Abhay Bang  SEARCH, Gadchiroli Empowering people for  Saving Newborns and Children   SEARCH, Gadchiroli Inspiration, Integ...
 
India Bombay New Delhi Maharashtra Gadchiroli SEARCH, Gadchiroli
 
 
 
 
S E A R C H (Society for Education, Action and Research in Community Health)
 
SEARCH, Gadchiroli
 
SEARCH, Gadchiroli Laboratory of 86 villages  IMR (1988) : 121 /1000 LB
Why do children die ? Main causes SEARCH, Gadchiroli Neonatal  39% Pneumonia  20% Diarrhoea  19% Immunisable  Diseases 15%...
Before Treatment After  Treatment (1988-2003) Percent Deaths due to Pneumonia
SEARCH, Gadchiroli NMR 62 IMR : 80 The IMR in Gadchiroli ( 39 villages ) 1990
Newborns in India  27 million newborns are born each year 51 % born at home Even the hospital delivered mother and newborn...
 
SEARCH, Gadchiroli
SEARCH, Gadchiroli
<ul><li>Limitations of hospital care </li></ul><ul><li>Inaccessible </li></ul><ul><li>Costly </li></ul><ul><li>Parents unw...
Home-Based Newborn Care Goal :   To reduce neonatal mortality by developing a low-cost, home-based model of primary newbor...
Baseline IMR 76 and NMR 60 *
SEARCH, Gadchiroli
How to provide HBNC Mother  TBA CHW Supervisor Training + Supervision + supplies + incentives SEARCH, Gadchiroli
SEARCH, Gadchiroli
SEARCH, Gadchiroli
 
<ul><li>Health education for behavior change & care    seeking  </li></ul><ul><li>Attending home delivery : with TBA </li>...
SEARCH, Gadchiroli
SEARCH, Gadchiroli
SEARCH, Gadchiroli
SEARCH, Gadchiroli
SEARCH, Gadchiroli
<ul><li>Supervision: Every 15 days </li></ul><ul><ul><li>Is the work of CHW complete ? </li></ul></ul><ul><ul><li>Is the q...
SEARCH, Gadchiroli
Neonatal mortality rate (1993 to 2003) (intervention and control area) Baseline Training & visiting Interventions Full Int...
Effect of home-based newborn care on case fatality   (1995-96 Vs 1996-03)   % case fatality ** p < 0.005, * p < 0.07 SEARC...
The Infant Mortality Rate in Gadchiroli  (1988 – 2007) 39 intervention villages SEARCH, Gadchiroli 0 20 40 60 80 100 120 1...
SEARCH, Gadchiroli
* SEARCH, Gadchiroli
 
SEARCH, Gadchiroli
How to transfer HBNCC from Gadchiroli to India ? SEARCH, Gadchiroli
ANKUR Project  (2001-05)  SEARCH, Gadchiroli Supported by Save the Children, US
Selected study sites SEARCH  HQ ANKUR Project   Villages : 91 Slums  : 6 Total Population : 88, 311 Tribal Tribal Rural Ru...
ANKUR : NMR 51 % reduction SEARCH, Gadchiroli
A combined package for children 0-5 years age :  Home-Based Newborn  and Child Care (HBNCC) 1 month – 5 year Causes of  de...
SEARCH, Gadchiroli ANKUR Project  in  Mahatashtra HBNCC Replication sites  ICMR Study:  Government of India, five states. ...
<ul><li>11 th  Five Year Plan   </li></ul><ul><li>HBNCC Gadchiroli model to be the main strategy to reduce IMR in India. <...
Guidelines of Ministry of Health Govt. of India  (2010) ASHAs to provide HBNC
Educational Aids from SEARCH  CHW Training Manual Flip-Chart for Health Education of Mothers A Film for Health Education o...
Policy change in Ethiopia   <ul><li>Management of Pneumonia in children  </li></ul><ul><li>Home-Based Newborn Care </li></ul>
Global Policy Acceptance Joint statement by WHO, UNICEF, US-AID and Save the Children  ( 2009). Endorsement of home visiti...
“ Never doubt  that a small group of thoughtful, committed citizens can change the world.  Indeed, it is the only thing th...
EVERY ONE OF US HAS POTENTIAL TO CHANGE
What can we do? <ul><li>Make the Newborn Your Talisman  </li></ul><ul><li>Don’t provide only health care  </li></ul><ul><l...
SEARCH, Gadchiroli
 
