The document describes about the History, trends and programs to improves the neonatal health of nepal. It will helps to know and understand the current programs and what was done before for the health of neonates and childrens in nepal. Mostly used for Public health, Nursing and Medical students. The document is developed on 2023 so, the policies and programs after 2023 was not encorporated in this document.
Maternal Health in Nepal _Saroj Rimal.pptxsarojrimal7
This document summarizes a presentation on maternal health in Nepal. It begins with background information on maternal health and maternal mortality globally and in Nepal. It then discusses Nepal's status and trends in maternal health indicators like the maternal mortality ratio over time. It also covers Nepal's obstetric transition stage, the evolution of maternal health policies, current programs and strategies to promote skilled birth attendance and institutional deliveries. Issues and challenges in achieving lower maternal and neonatal mortality rates are also presented.
The National Neonatal Strategy aims to improve newborn health and survival in Nepal. It was developed based on a situation analysis and expert recommendations. The goals are to increase adoption of healthy newborn care practices and strengthen neonatal health services at all levels. Key interventions include developing policies and guidelines, behavior change communication, strengthening service delivery through training health workers and improving facilities, better program management, and conducting operational research. The strategy provides an evidence-based framework to guide stakeholders in improving neonatal outcomes in Nepal.
The document outlines Nepal's Safe Motherhood Programme which aims to reduce maternal and neonatal morbidity and mortality through various strategies and activities. The major strategies include promoting birth preparedness, expanding 24-hour birthing facilities, and emergency obstetric care services. Key activities involve community-level maternal and newborn interventions, expanding service delivery sites, emergency referral funds, and programs to provide free delivery services and newborn supplies. The goals are to address delays in seeking and receiving care and improve access to institutional deliveries and emergency obstetric services.
Nepal legalized abortion in 2002 and further expanded access through its 2018 law. The law allows abortion up to 12 weeks with consent, up to 28 weeks in cases of rape/incest or health risks, and the government aims to make safe abortion services widely available. However, challenges remain due to stigma and some sex-selective abortions. National policies focus on training health workers and expanding comprehensive abortion care, including counseling, at health facilities across the country.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
The document summarizes Nepal's family planning program. The main objectives are to improve health outcomes for mothers and children by increasing access to quality family planning services, especially for rural and marginalized groups. Key activities include providing various contraceptive methods through both institutions and mobile clinics. While contraceptive use and access have increased over time, challenges remain such as high unmet need and an overreliance on emergency contraception and abortion. Recommendations focus on strengthening access to long-acting reversible contraceptives and services for adolescents.
Fulll chapter of national diarroheal control programme in nepalMonikaRijal1
National diarroheal control programme in nepal , presented and prepared this information was taken on 2076/77 and will be valid untill the next update of NDHS comes out, this is useful for bachleor level, community Health Nursing
Maternal Health in Nepal _Saroj Rimal.pptxsarojrimal7
This document summarizes a presentation on maternal health in Nepal. It begins with background information on maternal health and maternal mortality globally and in Nepal. It then discusses Nepal's status and trends in maternal health indicators like the maternal mortality ratio over time. It also covers Nepal's obstetric transition stage, the evolution of maternal health policies, current programs and strategies to promote skilled birth attendance and institutional deliveries. Issues and challenges in achieving lower maternal and neonatal mortality rates are also presented.
The National Neonatal Strategy aims to improve newborn health and survival in Nepal. It was developed based on a situation analysis and expert recommendations. The goals are to increase adoption of healthy newborn care practices and strengthen neonatal health services at all levels. Key interventions include developing policies and guidelines, behavior change communication, strengthening service delivery through training health workers and improving facilities, better program management, and conducting operational research. The strategy provides an evidence-based framework to guide stakeholders in improving neonatal outcomes in Nepal.
The document outlines Nepal's Safe Motherhood Programme which aims to reduce maternal and neonatal morbidity and mortality through various strategies and activities. The major strategies include promoting birth preparedness, expanding 24-hour birthing facilities, and emergency obstetric care services. Key activities involve community-level maternal and newborn interventions, expanding service delivery sites, emergency referral funds, and programs to provide free delivery services and newborn supplies. The goals are to address delays in seeking and receiving care and improve access to institutional deliveries and emergency obstetric services.
Nepal legalized abortion in 2002 and further expanded access through its 2018 law. The law allows abortion up to 12 weeks with consent, up to 28 weeks in cases of rape/incest or health risks, and the government aims to make safe abortion services widely available. However, challenges remain due to stigma and some sex-selective abortions. National policies focus on training health workers and expanding comprehensive abortion care, including counseling, at health facilities across the country.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
The document summarizes Nepal's family planning program. The main objectives are to improve health outcomes for mothers and children by increasing access to quality family planning services, especially for rural and marginalized groups. Key activities include providing various contraceptive methods through both institutions and mobile clinics. While contraceptive use and access have increased over time, challenges remain such as high unmet need and an overreliance on emergency contraception and abortion. Recommendations focus on strengthening access to long-acting reversible contraceptives and services for adolescents.
Fulll chapter of national diarroheal control programme in nepalMonikaRijal1
National diarroheal control programme in nepal , presented and prepared this information was taken on 2076/77 and will be valid untill the next update of NDHS comes out, this is useful for bachleor level, community Health Nursing
The document summarizes Nepal's Community Based Integrated Management of Newborn Care (Neonatal care) and Childhood Illness (CB-IMNCI) program. The key points are:
[1] CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing major causes of illness in newborns and children, and improving access to health services.
[2] It integrates newborn care programs with childhood illness management. Major interventions include birth preparedness, essential newborn care, treatment of neonatal sepsis, and management of childhood illnesses like pneumonia and diarrhea.
[3] The goal is to achieve targets for reducing under-5 and
This document outlines Nepal's National Neonatal Health Strategy. It begins with background on the high neonatal mortality rate in Nepal, with approximately 2/3 of infant deaths occurring in the first month of life. The strategy is based on a situation analysis and position papers. It aims to improve newborn health and survival through strategic interventions in policies, behavior change communication, health service delivery, program management, and research. Priority policy actions include establishing a neonatal health group and focal point. Behavior change communication will promote essential newborn care practices. Health services will be strengthened by improving skilled birth attendance and newborn care training.
This slide contains information regarding Maternal and Child Health Program. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
This document discusses adolescent reproductive and sexual health (ARSH) in India. It notes that adolescents aged 10-19 make up 22% of India's population and face increased health risks like anemia, early marriage, teenage pregnancy, and STIs/HIV. The ARSH strategy aims to reduce teenage pregnancies and meet contraceptive needs through health services, capacity building, and communication activities. It also discusses establishing linkages between ARSH and HIV programs to address shared challenges and risks factors cost-effectively. The strategies proposed to promote adolescent health include adopting healthy lifestyles, organizing youth-friendly clinics, providing life skills training, counseling, and empowering adolescents.
Unit 3.7 health sector stratigies 2004 agenda for reformchetraj pandit
This document outlines Nepal's health sector strategy from 2004. It draws on several key government health documents from 1991-2001. The strategy aims to reduce poverty and achieve Millennium Development Goals by focusing on essential health services for the poor, including safe motherhood, child health, and communicable disease control. It seeks to [1] ensure the poor have access to essential health care, [2] give local bodies responsibility for managing health facilities, and [3] recognize the roles of private and nonprofit sectors in service delivery. Sector management outputs include [1] coordinated planning and financing within the Ministry of Health, [2] sustainable health financing schemes, [3] effective management of assets and supplies, [4]
Brief Overview of Management of Safe Motherhood and Newborn Health Services i...Mohammad Aslam Shaiekh
The document provides an overview of the management of safe motherhood and newborn health services in Nepal. It discusses the goals and strategies of the Safe Motherhood and Newborn Health Program, which aims to reduce maternal and neonatal mortality through preventative activities and addressing delays in seeking and receiving care. Major activities outlined include birth preparedness, rural ultrasound programs, reproductive health services, expanding health facilities, training health workers, and demand-side financing incentives for institutional deliveries. It also reviews the program's status, management perspectives using the POSDCORB framework, and identifies issues such as high maternal mortality and the need to establish effective referral mechanisms.
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
Neonatal period is a very crucial period for child’s survival as there is always highest risk of infections and deaths during first week and month of birth. The power-point describes about essential newborn care services, danger signs, Status of newborn in global and national level, key monitoring indicators, issues, challenges and recommendations and the need of investments in newborn health for betterment.
