home based postnatal revised- june 14-06-10 ppp

8/9/2019 Home Based Postnatal Revised- June 14-06-10 Ppp

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48.6

43.4

39.0

78.5

67.6

57.0

109.3

94.9

74.3

0

20

40

60

80

100

120

NFHS 1 NFHS 2 NFHS 3

Neo- natal mortality Infant mortality

Under five mortailty

35

21.5

9.6


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Why Focus on Neonatal Care

y Considerable improvement in child health made in India

y Reductions are mainly in both postneonatal and 14-year-old child

y

A disproportionate burden of infant and under-5 childhoodmortality relates to deaths within the neonatal (0-28 days)period which has remained constant

y India has the single highest share of neonatal deaths in theworld;

y Out of the 4 million neonatal deaths globally, one millionneonates die in India, i.e. one child dies every 2 seconds.


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Why Focus on Maternal Health duringPostnatal Period

y India has the dubious distinction of having thehighest estimated number of maternal deaths in anycountry - 117, 000 out of 536,000 (WHO 2005)

y Accounts for 22% of all maternal deaths globally;over 320 women die every day due to pregnancy andchildbirth complications

y All pregnant women are at risk and can develop

complications at any time during pregnancy, deliveryor after delivery


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Need for HBPNC

y Providing effective care for mothers and newbornsduring the early post-natal period has the potentialto generate the greatest gains in survival and health

of any period in the continuum of carey Up to two-thirds of neonatal deaths can be prevented

if mothers and newborns receive universal access toantenatal care, skilled birth attendance and early

postnatal care.y Neonatal care delivered at two sites

At home - HBPNC

At health Facility SNCU, SNSU


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Who; Where; When;

yWho for? Integration of post-natal care for mothersand newborns provides more effective and efficientcare than separate approaches to post-partum and

newborn care.yWhere? Routine post-natal visits should be

provided at home, both to promote healthy behaviorsand to link with curative care instead of just

hoping that the mother or baby will be brought to ahealth facility if problems arise.

yWhen? Early contact with mothers and babies iscritical, ideally within 24 hours of birth for the first

visit.


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Delivery of Services

y Home Visits by a Community Health Worker afterbirth forms an important strategy

y HBPNC is a range of interventions that are packaged

for delivery At different times during pregnancy, childbirth, and after

birth,

Through various health-care providers in community settings(ASHA, AWW and ANM the triple A of community healthproviders).


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Core Principle of HBPNC

y The core principle of the HBPNC model is theContinuum of Care- from Pregnancy, birth andduring the newborn period and a continuum of care

Home and community, to the health centre andhospital and back again.

y Promoting improvement in household behaviorsthrough Home Visits by ASHA at critical times and

consists of three parts


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Parts of HBPNC

y A special training program (2+5 days) in HomeBased Newborn Care

y An incentive to the ASHA for completing PNC

checkup routiney A referral fund to ensure that sick newborns and

mothers can be referred to a facility with proper careavailable


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Components of HBPNC

1. Ante Natal Birth Preparedness

1. One Home Visit

2. Post natal Care of Newborn and Mother

1. Six Home visits


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Activities during Home Visits by ASHA

y Assessment of the health status of the newborn andthe mother; looking for danger signs and makingreferrals, as appropriate

y Counseling, especially on essential newborn care andbreastfeeding, and also on immunization and familyplanning

y Documentation (supporting birth registration and on

findings and process of care)


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Activities during Pre-natal Visit

y Counsel the family about JSY scheme and benefitsof institutional delivery

y Prepare one family member for supporting the

mother during and after deliveryy Ensure the mother has JSY beneficiary card and

ANC card

y Items required for facility/home delivery are kept

ready


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Activities during Pre-natal Visit 2

y Counsel for early initiation and exclusive breastfeeding

y Examine the breasts and treat flat/inverted nipples

y Educate the family when to inform ASHAy Other preparations including transport

y Plan for emergency situations - Educate family ondanger signs and suggest the need for immediatereferral When, Where and How


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Activities of ASHA if Present During HomeDelivery

Ensure

y Five cleans during delivery

y Baby is dried immediately after birth and wrapped

appropriately

y Birth weight is recorded

y Baby is put on to mothers breast within one hour ofbirth

y Examine baby and mother for danger signs

y Advice for delayed bathing


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Schedule of Postnatal visits


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Schedule of Postnatal visits

Visit Timing

Visit 1 Day 1 of birth

Visit 2 Day 2-3 after birth

Visit 3 Day 5 7 after birth

Visit 4 Day 14 -17 after birth

Visit 5 Day 23 28 after birthVisit 6 Day 42 45 after birth

Managers need to understand basics of newborn care in order to conduct effective

validation visits to the families. Keep a check list ready related to validation visits.


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Visit 1 - Day 1 of Birth

ASHA to examine the newborn for: Alertness : Activity Breathing

Color Temperature Malformations

2. Record birth weight3. Enquire initiation of breastfeeding and assess for positioning and

attachment, demonstrate to the mother4. Counsel mothers/caregivers on Breastfeeding, Keeping baby warm,cord care, Hygiene, Delayed bathing, Danger signs for baby and mother5. Examine mother for heavy vaginal bleeding, fever, pain, problem withurination, breast problem


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Visit 2 - Day 2 to 3 after birth

Same as the first visit. Additionally Looks for:1. Jaundice2. Feeding pattern, is the baby being exclusively breast fed3. Passage of urine and stool4. Cord condition

5. Skin Pustules (puss pockets on the skin)6. Check if birth registration is done7. Check if the baby received BCG and zero dose of OPV8. Counsel mothers/caregivers* on Breastfeeding, Keeping baby

warm, cord care, Hygiene, Delayed bathing, Danger signs for thebaby and mother9. Ensure birth registrationManager can cross verify from mother if she was informedabout care for low birth weight baby/cord care and when to

bathe.


