bang empowering

77
Abhay Bang SEARCH, Gadchiroli Empowering people for Saving Newborns and Children SEARCH, Gadchiroli Inspiration, Integration and Impact

Upload: core-group

Post on 07-May-2015

1.164 views

Category:

Health & Medicine


0 download

DESCRIPTION

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

TRANSCRIPT

Page 1: Bang empowering

Abhay Bang

SEARCH, Gadchiroli

Empowering people for

Saving Newborns and Children

SEARCH, Gadchiroli

Inspiration, Integration and Impact

Page 2: Bang empowering
Page 3: Bang empowering

Bombay

New Delhi

Maharashtra

Gadchiroli

SEARCH, Gadchiroli

Page 4: Bang empowering
Page 5: Bang empowering
Page 6: Bang empowering
Page 7: Bang empowering
Page 8: Bang empowering

S E A R C H(Society for Education, Action and

Research in Community Health)

Page 9: Bang empowering
Page 10: Bang empowering

SEARCH, Gadchiroli

Page 11: Bang empowering
Page 12: Bang empowering

SEARCH, Gadchiroli

Laboratory of 86 villages

IMR (1988) : 121 /1000 LB

Page 13: Bang empowering

Neonatal 39%

Pneumonia 20%

Diarrhoea 19%

Immunisable Diseases

15%

Malaria 7%

Why do children die ? Main causes

Malnutrition

SEARCH, Gadchiroli

Page 14: Bang empowering

Before Treatment After Treatment

(1988-2003)

Percent Deaths due to Pneumonia

Page 15: Bang empowering

SEARCH, Gadchiroli

0

10

20

30

40

50

60

70

80

90

NMR62

IMR : 80

The IMR in Gadchiroli ( 39 villages ) 1990

Page 16: Bang empowering

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

Page 17: Bang empowering
Page 18: Bang empowering

SEARCH, Gadchiroli

Page 19: Bang empowering

SEARCH, Gadchiroli

Page 20: Bang empowering

Limitations of hospital care

• Inaccessible

• Costly

• Parents unwilling

• Not enough beds and neonatologists

SEARCH, Gadchiroli

Page 21: Bang empowering

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

Page 22: Bang empowering

Baseline IMR 76 and NMR 60*

Page 23: Bang empowering

SEARCH, Gadchiroli

Page 24: Bang empowering

How to provide HBNC

Mother

TBA

CHW

Supervisor

Training + Supervision + supplies + incentivesSEARCH, Gadchiroli

Page 25: Bang empowering

SEARCH, Gadchiroli

Page 26: Bang empowering

SEARCH, Gadchiroli

Page 27: Bang empowering
Page 28: Bang empowering

•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

Interventions

SEARCH, Gadchiroli

Page 29: Bang empowering

SEARCH, Gadchiroli

Page 30: Bang empowering

SEARCH, Gadchiroli

Page 31: Bang empowering

SEARCH, Gadchiroli

Page 32: Bang empowering

SEARCH, Gadchiroli

Page 33: Bang empowering

SEARCH, Gadchiroli

Page 34: Bang empowering

Supervision: Every 15 days1. Is the work of CHW complete ?

2. Is the quality of work good ?

3. Are her skills up to the mark ?

4. Does she have the supplies ?

5. Are there any complications ?

6. Is the community satisfied & supportive ?

7. How much should she be paid ? SEARCH, Gadchiroli

Page 35: Bang empowering

SEARCH, Gadchiroli

Page 36: Bang empowering

Neonatal mortality rate (1993 to 2003)(intervention and control area)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

1993-95 1995-96 1996-97 1997-98 1998-01 2001-03Baseline Training

& visiting Interventions Full

InterventionsContinuation of care

Neonatal mortality rate

70 % reeducation in the NMR SEARCH, Gadchiroli

Page 37: Bang empowering

Effect of home-based newborn care on case fatality

(1995-96 Vs 1996-03)

11.3

4.9**

33.3

10.1**

18.5

6.9**

38.5

20.2*

0

5

10

15

20

25

30

35

40

45

Low birth weight Preterm Sepsis Asphyxia

1995-96, Before interventions 1996-03, With interventions

% case fatality

** p < 0.005, * p < 0.07SEARCH, Gadchiroli

Page 38: Bang empowering

The Infant Mortality Rate in Gadchiroli (1988 – 2007)

39 intervention villages

0

20

40

60

80

100

120

140

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003-2007

Infant Mortality Rate

Pneumonia case management

Home-based newborn care

Year

Linear regression trend in IMR

SEARCH, Gadchiroli

Page 39: Bang empowering

SEARCH, Gadchiroli

Page 40: Bang empowering

*

SEARCH, Gadchiroli

Page 41: Bang empowering
Page 42: Bang empowering

SEARCH, Gadchiroli

Page 43: Bang empowering

How to transfer HBNCC from Gadchiroli to India ?