The document discusses the Mother and Child Tracking System (MCTS) in India. MCTS aims to leverage information technology to ensure delivery of healthcare services to pregnant women and children under 5. It identifies beneficiaries and registers them to receive services. Data on pregnancies, deliveries, immunizations is collected digitally to monitor outcomes and refer at-risk cases. MCTS benefits include improved access to services for beneficiaries, better monitoring and planning for healthcare workers, and analytical reporting for states and national level review of program progress. Current implementation status shows nationwide coverage with graphical representation of data collected on beneficiaries.
The document discusses India's RMNCH+A (Reproductive, Maternal, Newborn, Child Health + Adolescence) strategy. It outlines the history and evolution of family welfare programs in India. The current goals are to reduce infant mortality, maternal mortality, and total fertility rate by 2017. The strategy focuses on providing a continuum of care through various levels of the health system across different life stages. Key interventions include reproductive health services, antenatal care, skilled birth attendance, postnatal care, and improving health systems and monitoring. The strategy aims to strengthen primary healthcare and community participation to improve maternal and child health outcomes across India.
The document discusses family planning and reproductive health in Nepal. It provides background on family planning, objectives and policies, targets, and major activities in FY 2075/76. Key achievements include modern contraceptive prevalence reaching 39% nationally, with the highest in Province 2 at 46%. New acceptors of spacing methods increased over the previous year, with the highest number in Province 5. The total fertility rate target is to reduce to 2.1 births per woman by 2030.
- India has a large population that impacts both its own and global health indicators. It launched its National Family Planning Programme in 1952 with goals of population stabilization.
- The current family planning programme in India provides a wide range of temporary and permanent contraceptive methods at various health facilities through trained personnel with a focus on increasing access and reducing gaps in knowledge and use.
- National initiatives like Family Planning 2020 aim to expand voluntary family planning services and coverage to meet targets by strengthening existing strategies and addressing socio-cultural barriers.
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus. The procedure is done by a licensed health care professional. The decision to end a pregnancy is very personal
The Reproductive and Child Health (RCH) program was launched in India in 1997 with the goal of reducing infant and maternal mortality rates and achieving population stabilization. RCH Phase I focused on promoting maternal and child health through interventions like family planning, maternal care, child survival, and prevention of diseases. RCH Phase II, launched in 2005, expanded the goals and components of the program. It aimed to further reduce infant and maternal mortality as well as increase immunization coverage, especially in rural areas through strategies like strengthening health infrastructure and focusing on high-priority states. The components of RCH Phase II included population stabilization, maternal health, newborn and child health, adolescent health, and control of diseases. Monitoring and evaluation was emphasized
The National Nutrition Policy of Nepal from 2004 aims to improve nutrition nationwide by reducing malnutrition rates. The key objectives are reducing protein-energy malnutrition, anemia, iodine deficiency, vitamin A deficiency, and intestinal worm infestation among children and women. The policy outlines strategies like community participation, advocacy, research, and multi-sector coordination to achieve its overall goal of ensuring nutritional well-being for all Nepalis. While programs have scaled up infant and young child feeding, coverage of interventions remains low and nutrition surveys need to be conducted more routinely. Strengthening food security and fully implementing breastfeeding recommendations could help address remaining weaknesses in Nepal's efforts to improve public health through nutrition.
Unit 3.2 national safe motherhood policy 1998chetraj pandit
The 1998 Safe Motherhood Policy in Nepal aimed to reduce maternal mortality and morbidity. Its objectives were to increase access, availability, and utilization of maternal health services; strengthen the capacity of maternal healthcare providers; strengthen referral services for maternity care; raise public awareness of maternal health and safe motherhood; and improve the legal and socioeconomic status of women. The strategies included promoting inter-sectoral collaboration, strengthening and expanding delivery services by skilled birth attendants and emergency obstetric care at all levels, supporting activities to raise the status of women, and promoting research on safe motherhood.
The document outlines core indicators for monitoring child health in three areas: child status, service access, and service quality. It provides the definition, measure, data source, and collection period for each indicator. For example, one indicator listed is child poverty rate, defined as the proportion of children living in households with income or assets below a certain level. This and other indicators can be used to monitor progress towards goals like reducing child mortality and improving nutrition. The document establishes a framework for tracking key health and development metrics in children.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
The document provides an overview of policies, programs and implementation strategies related to newborn care in Nepal. It discusses Nepal's historical programs for newborn and child health from 1983 to the current Community Based Integrated Management of Newborn Care and Childhood Illness (CB-IMNCI) program launched in 2014. The CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing illnesses and increasing access to services. It also outlines trends that show improvements in newborn health indicators like institutional delivery rates and policies like free newborn care services but challenges remain in quality, resources and scale-up.
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
This document outlines the RMNCH+A program in India, which aims to improve reproductive, maternal, newborn, child, and adolescent health. It discusses the historical background of maternal and child health programs in India. The key aspects of the RMNCH+A approach include focusing on the continuum of care across the lifespan, priority districts, and addressing interventions related to adolescent health, antenatal and delivery care, postnatal care, newborn and child health, immunization, and family planning. The goals are to reduce infant mortality, maternal mortality, and total fertility rate by 2017.
The document summarizes Nepal's Community Based Integrated Management of Newborn Care (Neonatal care) and Childhood Illness (CB-IMNCI) program. The key points are:
[1] CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing major causes of illness in newborns and children, and improving access to health services.
[2] It integrates newborn care programs with childhood illness management. Major interventions include birth preparedness, essential newborn care, treatment of neonatal sepsis, and management of childhood illnesses like pneumonia and diarrhea.
[3] The goal is to achieve targets for reducing under-5 and
This document outlines Nepal's National Neonatal Health Strategy. It begins with background on the high neonatal mortality rate in Nepal, with approximately 2/3 of infant deaths occurring in the first month of life. The strategy is based on a situation analysis and position papers. It aims to improve newborn health and survival through strategic interventions in policies, behavior change communication, health service delivery, program management, and research. Priority policy actions include establishing a neonatal health group and focal point. Behavior change communication will promote essential newborn care practices. Health services will be strengthened by improving skilled birth attendance and newborn care training.
This slide contains information regarding Maternal and Child Health Program. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
This document discusses adolescent reproductive and sexual health (ARSH) in India. It notes that adolescents aged 10-19 make up 22% of India's population and face increased health risks like anemia, early marriage, teenage pregnancy, and STIs/HIV. The ARSH strategy aims to reduce teenage pregnancies and meet contraceptive needs through health services, capacity building, and communication activities. It also discusses establishing linkages between ARSH and HIV programs to address shared challenges and risks factors cost-effectively. The strategies proposed to promote adolescent health include adopting healthy lifestyles, organizing youth-friendly clinics, providing life skills training, counseling, and empowering adolescents.
Unit 3.7 health sector stratigies 2004 agenda for reformchetraj pandit
This document outlines Nepal's health sector strategy from 2004. It draws on several key government health documents from 1991-2001. The strategy aims to reduce poverty and achieve Millennium Development Goals by focusing on essential health services for the poor, including safe motherhood, child health, and communicable disease control. It seeks to [1] ensure the poor have access to essential health care, [2] give local bodies responsibility for managing health facilities, and [3] recognize the roles of private and nonprofit sectors in service delivery. Sector management outputs include [1] coordinated planning and financing within the Ministry of Health, [2] sustainable health financing schemes, [3] effective management of assets and supplies, [4]
Brief Overview of Management of Safe Motherhood and Newborn Health Services i...Mohammad Aslam Shaiekh
The document provides an overview of the management of safe motherhood and newborn health services in Nepal. It discusses the goals and strategies of the Safe Motherhood and Newborn Health Program, which aims to reduce maternal and neonatal mortality through preventative activities and addressing delays in seeking and receiving care. Major activities outlined include birth preparedness, rural ultrasound programs, reproductive health services, expanding health facilities, training health workers, and demand-side financing incentives for institutional deliveries. It also reviews the program's status, management perspectives using the POSDCORB framework, and identifies issues such as high maternal mortality and the need to establish effective referral mechanisms.
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
Neonatal period is a very crucial period for child’s survival as there is always highest risk of infections and deaths during first week and month of birth. The power-point describes about essential newborn care services, danger signs, Status of newborn in global and national level, key monitoring indicators, issues, challenges and recommendations and the need of investments in newborn health for betterment.