<ul><li>Question  :   Does HBNC conflict </li></ul><ul><li>Majority home deliveries is a fact. </li></ul><ul><li>After hos...
How does HBNC fit with JSY ? SEARCH, Gadchiroli
JSY & HBNC are complementary SEARCH, Gadchiroli Antenatal Delivery Facility Home Post-natal JSY HBNC
HBNC is necessary to all neonates whether born in institution or at home. SEARCH, Gadchiroli
Does HBNC Affect Maternal Health? Mortality ? Morbidity ? SEARCH, Gadchiroli
SEARCH, Gadchiroli
Home-based Post partum  +   Neonatal care SEARCH, Gadchiroli
IMNCI Welcome addition of the ‘N’ to IMCI Training 8 days  NN care 4 days Does not include  - Asphyxia mgt at birth  - Sep...
Integrated HBMNCC HBNC + Maternal Care  + IMCI  Home-based Mother-Newborn- Child care + Referral of complicated cases. * S...
Mother-Newborn and Child Care  SEARCH, Gadchiroli Facility Based Newborn care Child Health (IMCI) ASHA + Training and supe...
Is it ethical ? <ul><li>First, advise referral </li></ul><ul><li>Does the ethical responsibility stop with advice? </li></...
Is it ethical ? <ul><li>Is it ethical to let the newborn die? </li></ul><ul><li>Is it ethical to give antibiotic as a life...
ASHA workbook ASHA progress book Story book on ASHAs
Feasibility of Home-based Sepsis Management (1996-2003) Parental acceptance Agreed to hospitalise   2.6 % Agreed to home-b...
We, the adults,  but are best protected by health care. are at the lowest risk of death, * * We reproduce, giving birth to...
Neonatal Sepsis  =  Pneumonia   (52% Deaths)     Meningitis   Septicemia   6 % to 10 % Neonates need treatment 2 Antibioti...
<ul><li>Payment to CHW </li></ul><ul><li>Time spent  : 1 hr 23 min. / day  </li></ul><ul><li>per 1000 popl.  </li></ul><ul...
Cost and cost-effectiveness of home-based neonatal care in Gadchiroli (2001-2003)  (1 US $=45 Indian Rs.) Non-recurring co...
The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, pleas...
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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