SEARCH, Gadchiroli

Page 44: Bang empowering

ANKUR Project (2001-05)

SEARCH, Gadchiroli

Supported by Save the Children, US

Page 45: Bang empowering

Selected study sites

SEARCH HQ

ANKUR Project

Villages : 91

Slums : 6

Total Population : 88, 311

Tribal

TribalRural

Rural

Rural

U.Slum

Rural

Nashik

Osmanabad

Sangli

Yawatmal

Nagpur

Gadchiroli

SEARCH, Gadchiroli

(2001-05)

Page 46: Bang empowering

46

23

05

101520253035404550

Baseline Intervention 3rd Year

ANKUR : NMR

51 % reduction

SEARCH, Gadchiroli

Page 47: Bang empowering

Neonatal 39%

Penumonia 20%

Diarrhoea 19%

Immunisable Diseases

15%

Malaria 7%

A combined package for children 0-5 years age : Home-Based Newborn and Child Care (HBNCC)

1 month – 5 yearCauses of death

IMCI + HBNC = HBNCCSEARCH, Gadchiroli

Page 48: Bang empowering

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

Page 49: Bang empowering

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

Page 50: Bang empowering

Guidelines of Ministry of Health

Govt. of India (2010)

ASHAs to provide HBNC

Page 51: Bang empowering

Educational Aids from SEARCH

Dialogue with Mother

Home Based Newborn Care

CHW Training Manual

Flip-Chart for Health Education of Mothers

A Film for Health Education of Mothers

SEARCH, Gadchiroli

Page 52: Bang empowering

Policy change in Ethiopia

• Management of Pneumonia in children

• Home-Based Newborn Care

Page 53: Bang empowering

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.

Page 54: Bang empowering

“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

Page 55: Bang empowering

EVERY ONE OF US HAS POTENTIAL TO CHANGE

Page 56: Bang empowering

What can we do?

1. Make the Newborn Your Talisman

2. Don’t provide only health care

But, provide capacity to care for health

3. Empowerment of women is the most sustainable and best strategy

4. Don’t withhold distribution of medical knowledge and skills.

5. Introduce Home-Based Newborn and Child Care wherever you work.

Page 57: Bang empowering

SEARCH, Gadchiroli

Page 58: Bang empowering
Page 59: Bang empowering

Question : Does HBNC conflict

Majority home deliveries is a fact.

After hospital delivery most mothers

discharged on the 2nd day.

Near complete absence of post-partum

care.

60 % maternal deaths occur in the PP period

with Safe Motherhood?

SEARCH, Gadchiroli

Page 60: Bang empowering

How does HBNC fit with JSY ?

SEARCH, Gadchiroli

Page 61: Bang empowering

Antenatal Delivery

Facility

Home

Post-natal

JSY HBNC

JSY & HBNC are complementary

SEARCH, Gadchiroli

Page 62: Bang empowering

HBNC is necessary to all neonates whether born in

institution or at home.

SEARCH, Gadchiroli

Page 63: Bang empowering

Does HBNC Affect Maternal Health?

Mortality ?

Morbidity ?

SEARCH, Gadchiroli

Page 64: Bang empowering

SEARCH, Gadchiroli

Page 65: Bang empowering

Home-based

Post partum + Neonatal

care

SEARCH, Gadchiroli

Page 66: Bang empowering

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

Page 67: Bang empowering

Integrated HBMNCC

HBNC

+

Maternal Care

+

IMCI

Home-based Mother-Newborn- Child care+ Referral of complicated cases.*

SEARCH, Gadchiroli

Page 68: Bang empowering

Antenatal Delivery

Facility

Home

Post-natal

JSY HBNC

Mother-Newborn and Child Care

SEARCH, Gadchiroli

Facility Based

Newborn care

Child Health

(IMCI)

ASHA + Training and supervision + Health System

Page 69: Bang empowering

Is it ethical ?

• First, advise referral

• Does the ethical responsibility stop with advice?

• What % actually go to hospital?

• What happens if not treated ?

• Case fatality 26 %

SEARCH, Gadchiroli

Page 70: Bang empowering

Is it ethical ?

• Is it ethical to let the newborn die?

• Is it ethical to give antibiotic as a life saving emergency measure?

• Other situations

- Insulin for juvenile diabetic child

- Needles for drug addicts

- Cholera vaccineSEARCH, Gadchiroli

Page 71: Bang empowering

ASHA workbook ASHA progress book Story book on ASHAs

Page 72: Bang empowering

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

Page 73: Bang empowering

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

**

Page 74: Bang empowering

Neonatal Sepsis = Pneumonia (52% Deaths) Meningitis Septicemia

6 % to 10 % Neonates need treatment

2 Antibiotics : Oral + Injectable

SEARCH, Gadchiroli, India

Page 75: Bang empowering

Payment to CHW

• Time spent : 1 hr 23 min. / day

per 1000 popl.

• Performance linked payment

• $ 4 Per mother-newborn

• Average $ 10 month

SEARCH, Gadchiroli

Page 76: Bang empowering

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

Page 77: Bang empowering

The preceding slides were presented at theCORE Group 2010 Fall Meeting

Washington, DC

To see similar presentations, please visit:www.coregroup.org/resources/meetingreports