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Bang empowering

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Inspiration, Integration and Impact Empowering people for Saving Newborns and Children. - Abhay Bang, SEARCH, Gadchiroli

Inspiration, Integration and Impact Empowering people for Saving Newborns and Children. - Abhay Bang, SEARCH, Gadchiroli

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  • 1. Abhay Bang SEARCH, Gadchiroli Empowering people for Saving Newborns and Children SEARCH, Gadchiroli Inspiration, Integration and Impact
  • 2.  
  • 3. India Bombay New Delhi Maharashtra Gadchiroli SEARCH, Gadchiroli
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8. S E A R C H (Society for Education, Action and Research in Community Health)
  • 9.  
  • 10. SEARCH, Gadchiroli
  • 11.  
  • 12. SEARCH, Gadchiroli Laboratory of 86 villages IMR (1988) : 121 /1000 LB
  • 13. Why do children die ? Main causes SEARCH, Gadchiroli Neonatal 39% Pneumonia 20% Diarrhoea 19% Immunisable Diseases 15% Malaria 7% Malnutrition
  • 14. Before Treatment After Treatment (1988-2003) Percent Deaths due to Pneumonia
  • 15. SEARCH, Gadchiroli NMR 62 IMR : 80 The IMR in Gadchiroli ( 39 villages ) 1990
  • 16. Newborns in India 27 million newborns are born each year 51 % born at home Even the hospital delivered mother and newborns are sent home < 24 hr. Newborn health care must visit where the neonates are. * SEARCH, Gadchiroli
  • 17.  
  • 18. SEARCH, Gadchiroli
  • 19. SEARCH, Gadchiroli
  • 20.
    • Limitations of hospital care
    • Inaccessible
    • Costly
    • Parents unwilling
    • Not enough beds and neonatologists
    SEARCH, Gadchiroli
  • 21. Home-Based Newborn Care Goal : To reduce neonatal mortality by developing a low-cost, home-based model of primary newborn care by using the human potential in villages. SEARCH, Gadchiroli
  • 22. Baseline IMR 76 and NMR 60 *
  • 23. SEARCH, Gadchiroli
  • 24. How to provide HBNC Mother TBA CHW Supervisor Training + Supervision + supplies + incentives SEARCH, Gadchiroli
  • 25. SEARCH, Gadchiroli
  • 26. SEARCH, Gadchiroli
  • 27.  
  • 28.
    • Health education for behavior change & care seeking
    • Attending home delivery : with TBA
    • Care of baby at birth
    • Home visits and support in newborn care
    • Monitor the newborns
    • Management of NB sicknesses
    • - Birth asphyxia
    • - LBW / Preterm
    • - Sepsis / Pneumonia
    Interventions SEARCH, Gadchiroli
  • 29. SEARCH, Gadchiroli
  • 30. SEARCH, Gadchiroli
  • 31. SEARCH, Gadchiroli
  • 32. SEARCH, Gadchiroli
  • 33. SEARCH, Gadchiroli
  • 34.
    • Supervision: Every 15 days
      • Is the work of CHW complete ?
      • Is the quality of work good ?
      • Are her skills up to the mark ?
      • Does she have the supplies ?
      • Are there any complications ?
      • Is the community satisfied & supportive ?
      • How much should she be paid ?
    SEARCH, Gadchiroli
  • 35. SEARCH, Gadchiroli
  • 36. Neonatal mortality rate (1993 to 2003) (intervention and control area) Baseline Training & visiting Interventions Full Interventions Continuation of care Neonatal mortality rate 70 % reeducation in the NMR SEARCH, Gadchiroli
  • 37. Effect of home-based newborn care on case fatality (1995-96 Vs 1996-03) % case fatality ** p < 0.005, * p < 0.07 SEARCH, Gadchiroli
  • 38. The Infant Mortality Rate in Gadchiroli (1988 – 2007) 39 intervention villages SEARCH, Gadchiroli 0 20 40 60 80 100 120 140 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003-2007 Infant Mortality Rate Pneumonia case management Home-based newborn care Year Linear regression trend in IMR
  • 39. SEARCH, Gadchiroli
  • 40. * SEARCH, Gadchiroli
  • 41.  
  • 42. SEARCH, Gadchiroli
  • 43. How to transfer HBNCC from Gadchiroli to India ? SEARCH, Gadchiroli
  • 44. ANKUR Project (2001-05) SEARCH, Gadchiroli Supported by Save the Children, US
  • 45. Selected study sites SEARCH HQ ANKUR Project Villages : 91 Slums : 6 Total Population : 88, 311 Tribal Tribal Rural Rural Rural U.Slum Rural Nashik Osmanabad Sangli Yawatmal Nagpur Gadchiroli SEARCH, Gadchiroli (2001-05)
  • 46. ANKUR : NMR 51 % reduction SEARCH, Gadchiroli
  • 47. A combined package for children 0-5 years age : Home-Based Newborn and Child Care (HBNCC) 1 month – 5 year Causes of death IMCI + HBNC = HBNCC SEARCH, Gadchiroli
  • 48. SEARCH, Gadchiroli ANKUR Project in Mahatashtra HBNCC Replication sites ICMR Study: Government of India, five states. Other NGOs Africa Other Countries Total 49 Sites SEARCH, Gadchiroli Other States 4 countries
  • 49.
    • 11 th Five Year Plan
