postnatal care program experience and innovative learning · learning from the nuapada...
TRANSCRIPT
Postnatal Care Program Experience and Innovative Learning
Where it all began
PNC home visits can save newborn lives
Home-based PNC pilot: TBAs
Birth-preparedness package: FCHVs conducting home visits
PSBI management MINI project
CB-Postpartum care meeting Dhaka 2005• Most deliveries are at home &
most deaths are at home• Dearth of information on
effective integrated community-based postpartum care
• Immediate postpartum care that reaches into homes much needed
• Neither mothers nor providers appreciate the need for postpartum care
• Home visits: days 1, 3 and 7 (if possible)
• Promote breastfeeding, thermal care and hygiene, birth registration and vaccination
• Assess for danger signs and prompt medical care
• Identify and support newborns needing additional care (LBW, sick etc.)
https://www.who.int/maternal_child_adolescent/news_events/news/2009/09_07_08/en/
Bangladesh, Malawi, Nepal, Nigeria, Rwanda2012
• Enabling policy environment: strategies, implementation plans
• Development partners sharing and bearing bulk of implementation costs
• Challenging for CHWs to make household visits in most countries
• Early home visits – most difficult to achieve
• Quality of facility-based care increasingly important
http://www.healthynewbornnetwork.org/hnn-content/uploads/Postnatal-Care-Home-Visits-A-Review-of-the-Current-Status-of-Implementation-in-Five-countries-A.pdf
• First PNC contact within 24 hours of birth (home and facility)
• Timing of discharge from facility: 24 hours after birth
• Additional PNC contacts on days 3, 7-14 and 42
• Home visits for PNC: in the first week after birth
https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/
Postnatal home visitation: Lessons from country programs operating at scale 2016• Bangladesh, Ethiopia, Ghana, India, Indonesia, Malawi, Myanmar,
Nepal, Pakistan, Rwanda, Sri Lanka and Uganda
• Evidence of implementing at scale through government health service systems, maturity of implementation, availability of performance data and with diversity of models of implementation
• Experience in implementation were captured through document reviews, key informant interviews with policy makers, programmers and service providers
https://pubmed.ncbi.nlm.nih.gov/29977530/
Postnatal home visitation: Lessons from country programs operating at scale• Some countries responded to the Joint Statement by adopting the
schedule recommended
• Some others modified the recommended schedule
• Translating the JS from the policy level to the operations - a challenge
• Proportion of births happening in health facilities higher –opportunities for PNC
https://pubmed.ncbi.nlm.nih.gov/29977530/
Postnatal home visitation: Lessons from country programs operating at scale• Home deliveries with PNC within 48 hours of birth following home
birth <10%
• Country responses varied: some continued programming unchanged, some suspended attempts to provide PNHVs, and others modified their strategies for providing PNC
https://pubmed.ncbi.nlm.nih.gov/29977530/
Postnatal home visitation: Lessons from country programs operating at scale• Feasibility of implementation in the real world is key
• Context and local feasibility need to be considered when determining whether and how to use a strategy like PNHVs
https://pubmed.ncbi.nlm.nih.gov/29977530/
An innovative trial in Nuapada district, Odisha state of India
• Risk stratification to increase pre- and post-discharge PNC for mothers and their newborns
• Establishment of linkage between facility and family using text messages for CHWs and families
• Inputs:• improvement of pre-discharge postnatal care and
counseling
• pre-discharge screening
• mobile application linking facility to CHWs
• Improvement in content of home-based PNC
• monitoring and documentation
Odisha
Results: pre-discharge PNC
Results: pre-discharge PNC
Results: post-discharge PNC
Learning from the Nuapada risk-stratification pilot• Risk stratification helped to increase the attention to postnatal
mothers and newborns
• Linkages between facility and community providers go a big way in improving care for mothers and newborns at home
• Implementation research / feasibility testing designed pilots ensure system ownership and more likely of being taken up for scale
• Technology use is feasible in low resource settings and can help with communications and build linkages between facility, community and homes of postnatal mothers and newborns
Why do we need to focus on postnatal care?
Source: Countdown to 2030, Report 2017
Why the need to focus on postnatal care?
• Common platform for several RMNCAH interventions: postpartum family planning, maternal nutrition, breastfeeding, care of adolescent mothers and fathers, maternal mental health and wellbeing, early childhood development
• Equity and gender empowerment
• Mortality reduction
So what is needed?
• Demand creation: awareness of the critical importance of the postnatal period to improve survival and to ensure mothers and babies thrive
• Value of PNC: quality of care at facilities and linkages between care providers at all levels
• Human resources: facility and community levels – aware, motivated, skilled and supported
• Supplies and commodities: at facility and with community providers• Metrics: routine and survey data and use • Policies and contextualized strategies: national and sub-national
government ownership and context specific PNC home visits • Integration within services along the continuum of care and within reliable
and functioning health systems
https://pubmed.ncbi.nlm.nih.gov/29977530/
Thank you!