBNC : 39 minutes per day

D. Main streaming Workshop of state health secretaries / directors ICMR Government of India – RCH - II