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Table 3 Major policies and programs to improve neonatal health

From: Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality

Program Description Newborn survival interventions Evidence of program effectiveness in Nepal Program timeline and scale
Community Based Integrated Management of Childhood Illness (CB IMCI) National program, which forms part of the broader WHO/UNICEF IMCI model to improve child health and survival and focuses on treatment of common childhood illness at community level through disease prevention and health promotion, in particular by improving performance of health workers, improving health services, and improving knowledge about the care of children at home and in the community. • Early identification of newborn illness • Increased case reporting of diarrhoea and acute respiratory infections (ARI) (0.21 and 0.16 diarrhoea episodes per child per year in areas with and without intervention respectively; 55% and 27% of all under-five children reporting with ARI in areas with and without intervention respectively) [40] Initiated: 1997
• Community-based management and referral of sick newborns Nationwide: 2009
• Decreased case severity of diarrhoea and ARI (29% and 35% of all diarrhoea cases with some dehydration in areas with and without intervention respectively; 28% and 38% of ARI cases reported as pneumonia in areas with and without intervention respectively) [41]
• Program scalability [42]
• Program contribution to overcoming problem of insufficient human resources for health [42]
Birth preparedness package (BPP) National package of interventions to encourage pregnant women, their families and communities to plan for normal pregnancies and deliveries as well as for obstetric emergencies, designed to be implemented through female community health volunteers and health workers in primary care facilities. Education and counselling on: • Increase in putting into practice five healthy newborn care practices ranging from 19% to 29% from baseline (42% to 71% for clean cord care, 56% to 75% for immediate wiping, 56% to 79% for immediate wrapping, 21% to 40% for immediate breastfeeding and 12% to 41% for delayed bathing) [43] Initiated: 2003
• Preparedness for safe delivery and promoting essential newborn care practices (clean cord, wiping, wrapping, immediate breastfeeding and delayed bathing) Nationwide: 2008
• Danger signs during pregnancy, delivery and the postnatal period
• Danger signs among newborns
• Tetanus toxoid vaccination
Community-based Newborn Care Package (CB NCP) A pilot program developed on the basis of CB-IMCI with a new set of interventions to improve the health and survival of newborn babies. The package reflects evolving evidence and national, regional and global experience, taking into account causes of neonatal mortality, suitability of interventions to large-scale implementation and cost. [39] • Behavior change communication • Ongoing assessment of the pilot in ten districts through Nepali Ministry of Health and Population with USAID, UNICEF and the Saving Newborn Lives program, and ongoing mixed-method study by Paudel et al. [40] to assess impact of the program on newborn care practices Initiated: 2008
• Promotion of institutional delivery and clean delivery practices at home Ongoing: 35 districts (Dec 2012) 1, preparation for review and national scale-up
• Postnatal care
• Community-based case management of pneumonia and severe bacterial infections
• Care for low birth weight newborns
• Prevention and management of hypothermia
• Recognition of asphyxia
• Initial stimulation and resuscitation of newborns
Umbilical cord care for newborns (CHX cord care) A pilot program currently being scaled-up, integrated with other maternal and newborn programs such as BPP and CB-NCP to prevent newborn infections and improve newborn survival by applying chlorohexidine to the umbilical cord stump. • Use of chlorohexidine for prevention of umbilical cord infections • 24% reduction in neonatal mortality among those who used chlorohexidine compared to those who practiced dry cord care; even greater 34% reduction among those who applied chlorohexidine within 24 hour after birth [44] Initiated: 2007
Ongoing: 33 districts (Dec 2012) 2, preparation for national scale-up
Safe Delivery Incentives Program (SDIP) also described as Maternity Incentives Program or Aama Surakchya Program National program to increase utilization of professional care during childbirth. It provides cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. • Promotion of institutional delivery and/or home delivery by skilled birth attendant • Substantial increase (2.3% points) in probability of deliveries attended by a skilled birth attendant [45] Initiated: 2005
• Care for immediate newborn problems (e.g. birth asphyxia) • No impact on neonatal mortality [45] Nationwide: 2008
  1. 1Dhankuta, Morang, Palpa, Doti, Bardiya, Dang, Chitwan, Kavre, Parsa, Sunsari, Terathum, Sankhuwasava, Kailali, Myagdi, Bajhang, Banke, Kapilbastu, Arghakhachi, Mohattari, Salyan, Dailekh, Jumla, Nawalparasi, Saptari, Sarlahi, Jajarkot, Lamjung, Humla, Taplejung, Bara, Baglung, Dolpa, Rautahat, Baitadi, Rupandehi.
  2. 2Banke, Jumla, Bajhang, Parsa, Darchula, Baitadi, Doti, Kailali, Bardiya, Dailekh, Dolpa, Rolpa, Myagdi, Palpa, Rautahat, Mahottari, Saptari, Sankhuwasava, Morang, Sunsari, Dhankuta, Sarlahi, Nawalparasi, Kapilbastu, Arghakhachi, Humla, Kanchanpur, Baglung, Lamjung, Bara, Khotang, Taplejung, Salyan.