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Visit 3 : Day 5 7 after birth

All activities as the second visit:1. Counsel the mother and family on newborn care2. Observe the feeding practices; record observation

and counsel mother for correct practices3. Check the condition of the cord4. Weigh the baby and record it in the PNC card5. Counsel the mother for adequate rest and nutrition6. Identify danger signs in the mother and the newbornand make referralSupervisors and BCHM need to validate if ASHA uses theweighing scale correctly and records weight it in the PNC

card.


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Visits 4 - Day 12-14 after birth

All activities to continue as in visit 3:y Routine examination & referral if the newborn is

identified with danger signals.

y Check if the couple opted for FP optionsy Check if the mother is bleeding excessively or has

any other danger sign; if needed, make referraly Check if the mother practices hygiene related

messagesyWeigh the baby and record weight gainy Facilitate zero dose immunization if not given at

birth

BCHM must check the process of referral from mother


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Visit 5: 23-28th day-role of ASHA,

y Check if the couple opted for FP optionsy Check for danger sign mother n babyy Check if the mother practices hygiene related

messagesy Record the weight of the baby and look for weight

gainy Counsel for RI


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Visit 6 : Day 42 45 after birth

Routine examination of the baby and the mother and advise

accordingly

Weigh the baby and look for weight gain

Counsel the mother on immunization of the baby

Counsel the mother on spacing


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Tools for ASHA

y Recording home visits and events PNC card for recording the visits and findings

Referral card

Register for recording

y Supporting tools Weighing scale and sling

Thermometer

Flip chart for counseling

ASHA Booklets

Reference sheet

Additional components in ASHA kit


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o e o uperv sors(e.g.ANM, LHV)

1. Identify facilities and/or medical personnel forreferrals along with the MO/IC

2. Support ASHA/AWW in identifying referral

system in the village3. Random validation of home visits- 5% sample

check (orissa2%) and checking the PNC foraccuracy and completeness

4. Ensure that ASHA is maintain the counterfoil ofthe PNC

5. Ensure availability of referral funds with ASHA


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Role of Supervisors(e.g.ANM, LHV) Contd

7. Ensure that the birth is registered8. Inform the Block manager in case there is shortage

of PNC card or Referral slip or other equipment

(weighing scale, thermometer etc)9. Check that ASHA has the counterfoil of the Referral

slip in case a child has been referred10. Check if ASHA is using the Flip book and other

literature provided to her11. Ensure incremental capacity building of ASHA

during the field visits and also in the monthly reviewmeetings


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Role of Managers

1. Understand the significance of ASHA making the fivevisits

2. Identify facilities and/or medical personnel for referral

3. Support ASHA/AWW in identifying referral transportfrom the community4. Ensure that the hospital have system for respecting the

referrals made by ASHA

5. Coordinate with DHS for replenishing ASHA kit6. Organize ASHA capacity building to ensure correct andcomplete recording in the PNC card

7. Undertake random validation home visits and check thePNC card for accuracy and completeness


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Role of Managers Contd

7. Ensure availability of referral funds with ASHA8. Establish a system to ensure that the PNC cards are being

delivered at the Block on time9. Establish a process to ensure that the PNC cards are being

entered in the database correctly at the block10. Cross validate the progress reports for compliance of

guidelines11. Ensure that ASHAs have the PNC cards, registers, Flip books

Weighing scale, thermometer and use them appropriately.12. Establish a system with MoIC and Block accountant forensuring timely incentive payment to ASHA

13. Incremental capacity building of ASHAs during field visits


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Display PNC Card and ReferralCard


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Importance of PNC Card

Purpose of filing the PNC card is to gather data on the Number of mothers received counseling on newborn care, Number of neonates identified with sickness and danger

signs and referred Number of mothers or neonates died in that community. Gender differentials in the data

Role of the Supervisor Should verify and check the quality of the PNC cards filledby ASHA . Needs to ensure that the filled PNC cards reach the MoICon time and for further processing for incentive payment


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Importance of PNC Card

Role of th

e manager To collect the data electronically for better analysis Further refinement of the processes based on thefindings

Review the progress based on the data and developstrategies Establish a system to get feedback from ANM/LHV/external agency , regarding quality of the information

filled in the PNC card and develop a system ofdissemination. Ensure that all supervisors, MoIC, Block accountant andASHAs are aware of the various steps to complete the

process.


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Role of Manager in Incentive

and referral fund management

Managers must:

Ensure that the block PHC has received the necessaryfunds for making timely incentive disbursement to ASHA,supervisor and Accountant .Ensure that the accountants have clarity on the ASHA

incentive payment instructions and schedule for payment isavailable. Ensure that the ASHAs receive the referral fund with themfrom the Block PHC after completing the necessary training


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Role of Manager in Capacity Building

All the TOT are planned and organized in the

respective blocks as per plan A block training calendar is developed and theschedules are communicated well in advance to all thetrainers, Block MoICs, ASHAs and accountants

Ensure that the required budget is made and approvalsare obtained on time for ensuring the fund release. Develop a checklist related to all the aspects thatrequire coordination with the CMHO/MoIC


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Capacity Building Checklist -

Coordinationo Fund releaseo Availability of resource persons

o Travel arrangement for the participants and resourcepersonso Training materials, training aideso Venueo Transporto Boarding and lodging arrangement for the trainees and

resource personso Honorarium to the resource personso Practical facilities such as toilets, drinking water, power

supply at the venue

home based postnatal revised- june 14-06-10 ppp

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