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Dr. Abhay Bang Director, SEARCH, Gadchiroli

ASHA Training Modules 6 and 7. Dr. Abhay Bang Director, SEARCH, Gadchiroli. Skills for saving life. Maternal Health Newborn Health Child Health Nutrition Infections Social mobilization. *. Home-Based Newborn and Child Care. The MDG : to reduce IMR to 28 by 2015.

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Dr. Abhay Bang Director, SEARCH, Gadchiroli

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  1. ASHA Training Modules 6 and 7 Dr. Abhay Bang Director, SEARCH, Gadchiroli

  2. Skills for saving life • Maternal Health • Newborn Health • Child Health • Nutrition • Infections • Social mobilization * Home-Based Newborn and Child Care

  3. The MDG : to reduce IMR to 28 by 2015 The current IMR : 53 Reduction to be done by 25 points JSY reduced NMR by 2 ( Lancet 2010) IMNCI can reduce NMR by 13 % ( 4) More effective interventions urgently needed.

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

  5. 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

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

  7. SEARCH, Gadchiroli

  8. Interventions • Health education for behavior change & care seeking • Attending home delivery : with TBA • Care of baby at birth • Home visits and support in newborn care • Monitor the newborns • Management of NB sicknesses - Birth asphyxia - LBW / Preterm - Sepsis / Pneumonia SEARCH, Gadchiroli

  9. Supervision: Every 15 days • Is the work of CHW complete ? • Is the quality of work good ? • Are her skills up to the mark ? • Does she have the supplies ? • Are there any complications ? • Is the community satisfied & supportive ? • How much should she be paid ? SEARCH, Gadchiroli

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

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

  12. * SEARCH, Gadchiroli

  13. SEARCH, Gadchiroli

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

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

  16. What is necessary to implement HBNCC successfully ? • Community support • Training : Contents, duration, strategy • and quality of trainers. • Management support to ASHA program • in the field • Computerized records and MIS • Support by the Health System • Finances

  17. Training for HBNCC Program Manager : 10 days Trainer : 30 days Facilitator : 25 days ASHA : 20 days + Work in her Community

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

  19. ASHA workbook ASHA progress book Story book on ASHAs

  20. ANKUR : NMR 51 % reduction SEARCH, Gadchiroli

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

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

  23. 11th Five Year Plan • HBNCC Gadchiroli model to be the main strategy to reduce IMR in India. • Introduce HBNCC in all districts with IMR > 45 SEARCH, Gadchiroli

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

  25. Expected outcomes Improved MCH Improved ASHA work Development of ASHA training and support system

  26. Why Newborn Health ? IMR : 53 NMR : 36 * JSY reduced NMR by 2 ( Lancet 2010) IMNCI can reduce NMR by 13 % ( 4)

  27. SEARCH, Gadchiroli

  28. 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.

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

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

  31. Payment to CHW • Time spent : 1 hr / day • per 1000 popl. • Performance linked payment • Rs 200 Per mother-newborn • Average Rs 500 Per month SEARCH, Gadchiroli

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