HOME BASED NEWBORN CARE
(HBNC)
FOR IMPROVING
NEWBORN AND
INFANT SURVIVAL
NMR and IMR: India vs Other Developing Nations
0 20 40 60 80 100
1990 (NMR) 2015 (NMR) 1990 (IMR) 2015 (IMR) India
NMR / IMR
Sri Lanka Thailand The most vulnerable period of a newborn’s life is the
period during birth and the first week of life. The IMR (Infant Mortality Rate) and NMR (Neonatal Mortality Rate) in India compare unfavourably to other developing countries such as Sri Lanka and Thailand, as shown in the graph below
1. Newborn mortality is the major contributor (58%) to infant mortality and HBNC can be used to effectively decrease IMR.
The major causes of neonatal and infant deaths are infections (including sepsis, pneumonia, diarrhoea and tetanus), prematurity, and birth asphyxia
2Many of these are preventable if addressed in a timely manner.
THE NEED
NMR and IMR
India vs Other
Developing Nations
It is a package of interventions delivered by trained Community Health Workers (CHW) and it typically covers the following aspects:
Home Based Newborn Care (HBNC) is a programme designed to overcome the burden of newborn deaths in the first weeks of life, especially within communities where hospital care is unaffordable, unacceptable
or inaccessible
HOME BASED NEWBORN CARE
THE SOLUTION
HOME CARE FOR NEWBORN AND MOTHER
SICKNESS MANAGEMENT
HEALTH EDUCATION AND BEHAVIOURAL CHANGE
• Provision of essential newborn care to all newborns and the prevention of complications
• Initiation of breastfeeding
• Early detection and special care of pre- term and low birthweight newborns
• Early identification of illness in the newborn (especially acute respiratory infections, malaria and diarrhoea) and provision of appropriate care and referral
• Vaccination
• Support the family for adoption of healthy practices
• Build the confidence and skills of the
mother to safeguard her health as well
as the health of her child
RANKING INTERVENTION COST PER DAY SAVED ($)
1 Home-based neonatal care 7
2 Zinc fortification 14
3 Zinc supplementation to children 47
4 Case management of pneumonia in children 86
PROVIDES ACCESS TO UNDERSERVED POPULATIONS
A significant portion of the population does not have access to basic health facilities due to inadequate infrastructure, shortage of doctors and other medical personnel, lack of transport and poor quality of care. HBNC offers a more people-friendly solution at their doorsteps.
RESPONSIVE TO THE COMMUNITY’S NEEDS AND BELIEFS
HBNC promotes practices which are culturally familiar, thereby making it widely accepted.
HBNC trains women from within the community, thus encouraging community participation.
COST-EFFECTIVE
HBNC is one of the most cost-effective approaches to newborn health in comparison to other interventions as indicated in the table below
3:
Why is HBNC recommended?
Here are 6 reasons
EASILY REPLICABLE
Multiple facets of the HBNC programme have been adopted by the Indian Government as part of Accredited Social Health Activist (ASHA) modules 6 and 7. The HBNC programme has been successfully implemented in countries across Sub-Saharan Africa and South Asia.
EVIDENCE OF IMPACT
Several rigorous evaluations across the world have successfully used the HBNC approach to reduce NMR and IMR. Reductions in NMR have been in the range of 34% - 70%
EMPOWERS WOMEN
HBNC empowers and enhances the CHW’s status in the community by organising them through a profession that is accorded lot of respect in communities. Many of these women also become community champions and leaders, driving social change at grassroots.
“ HBNC is one
of the most
cost-effective
approaches
to newborn
health
The overall steps in implementing
HBNC are...
Implementing HBNC
Typical HBNC programs run for between 3 to 4 years, with a set-up time
of approximately 9-12 months.
Selection of Community
HBNC is best implemented in:
• Areas with high NMR (>20-25 per 1000 live births).
• Areas with a high percentage of home-deliveries.
Community Mapping
• Participatory exercises
• Demographics & socio- economic survey
• Mapping healthcare infrastructure
• Baseline survey
Identify NGOs
• Already working in healthcare
• Having strong connect with the community
• Having strong government linkage
Selection &
Training of CHWs
• Select from the community, with its buy-in
• Training conducted in the community
• Provision of basic kit and supplies
• Incentives
• Supervision
1
2
3
4
Monitoring &
Evaluation
M&E for HBNC should consist of a robust and comprehensive
monitoring system e.g.
Demographic Surveillance System (DSS) and an independent
validation of results
5
The framework below provides an indicative roadmap for companies to contribute either financially or non-financially
HOW CAN COMPANIES HELP?
TYPE OF COMPANY TYPE OF SUPPORT TYPE OF SUPPORT
A company with location- specific interest
Standardised, aligned to government guidelines
• Support and strengthen the local PHC to implement HBNC through CHWs
• Support emergency obstetric care facilities4
Customised, going beyond government
requirements
Replicate HBNC in their geographies with help of NGO partners
A company with specific core competency such as IT or media
industry
Catalytic
• Create tech-enabled MIS and auto-analysis systems for PHCs
• Create app-based training and M&E solutions for CHWs
• Design behaviour-change messages for the target group
• Run mass or social media campaigns
A company with a strategic interest in HBNC such as pharma or diagnostic
equipment
Non-financial Provide requisite medicines and / or equipment
4 While not strictly a part of HBNC, these emergency facilities are crucial in saving new born lives and also a critical gap in India.
COMPANY OTHER PARTNERS GEOGRAPHY PROJECT DESCRIPTION IMPACT
Tata Steel5
American India Foundation (AIF), Government of Jharkhand and SEARCH
Seraikela district in Jharkhand
MANSI was conceptualized to deliver preventive and therapeutic care for mothers and newborns both during and after pregnancy6 through community health workers called ‘Sahiyas’
• Neonatal mortality reduced by 32.7% since the initiation of MANSI in Seraikela.
• Infant mortality has reduced by 26.5%.
• The percentage of home deliveries in 2007 – 08 was 75.6%. It has reduced to 25.11%
• Institutional deliveries have increased by 50%
GSK India7
ARTH and CARE
High burden districts in
Rajasthan and Madhya
Pradesh
Build capacity of the ASHA workers, train the skilled birth attendants, generate awareness and ensure improved facility based and home based newborn care.
Estimated to save lives of over 6,000 newborns over the span of two years.
Daiichi- Sankyo8
Ranbaxy coordinating with the government and hospitals and providing support, and Ranbaxy Community Health Care Society executing and managing activities.
Dewas district in
Madhya Pradesh
Under this project, the mobile healthcare vans visit doctorless underserved villages to provide medical examinations and care for newborn babies and pre antal check-up for pregnant women. The local ASHA also provide instructions on the importance of breastfeeding and nutrition.
• About 96% deliveries were conducted at hospital9.
• 86% neonates had weight more than 2.5 kg.
• 65% mothers had the knowledge of umbilical cord care.
• Assessment of
hypothermia was known by 59% of mothers.
• The mother was the first person to detect the illness in 58% of babies.
