1. Looking for fire while carrying a lamp? Evaluating the CB-NCP program implemented by CARE Nepal from 2007 to 2011

2. SES Village location Ethnicity and Caste Access to services KAP of danger signs Birth preparedness Parity Place of birth Health facility equipment Community commitment Maternal nutrition Infection Continuum of care Quality services Skilled birth attendance Cord care practices Delivery complications Preterm birth Low birth weight Asphyxia Sepsis Hypothermia Neonatal Mortality Determinants in the Causal Pathway of Neonatal Mortality Key: SDIP program CB-NCP program

3. Evaluating the CB-NCP program 1.Is there evidence that home-based care is needed? 2.Is there evidence that the program achieved intermediate results? 3.Was there an impact on neonatal mortality?

4. Is there evidence that home-based care is needed? 2008-2011 BirthsPlace of Death N (%) Place of BirthHomeHealth facilityOtherTotal Home172 (91.5)4 (2.1)12 (6.4)188 (81.0) Health facility20 (62.5)9 (28.1)3 (9.4)32 (13.8) Other5 (41.7)1 8.3)6 (50.0)12 (5.2) Total197 (84.9)14 (6.0)21 (9.1) 232* (100) Overall, 85% of neonatal deaths occurred in the home Use of health facilities increased from 16% in 2008 to 37% in 2011 Source: POSS and HMIS

5. Intermediate Results: Access and Quality of Services

6. Intermediate Results: Improved Knowledge of Health Workers Source: independent survey during midterm evaluation

7. Intermediate Results: Improved Knowledge of mothers

8. Impact on Neonatal Mortality

9. Reductions in Sepsis, Hypothermia, and Asphyxia

10. Timing of neonatal deaths

11. Influence of Place of Birth

12. Knowledge on Asphyxia Treatment

13. Evaluating the CB-NCP Program 1.Is there evidence that home-based care is needed? YES 2.Is there evidence that the program achieved intermediate results? YES 3.Was there an impact on neonatal mortality? YES

14. Conclusions How CB-NCP compares with SDIP: “SDIP did result in more women giving birth in the health facility, but did not result in a greater decrease in neonatal mortality”(3) NDHS 2011 showed no real change in neonatal mortality since SDIP (implemented beginning 2005) All of this suggests that CB-NCP works at least as well as SDIP at reducing neonatal mortality. There is a need for cost-benefit or cost- effectiveness analysis to ensure resources are used in the most effective way.

15. References 1)Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. (2011). Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 24;378(9797):1139-65. 2)UN Inter-agency Group on Child Mortality Estimation. (2011). Levels and Trends in Child Mortality, Report 2011. http://www.childinfo.org/files/Child_Mortality_Report_2011.pdfhttp://www.childinfo.org/files/Child_Mortality_Report_2011.pdf 3)Powell-Jackson T, Neupane BD, Tiwari S, Tumbahangphe K, Manandhar D, Costello AM. (2009). The impact of Nepal's national incentive programme to promote safe delivery in the district of Makwanpur. Advances in health economics and health services research. 21:221-249.Powell-Jackson TNeupane BDTiwari STumbahangphe KManandhar DCostello AM