The document discusses the Mother and Child Tracking System (MCTS) in India. MCTS aims to leverage information technology to ensure delivery of healthcare services to pregnant women and children under 5. It identifies beneficiaries and registers them to receive services. Data on pregnancies, deliveries, immunizations is collected digitally to monitor outcomes and refer at-risk cases. MCTS benefits include improved access to services for beneficiaries, better monitoring and planning for healthcare workers, and analytical reporting for states and national level review of program progress. Current implementation status shows nationwide coverage with graphical representation of data collected on beneficiaries.
The document discusses India's RMNCH+A (Reproductive, Maternal, Newborn, Child Health + Adolescence) strategy. It outlines the history and evolution of family welfare programs in India. The current goals are to reduce infant mortality, maternal mortality, and total fertility rate by 2017. The strategy focuses on providing a continuum of care through various levels of the health system across different life stages. Key interventions include reproductive health services, antenatal care, skilled birth attendance, postnatal care, and improving health systems and monitoring. The strategy aims to strengthen primary healthcare and community participation to improve maternal and child health outcomes across India.
The document discusses family planning and reproductive health in Nepal. It provides background on family planning, objectives and policies, targets, and major activities in FY 2075/76. Key achievements include modern contraceptive prevalence reaching 39% nationally, with the highest in Province 2 at 46%. New acceptors of spacing methods increased over the previous year, with the highest number in Province 5. The total fertility rate target is to reduce to 2.1 births per woman by 2030.
- India has a large population that impacts both its own and global health indicators. It launched its National Family Planning Programme in 1952 with goals of population stabilization.
- The current family planning programme in India provides a wide range of temporary and permanent contraceptive methods at various health facilities through trained personnel with a focus on increasing access and reducing gaps in knowledge and use.
- National initiatives like Family Planning 2020 aim to expand voluntary family planning services and coverage to meet targets by strengthening existing strategies and addressing socio-cultural barriers.
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus. The procedure is done by a licensed health care professional. The decision to end a pregnancy is very personal
The Reproductive and Child Health (RCH) program was launched in India in 1997 with the goal of reducing infant and maternal mortality rates and achieving population stabilization. RCH Phase I focused on promoting maternal and child health through interventions like family planning, maternal care, child survival, and prevention of diseases. RCH Phase II, launched in 2005, expanded the goals and components of the program. It aimed to further reduce infant and maternal mortality as well as increase immunization coverage, especially in rural areas through strategies like strengthening health infrastructure and focusing on high-priority states. The components of RCH Phase II included population stabilization, maternal health, newborn and child health, adolescent health, and control of diseases. Monitoring and evaluation was emphasized
The National Nutrition Policy of Nepal from 2004 aims to improve nutrition nationwide by reducing malnutrition rates. The key objectives are reducing protein-energy malnutrition, anemia, iodine deficiency, vitamin A deficiency, and intestinal worm infestation among children and women. The policy outlines strategies like community participation, advocacy, research, and multi-sector coordination to achieve its overall goal of ensuring nutritional well-being for all Nepalis. While programs have scaled up infant and young child feeding, coverage of interventions remains low and nutrition surveys need to be conducted more routinely. Strengthening food security and fully implementing breastfeeding recommendations could help address remaining weaknesses in Nepal's efforts to improve public health through nutrition.
Unit 3.2 national safe motherhood policy 1998chetraj pandit
The 1998 Safe Motherhood Policy in Nepal aimed to reduce maternal mortality and morbidity. Its objectives were to increase access, availability, and utilization of maternal health services; strengthen the capacity of maternal healthcare providers; strengthen referral services for maternity care; raise public awareness of maternal health and safe motherhood; and improve the legal and socioeconomic status of women. The strategies included promoting inter-sectoral collaboration, strengthening and expanding delivery services by skilled birth attendants and emergency obstetric care at all levels, supporting activities to raise the status of women, and promoting research on safe motherhood.
The document outlines core indicators for monitoring child health in three areas: child status, service access, and service quality. It provides the definition, measure, data source, and collection period for each indicator. For example, one indicator listed is child poverty rate, defined as the proportion of children living in households with income or assets below a certain level. This and other indicators can be used to monitor progress towards goals like reducing child mortality and improving nutrition. The document establishes a framework for tracking key health and development metrics in children.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
The document provides an overview of policies, programs and implementation strategies related to newborn care in Nepal. It discusses Nepal's historical programs for newborn and child health from 1983 to the current Community Based Integrated Management of Newborn Care and Childhood Illness (CB-IMNCI) program launched in 2014. The CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing illnesses and increasing access to services. It also outlines trends that show improvements in newborn health indicators like institutional delivery rates and policies like free newborn care services but challenges remain in quality, resources and scale-up.
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
This document outlines the RMNCH+A program in India, which aims to improve reproductive, maternal, newborn, child, and adolescent health. It discusses the historical background of maternal and child health programs in India. The key aspects of the RMNCH+A approach include focusing on the continuum of care across the lifespan, priority districts, and addressing interventions related to adolescent health, antenatal and delivery care, postnatal care, newborn and child health, immunization, and family planning. The goals are to reduce infant mortality, maternal mortality, and total fertility rate by 2017.
The document discusses the evolution of reproductive, maternal, newborn, child and adolescent health (RMNCH+A) programs in India from the 1950s to present. It outlines the key historical programs and approaches, including the shift from a family planning focus to a more integrated reproductive health approach. The current RMNCH+A strategy aims to reduce maternal and child mortality by emphasizing continuum of care across the lifecycle through high impact interventions at various levels of the health system.
1) India accounts for 27.8% of global newborn mortality, with 0.88 million neonatal deaths annually. Half of deaths occur in the first week, and 39.3% occur on the first day of life.
2) Major programs and policies introduced in India to reduce newborn mortality include the Child Survival and Safe Motherhood program in 1992, National Maternity Benefit Scheme in 1995, Integrated Management of Neonatal and Childhood Illnesses in 2004, and Home-Based Newborn Care implemented nationwide in 2011.
3) Home-Based Newborn Care involves community health workers making home visits on the 1st, 3rd, 7th, 21st, 28th and 42nd day
The document outlines the goals and strategies of India's Reproductive, Maternal, Newborn, Child PLUS Adolescent Health (RMNCH+A) program. The goals include increasing coverage of key interventions like facility births, antenatal care, immunizations, and reducing issues like anemia and malnutrition. The program aims to provide continuum of care across the life stages of reproduction, pregnancy, childbirth, newborn, child, and adolescent. It focuses on community and facility-based interventions like immunization drives, nutrition programs, reproductive healthcare, and strengthening health systems. Key challenges include addressing adolescent health and improving implementation through use of data and timely payments.
The India Newborn Action Plan (INAP) aims to reduce preventable newborn deaths and stillbirths in India. Its two goals are to achieve a neonatal mortality rate (NMR) and stillbirth rate (SBR) of less than 10 by 2030. It outlines six intervention pillars including care during pregnancy, childbirth, the postnatal period and beyond. The plan emphasizes improving services for maternal and newborn care across various levels of India's health system through strategies like the Home Based Newborn Care program and strengthening special newborn care units. Successful implementation of INAP requires active participation and commitment from India's states to achieve its vision by 2030.
The NRHM aims to provide accessible and quality healthcare to rural populations. It focuses on reducing maternal and infant mortality rates through programs like ICDS, CSSM, JSY and RCH. ICDS provides nutrition and health services to children aged 0-6 years. CSSM aims to improve MCH services and reduce MMR and IMR. JSY provides cash incentives for institutional deliveries. RCH integrates programs related to fertility, MCH and reproductive health. Expanded immunization programs aim to immunize all children and pregnant women.
The National Family Welfare Programme was launched in 1952 to promote family planning and improve quality of life. It aims to encourage small family sizes and use of spacing methods. Key strategies include integrating family welfare services with health services, focusing on rural areas, and using mass media campaigns. The programme monitors indicators like contraceptive use, antenatal care coverage, and immunization rates. Maternal and Child Health programmes were also launched to reduce mortality and morbidity rates by providing reproductive health services, nutrition programmes, and disease prevention.
This presentation provides an overview of family planning, including its history and definition. It discusses global trends in contraceptive use and unmet need for family planning. Specific data on South Asia and Nepal is presented regarding population growth trends, total fertility rates, and contraceptive prevalence over time. The major activities of Nepal's family planning program are outlined. The presentation concludes with an overview of various contraceptive methods and a discussion of a potential new reversible male contraceptive method called RISUG.
This document provides an overview of maternal and child health services and family welfare services in India. It defines maternal and child health services according to the WHO as services that promote, prevent, treat or rehabilitate care for mothers and children. The key aims of maternal and child health services in India are outlined as reducing infant, maternal and child mortality rates and morbidity. Key indicators for assessing maternal and child health outcomes are also presented. The document then discusses the various aspects of maternal and child health services like antenatal care, intranatal care, postnatal care, and integrated management of neonatal and childhood illnesses. It concludes with an overview of strategies, importance and the role of community health nurses in family welfare services in India.