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Bang empowering

  1. 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
  3. 8. S E A R C H (Society for Education, Action and Research in Community Health)
  4. 10. SEARCH, Gadchiroli
  5. 12. SEARCH, Gadchiroli Laboratory of 86 villages IMR (1988) : 121 /1000 LB
  6. 13. Why do children die ? Main causes SEARCH, Gadchiroli Neonatal 39% Pneumonia 20% Diarrhoea 19% Immunisable Diseases 15% Malaria 7% Malnutrition
  7. 14. Before Treatment After Treatment (1988-2003) Percent Deaths due to Pneumonia
  8. 15. SEARCH, Gadchiroli NMR 62 IMR : 80 The IMR in Gadchiroli ( 39 villages ) 1990
  9. 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
  10. 18. SEARCH, Gadchiroli
  11. 19. SEARCH, Gadchiroli
  12. 20. <ul><li>Limitations of hospital care </li></ul><ul><li>Inaccessible </li></ul><ul><li>Costly </li></ul><ul><li>Parents unwilling </li></ul><ul><li>Not enough beds and neonatologists </li></ul>SEARCH, Gadchiroli
  13. 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
  14. 22. Baseline IMR 76 and NMR 60 *
  15. 23. SEARCH, Gadchiroli
  16. 24. How to provide HBNC Mother TBA CHW Supervisor Training + Supervision + supplies + incentives SEARCH, Gadchiroli
  17. 25. SEARCH, Gadchiroli
  18. 26. SEARCH, Gadchiroli
  19. 28. <ul><li>Health education for behavior change & care seeking </li></ul><ul><li>Attending home delivery : with TBA </li></ul><ul><li>Care of baby at birth </li></ul><ul><li>Home visits and support in newborn care </li></ul><ul><li>Monitor the newborns </li></ul><ul><li>Management of NB sicknesses </li></ul><ul><li>- Birth asphyxia </li></ul><ul><li>- LBW / Preterm </li></ul><ul><li>- Sepsis / Pneumonia </li></ul>Interventions SEARCH, Gadchiroli
  20. 29. SEARCH, Gadchiroli
  21. 30. SEARCH, Gadchiroli
  22. 31. SEARCH, Gadchiroli
  23. 32. SEARCH, Gadchiroli
  24. 33. SEARCH, Gadchiroli
  25. 34. <ul><li>Supervision: Every 15 days </li></ul><ul><ul><li>Is the work of CHW complete ? </li></ul></ul><ul><ul><li>Is the quality of work good ? </li></ul></ul><ul><ul><li>Are her skills up to the mark ? </li></ul></ul><ul><ul><li>Does she have the supplies ? </li></ul></ul><ul><ul><li>Are there any complications ? </li></ul></ul><ul><ul><li>Is the community satisfied & supportive ? </li></ul></ul><ul><ul><li>How much should she be paid ? </li></ul></ul>SEARCH, Gadchiroli
  26. 35. SEARCH, Gadchiroli
  27. 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
  28. 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
  29. 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
  30. 39. SEARCH, Gadchiroli
  31. 40. * SEARCH, Gadchiroli
  32. 42. SEARCH, Gadchiroli
  33. 43. How to transfer HBNCC from Gadchiroli to India ? SEARCH, Gadchiroli
  34. 44. ANKUR Project (2001-05) SEARCH, Gadchiroli Supported by Save the Children, US
  35. 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)
  36. 46. ANKUR : NMR 51 % reduction SEARCH, Gadchiroli
  37. 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
  38. 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
  39. 49. <ul><li>11 th Five Year Plan </li></ul><ul><li>HBNCC Gadchiroli model to be the main strategy to reduce IMR in India. </li></ul><ul><li>Introduce HBNCC in all districts with IMR > 45 </li></ul>SEARCH, Gadchiroli
  40. 50. Guidelines of Ministry of Health Govt. of India (2010) ASHAs to provide HBNC
  41. 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
  42. 52. Policy change in Ethiopia <ul><li>Management of Pneumonia in children </li></ul><ul><li>Home-Based Newborn Care </li></ul>
  43. 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.
  44. 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
  45. 55. EVERY ONE OF US HAS POTENTIAL TO CHANGE
  46. 56. What can we do? <ul><li>Make the Newborn Your Talisman </li></ul><ul><li>Don’t provide only health care </li></ul><ul><li>But, provide capacity to care for health </li></ul><ul><li>Empowerment of women is the most sustainable and best strategy </li></ul><ul><li>Don’t withhold distribution of medical knowledge and skills. </li></ul><ul><li>Introduce Home-Based Newborn and Child Care wherever you work. </li></ul>
  47. 57. SEARCH, Gadchiroli
  48. 59. <ul><li>Question : Does HBNC conflict </li></ul><ul><li>Majority home deliveries is a fact. </li></ul><ul><li>After hospital delivery most mothers </li></ul><ul><li>discharged on the 2 nd day. </li></ul><ul><li>Near complete absence of post-partum </li></ul><ul><li>care. </li></ul><ul><li>60 % maternal deaths occur in the PP period </li></ul>with Safe Motherhood? SEARCH, Gadchiroli
  49. 60. How does HBNC fit with JSY ? SEARCH, Gadchiroli
  50. 61. JSY & HBNC are complementary SEARCH, Gadchiroli Antenatal Delivery Facility Home Post-natal JSY HBNC
  51. 62. HBNC is necessary to all neonates whether born in institution or at home. SEARCH, Gadchiroli
  52. 63. Does HBNC Affect Maternal Health? Mortality ? Morbidity ? SEARCH, Gadchiroli
  53. 64. SEARCH, Gadchiroli
  54. 65. Home-based Post partum + Neonatal care SEARCH, Gadchiroli
  55. 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
  56. 67. Integrated HBMNCC HBNC + Maternal Care + IMCI Home-based Mother-Newborn- Child care + Referral of complicated cases. * SEARCH, Gadchiroli
  57. 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
  58. 69. Is it ethical ? <ul><li>First, advise referral </li></ul><ul><li>Does the ethical responsibility stop with advice? </li></ul><ul><li>What % actually go to hospital? </li></ul><ul><li>What happens if not treated ? </li></ul><ul><li>Case fatality 26 % </li></ul>SEARCH, Gadchiroli
  59. 70. Is it ethical ? <ul><li>Is it ethical to let the newborn die? </li></ul><ul><li>Is it ethical to give antibiotic as a life saving emergency measure? </li></ul><ul><li>Other situations </li></ul><ul><li> - Insulin for juvenile diabetic child </li></ul><ul><li> - Needles for drug addicts </li></ul><ul><li>- Cholera vaccine </li></ul>SEARCH, Gadchiroli
  60. 71. ASHA workbook ASHA progress book Story book on ASHAs
  61. 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
  62. 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 * *
  63. 74. Neonatal Sepsis = Pneumonia (52% Deaths) Meningitis Septicemia 6 % to 10 % Neonates need treatment 2 Antibiotics : Oral + Injectable SEARCH, Gadchiroli, India
  64. 75. <ul><li>Payment to CHW </li></ul><ul><li>Time spent : 1 hr 23 min. / day </li></ul><ul><li>per 1000 popl. </li></ul><ul><li>Performance linked payment </li></ul><ul><li>$ 4 Per mother-newborn </li></ul><ul><li>Average $ 10 month </li></ul>SEARCH, Gadchiroli
  65. 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
  66. 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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