Morang Innovative Neonatal Intervention 2006 (Summary)
Nepal is one of the countries having highest IMR in the world. Nepal has experienced the trend of under 5 mortality rate over last two decades, as remarkable decrease in <5 yrs mortality but not change in neonatal mortality rate. Safe motherhood programmes, Community Based-Integrated Management of Childhood Illness (CB-IMCI) programmes have been going on in primary health care package, but it has proved to be inadequate to address the particular neonatal health care. Such evidence based data has guided us to make a neonatal health policy in the country. Now, National Neonatal Health Policy 2004 has been formulated in the country. Policy has opened rooms for piloting neonatal health care in district. Morang district has now neonatal health care programme, which mainly aims at reducing neonatal deaths by controlling neonatal infections. Now, we have passed two years for neonatal health programme in Morang district. District Public Health Office (DPHO) Morang and Morang Innovative Neonatal Intervention (MINI) or JSI (R & T) have joined their hands in preparation, intervention and evaluation of the programme. About nine months period has been passed solely in preparation phase for training for trainers, training for health workers and FCHVs in the communities. Service intervention was begun from June 2005 in 21 Village Development Committees (VDC) of the district. Now, we are able to collect data of one year from this intervention VDCs. DPHO Morang, District Technical Working Group (DTWG) and MINI programme have fulfilled their responsibilities of managing and analyzing data during intervention with the ongoing programme. Preliminary analysis has generated the data which can be used in assessing this programme. This programme has covered 21 VDCs population of about 40 percent proportion of total district population. Programme has captured two third target populations. In Morang, Neonatal Mortality Rate was estimated as 30 per 1000 live births at beginning of the programme in 2004. This is now estimated that it dropped down as 21 per 1000 live births. About two third beneficiaries are from disadvantaged population such as Dalits, Indigenous people and Muslims in the population. Some adverse implications with relatively lower coverage have been observed in intervention VDCs than in control VDCs. On the other, many public health programmes like safe motherhood, family planning, CB-IMCI are improved following the intervention and also strengthened other supportive programmes like FCHV programmes, PHC-ORC and EPI-ORC programme. This neonatal health programme is replicable to other districts. But, there is room for some fine tunings of the programme. This programme is to be integrated with safe-motherhood and CB-IMCI programme. Special technical measures for low birth weight to be addressed. Since, there is large proportion of local umbilical infection in neonates; it can be prevented by applying Chlorhexidine right after cutting umbilical cord instead of leaving it applying nothing. FCHV and TBAs have played important role in this programme. They have also served pregnant women by giving advice for going to health institutions when they identify danger signs. So, they are needed to be oriented about BPP or safe delivery kit and ANC, PNC. Incentives for CHWs and FCHVs have been sought in the programme which can help in making sure its effective implementation.
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