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

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

3. India Bombay New Delhi Maharashtra Gadchiroli SEARCH, Gadchiroli

8. S E A R C H (Society for Education, Action and Research in Community Health)

10. SEARCH, Gadchiroli

12. SEARCH, Gadchiroli Laboratory of 86 villages IMR (1988) : 121 /1000 LB

13. Why do children die ? Main causes SEARCH, Gadchiroli Neonatal 39% Pneumonia 20% Diarrhoea 19% Immunisable Diseases 15% Malaria 7% Malnutrition

14. Before Treatment After Treatment (1988-2003) Percent Deaths due to Pneumonia

15. SEARCH, Gadchiroli NMR 62 IMR : 80 The IMR in Gadchiroli ( 39 villages ) 1990

16. Newborns in India 27 million newborns are born each year 51 % born at home Even the hospital delivered mother and newborns are sent home < 24 hr. Newborn health care must visit where the neonates are. * SEARCH, Gadchiroli

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21. Home-Based Newborn Care Goal : To reduce neonatal mortality by developing a low-cost, home-based model of primary newborn care by using the human potential in villages. SEARCH, Gadchiroli

22. Baseline IMR 76 and NMR 60 *

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24. How to provide HBNC Mother TBA CHW Supervisor Training + Supervision + supplies + incentives SEARCH, Gadchiroli

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36. Neonatal mortality rate (1993 to 2003) (intervention and control area) Baseline Training & visiting Interventions Full Interventions Continuation of care Neonatal mortality rate 70 % reeducation in the NMR SEARCH, Gadchiroli

37. Effect of home-based newborn care on case fatality (1995-96 Vs 1996-03) % case fatality ** p < 0.005, * p < 0.07 SEARCH, Gadchiroli

38. The Infant Mortality Rate in Gadchiroli (1988 – 2007) 39 intervention villages SEARCH, Gadchiroli 0 20 40 60 80 100 120 140 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003-2007 Infant Mortality Rate Pneumonia case management Home-based newborn care Year Linear regression trend in IMR

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43. How to transfer HBNCC from Gadchiroli to India ? SEARCH, Gadchiroli

44. ANKUR Project (2001-05) SEARCH, Gadchiroli Supported by Save the Children, US

45. Selected study sites SEARCH HQ ANKUR Project Villages : 91 Slums : 6 Total Population : 88, 311 Tribal Tribal Rural Rural Rural U.Slum Rural Nashik Osmanabad Sangli Yawatmal Nagpur Gadchiroli SEARCH, Gadchiroli (2001-05)

46. ANKUR : NMR 51 % reduction SEARCH, Gadchiroli

47. A combined package for children 0-5 years age : Home-Based Newborn and Child Care (HBNCC) 1 month – 5 year Causes of death IMCI + HBNC = HBNCC SEARCH, Gadchiroli

48. SEARCH, Gadchiroli ANKUR Project in Mahatashtra HBNCC Replication sites ICMR Study: Government of India, five states. Other NGOs Africa Other Countries Total 49 Sites SEARCH, Gadchiroli Other States 4 countries

50. Guidelines of Ministry of Health Govt. of India (2010) ASHAs to provide HBNC

51. Educational Aids from SEARCH CHW Training Manual Flip-Chart for Health Education of Mothers A Film for Health Education of Mothers SEARCH, Gadchiroli Dialogue with Mother Home Based Newborn Care

53. Global Policy Acceptance Joint statement by WHO, UNICEF, US-AID and Save the Children ( 2009). Endorsement of home visiting the neonates and management of sick neonates at home by trained worker if the referral is not possible.

54. “ Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Margaret Mead

55. EVERY ONE OF US HAS POTENTIAL TO CHANGE

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60. How does HBNC fit with JSY ? SEARCH, Gadchiroli

61. JSY & HBNC are complementary SEARCH, Gadchiroli Antenatal Delivery Facility Home Post-natal JSY HBNC

62. HBNC is necessary to all neonates whether born in institution or at home. SEARCH, Gadchiroli

63. Does HBNC Affect Maternal Health? Mortality ? Morbidity ? SEARCH, Gadchiroli

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65. Home-based Post partum + Neonatal care SEARCH, Gadchiroli

66. IMNCI Welcome addition of the ‘N’ to IMCI Training 8 days NN care 4 days Does not include - Asphyxia mgt at birth - Sepsis mgt with 2 antibiotics i.e. nearly 60 % deaths - Expected effect small. SEARCH, Gadchiroli

67. Integrated HBMNCC HBNC + Maternal Care + IMCI Home-based Mother-Newborn- Child care + Referral of complicated cases. * SEARCH, Gadchiroli

68. Mother-Newborn and Child Care SEARCH, Gadchiroli Facility Based Newborn care Child Health (IMCI) ASHA + Training and supervision + Health System Antenatal Delivery Facility Home Post-natal JSY HBNC

71. ASHA workbook ASHA progress book Story book on ASHAs

72. Feasibility of Home-based Sepsis Management (1996-2003) Parental acceptance Agreed to hospitalise 2.6 % Agreed to home-based treatment 91.1 % Refused both 6.3 % Proportion of total neonates in community treated by VHWs for sepsis 8.9 % SEARCH, Gadchiroli

73. We, the adults, but are best protected by health care. are at the lowest risk of death, * * We reproduce, giving birth to the most vulnerable human beings – the neonates, * In a just society, * we should all be hanged ! * and then let them die – 1 million in India, 3.6 million globally, every year * *

74. Neonatal Sepsis = Pneumonia (52% Deaths) Meningitis Septicemia 6 % to 10 % Neonates need treatment 2 Antibiotics : Oral + Injectable SEARCH, Gadchiroli, India

76. Cost and cost-effectiveness of home-based neonatal care in Gadchiroli (2001-2003) (1 US $=45 Indian Rs.) Non-recurring costs (2002-03 prices ) US $ Annual recurring costs US $ Cost per village Training : 89 Equipments : 66 Total : 155 118 Cost per mother–newborn served 7 Cost per death averted 151 Cost per DALY saved 7

77. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports