udai

udai-1 An intervention to improve the survival of newborns in southern Rajasthan

(2015-17)

Project area

Two contiguous blocks of southern Rajasthan, one each in Udaipur (Gogunda) and Rajsamand (Kumbhalgarh) districts of Rajasthan.

Rationale for the project

  • The state of Rajasthan witnesses 38 neonatal and 47 infant deaths per 1000 live births annually (Source: Annual Health Survey Bulletin, Rajasthan 2011-12 & Sample Registration System Bulletin September, 2014- Volume 49 of 1, respectively).
  • Any attempt to improve child survival hinges on improving the health and survival of newborns. Health outcomes of newborns are shaped in turn by biological, social and economic factors. Over half of the under-five (0-5 years) mortality rate of 80 per 1000 live births is related to the newborn period. Hence any effort to reduce newborn deaths would contribute to improving the economic condition of the poorest segment of the population.
  • The tribal dominated southern zone of Rajasthan comprising 6 districts of Udaipur division has the most adverse health, educational and economic indicators. Hence action to reduce neonatal mortality is of particular relevance in this part of the state.
  • Most (75%) neonatal deaths occur within the first week of life, mainly among high-risk newborns (those that have suffered with asphyxia or are of low birth weight). High risk newborns (those that have suffered birth asphyxia or are low birth weight–(2500 gm) constitute 30-35% of all births, but are by and large not being identified at the time of delivery, even in health facilities.
  • In view of a collective experience of poor newborn care in hospitals, apprehensions regarding costs and duration of stay, families are reluctant to seek care for sick newborns, unless the same is actively facilitated.
  • The mandatory 5 routine postpartum home visits by ASHAs lacks proper implementation due to lack of field supervision and support stemming from vacant supervisory positions and lack of mobility on part of supervisors.
  • Mothers and newborns are discharged after a prescribed stay of 48 hours after childbirth (or even earlier as per convenience of providers and families), irrespective of the condition of the newborn. Hence a newborn that is not maintaining temperature or feeding well might be sent home.

Proposed interventions

  • Recruitment and training: Project personnel will be recruited and placed by ARTH, Udaipur in the two blocks being covered by the project. Health facility staff will be oriented about the project, labour room staff will be re-trained on newborn care at birth as per NHM guidelines; Project Community Organizers and facility health educators will be trained to perform their roles in promoting newborn care.
  • Reinforcing skills for neonatal resuscitation: Labour room staff will be re-trained on neonatal resuscitation using mannikins to allow for adequate practice.
  • Call centre to facilitate newborn care and referral: A day time (10am to 4 pm) call centre will be established at Udaipur, women delivering in the project area and local ASHAs will be able to make calls reporting danger signs or problems in the mother or newborn and to decide on referral. The call centre will provide guidance on referral and inform a helpline worker at the district SNCU about impending referral. The call centre will also inform ASHAs and their supervisors about new births in their jurisdiction, to enable timely home visits.
  • Strengthening maternal-newborn care in facilities and homes: Each facility health educator will be assigned 1 to 3 facilities depending on work volume and intervening distances. Facility workers will ensure that all newborns are classified as low or high risk on the basis of birth records. High risk newborns will be distinctly labeled, monitored more intensively and will receive added care by staff. All mothers and newborns will be discharged using a discharge card approved by the State Health Directorate. Each high risk newborn will receive a take-home kit comprising a basic warmer, thermometer, weighing scale and pictorial booklet, to enable families to track progress of the newborn. Families will be educated about routine newborn care, how to contact the local ASHA and invite her to make timely home visits, and to contact the call centre in case of danger signs in the mother or newborn.
  • Building community support for ASHAs: Project Community Organizers will visit each newborn at least twice and track neonatal and maternal outcomes at 28 and 42 days. They will encourage family and community demand for home based maternal-neonatal care services, support the ASHAs in making timely home visits, help them to provide quality Home Based Postnatal Care (HBPNC) as per NHM guidelines and give feedback to block health officials. Community organizers will be given two-wheeler mobility to ensure complete coverage.
  • Facilitating admission and care of sick newborns at district SNCU : Two helpline workers can be posted at the Government District Hospitals at Udaipur and Rajsamand. They will help sick newborns and mothers having a complication, to get admitted at the Sick Newborn Care Unit or maternity unit of the hospital, and support families during the period of admission.
  • Strengthening newborn stabilization care at ARTH Health Centres: Two ARTH centres that currently carry out 80-100 deliveries per month will upgrade their newborn care rooms to provide care to stabilize high risk and sick newborns through provision of equipment, telephonic support and bi-weekly visits by doctors.
  • Tracking progress of the project: Project staff in Udaipur will track progress of each of the aforementioned steps and maternal and newborn outcomes at 42 and 28 days, for newborns covered by the project. They will send monthly reports to Block and District Health Officers of Government of Rajasthan and hold bi-annual meetings to share experiences and make mid-course corrections.

For more details, contact Bharat Singh Ranawat

E-mail id: arth.programmes@gmail.com

Mob No: +91 9001991534

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