ASHA Training Modules 6 and 7 Dr Abhay

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 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.

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

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

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

SEARCH, Gadchiroli

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

Supervision: Every 15 days 1. 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

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

The Infant Mortality Rate in Gadchiroli (1988 – 2007) 39 intervention villages Infant Mortality Rate 140 Pneumonia case management 120 Home-based newborn care 100 80 60 40 Linear regression trend in IMR 20 0 19 88 19 8 9 19 90 19 91 19 92 19 93 19 94 19 95 Year 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 -2 0 07 SEARCH, Gadchiroli

* SEARCH, Gadchiroli

SEARCH, Gadchiroli

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

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

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

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

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

ASHA workbook ASHA progress book Story book on ASHAs

ANKUR : NMR 51 % reduction SEARCH, Gadchiroli

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

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

th 11 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

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

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

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

SEARCH, Gadchiroli

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.

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

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

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