    • HBNCC Gadchiroli model to be the main strategy to reduce IMR in India.
    • Introduce HBNCC in all districts with IMR > 45
    SEARCH, Gadchiroli
  • 50. Guidelines of Ministry of Health Govt. of India (2010) ASHAs to provide HBNC
  • 51. Educational Aids from SEARCH CHW Training Manual Flip-Chart for Health Education of Mothers A Film for Health Education of Mothers SEARCH, Gadchiroli Dialogue with Mother Home Based Newborn Care
  • 52. Policy change in Ethiopia
    • Management of Pneumonia in children
    • Home-Based Newborn Care
  • 53. Global Policy Acceptance Joint statement by WHO, UNICEF, US-AID and Save the Children ( 2009). Endorsement of home visiting the neonates and management of sick neonates at home by trained worker if the referral is not possible.
  • 54. “ Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Margaret Mead
  • 55. EVERY ONE OF US HAS POTENTIAL TO CHANGE
  • 56. What can we do?
    • Make the Newborn Your Talisman
    • Don’t provide only health care
    • But, provide capacity to care for health
    • Empowerment of women is the most sustainable and best strategy
    • Don’t withhold distribution of medical knowledge and skills.
    • Introduce Home-Based Newborn and Child Care wherever you work.
  • 57. SEARCH, Gadchiroli
  • 58.  
  • 59.
    • Question : Does HBNC conflict
    • Majority home deliveries is a fact.
    • After hospital delivery most mothers
    • discharged on the 2 nd day.
    • Near complete absence of post-partum
    • care.
    • 60 % maternal deaths occur in the PP period
    with Safe Motherhood? SEARCH, Gadchiroli
  • 60. How does HBNC fit with JSY ? SEARCH, Gadchiroli
  • 61. JSY & HBNC are complementary SEARCH, Gadchiroli Antenatal Delivery Facility Home Post-natal JSY HBNC
  • 62. HBNC is necessary to all neonates whether born in institution or at home. SEARCH, Gadchiroli
  • 63. Does HBNC Affect Maternal Health? Mortality ? Morbidity ? SEARCH, Gadchiroli
  • 64. SEARCH, Gadchiroli
  • 65. Home-based Post partum + Neonatal care SEARCH, Gadchiroli
  • 66. IMNCI Welcome addition of the ‘N’ to IMCI Training 8 days NN care 4 days Does not include - Asphyxia mgt at birth - Sepsis mgt with 2 antibiotics i.e. nearly 60 % deaths - Expected effect small. SEARCH, Gadchiroli
  • 67. Integrated HBMNCC HBNC + Maternal Care + IMCI Home-based Mother-Newborn- Child care + Referral of complicated cases. * SEARCH, Gadchiroli
  • 68. Mother-Newborn and Child Care SEARCH, Gadchiroli Facility Based Newborn care Child Health (IMCI) ASHA + Training and supervision + Health System Antenatal Delivery Facility Home Post-natal JSY HBNC
  • 69. Is it ethical ?
    • First, advise referral
    • Does the ethical responsibility stop with advice?
    • What % actually go to hospital?
    • What happens if not treated ?
    • Case fatality 26 %
    SEARCH, Gadchiroli
  • 70. Is it ethical ?
    • Is it ethical to let the newborn die?
    • Is it ethical to give antibiotic as a life saving emergency measure?
    • Other situations
    • - Insulin for juvenile diabetic child
    • - Needles for drug addicts
    • - Cholera vaccine
    SEARCH, Gadchiroli
  • 71. ASHA workbook ASHA progress book Story book on ASHAs
  • 72. Feasibility of Home-based Sepsis Management (1996-2003) Parental acceptance Agreed to hospitalise 2.6 % Agreed to home-based treatment 91.1 % Refused both 6.3 % Proportion of total neonates in community treated by VHWs for sepsis 8.9 % SEARCH, Gadchiroli
  • 73. We, the adults, but are best protected by health care. are at the lowest risk of death, * * We reproduce, giving birth to the most vulnerable human beings – the neonates, * In a just society, * we should all be hanged ! * and then let them die – 1 million in India, 3.6 million globally, every year * *
  • 74. Neonatal Sepsis = Pneumonia (52% Deaths) Meningitis Septicemia 6 % to 10 % Neonates need treatment 2 Antibiotics : Oral + Injectable SEARCH, Gadchiroli, India
  • 75.
    • Payment to CHW
    • Time spent : 1 hr 23 min. / day
    • per 1000 popl.
    • Performance linked payment
    • $ 4 Per mother-newborn
    • Average $ 10 month
    SEARCH, Gadchiroli
  • 76. Cost and cost-effectiveness of home-based neonatal care in Gadchiroli (2001-2003) (1 US $=45 Indian Rs.) Non-recurring costs (2002-03 prices ) US $ Annual recurring costs US $ Cost per village Training : 89 Equipments : 66 Total : 155 118 Cost per mother–newborn served 7 Cost per death averted 151 Cost per DALY saved 7
  • 77. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports

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