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Newborn Care

About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal period—the first 28 days of life—carries the highest risk of mortality per day than any other period during childhood. The daily risk of mortality in the first 4 weeks of life is ~30-fold higher than the post-neonatal period, that is, from 1 month to 59 months of age. Still, newborn health did not receive the commensurate attention it deserved until during the past decade.

This has resulted in a slow decline in neonatal mortality rate (NMR) in most countries including India and has hampered they're achieving the Millennium Development Goal-4 (MDG 4) by year 2015. Though Bihar has witnessed a steady decline in neonatal mortality rate (NMR) in recent years, it accounts for second highest total number of neonatal deaths in India.

Our Approach

As we designed the TSU work in 2014, we postulated that in addition to direct technical assistance at frontline operational levels, sustainable change required that we catalytically engage the two programs to:

  • a) Improve public health leadership and managerial skills,
  • b) Sharpen focus on outcomes and gain ability to use data and be driven by evidence and strengthened internal accountability
  • c) Strengthen core systems within both programs to provide an enabling environment for effective implementation of RMNCHN interventions.

Scale of Intervention on the groundNewborn Care Intervention on the ground

The mandate during 2010- 2013 was to engage with Health and ICDS programs of the GoB to improve the coverage of a range of RMNCHN interventions at a scale of eight districts (~28 m population), using creative yet replicable ways of improving frontline worker performance, appropriate to the challenging context: sharply defined intervention priorities, better tools, job aids, skill-building, improved last-mile supervision.

It became equally clear by 2013 that the responsiveness of the FLWs and nurses to our interventions were not matched by more than a lukewarm response from the program leadership itself. Thus, the scale-up technical assistance plans evolved into a Technical Support Unit, with work under a fresh grant kicking in effectively in mid-2014 and spreading across all 38 districts of Bihar.

Innovations

1

Weak New Born Tracking : Including mechanisms of mentoring, supervising and supporting FLWs to focus on delivering services and support equitably to all families, robust name based tracking systems, logistics for ensuring supplies at the last mile.

2

ICT/mobile app : the algorithm in this mobile app comprehensively covers almost all that the TSU has been pushing the GoB to pay attention to in outreach services, and has a number of supervision and monitoring features that would help fix accountability. Ministry of Women and Child Development has pushed an ambitious plan to scale up the CAS-ICT-RTM mobile app across the country, beginning with using World Bank assistance funds to provide smartphones to AWW in 8 states (including Bihar), with CARE supporting the roll out in all states.

3

VHSND platform : The TSU, under a smaller separate grant attempted to explore another channel to promote FLW-family interactions, besides home visits, since FLWs could not be persuaded to increase home visits. The monthly VHSND platform was redesigned with the help of a number of partner agencies (BBC, CKS) in an attempt to make the platform attractive for mothers and children to attend, and more reliable in terms of the availability of a range of supplies including nutritional supplements, contraceptives and ORS-Zn.

4

Institutionalized Incremental Learning strategy : CARE India is supporting GoI to design and implement an innovative capacity building and supervision system strengthening approach called, Incremental Learning Approach (ILA) as part of the World Bank supported NNM. ILA is aimed to strengthen the knowledge and skills of field functionaries and enhance quality and content of supervision in ICDS program.

Achievements

The incidence of stillbirths declined steadily over the year, by about 11% in May 2019.

Indicator Mid-2014 End-2016
Timely breastfeeding among home births 40% 45%
Exclusive breastfeeding 54%* 64%
Proportion of vLBW babies identified at facility birth receiving KMC at home 4%** 29%
First month mortality among identified preterm/vLBW babies^ 20.8% 15.5%

* this value is for 2015, a winter measurement as in 2016
** baseline assessment in May 2015