Community Based Newborn Care Program

In Nepal the under-five mortality rate is 59 for every 1000 births. Nepal is one of only seven countries in the world on track to cut child mortality by two thirds between 1990 and 2015. The NDHS 2006 showed impressive progress in infant and child mortality. However, the progress on reduction of newborn mortality is not satisfactory. In order to reach MDG 4, Nepal is focusing on reducing newborn mortality. Considering this fact, the Ministry of Health & Population (MoHP) developed and endorsed a community based newborn care package (CB-NCP) in partnership with various stakeholders with a target to reduce the high rate of neonatal mortality. CBNCP program has been implemented in 39 districts till date. This program promotes the use of skilled birth attendants during delivery, provides community-based counseling, treatment and referral of sick neonates. It encourages clean delivery, newborns resuscitation, prevention of hypothermia, kangaroo care (Maya ko Angaalo), breast-feeding education, low birth weight management and delay bathing.

IRHDTC provided technical assistance with financial support from UNICEF in Dang & Kavre districts. The Female Community Health Volunteer (FCHV) along with facility Based–Community Health Workers (VHW, MCHW) were identified as the main leads for the implementation of CB¬NCP.

Objectives of CBNCP in Dang & Kavre

1. To encourage institutional delivery
2. To Promote hand washing and 5 clean during delivery
3. To Manage post delivery asphyxia
4. To Prevent and Manage hypothermia and low birth weight (LBW) babies
5. To Prevent and Manage newborn infections
6. To Develop an effective system for referral of sick newborns
7. Monitoring, supervision and evaluation

Methodology
We collected data from two districts using two methods;
(1) The data were extracted from NHIS software in which CBNCP variables received from monthly reports of health facilities were entered and then recorded in MS- Excel. (Later on a format in Ms- Excel was developed)
(2) Through TSV: The District and field co-ordinators had used a set of questionnaire to assess the knowledge, skill and availability of logistic materials with the health service providers. These were recorded in MS- Excel and Color Coded Monitoring Software System.
(2.1)The neonatal deaths identified from the NHIS report were used to take verbal autopsies.
(2.2) Interview of Mother having under 1 year baby was taken for KAP during TSV.

IRHDTC Performance in Dang and Kavre
IRHDTC provided support to District Health Offices of Dang & Kavre to perform various activities related to CBNCP. Some of them are as follows:

 Technical Support visit (including home visit) to upgrade the knowledge and skill of health workers and FCHVs. 100 % Coverage in Health Facilities while 80% of health workers and FCHVs were covered in both the districts.
 Support in Ilaka/Revew/Semi – Annual/Annual meeting, Support to DPHO/DHO in National Immunization Day, Measles Rubella Campaign (Dang), Support in supply of logistics materials, Support in Chlorohexadine Program (Kavre)
 IRHDTC initiated for strengthening Mother’s Group meeting and spread CBNCP messages among the mothers.
 Joint Monitoring visit from IRHDTC Central Office/UNICEF/CHD/DPHO was conducted to observe CBNCP performances in the districts.
 Intensive Monitoring of CBNCP and CBIMCI were conducted with NFHP II in Dang.
 Observation visit done by External visitors – Japan, Norway, Germany , Australian Aid, Faya Nepal (Kailali) & Source Nepal (Doti), PHD group (Chitwan), visitors from Pakistan, Bangladesh, Afghanistan, Ghana and France. Similarly, Representative from Country Office and Regional Director from ROSA UNICEF visited Dang to observe CBNCP.
 IEC/BCC Activities conducted in both the districts which included School Health Program, Street Drama, Wall Painting, airing CBNCP messages in local FM etc.
 We took an Interview with recently delivered women to identify the KAP related to newborn care shared to them by FCHV
 Case studies are the integral part of monitoring and an essential aspect for highlighting the success and failure of the program. The different case studies done during the CBNCP period.