Analysis of Preconception Healthcare Services Delivered in Selected Medical ...Chamil Wijekoon
Dr. W M C R Wijekoon, Prof. Samath Dharmarathne, Dr. V G S C Ubeysekara, Dr. I P Wickramasinghe, Dr. A P Maduragoda (2020); Analysis of Preconception Healthcare Services Delivered in Selected Medical Officer of Health Areas of Kandy District in Sri Lanka; International Journal of Scientific and Research Publications (IJSRP) 10(07) (ISSN: 2250-3153), DOI: http://dx.doi.org/10.29322/IJSRP.10.07.2020.p10388
Public private partnership in safemotherhood program in NepalBidhya Basnet
The document discusses public private partnerships in Nepal's Safemotherhood program. It provides definitions of key terms, describes the status and activities of the program, and outlines various PPP models used. The program aims to reduce maternal and neonatal mortality by improving access to antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care. It partners with various organizations to implement activities like community mobilization, ultrasound programs, and expanding emergency referral services. However, partnerships face limitations like unclear policies, weak coordination, and a lack of regulatory frameworks and research on the private health sector.
RMNCH+A strategy: Reproductive, Maternal, neonatal, child and Adolescent Health Gaurav Kamboj
This document provides an overview of the RMNCH+A strategy in India. It discusses the historical background and goals of reducing maternal and child mortality. The key challenges include operating the different components vertically and strengthening adolescent health. Major causes of maternal and child deaths in India are hemorrhage, sepsis, abortion for mothers and pneumonia, preterm birth and sepsis for under-5 children. The strategy aims to address these across various life stages through interventions like adolescent nutrition programs, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns. It also discusses strengthening the health system to deliver comprehensive RMNCH+A services and monitoring progress.
National health programs are one of the measures taken by the government of India to improve the health status of the people.National health Programs useful to controlling or eradicating diseases which cause considerable morbidity and mortality in India
which are either centrally sponsored
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The document summarizes family welfare services in India, including:
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Nepal has successfully reduced under-five mortality and neonatal mortality through various programs. About two in five neonatal deaths occur on the first day of life, and over eight in ten in the first week. The most common causes of neonatal death are sepsis, birth asphyxia, hypothermia, low birth weight, and prematurity. National programs addressing maternal and child health include the Safe Motherhood Program, Integrated Management of Childhood Illness, bi-annual vitamin A supplementation, and immunization. Strategies to further reduce mortality focus on birth preparedness, institutional delivery, and expanding emergency obstetric care. Major challenges include inadequate skilled birth attendants, poor quality of care, and lack of funding and infrastructure especially for
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3. Definitions
● Neonatal period: 0-27 days after birth (first month after birth)
● Early neonatal period: 0-6 days after birth (first week after birth)
● Late neonatal period: 7-28 days after birth (2nd week to 4th week after birth)
3
7. Neonatal Mortality in Nepal
7
By Sex
Male: 24 per thousand
Female: 17 per thousand
By residence
Urban: 16 per thousand
Rural: 26 per thousand
Source: NDHS 2016
By ecological zone
Mountain: 35 per thousand
Hill: 23 per thousand
Terai: 28 per thousand
10. Major factors affecting neonatal mortality
10
Mother’s age at birth
<20 : 39 per thousand
20-29 : 21 per thousand
30-39: 31 per thousand
Birth order
1 : 30 per thousand
2-3 : 19 per thousand
4-6: 29 per thousand
Mother’s education
No education : 36 per thousand
Primary : 25 per thousand
Some secondary: 20 per thousand
SLC and above: 12 per thousand
Source: NDHS 2016
11. During COVID-19
● There was a reduction of 52.4% births during lockdown.
● Institutional neonatal mortality increased from 13 per 1000 live births to 40 per
1000 live births.
● The institutional stillbirth rate increased from 14 per 1000 total births before
lockdown to 21 per 1000 total births during lockdown.
● However, some behaviors improved like hand hygiene and keeping the baby
skin-to-skin with their mother.
11
Source: Ashish KC, Gurung R, Kinney MV, Sunny AK, Moinuddin M, Basnet O, Paudel P, Bhattarai P, Subedi K, Shrestha MP, Lawn JE.
Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective
observational study. The lancet Global health. 2020 Oct 1;8(10):e1273-81.
12. Critical Actions for Increasing Child Survival
1. Skilled care during pregnancy and birth
- Safe and clean delivery at birth
- Care of newborn at birth
2. Appropriate feeding during sickness and in health
- Exclusive breastfeeding for first 6 months of life
- Appropriate complementary feeding along with breastfeeding, starting at 6 years
of age upto 2 years and beyond
- Micronutrient supplementation- Vit A, Iron, Folic acid
12
Source: Bhandari G. An Introduction to Family Health, 2012
*Actions that directly improve neonatal health are in green fonts
13. Critical Actions for Increasing Child Survival..
3. Prevention of Illness
- Vaccination
- Insecticide treated materials
- WASH
4. PMTCT of HIV/AIDS
- Antiretroviral therapy
- Safer infant practices
5. Treatment of Illness
- ORT to prevent and treat dehydration resulting from diarrhea
- Zinc to reduce the duration and severity of diarrhoea
- Antibiotics for sepsis, pneumonia and dysentry
13
Source: Bhandari G. An Introduction to Family Health, 2012
*Actions that directly improve neonatal health are in green fonts
14. SDG targets
Child health targets include:
● Newborn: From 23 to 12 per thousand
● Under 5: From 38 to 20 per thousand
● Reduction of preventable deaths of newborn and children to less than 1%
14
Indicators 2016 (NDHS) 2022 (NDHS) 2025 2030
Neonatal Mortality 21 21 (16) 14 12
Under 5 Mortality 39 33 (27) 24 20
* Digits in parentheses indicate targets set
Source: National Planning Commission, SDG Status and Roadmap: 2016-2030
15. Landmarks for Neonatal Health in Nepal
15
1979
National Immunization
Program
Control of Diarrhoeal
Diseases (CDD program)
1983
ARI Control Program
1987
CB-ARI Program Piloting
1995/96
Source: DoHS Annual Report, 2077/78
16. Landmarks for Neonatal Health in Nepal..
Source: DoHS Annual Report, 2077/78
16
1997/98
CBAC Program
CB-ARI program combined
with CDD
IMCI Program
Initiated from Mahottari
1997
CBAC + IMCI = CB-IMCI
1999
Nutrition and
Immunization were also
incorporated in CBAC
program
1999
Source: DoHS Annual Report, 2077/78
17. Landmarks for Neonatal Health in Nepal..
17
2004
National Neonatal
Health Strategy
First South Asian Country
to do so
Low Osmolar ORS +
Zinc for diarrhoea
treatment
Morang Innovative
Neonatal Intervention
Pilot (MINI)
2005
Community Based
Newborn Care
Program (CB-NCP)
was designed
2007
CB-NCP Piloted in10
districts and CB-IMCI
covered nationwide
2009
Source: DoHS Annual Report, 2077/78
18. Landmarks for Neonatal Health in Nepal..
18
2011
Chlorhexidine (CHX)
use initiated for cord
care
CB-IMCI revised
incorporating new
interventions
and
CB-NCP scaled up
nationwide
2012
CB-IMNCI (Community
Based- Integrated
Management of
Neonatal and Childhood
Illness
2014
Source: DoHS Annual Report, 2077/78
19. Landmarks for Neonatal Health in Nepal..
19
2016
● Nepal Every
Newborn Action
Plan (NENAP)
● Establishment and
expansion of
SNCU and NICU
● Free Newborn
Care Program
● Facility based
IMNCI Program
Comprehensive
Newborn Care
Training (Level II)
Package
2017
Kangaroo Mother Care
Program
2021
Source: DoHS Annual Report, 2077/78
21. Constitution of Nepal- 2072 BS
Article 35: Right relating to health
(1) Every citizen shall have the right to free basic
health services from the State, and no one shall be
deprived of emergency health services.
Article 39: Right of child
(1)Each child shall have the right to his/her identity
with the family name and birth registration.
21
22. National Health Policy - 2048 BS
# First National Health Policy of Nepal
By the year 2000 AD
❏ The mortality rate of children below 5 years will be
reduced to 70 per thousand from the present 197 per
thousand.
