Day 2, Monday, April 25, 2005

Objectives:

• Continued technical update
• Advance the understanding and planning of country programs
• Identify research, practice and program gaps, and ongoing program and research activities

 Dr. Stephen Wall Save Newborn Lives (SNL-Global)
Dr Wall from SNL presented on Timing and Causes of Neonatal Mortality:  Opportunities for Intervention. He shared that 30% of neonatal deaths occurred on first day of life, 50% of neonatal deaths occurred within the first 3 days and 75% of neonatal deaths occurred within the first 7 days. Given this reality he concluded that early postpartum care linked to antenatal and intra-partum care is critical to avert neonatal and maternal deaths. Interventions should be packaged and delivered at the opportune timesantenatal, intrapartum, and early postpartum periodfor maximal impact. Combining maternal and neonatal care at the same postpartum visit(s) will increase impact on mothers/newborns and be resource-efficient.

Case reports from countries

Dr Stephen R Hodgins, Nepal
Community Based Postpartum Care in Nepal - Results from a Pilot Project 2002 - 2004
A small feasibility study aimed at defining a working model of postnatal care for both mothers and their newborns was presented. Lessons learnt included:
 
It is feasible to provide home-based PNC via a trained local volunteer. The coverage could be achieved and it is culturally acceptable. Visual job-aids can overcome literacy barriers. There are chances of high rates of identification and referral of postnatal problems for both mothers and newborns coupled with high rates of care seeking among those identified and referred.

Dr Rashmi Kukreza, RACHNA Pproject, CARE India
The project aims to strengthen the national ICDS/RCH programme to deliver and scale up critical interventions by supporting planning activities with adequate focus on effective interventions at critical life cycle periods, supervision and  management monitoring for effective use of time, resources and manpower, need based capacity -building, BCC with emphasis on IPC and facilitation of community support/mobilization for improving care seeking.

RACHNA is an umbrella program of CARE-India, which addresses maternal and  child health and nutrition, community-based newborn care, routine immunization, infant feeding, micronutrient supplementation, birth spacing, RTI/STI/HIV/AIDS

It covers ten States and approximately 100 million population.

Some of the lessons learnt include the need for engagement/advocacy at district and block levels to focus on the high newborn mortality contributing significantly to infant mortality.

Need for development of a specific action plan, where there is clarity of roles and tasks for service providers, supervisors and program managers to reduce newborn mortality using low cost home based interventions. Building the skills and confidence of the service providers in solving problems for behavior change is critical, along with greater emphasis on contacts and counseling at critical periods, reinforced by effective supervision and monitoring.

Presentations on community health systems for improving community-based postpartum care

Patricia Daly, ACCESS
Elements of current community-based PPC programmes include: initiation during the antenatal period - Identification of pregnant women, birth registration and promotion of preventive practices for both mothers and newborns, Counseling and referral for family planning and immunization, distribution of Vit A and iron/folate, recognition and management of maternal and newborn danger signs, linkage with health facilities for management of complications and provision of preventive services.

The referral strategies include community mobilization to facilitate establishment of emergency transport and funds, community participation in quality improvement activities, home based Life Saving Skills training, deployment of additional or new skilled providers to communities, CHWs training to detect and treat sick newborns appropriately, supervision of trained CHWs by health facility providers including on the job training. It also includes strengthening health facility staff skills through in-service and pre-service training; ensuring that the district hospital has the capacity to perform surgery and establishing Kangaroo Mother Care centers within existing health facilities to manage referred LBW babies.

The main challenges include government policies to support availability of life saving procedures at peripheral health facilities, access to care including emergency transportation, availability and skills of providers, commitment of government, donors, civil society and communities to support the household to hospital continuum of care

Dr Indira Narayanan, Community Based Postpartum Care Communication strategies.
BASICS
The main conclusions include the need to understand reasons for poor behavior and community perceptions on care seeking. Activities should be supervised for quality (e.g. visits need to be timely and goal oriented/content focused). A multi-pronged approach with prioritization and phasing as necessary is required. Community-based postpartum BCC should ideally be part of the home-to-hospital continuum of care and  scaling up and adequate coverage is needed to achieve MDGs.
 
Dr Abdullah Baqui, HARP/JHU
Dr Baqui gave an update on neonatal research activities. He concluded that clearly, ample evidences exist for benefits of a number of antenatal, intrapartum and postnatal interventions. For many of these proven interventions, however, critical operational questions remain regarding how to implement them in an affordable and acceptable manner at scale. However, it must not hamper implementation of many interventions of known impact at a wider scale. There is need for continued research on the feasibility and cost-effectiveness of a number of interventions on perinatal and neonatal outcomes, particularly prevention and care of LBW babies, prevention and management of birth asphyxia; postpartum birth spacing; cholohexidine cleansing; and emollient therapy.

The participants then worked in four breakaway groups for small group discussions on
Technical Issues
Systems Support
Monitoring
Scaling up