Community Based Newborn CareBRAC
PARTNERSHIP APPROACH TO ACHIEVE THE MDGS IN BANGLADESH
PRESENTATION OUTLINE
Maternal and Child Health Scenario in Bangladesh
BRAC MNCH Programme
Service Delivery
Service provider
Intervention areas
ANC, PNC
Essential Newborn Care
Reduction of NMR
Challenges addressed, Lessons learned
Maternal and Child Health Scenario in Bangladesh
An increase in hospital birth from 9.2% to 23% and skilled attendance at delivery from 12.2% to 26.5% in three years
Of 250,000 annual under-five deaths, over half die in their first month
At least two-thirds of these deaths could be averted by ensuring appropriate care
A reduction from 12,000 maternal deaths per year in 2001 to about 7,300 in 2010
Source : BMMS 2010, BDHS 2007
www.brac.net
Rural MNCH
Improving Maternal, Neonatal and Child Survival
BRAC-GoB-Unicef
DFID, AusAID, EKN and BRAC
BRAC MNCH PROGRAMME
www.brac.net
19 million rural populations
BRAC MNCH PROGRAMME IMPLEMENTATION AREAS
1. Capacity development of HR
2. Community empowerment
5. Linkage between community and public/private health facilities
4. Timely Referral of emergency cases
NHW
SK
Staff
SS
CSBAMidwife
p
OPERATIONAL STRATEGIES
3. Services rendered at community, households and facilities
SERVICE PROVIDER AT COMMUNITY LEVEL
Selected from localities Age 25-45 years Married Willingness to work Community acceptability
Selected from localities Age 25-45 years Married Willingness to work Community acceptability
Selected from localities Age 20-35 years Married Minimum SSC Willingness to work Community acceptability
Newborn Health Worker
Shasthya Shebika
Shasthya Kormi
SERVICE DELIVERY
Maternal Care Identification of pregnancy Ante, intra & post natal care Referral of maternal complications Family planning Post-abortion care
Essential Newborn care Special care for LBW babies Management of birth asphyxia Detection and referral of Neonatal sepsis Referral of complications
Exclusive breast feeding and complementary feeding Immunization and Vitamin A intake Community case management of ARI and diarrhea Referral of complications
Neonatal Care
Child Care
REFERRAL SYSTEM
Referral Hub
www.brac.net
UTILIZATION OF ANTENATAL AND POSTNATAL CARE
BDHS 2007 2009 2010 2011 (Jan-Sep)0
20
40
60
80
100
15
8388
93
4 or more ANC
Perc
enta
ge
Baseline 2009 2010 2011 (Jan-Sep)0
20
40
60
80
100
28
80 84 86
3 or more PNC
Perc
enta
ge
Baseline
www.brac.net
A major shift is observed in place of birth from home to Hospitals
TREND IN PLACE OF BIRTH
Baseline 2009 2010 2011 (Jan-Sep)50
60
70
80
90
100
8678 75 70
1422 25 30
Trend in place of birth
Home Hospital
ESSENTIAL NEWBORN CARE
Increasing coverage of essential newborn care
BDH
S 20
07
2009
2010
2011
(Jan
-Sep
)
BDH
S 20
07
2009
2010
2011
(Jan
-Sep
)
BDH
S 20
07
2009
2010
2011
(Jan
-Sep
)
Trained attandance at home delivery
Thermal care within 10 minutes
Initiation of breast feeding within 1 hour
of birth
0
25
50
75
100
11
66 6876
26
8491 94
0
8793 95
Pe
rce
nta
ge
43
LOW BIRTH WEIGHT DETECTION AND SPECIAL CARE
2010 2011 (Jan-Sep)Rangpur,
Gaibandha, Mymensingh
0
20
40
60
80
100
84 85
19 2115
19
Low birth weight detection and special care
Birth weight taken Low birth weight Spacial care
Sick Newborn Case Management
2009 2010 2011 (Jan-Sep)0
0.5
1
1.5
2
2.5
Neonatal sepsis diagnosed and referred
Diagnosed Referred
2009 2010 2011 (Jan-Sep)0
0.5
1
1.5
2
2.5
3
3.5
4
Birth asphyxia diagnosed and managed
Diagnosed Managed by SS
* BDHS 2007; BRAC MIS
REDUCTION OF NEONATAL MORTALITY
The NMR reduction
is 29% over four
years
19931997
20012004
20072008
20092010
2011 (Jan-S...
MDG ta
rget
0
10
20
30
40
50
60
52
48
42 41
37
2231 30
2826
22
National Statistics Intervention Areas
Per
1,00
0 Li
ve B
irth
s
CHALLENGES ADDRESSED
Changes in behavior and practices
Community health worker’s adoption of new knowledge and practices
Lack of competence among health providers to manage neonatal sepsis
Lack of services in referral facilities for managing newborn complications
LESSONS LEARNED
Community health workers can perform if properly trained and supervised
Support of skill mix team
Performance based incentives
Community support network
Postnatal home visit
Referral support network
THE END
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