Eleventh Five Year Plan

Health and Family Welfare and AYUSH 91Requirements• Transparent selection of best motivated• Rigorous training• Intensive supervision• Curative role for CHWs• Performance-based remunerationBox 3.1.13Home Based Newborn Care—Gadchiroli ModelInterventions• Health education of mothers and the community• Attending home delivery with TBA• Care of baby at birth• Home visits and support to mother and baby up to 28 days• Management of newborn sicknessesInterventions Aimed at Prevention and Management of• Birth asphyxia• Sepsis/Pneumonia• Low Birth Weight (LBW)/Preterm• Breast feeding problems• HypothermiaAchievements• NMR reduced by 51%• IMR reduced by 47%• High community acceptance and beneficiary preference to CHW as the source of newborn care at home (85%)Lessons Derived• CHWs could be trained to provide HBNC in villages and urban slums• 85% mothers and newborns can be covered• The various components of HBNC including the management of birth asphyxia in home deliveries and the diagnosis andtreatment of newborn sepsis by using injectable gentamicin could be safely and effectively delivered by trained CHWsworking under supervisioncommunity based IMNCI. 104 districts all over thecountry have initiated implementation of IMNCI.During the Eleventh Five Year Plan, efforts will be madeto implement the IMNCI programme coupled withhome-based neonatal care throughout the country ina phased manner.HBNC AND IMNCI: DIFFERENT BUT COMPLEMENTARYROLES3.1.136 In order to reduce infant and child mortalitya continuum of care is needed at the community aswell as facility level. Of the two main packages availablefor reducing child mortality, the HBNC operatesat the community level and has a strong evidence offeasibility and reducing child mortality. It should beused to deliver care at home through ASHAs andANMs. IMNCI training is primarily facility-based andhas been shown to improve neonatal care. Hence theIMNCI should focus on improving newborn and childcare in the district hospitals and CHCs. This will avoidduplication of efforts and, at the same time, providecontinuum of care.SKILLED CARE AT BIRTH3.1.137 The underlying principle of effective care atbirth is that wherever she is born whether at home orfacility, she is provided clean care, warmth, resuscitation,and exclusive breastfeeding. She is weighed andexamined, and if clinical needs are not manageable atthe place of delivery, she is referred and managed at an