Community Based Newborn Care BRAC

PRESENTATION OUTLINE Maternal and Child Health Scenario in Bangladesh BRAC MNCH Programme Service Delivery Service provider Intervention areas ANC, PNC Essential Newborn Care Reduction of NMR Challenges addressed, Lessons learned

Maternal and Child Health Scenario in Bangladesh An increase in hospital birth from 9.2% to 23% and skilled attendance at delivery from 12.2% to 26.5% in three years Of 250,000 annual under-five deaths, over half die in their first month At least two-thirds of these deaths could be averted by ensuring appropriate care A reduction from 12,000 maternal deaths per year in 2001 to about 7,300 in 2010 Source : BMMS 2010, BDHS 2007

Rural MNCH Improving Maternal, Neonatal and Child SurvivalBRAC-GoB-UnicefDFID, AusAID, EKN and BRAC BRAC MNCH PROGRAMME

19 million rural populations BRAC MNCH PROGRAMME IMPLEMENTATION AREAS

1. Capacity development of HR 2. Community empowerment 5. Linkage between community and public/private health facilities 4. Timely Referral of emergency cases NHW SK Staff SS CSBA Midwife p OPERATIONAL STRATEGIES 3. Services rendered at community, households and facilities

SERVICE PROVIDER AT COMMUNITY LEVEL  Selected from localities  Age years  Married  Willingness to work  Community acceptability  Selected from localities  Age years  Married  Willingness to work  Community acceptability  Selected from localities  Age years  Married  Minimum SSC  Willingness to work  Community acceptability Newborn Health Worker Shasthya ShebikaShasthya Kormi

SERVICE DELIVERY Maternal Care  Identification of pregnancy  Ante, intra & post natal care  Referral of maternal complications  Family planning  Post-abortion care  Essential Newborn care  Special care for LBW babies  Management of birth asphyxia  Detection and referral of Neonatal sepsis  Referral of complications  Exclusive breast feeding and complementary feeding  Immunization and Vitamin A intake  Community case management of ARI and diarrhea  Referral of complications Neonatal Care Child Care

REFERRAL SYSTEM Referral Hub

UTILIZATION OF ANTENATAL AND POSTNATAL CARE Baseline

A major shift is observed in place of birth from home to Hospitals TREND IN PLACE OF BIRTH

ESSENTIAL NEWBORN CARE Increasing coverage of essential newborn care

LOW BIRTH WEIGHT DETECTION AND SPECIAL CARE

Sick Newborn Case Management

* BDHS 2007; BRAC MIS REDUCTION OF NEONATAL MORTALITY The NMR reduction is 29% over four years

CHALLENGES ADDRESSED Changes in behavior and practices Community health worker’s adoption of new knowledge and practices Lack of competence among health providers to manage neonatal sepsis Lack of services in referral facilities for managing newborn complications

LESSONS LEARNED  Community health workers can perform if properly trained and supervised  Support of skill mix team  Performance based incentives  Community support network  Postnatal home visit  Referral support network

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