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

3. Hidden Child Mortality in Maharashtra ( 1998 – 2000 )

28. 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.

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

36. 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.

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

39. Transfer of Motivation

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

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

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

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

44. B. Health education material

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

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

48. Pregnant women who received health educations

49. Home deliveries attended by VHW

50. First Breast Feed % Neonates First breast feed

51. E. RESEARCH STUDIES 4 studies

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

53. YearLive BirthsNMRPNMR 1991 - 96547660.822.6 1996 – 01494160.716.8 % change- - 0.2-25.7 Control area YearLive BirthsNMRPNMR 1991 - 96502958.516.7 1996 – 01427329.312.4 % change- -49.9-25.3 Intervention area

54. 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.

55. 4. Time inputs necessary for providing HBNC

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

57. 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

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