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Innovation to Institutionalization Newborn Care in India (2001-2010) CARE-India’s experiences Mukesh Kumar Program Director, CARE India.

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Presentation on theme: "Innovation to Institutionalization Newborn Care in India (2001-2010) CARE-India’s experiences Mukesh Kumar Program Director, CARE India."— Presentation transcript:

1 Innovation to Institutionalization Newborn Care in India (2001-2010) CARE-India’s experiences Mukesh Kumar Program Director, CARE India

2 Objective Integration of key-family practices for prevention and timely management of neo-natal and childhood illnesses into existing national programs Appropriate and accessible care and information about prevention and management of neonatal and childhood illnesses from community-based service providers Better partnership between health facilities and the communities

3 Rational for the objective Per 1,000 Source: DHS- 3 Early Childhood Mortality Rates India Chhattisgarh

4 INHP Timeline in global context Baseline Survey Jan 2001 Endline Survey, Feb 2006 2001 2006 Lancet, CS, 2003 Lancet, Neonatal Survival, 2005 NRHM launch, 2005 Newborn Evaluation Study (1 district, UP) Early Learning phase Apr 02 200120022003200420052006 Institutionalization phase 2007-2010 ESD Project

5 I I nnovation D D ocumentation E E xternal marketing A A dvocacy SScale-up & Institutionalize Framework for Innovation to institutionalization IDEAS

6 Early learning Sites ( 150 Villages across eight states) Demonstration sites- Approx. 10,000 villages

7 Key Interventions Promoted Tetanus Toxoid along with basic ANC for mothers. Essential home-based newborn care:  Clean delivery, cord care, handling  Adequate thermal care (warmth)  Early and exclusive breastfeeding Early recognition of and extra care for the weak (premature/LBW) newborn. Recognition and referral of sick newborn

8 Scale up phase Project universe = 95,000 AWC, 747 blocks, 78 districts, 9 states, 100 m + population

9 Modifications – Did pilot test the intervention package with the help of ICDS and RCH functionaries in ‘early learning sites’. – Referral of sick and weak neonates were promoted only if there were health facilities

10 Program Approaches to Promote NBC Home visits and advice by AWW, ANM, Volunteers with emphasis on: Late pregnancy, first day, first week Family, not just the mother Immediate care at birth Recognition of preterm / LBW at birth, marked for extra care Home visit planner for AWW and close supervision Supplemented by varied BCC and community-based monitoring efforts

11 What did CARE do? Facilitation and catalysis: – Capacity building: ICDS, RCH, volunteers, community bodies – System strengthening: functional convergence, Supportive supervision (ICDS) – Behavior Change Communication Advocacy: – Prioritizing neonatal care – Measuring and Monitoring

12 Progress made

13 Composite neonatal care indicator increased across most states Baseline-Endline (2001-06 ), home deliveries last 6 months Table 3.1 Denominators: BL ~ 105-170 EL ~ 330-550

14 Factors that possibly influenced change

15 Those who reported receiving home visits also provided better care (composite indicator) Endline (2006), Mothers of children 0-5 months old) Table 3.2

16 Those who reported receiving advice also reported practice more often (early breastfeeding) Endline (2006), Mothers of children 0-5 months old) Table 3.2

17 Women were visited at home during the last trimester more often over time RAPs (2003, 04, 05), home delivered 0-5 month children Figure 3.16 Denominators: Round 1: ~ 90-130 Round 2,3: ~ 250-400

18 More families were visited at home on the day of childbirth RAPs (2003, 04, 05), home delivered 0-5 month children Figure 3.17, 3.18 Denominators: Round 1: ~ 90-130 Endline: ~170-550

19 Institutional birth did not affect most indicators of basic newborn care Endline (2006), children 0-5 months old Figure 3.14

20 Institutionalization phase (2007-2010) ESD project started in Chhattisgarh to institutionalize best practices through IMNCI program of Govt. of India Total Districts: 16 Blocks : 168 AWCs :33000 Chhattishgarh

21 Activities Capacity Building of ICDS state, district and project level program leaders was done through ongoing forums and structured CB events. Different communication materials (leaflets/booklets /modules) developed and distributed in close collaboration with state resource center, department of women and child development. Communication Campaign organized through multi-media channels & structured home contacts by AWW / ANM / Volunteers. Mainstreaming C-IMNCI & HTSP into ICDS / RCH program at district & state level through PIP development process and Kuposan Mukti Abhiyan (state sponsored malnutrition eradication drive)

22 Institutionalization – Incorporating C-IMNCI components into the training modules for Supervisors and Outreach workers jointly developed with SRC. – Undertook training of key ICDS functionaries in collaboration with W & CD – Incorporated the key messages into website developed for the department – District level advocacy efforts undertaken for discussion of key components during ongoing forums

23 Challenges – Programming in civil unrest areas – Varied capacities of outreach workers – Competing priorities of health department – Engagement of AWWs / ICDS block functionaries time for back to back training

24 Lessons What does this imply?

25 1. Current programs can deliver The changes were brought about by ICDS and RCH staff Change was brought about in “difficult” states and districts Efforts were multi-dimensional: all other services continued What worked was probably: – Focus on effective interventions – Strengthening accountability mechanisms – internal, external

26 2. Can ICDS continue to contribute to neonatal care? It can, and must: – ICDS has a mandate for addressing mortality – Basic neonatal care is simple – AWW is available to the community – AWW has greater credibility than ASHA – AWW is backed by a mature, well-defined support structure – AWW has proven she can deliver

27 3. Let us do what is doable More aggressive interventions have yet to be shown to be scalable Basic care must be scaled up until more effective ones are available Much needs to be done, and time is slipping by….


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