Navjeevan (2010-2012)

Overview

The intervention provides incentives to ASHAs for helping families in the decision to accept referral recommendations, the creation of a telephone helpline and of access to a pool of vehicles to facilitate transport to referral facilities, and providing social support during stay at hospital. In addition, first referral level facilities, i.e. Community Health Centres (CHCs), are being supported for improved management of labour, provision of essential newborn care at birth and management of sick newborns. The primary impact of the intervention will be measured in terms of reduction in newborn mortality, increased utilization of CHCs and district hospitals for newborns with severe illness.

Rationale for the Project

Interventions to improve newborn survival can be delivered during pregnancy, during labour and childbirth, and during the newborn period. Obstetric complications, particularly in labour, are a major source of stillbirths and early neonatal deaths. Intrapartum risk factors increase the risk of perinatal or neonatal death more than pre-pregnancy or antenatal factors. Improved delivery care, with labour surveillance for early identification of complications, such as provided by the partograph, has been associated with significant reductions in newborn mortality.

Studies indicated that quality of delivery care in many health facilities do not meet the standards required for their full impact on maternal or newborn survival. While the provision of newborn care at the home and first level facilities such as primary health centres is a core child health intervention that is expected to reduce newborn mortality by over 30%, newborns that are severely ill will need to be referred to a higher level facility for care.

Therefore this intervention was implemented and evaluated to understand the impact of improving access to quality referral care for newborns identified with danger signs in the community. It was conducted in settings where IMNCI had been implemented both at the community and first level facility.

Key partners and their roles:

The study was implemented by following key partners – Department of Medical, Health & FW services, Government of Rajasthan, ARTH Udaipur, UNICEF, Rajasthan and WHO. Their roles are mentioned below:

1. ARTH: ARTH’s main role was to anchor the study, conduct evaluations and implement the helpline.
2. Department of Medical, Health and Family Welfare, Government of Rajasthan:
   1. Provide overall oversight, finance additional staff, renovate infrastructure and equipment for newborn care at CHCs. Oversee the provision of routine services at CHC and ensure that inputs (human resources, supplies etc.) are available on a regular basis.
   2. Monitor progress of implementation of CHC strengthening
   3. Strengthen routine health information system at the CHCs
   4. Follow up on study findings, including expansion to other areas in the state if the intervention is effective
3. UNICEF:
   1. Help finance renovations in infrastructure, equipment, incentives for ASHAs and transport costs for newborns with severe illness
   2. Help finance establishment and functioning of the helpline
   3. Oversee the strengthening of CHCs, including capacity development and health systems
   4. Technical support for process and outcome monitoring
   5. Dissemination of findings and follow up
4. WHO:
   1. Finance progress and outcome measurement
   2. Help finance, establishment and functioning of helpline
   3. Technical support for capacity development and for process and outcome monitoring
   4. Dissemination of findings

THE STUDY

Secondary Objectives

2. To evaluate the effectiveness of strengthening CHCs for improved management of severely ill newborns on quality of care received by newborns with danger signs presenting to these facilities.
3. To evaluate the effectiveness of strengthening CHCs for improved management of labour and essential newborn care at birth, in improving quality of care received by women in labour and newborns born at these health facilities.
4. To evaluate the effectiveness of strengthening CHCs for improved management of labour, essential newborn care at birth and management of severely ill newborns in reducing perinatal mortality for births occurring at these facilities.

Intervention Clusters:

• Kapasan (Chittorgarh)
• Devgarh (Rajsamand)
• Choti Sadri (Pratapgarh)
• Abu Road (Sirohi)
• Gangapur (Bhilwara)
• Partapur, Chhota Dungra and Ganoda (Banswara)

Description of Activities:

1. Baseline Survey
2. Intervention Implementation :
   1. Intervention Introduction Phase (six months): The purpose of this phase is to pilot the intervention and ensure its effective implementation. It includes:
      1. Establishment of Newborn Stabilization Units at CHCs
      2. Launch Navjeevan Helpline to provide referral transport to sick newborns upto CHC and community activities to publicize helpline
      3. IMNCI refresher training of ASHAs
      4. Improve MIS on newborn care
   2. Intervention delivery Phase: The purpose of this phase is to optimally implement the intervention over two full years, with all components being operational on the ground. Processes will be monitored during this phase in intervention and control areas.
   3. Outcome Measurement Phase: During this phase, an end line survey will be carried out in the involved clusters and major learning from the intervention as well as outcomes will be documented.

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