22
23. NHP 2048….
● Preventive Health Services
These services Family Planning and Maternal and Child Health, Expanded
Immunization will be provided in an integrated way.
● Curative Health Services
At least one hospital in each district with maternity and child health
services, immunization services.
● Basic Primary Health Services
❏ At least one Health Institutions (SHP/HP/PHC) will be in each VDC.
❏ Immunization, child health will also be extended by these Sub-Health
Posts, up to the ward level
23
24. GOAL : “To improve the health and survival of
newborn babies in Nepal”
Strategic Objectives
● To achieve a sustainable increase in the adoption
of healthy newborn care practices and reduce
prevailing harmful practices.
● To strengthen the quality of promotive, preventive
and curative neonatal health services at all levels.
24
25. Strategic Interventions
● Policy
● Behavior Change Communication
● Strengthening health service delivery
● Strengthening program management
● Research
25
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
26. 1.Policy
● Institute Family Health Division as the focal point for neonatal health activities
● Facilitate the institutionalization of neonatal care as a sub-specialty with
appropriate training courses (both in-service and pre service) for different
cadres of health workers at the tertiary and secondary level of care.
● Ensure the activation of the National Breastfeeding Promotion and Protection
Committee (to monitor health facility Baby friendly status and adherence to
Nepal’s Code for Marketing of Breast milk Substitutes).
● Support and coordinate for the strengthening of the system of universal
registration of all births and deaths.
26
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
27. 2. BCC(Behaviour change communication)
● BCC emphasize improved immediate and exclusive breast feeding
● Newborn care practices such as clean cord cutting, drying,
wrapping, delayed bathing, applying nothing on cord stump etc.
● Promote BCC activities through TBAs, FCHVs , mothers’ groups and
other community groups with the involvement of husbands and
families.
● Reinforcement of BCC messages targeting danger signs during
pregnancy, delivery and the postnatal period.
27
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
28. 3. Strengthening Health Service Delivery
● The improved coverage of skilled attendance at delivery.
● Linking up with the Integrated Management of Childhood Illnesses to
include the total neonatal period as well.
● The introduction, promotion and evaluation of “kangaroo mother
care” or other culturally appropriate practices for LBW babies at
various levels of care.
● Postnatal visits (within 24 to 48 hours, again within 6 days and a third
at 6 weeks) by skilled / trained attendants at home or at health
facilities.
28
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
29. 4. STRENGTHENING PROGRAM MANAGEMENT
❏ The review of neonatal content of existing curricula (pre- and in-
service) and protocols, in particular the ones developed for Safe
Motherhood, IMCI, for all levels of care providers.
❏ Continuing Medical Education for updating to be arranged at
regular intervals for medical and paramedical personnel.
❏ Promote newborn care health practices in governmental, non-
governmental and private through coordination and collaboration at
different level.
29
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
30. 5. RESEARCH
● Community based operations research to improve neonatal care
● The evaluation of the quality of maternal and neonatal care offered by
all levels of health workers along with reassessment and strengthening
of their role as skilled attenders in the light of the results
● The promotion of verbal autopsy of perinatal deaths in the community
and perinatal death audit or review in peripheral hospitals
30
Source: Division F. NATIONAL NEONATAL HEALTH STRATEGY [Internet]. Available from:
https://km.mohp.gov.np/sites/default/files/2018-07/National_Neonatal_Health_Strategy.pdf
33. National Health Policy-2071
1.15 Periodical health related programs will be
made and implemented making the action plan on the
basis of the indices based on maternal death rate,
Neonatal & U5 death rate and Increase the Life
expectancy.
1.22 Unified child-disease management program to
promote the child health will be strengthened, made
current and acted upon.
33
34. Provision for Immunization service
● Free immunization services to targeted group
● Provision to make compulsory use of vaccines
● Duty of guardians to get children vaccinated
● Those who come for vaccination should be provided complete information
about the vaccine
● Responsibility of doctors and Health workers to get involved in vaccination
according to this act.
● There cannot be any obstacle for conducting vaccination programs.
34
Source: Nepal_2016.01.26_Act_Nepal-Vaccination-Act-2072_NEP.pdf
35. Chapter-2:
Every citizen shall have the right to obtain free basic health services under
the following headings, as prescribed:
(a) Vaccination service,
(b) Motherhood, infant and pediatric health service such as integrated
infant and pediatric disease management, nutrition service, pregnancy, labor
and child birth service, family planning, abortion and reproductive health.
35
Source: Public health service act 2018
36. National Health Policy 2076
1. Free basic health services shall be ensured from health
institutions of all levels as specified.
20. In accordance with the concept of health across the
lifecycle, health services around safe motherhood, child
health, adolescence and reproductive health, adult and
senior citizen shall be developed and expanded.
20.2. Health services targeted to vulnerable age groups such
as maternal-infant health, child health, adolescent health,
adult health and geriatric health shall be strengthened.
36
37. Public Health Service Regulations, 2020
37
Source: Public health service regulation 2020
39. Second long term Health plan(1997-2017)
Objective:
● To improve the health status of the population of the most vulnerable groups, particularly
those whose health needs often are not met-women and children, the rural population, the
poor, the underprivileged, and the marginalized population.
Target:
● To reduce the infant mortality rate to 34.4 per thousand live births;
● To reduce the under-five mortality rate to 62.5 per thousand;
● To increase the percentage of deliveries attended by trained personnel to 95%;
● To increase the percentage of pregnant women attending a minimum of four antenatal
visits to 80%;
● To decrease the percentage of newborns weighing less than 2500 grams to 12%
39
Source: .Government of Nepal MINISTRY OF HEALTH AND POPULATION SECOND LONG TERM HEALTH PLAN
Perspective Plan for Health Sector Development Health Sector Reform Unit Kathmandu, Nepal Reprinted [Internet].
1997. Available from: ttps://nepalindata.com/media/resources/items/20/bSecond_Long_Term_Health_Plan-2.pdf
41. ● Nepal was one of 10 fast track countries that were on-track to achieve MDG 4.
● Nepal notably had a lower IMR and U5MR than India and Bhutan among
five South Asian countries.
41
43. What makes MDG 4 Successful???
❏ Semi-annual vitamin A supplementation and de-worming programme;
❏ Community-based Integrated Management of Childhood Illness (CB-IMCI),
❏ Community Based-Integrated Management of Neo-natal and Childhood Illness
(CB-IMNCI),
❏ SBA policy
❏ Community Based Newborn Care Package (CB-NCP),
❏ High rates of full child immunization
❏ Coverage of the exclusive breastfeeding of children under-six months.
❏ National Immunization Programme (NIP)
❏ Nepal has also seen the rapid expansion of private health care, which has
improved access to health care
43
44. Goal: Improved maternal and neonatal health and
survival, especially of the poor and excluded.
The key indicators for this NSMNH-LTP goal are:
1. A reduction in the maternal mortality ratio from 539 per
100,000 live births to 134 per 100,000 by 2017.
2. A reduction in the neonatal mortality ratio from 39 per
1,000 to 15 per 1,000 by 2017.
44
National SMNH Long term Plan (2006-2017)
45. Purpose:
Increased healthy practices, and utilisation of quality maternal and neonatal
health services, especially by the poor and excluded, delivered by a well-
managed health sector.
Key indicators for this include:
1. Increase in the percentage of deliveries assisted by an SBA to 60% by 2017
2. The percentage of deliveries taking place in a health facility increased to
40% by 2017
3. Increase in met need for emergency obstetric care of 3% per year
4. Increase in met need for caesarean section of 4% per year
45
50. Nepal Health Sector Strategy 2015-2020 AD
Articulates nation’s commitment towards
achieving Universal Health Coverage (UHC) and
provides the basis for gathering required resources
and investments
Strategic Principles
◆Equitable access to health services
◆Quality Health Services
◆Health System Reform
◆Multi Sectoral Approach
50
51. Vision
All Nepali citizens have productive and quality lives with highest level of
physical, mental, social and emotional health
Mission
Ensure citizens’ fundamental rights to stay healthy by utilizing available
resources optimally and through strategic cooperation between service
providers, service users and other stakeholders
Goal
Improved health status of all people through accountable and equitable health
service delivery system
51
Target
◆MMR- 125 (per 100,000 live births)
◆U5MR- 28 (per 1000 live births)
◆NMR - 17.5 (per 1000 live births)
54. Supporting program for SDG
- NENAP( Nepal Every Newborn Action Plan) 2016-2035
- NHSS(2015-2020)
- HF-IMNCI (2016)
- Free Newborn Care program(2016)
- Comprehensive newborn care training package level -II (2017)
- Vit-K1 to Newborn babies (2018/19)
- SMNH Road map (2019-2030)
- Full fledged KMC Program(2021)
54
55. Contd…
- Public Health service Act 2075
- National Health policy 2019
- National HRH Strategy (2077/78-2086/87)
- National Guideline on ANC/PNC care 2076
- Strategy for Skilled Health Personnel and SBA (2020-2025)
- National Strategy on Nurses and Midwifery 2022
55
56. Vision: ‘There is no preventable deaths of New-
born or stillbirths, where every pregnancy is
wanted, every birth celebrated and women,
babies and children survive, thrive and reach
their full potential'.
