NRHM Haryana : HBPNC Home Based Post Natal Care Saving Lives

Name of the Organisation : National Rural Health Mission (NRHM) nrhmharyana.org
Type of Announcement : HBNC (Home Based Newborn Care) Home Based Post Natal Care HBPNC Saving Lives

http://www.nhmharyana.gov.in/
http://www.nrhmharyana.org/

HBPNC SAVING LIVES :
Objective:
The Home Based Post Natal Care is a package of interventions delivered at home level by community link workers (ASHA) to reduce neonatal mortality.

A comprehensive approach comprising essential care during pregnancy; assistance during delivery and immediate postpartum period; postnatal care; and critical clinical care for a few sick newborns is needed to meet the rising demand and to tackle unaddressed newborn care challenges.

NRHM includes a comprehensive package of newborn and child health interventions for implementation, the aim being “a decisive breakthrough in neonatal, infant and child mortality”. The strategy encompasses home, community and facility level care to reflect a “continuum of care”. (The chain of service delivery for continuum of care)

Birth preparedness (through health worker) –> safe delivery (JSY and skilled care at birth) –> basic care of the newborn at home –> identification and management of illnesses (IMNCI) and referral.

Providing basic care to newborns at home has been identified as a critical intervention that helps in preventing newborn deaths. However, postnatal care has not received adequate attention until recently and NFHS-III records only a small percentage of women or children being visited by a health worker during the first month of life.

OBJECTIVE OF HBPNC :
The Home Based Post Natal Care is a package of health services delivered at home by community link workers aimed at reducing neonatal mortality.

The package, in the context of continuum of care, comprises health services provided to mother and newborn at a high coverage by trained ASHAs visiting homes systematically under supportive supervision with the backup of referral facilities and transport.

KEY COMPONENTS OF HBPNC PACKAGE :
1) Capacity building of ASHA to provide HBPNC services
2) Delivery of quality home based essential newborn and maternal care services.
3) Creating an enabling environment for ASHA to provide HBPNC services
o Provision of performance based incentive to ASHA
o Provision of kit
o Referral transport funds
4) Supportive supervision
5) Data capture and analysis

EXPECTED OUTPUTS :
Outputs expected from this package are:
1. Delivery of basic newborn and maternal care at home
2. Early breast feed initiated newborn
3. BCG and Zero dose polio completed newborn
4. Birth weight recorded
5. Birth Registration done
6. Neonate Death recorded
7. Maternal death recorded
8. Key messages on maternal and newborn care provided to Mother and Family Members.
9. Identification of danger signs in newborn and mother and referral

HOME VISIT SCHEDULE:
Birth Preparedness visit (8th month of pregnancy)
1st visit (Day 1- Day of birth)
2nd visit (Day 2-3 after birth)
3rd visit (Day 5-7 after birth)
4th visit (Day 14-17 after birth)
5th visit (Day 23-28 after birth)
6th visit (42-45 days after birth)

STATUS OF HBPNC :
HBPNC is currently operational in 12 NIPI focus districts with a population of approximately 20 million. In Bihar, Madhya Pradesh, Orissa and Rajasthan 15,483 ASHAs has been oriented and are following up deliveries in their communities. Approximately 300,000 mother baby cohorts have been provided HBPNC.

A 5 day skill based training of 8019 ASHAs in identification of danger signs and referral of sick newborn is completed in Rajasthan & Odisha.

Third party external supervisors supervise ASHAs; in Bihar supervision is undertaken by a Social Science Institute – a Semi Government agency, in Orissa an NGO is supervising the ASHAs, in Rajasthan the Chain of ASHA Supervisors (rechristened as Health Supervisor) under the NRHM system is also overlooking HBPNC.

The HBPNC Coverage in the districts is targeted at 80% of estimated deliveries. However it is at present ranging between 58% in Sambalpur, Orissa and 90% in Sheikhpura, Bihar. The intervention aims at increasing identification and referral of sick newborns to health facilities, and to reduce neonatal mortality. Apart from these three indicators intermediate outputs like; weight, birth dose immunization and initiation of breastfeeding are also being closely monitored.