BRAC
Community Based
Newborn Care
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
A reduction from 12,000 maternal deaths per year in 2001 to
about 7,300 in 2010
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
Source : BMMS 2010, BDHS 2007
BRAC MNCH PROGRAMME
Rural MNCH
Improving Maternal, Neonatal and Child Survival
BRAC-GoB-Unicef
DFID, AusAID, EKN and BRAC
www.brac.net
BRAC MNCH PROGRAMME IMPLEMENTATION AREAS
19
million rural
populations
www.brac.net
5. Linkage between community and
p health facilities
public/private
4. Timely Referral of emergency
cases
2. Community empowerment
1. Capacity development of HR
NHW
SS
SK
CSBA
Midwife
3. Services rendered at community,
households and facilities
Staff
OPERATIONAL STRATEGIES
SERVICE PROVIDER AT COMMUNITY LEVEL





Selected from localities
Age 25-45 years
Married
Willingness to work
Community acceptability



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
Selected from localities
Age 25-45 years
Married
Willingness to work
Community acceptability
Shasthya Shebika






Selected from localities
Age 20-35 years
Married
Minimum SSC
Willingness to work
Community acceptability
Shasthya Kormi
Newborn Health Worker
SERVICE DELIVERY
Maternal Care

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
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Identification of pregnancy
Ante, intra & post natal care
Referral of maternal complications
Family planning
Post-abortion care
Neonatal Care





Essential Newborn care
Special care for LBW babies
Management of birth asphyxia
Detection and referral of Neonatal sepsis
Referral of complications
Child Care



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Exclusive breast feeding and complementary feeding
Immunization and Vitamin A intake
Community case management of ARI and diarrhea
Referral of complications
REFERRAL SYSTEM
Referral
Hub
UTILIZATION OF ANTENATAL AND POSTNATAL CARE
4 or more ANC
100
83
88
93
60
40
20
3 or more PNC
15
100
0
BDHS 2007
Baseline
2009
2010
2011 (JanSep)
80
80
Percentage
Percentage
80
84
86
60
40
20
28
0
Baseline
2009
2010
2011 (Jan-Sep)
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TREND IN PLACE OF BIRTH
Trend in place of birth
100
14
90
22
25
78
75
30
80
70
86
60
70
50
Baseline
2009
Home
2010
2011 (Jan-Sep)
Hospital
A major shift is observed in place of birth from home to Hospitals
www.brac.net
91
94
93
95
2011 (Jan-Sep)
100
2010
ESSENTIAL NEWBORN CARE
87
84
76
Percentage
75
66
68
50
43
26
25
11
Thermal care within 10
minutes
BDHS 2007
2011 (Jan-Sep)
2010
2009
BDHS 2007
2011 (Jan-Sep)
2010
2009
BDHS 2007
Trained attandance at home
delivery
2009
-
0
Initiation of breast
feeding within 1 hour of
birth
Increasing coverage of essential newborn care
LOW BIRTH WEIGHT DETECTION AND SPECIAL CARE
Low birth weight detection and special care
100
85
84
80
60
40
20
19
21
15
19
0
2010
Birth weight taken
2011 (Jan-Sep)
Low birth weight
Spacial care
Sick Newborn Case Management
Neonatal sepsis diagnosed and referred
2.5
Birth asphyxia diagnosed and managed
4
3.5
2
3
2.5
1.5
2
1
1.5
1
0.5
0.5
0
0
2009
2010
Diagnosed
2011 (Jan-Sep)
Referred
2009
2010
Diagnosed
2011 (Jan-Sep)
Managed by SS
REDUCTION OF NEONATAL MORTALITY
60
52
50
48
The NMR
reduction
is
29%
over four
years
Per 1,000 Live Births
42
40
30
41
37
31
30
22
28
26
22
20
10
0
National Statistics
Intervention Areas
* BDHS 2007; BRAC MIS
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

Postnatal home visit

Performance based incentives

Community support network

Referral support network
THE END