Strategic directions:
● Equitable utilization of health services,
● Quality for all,
● Multi-sectoral approach and
● Reform, particularly for poor and vulnerable
populations.
56
57. Goal 1: Reduce preventable newborn deaths in every province to less than 11
newborn deaths per 1000 live births by 2035.
Goal 2: Reduce preventable stillbirths in every province to less than 13 stillbirths
per 1000 total births by 2035.
57
58. Strategic Objectives of NENAP
1. Rebuild and strengthen Health system ( infrastructure, HR & supply chain)
2. Improve the quality of care at the point of the delivery
3. Ensure the utilization of health care services
4. Strengthen decentralized budgeting and planning
5. Improve sector management and governance
6. Improve sustainability of health sector financing
7. Improve healthy lifestyle and Environment
8. Strengthen management of public health emergencies
9. Improve availability & use of evidence based decision making process at
all level
58
61. NSMNH Road Map 2019- 2030
Vision: All Nepali citizens have the physical, mental,
social and spiritual health to lead productive and high-
quality lives
Goal: Ensuring healthy lives and promoting wellbeing
for all mothers and newborns.
61
62. The Road Map adapts the conceptual framework proposed by the 2018 Lancet
Commission on Quality of Care.
62
63. Outcomes
Outcome 1: The availability of high-quality MNH services increased,
leaving no one behind
Outcome 2: The demand for and utilisation of equitable MNH services
increased.
Outcome 3: The governance of MNH services improved, and
accountability ensured.
Outcome 4: M&E of MNH improved.
Outcome 5: Emergency-preparedness and response for MNH strengthened
63
64. Neonatal Health in Five Year Plan
Plan Period Focus
Fourth 1970-1975 Life expectancy to 42.3 & IMR to 157/1000 live birth
Thirteenth 2013-2015 MDG
Fifteenth 2018-2023 Balanced development and expansion of health service at
federal, provincial and local level,
64
Source: Periodic Plans || National Planning Commission [Internet]. Npc.gov.np. 2015 [cited 2023 May 12]
65. Neonatal Health in Current 5 Year Plan
Strategy 3:
To address the health necessity of citizens of all age groups as per the Life
Course Approach and to make additional improvements and expansion of
overall development of mother and child, children and adolescents, and family
management services.
Working Policy 1:
The overall development of mother and child, children and adolescents, and
family management services will be reformed further and expanded as per the
concept of the life cycle.
65
Source: The Fifteenth Plan National Planning Commission Singhadurbar, Kathmandu [Internet]. Available from:
https://www.npc.gov.np/images/category/15th_plan_English_Version.pdf
66. Expected Result
Neonatal mortality rate will have decreased to 14 per 1000 live births
The percentage of pregnant women having their antenatal check-ups according
to the protocol will have reached 81 %
The percentage of children born in the presence of skilled healthcare workers
will have reached 79 %
The percentage of children with total vaccination will have reached 95 %
66
Source: The Fifteenth Plan National Planning Commission Singhadurbar, Kathmandu [Internet]. Available from:
https://www.npc.gov.np/images/category/15th_plan_English_Version.pdf
68. National Immunization program
● The National Immunization initiative (NIP) of Nepal, also known
as the Expanded Program on Immunization, was started in 2034
BC and is a priority 1 initiative.
● The Immunization Act, 2072 of Nepal has recognized
immunization as a right of all children.
68
Source: Annual Report Department of Health Services 2077/78 (2020/21)
69. Contd…
Vision
● Nepal: a country free of vaccine-preventable diseases.
Mission
● To provide every child and mother high-quality, safe and affordable vaccines
and immunization services from the National Immunization Program in an
equitable manner.
Goal
● Reduction of morbidity, mortality and disability associated with vaccine
preventable diseases.
69
Source: Annual Report Department of Health Services 2077/78 (2020/21)
70. Strategic Objectives
● Objective 1. Reach every child for full immunization
● Objective 2. Accelerate, achieve and sustain vaccine preventable diseases
control, elimination and eradication
● Objective 3. Strengthen immunization supply chain and vaccine
management system for quality immunization services
● Objective 4. Ensure financial sustainability for immunization program
● Objective 5. Promote innovation, research and social mobilization activities
to enhance best practices
70
Source: Annual Report Department of Health Services 2077/78 (2020/21)
72. Tetanus Toxoid for Pregnant Women
● Comprehensive Multi-year Plan for Immunization ( cMYPI
2017- 21 )
● The National immunization schedule was intended to
protect child at birth by providing 2 doses of TT (now TD)
containing vaccine to pregnant mothers and completing TT
towards 5 doses throughout her reproductive age.
Objective 4: Maintain maternal and neonatal tetanus
elimination status
Nepal achieved MNT elimination status in 2005.
72
Source: Comprehensive Multi-year Plan for Immunization ( cMYPI 2017- 21 )
73. ● 1983- Control of Diarrhoeal Disease (CDD)
program
● 1987 - Acute Respiratory Infection (ARI)
Control Program
● 1997/98 - ARI intervention combined with
CDD and named as CB-AC program
● 1999/2000- Nutrition and immunization were
also incorporated in the CBAC program
● IMCI program was piloted in Mahottari
district and was extended to the community
level as well 73
Source: Annual Report Department of Health Services 2077/78 (2020/21)
Community Based-Integrated Management of Childhood Illness and
Newborn Care Program
74. Contd…
● 1999 - Merge the CBAC into IMCI and named it as Community-Based Integrated
Management of Childhood Illness (CB-IMCI) as both of the program targeted
same population with involvement of similar Health Service Providers
● The CB-IMCI and CB-NCP programs are combined into the CB-IMNCI program in
Nepal.
● This integrated package of child-health intervention addresses the major problems
of sick newborn such as birth asphyxia, bacterial infection, jaundice,
hypothermia, and low birth weight.
● Aims: To address major childhood illnesses like Pneumonia, Diarrhoea, Malaria,
Measles and Malnutrition among under 5 year’s children
74
Source: Annual Report Department of Health Services 2077/78 (2020/21)
75. Goal:
● Improve Newborn child survival and ensure healthy growth and development.
Targets:
● Target for reduction of NMR, U-5MR & Stillbirths by NHSS, NENAP, SDGs
Objectives
● To reduce neonatal morbidity and mortality by promoting essential Newborn
care services & managing major causes of illness
● To reduce childhood morbidity and mortality by managing major causes of
illness among under 5 years of age children
75
Source: Annual Report Department of Health Services 2077/78 (2020/21)
Contd…
76. Strategies
● Quality of care through system strengthening and referral services for
specialized care
● Ensure universal access to health care services for Newborn and under 5
years of age children
● Capacity building of health service providers and FCHVs
● Increase service utilization through demand generation activities
● Promote decentralized and evidence-based planning and programming
76
Source: Annual Report Department of Health Services 2077/78 (2020/21)
Contd…
Contd…
77. Major interventions
Newborn Specific Interventions
● Promotion of birth preparedness plan
● Promotion of essential Newborn care practices and postnatal care to mothers
and Newborn
● Identification and management of non-breathing babies at birth
● Identification and management of preterm and low birth weight babies
● Management of sepsis among young infants (0-59days) including diarrhoea
77
Source: Annual Report Department of Health Services 2077/78 (2020/21)
Contd…
79. Community-Based NewBorn Care Program (CB-NCP)
● National Neonatal Health Strategy was formulated by the government of Nepal
in 2004 to improve neonatal survival and health.
● CB-NCP was designed in 2007, piloted in 2009 in 10 district, and incorporated
seven strategic interventions to target new-borns at the community level.
➢Behaviour change communication
➢Care of low-birth-weight New-born,
➢Promotion of institutional delivery
➢Prevention and management of hypothermia
➢Postnatal care,
➢Recognition and resuscitation of birth asphyxia
➢Management of neonatal sepsis
79
Source: Annual Report Department of Health Services 2077/78 (2020/21)
80. Facility-Based Integrated Management of Childhood and Neonatal Illnesses
● Started in 2016 to bridge the gap in the management of neonatal and
childhood cases referred from peripheral level health institutions to higher
institutions.
● Aim: To capacitate team of health service providers at district hospital
with required knowledge and skills to manage complicated under-five and
neonatal cases to ensure timely and effective management of referral cases
● Linked with the CB-IMNCI
● Addresses the major causes of common childhood illnesses towards
diagnosis and treatment especially new-born care, cough, diarrhoea, fever,
malnutrition and anemia.
80
Source: Annual Report Department of Health Services 2077/78 (2020/21)
81. Comprehensive NewBorn Care program
● Purpose: Reducing Neonatal mortality and timely management of sick
Newborn
● To provide training to paediatricians, senior medical officers and medical
officers working in the hospitals providing level II newborn care services
81
Source: Annual Report Department of Health Services 2077/78 (2020/21)
82. Contd…
This package covers
● Counselling
● Infection prevention
& control practices
● Care of newborn
● Feeding
● Neonatal resuscitation
82
● Thermal protection
● Fluid management
● Identification, and management of
small &/or sick neonates
● Management for low birth weight and
● Neonatal sepsis
Source: Annual Report Department of Health Services 2077/78 (2020/21)
83. Kangaroo Mother Care Program
● Cost-effective intervention to care for stable preterm/LBW babies
● Skin to skin contact has been part of different programs/ training packages
such as CB-IMNCI, FB-IMNCI, SBA Training, Comprehensive level-II
new-born care etc. a full-fledged KMC program from 2021
Goal:
● To end preventable newborn deaths due to prematurity & low birth weight
through skin-to-skin contact, breastfeeding and early discharge from health
center.
83
Source: Annual Report Department of Health Services 2077/78 (2020/21)
84. Infant and young child feeding (IYCF)
● Include early initiation of breastfeeding within an hour of
childbirth, exclusive breastfeeding for six months and providing
nutritionally adequate and appropriate complementary feeding
starting from six months with continued breastfeeding up to two
years of age or beyond
● IYCF programme has been ongoing in all 77 districts from the FY
2072/73.
● Nationally, the 5 year data trend shows an increase in exclusive
breastfeeding among children aged 0-6 months from 25.1% in FY
2073/74 to 36.9% in this FY 2077/78
84
Source: Annual Report Department of Health Services 2077/78 (2020/21)
85. Integrated management of acute malnutrition (IMAM)
● Integrated Management of Acute Malnutrition (IMAM) Program (previously
known as Community based Management of Acute Malnutrition [CMAM]
program) provides treatment for children aged 0-59 months with Severe
Acute Malnutrition (SAM) through inpatient and outpatient treatment
services at health facility and community levels.
● Aim: To integrate across health, early childhood development, WASH, and
social protection sectors for the continued rehabilitation of SAM cases and to
widen the reach of malnutrition prevention programs and services.
● Program was piloted in 2009/10 in five districts; Achham, Kanchanpur,
Mugu, Bardiya and Jajarkot
85
Source: Annual Report Department of Health Services 2077/78 (2020/21)
86. Contd…
● Pilot evaluation in 2011/12,and after evaluation program sifted from CMAM
to IMAM program and gradually scaled up throughout the country covering
many more district
● 22 nutritional rehabilitation homes (NRHs) in different federal and provincial
level hospitals for inpatient treatment of severe acute malnutrition
86
Source: Annual Report Department of Health Services 2077/78 (2020/21)
87. Nutrition in emergencies (NiE)
● Family Welfare Division provides essential and high-quality nutrition
services during emergencies.
● Nutrition in emergencies interventions focuses on pregnant and lactating
women (PLWs) and children under-five years of age as they are nutritionally
the most vulnerable during any type of emergency
87
Source: Annual Report Department of Health Services 2077/78 (2020/21)
88. Pillars of NiE:
● Promotion, protection and support to breast feeding of infants and young
children aged 0-23 months.
● Promotion of proper complementary feeding for infants and young children
aged 6-23 months.
● Management of moderate acute malnutrition (MAM) among the children
aged 6-59 months and among PLWs through targeted supplementary feeding
program (TSFP).
● Management of severe acute malnutrition among the children aged 6-59
months through therapeutic feeding
● Intensification of Micro-nutrient supplementation for children and women
including MNP and Vitamin A for children aged 6-59 months, IFA for
pregnant and postnatal women.
88
Source: Annual Report Department of Health Services 2077/78 (2020/21)
Contd…
89. Vitamin K1 to newborn babies
● FY 2077/78, after the decision of Ministry of Health and Population
to introduce Vit K1 injection to newborn babies for preventing from
Vitamin K Deficiency Bleeding (VKDB) Family Welfare Division
allocated budget to purchase injection Vitamin K1 for distributing in
all BC/BEONC and CEONC sites
● Injection Vitamin K1 need to be given to newborn IM after breast
feeding within 1 hour of delivery.
89
Source: Annual Report Department of Health Services 2077/78 (2020/21)
90. Free Newborn Programme
Aim: To prevent any sort of deprivation to health care services of the newborn due
to poverty
Goal: to achieve the sustainable development goal to reduce newborn mortality
through increased access of the newborn care services
Based on the treatment services offered to the sick-newborn, the services are
classified into 3 packages: A, B and C.
● Package A: newborn corners in health posts and PHCCs
● Package B: district hospitals with Special Newborn Care Unit (SNCU)
● Package C: provincial and other tertiary hospitals offer Neonatal Intensive Care
Unit (NICU) services
90
Source: Annual Report Department of Health Services 2077/78 (2020/21)
91. Nyano Jhola Programme
● The Nyano Jhola Programme was launched in 2069/70 to protect newborns
from hypothermia and infections and to increase the use of peripheral
health facilities (birthing centres).
● Two sets of clothes (bhoto, daura, napkin and cap) for newborns and
mothers, and one set of wrapper, mat for baby and gown for mother are
provided for women who give birth at birthing centres and district
hospitals.
● The programme was implemented in all 75 districts in 2072/73.
91
Source: Annual Report Department of Health Services 2077/78 (2020/21)
92. Nepal Chlorhexidine (Navi Cord Care) Program
● About 70 percent of under-five deaths in Nepal occur within the first
month of life, and approximately 50 percent are attributed to infection.
● Chlorhexidine is proven to be a safe, efficacious antiseptic to prevent infection and
sepsis among newborns if applied to the umbilical stump immediately after cutting
the cord.
● In Nepal, use of this simple antiseptic has decreased newborn deaths by 24 percent
and newborn infections by 68 percent.
● The Chlorhexidine “Navi” Care Program is a six-year (2011-2017)
92
Source: Nepal fact sheet chlorhexidine “Navi” (cord) care program.
93. Objectives
● Scaling up chlorhexidine in all 75 districts as an essential component of
Maternal Newborn and Child Health
● Establishing a strong monitoring and supervision system for chlorhexidine
● Including chlorhexidine in all policies and strategies related to newborn care
● Increasing demand for chlorhexidine at the community and facility levels
● Sharing Nepal’s experience and learning on chlorhexidine at national and
international fora
● Providing technical support to enhance the capacity of local pharmaceutical
companies to manufacture quality chlorhexidine gel
93
Source: Nepal fact sheet chlorhexidine “Navi” (cord) care program.
94. Program Activities
● Advocacy, training, and orientation on the use of chlorhexidine gel
● Support to the MoHP’s Child Health Division to roll out the revised
Community-Based Integrated Management of Newborn and
Childhood Illness protocol in new districts
● Support MoHP to sustain the chlorhexidine program as a part of its
newborn and maternal and child health programs
● Monitoring and supervision of chlorhexidine programming
94
Source: Nepal fact sheet chlorhexidine “Navi” (cord) care program.
95. ● Coordination and networking among chlorhexidine partners
● Advocacy to include chlorhexidine in pre-service training of nurses
and other medical professional curricula
● Work with Family Health Division and National Health Training
Center to include chlorhexidine in the in-service curriculum of skilled
birth attendants
95
Source: Nepal fact sheet chlorhexidine “Navi” (cord) care program.
Contd…
96. ● A comparative observational study carried out in the Neonatal unit, Paediatrics
Department of Kathmandu Medical College Teaching Hospital shows no
significant difference between the cord separation times in dry and chlorhexidine
cord care regimens. Both dry cord care and chlorhexidine cord care regimens
were found to be safe and effective.(1)
● The WHO recommends clean, dry cord care for all newborns and daily CHX
application to the umbilical stump for the first week of life for home births in high
neonatal mortality settings (> 30 deaths/1000 live births) Use of chlorhexidine in
these situations may be considered only to replace application of a harmful traditional
substance, such as cow dung, to the cord stump.(2)
96
Source: 1. Basnet R, Manandhar SR, Bhatta A, Shah RK, Basnet R. Effect of dry cord care versus chlorhexidine cord care on cord separation time in
healthy newborns: A comparative study. Journal of Kathmandu Medical College. 2020 Jun 30;9(2):70-3.
2.World Health Organization: Recommendations on Postnatal care of the mother and newborn. 2014 WHO library cataloguing- Oct 2013
Significance of Use of Chlorhexidine Gel for cord care
97. Maternal and Perinatal Death Surveillance and Response (MPDSR)
● Continuous process of identification, notification, quantification and
determination of causes and factors to avoid all maternal and perinatal
deaths, as well as the use of this information to respond with actions that will
prevent future deaths
● Aim: To measure and track all maternal deaths in real time with the objective to
understand the underlying factors contributing to mortality and to provide
guidance on how to respond and prevent future deaths.
● FWD conducted policy dialogues and orientation on MPDSR to sensitize and
orient policy maker from Health Directorates, Health Offices and Provinces and
service providers from hospitals as well as districts.
97
Source: Annual Report Department of Health Services 2077/78 (2020/21)
98. Contd…
Community-based MPDSR: At present, community based MPDSR program is
being implemented in 15 districts. In the community-based MPDSR program,
only maternal deaths are reviewed and responses are planned.
Hospital-based MPDSR: 95 hospitals are implementing MPDSR program. In
the hospitals, the maternal death review (MDR) form is filled for every
maternal death, which is then reviewed. Whereas, in case of perinatal death, the
perinatal death review (PDR) form is filled for every perinatal death, but
only the summary perinatal death review form is reviewed once a month and
responses are planned.
98
Source: Annual Report Department of Health Services 2077/78 (2020/21)
100. 1. The United Nations
Children’s Fund
(UNICEF)
Source: UNICEF Nepal
100
101. Maternal and perinatal death surveillance and
response (MPDSR) approach for maternal and
neonatal mortality.
Establishing intensive care units for newborns and
relevant referral systems for mothers and
newborn babies.
Promotion of postnatal and essential newborn
care and early screening, detection, referral and
the rehabilitation of children with disabilities
Practices that harms the care of mothers and
newborns will be addressed by promoting positive
care seeking behaviour.
Source: UNICEF Nepal- Country Program Action Plan 2018-22 101
105. 3. Save the Children • Save the Children, with its life cycle approach design, ensures
that every child survives and grows in an environment that
prevents them from dying from preventable causes.
• Save the Children works to complement and in partnership
with the Government focusing on improving their capacities
and strengthen systems for service delivery and with local
NGOs and communities by focusing on health care practices
and nutrition for newborns, children and mothers.
• Save the Children supports the Ministry of Health and
Population and its department, divisions and provincial
offices to design, revise, pilot, scale-up, monitor and review
of newborn, child, adolescent and maternal health-focused
activities at local, provincial and national levels
Source: Save the Children Nepal
105
107. • USAID is providing coaching and mentoring to health
care providers and other staff on clinical care, data
management, and supply chain management. This
enables health facilities to offer a full range of high
quality, client-centered maternal newborn, child health,
and family planning services.
• USAID is expanding the reach and quality of critical
public health services especially maternal, newborn,
child health and family planning. To achieve this, the
activity provides private health care providers access to
standard treatment protocols and guidelines.
Source: USAID Nepal- SSBH https://www.usaid.gov/nepal/fact-sheets/ho-ssbh 107
109. Conclusion
● Maternal infections, prematurity, and multiple births are important
risk factors for birth asphyxia mortality in the low-resource,
community-based setting.
● Hospital based data suggest that the major direct causes of neonatal
death in Nepal are:
➢ Infection
➢ Birth asphyxia/trauma
➢ Prematurity
➢ Hypothermia
109
Source:1. Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL. Risk factors for
neonatal mortality due to birth asphyxia in southern Nepal: a prospective, community-based cohort study. Pediatrics. 2008
May;121(5):e1381-90.
2. Paudel D, Shrestha IB, Siebeck M, Rehfuess EA. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of
110. Conclusion
Underlying these direct causes is a constellation of underlying causes,
including:
➢ Poor pre-pregnancy health
➢ Inadequate care during pregnancy
➢ Inadequate care during delivery
➢ Low birth weight
➢ Inadequate newborn and postpartum
Source: Chalise SP, Mishra SK, Kasakar P, Anjum MF. Causes of Mortality in Low Birth Weight Babies at a Tertiary Care Hospital. Journal of
Nepal Paediatric Society. 2021;41(3):150-6.
110
111. Conclusion
● Low socioeconomic status is highly associated with neonatal mortality.
● Neonatal mortality varies greatly by socio-demographic variables.
● Much remains to be achieved in terms of reducing neonatal mortality across
different socio-economic, ethnic and geographical population groups in
Nepal.
● Low coverage & quality of care of program.
● Boys had higher mortality in the first week followed by no sex difference in
weeks 2 and 3 and a reversal in risk in week 4, with girls dying at more than
twice the rate of boys.
111
Source: 1. Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL. Risk factors for neonatal mortality due to birth
asphyxia in southern Nepal: a prospective, community-based cohort study. Pediatrics. 2008 May;121(5):e1381-90
2. Erchick DJ, Lackner JB, Mullany LC, Bhandari NN, Shedain PR, Khanal S, Dhakwa JR, Katz J. Causes and age of neonatal death and associations with maternal and
newborn care characteristics in Nepal: a verbal autopsy study. Archives of Public Health. 2022 Dec;80(1):1-0.
3.Subedi S, Katz J, Erchick DJ, Verhulst A, Khatry SK, Mullany LC, Tielsch JM, LeClerq SC, Christian P, West KP, Guillot M. Does
higher early neonatal mortality in boys reverse over the neonatal period? A pooled analysis from three trials of Nepal. BMJ open. 2022
112. Conclusion
● The main reason for the stagnation in reducing neonatal deaths in
Nepal is the continuing challenge in delivering quality neonatal health
services, characterised by inadequate and unskilled human resources,
poor infrastructure and equipment, and inaccessible health facilities,
especially in hills and mountain districts.
● Though delivery services are free, neonatal care cost high, due to
which most parents are found reluctant to provide treatment for ill
newborns.
112
Source:Neupane S, Doku DT. Neonatal mortality in Nepal: a multilevel analysis of a nationally representative. Journal of
epidemiology and global health. 2014 Sep
113. Recommendations
● Programs:
○ Scale up programs of proven effectiveness, conduct in-depth evaluation of
promising new approaches, target unreached and hard-to-reach populations,
○ Maximize use of financial and personnel resources through integration
across programs.
○ Strengthen quality improvement Onsite coaching program.
○ Need for interventions at the individual level with regard to access and
utilization of healthcare in order to reduce the neonatal mortality in Nepal.
○ Focus on tertiary care.
○ Strengthen measurement, programme-tracking and accountability to count
every newborn and stillbirth.
113
Source:1. Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL. Risk factors for neonatal mortality due to birth asphyxia in
southern Nepal: a prospective, community-based cohort study. Pediatrics. 2008 May;121(5):e1381-90.
2. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality
114. Recommendations
● Midwifery:
○ Provide high quality of antenatal care, skilled care at birth, postnatal care
for mother and baby, and care of preterm baby and sick newborns.
○ A large proportion of neonatal deaths occur during the first 48 hours
after delivery. So, prompt postnatal care for the child is important to
treat any complications arising from the delivery.
○ Improve the quality of maternal and newborn care from pregnancy to the
entire postnatal period, including strengthening midwifery.
Source: 1. Paudel D, Shrestha IB, Siebeck M, Rehfuess EA. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality. BMC Public Health.
2013 Dec;13(1):1-3.
2. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality
114
115. Recommendations
● Focus on determinants:
○ Promote engagement of and empower mothers, families and
communities to participate in and demand quality newborn care.
○ Reduce inequities in accordance with the principles of universal
health coverage, including addressing the needs of newborns in
humanitarian and fragile settings.
115
Source:1. Paudel D, Shrestha IB, Siebeck M, Rehfuess EA. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce
neonatal mortality. BMC Public Health. 2013 Dec
2. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality
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117
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118