Mother, Newborn & Child Health

Child health has been an important focus area of SEARCH since 1986. SEARCH has carried out pioneering research and developed new and effective community level model for managing childhood pneumonia and home based newborn care model addressing the problem of high NMR. The combination of these models now known as the model of Home-based Management of Newborn and Child Care(HBNCC) has brought down the infant mortality rate in 39 intervention villages of SEARCH from a high of 120 in 1988 to less than 30 in 2003 and thereafter. Presently following activities are being carried out by SEARCH in the field of child health.

Health care services

1. Community level services in the 39 intervention villages of the Gadchiroli district.
2. Pneumonia treatment for <5 children through male and female Arogyadoots (CHWs)
3. Home based New-born Care (HBNC)through female Arogyadoots CHWs using the SEARCH model of Home based New-born Care.

This service includes screening of pregnant women and necessary advise and referral, one to one appropriate health education of pregnant women during pregnancy and post-partum, attending delivery and managing birth asphyxia if necessary, examination of the baby to identify high risk babies, making home visits to provide routine care to all babies and also special care to high risk babies, identifying and managing new born morbidities such as hypothermia, breast feeding problems, low birth weight babies, preterm babies and following babies not showing adequate weight gain in the second month.

Details of the Home-based Maternal, Newborn and Child Care Program:
i) The development of the community based childhood Acute Respiratory Tract Infection (ARI) management program:

• ARI was identified as one of the key preventable cause of childhood mortality and contributing to high Infant Mortality Rate of 121 in the villages of Gadchiroli district.
• A field control trial from 1988 to 1990 for treatment of ARI amongst children by trained community health workers and TBAs using the methods of detection and treatment specially designed for use by them The IMR was reduced by 40% to 80. The results of this program were published in the Lancet and formed the basis of the Global ARI Control Program of the WHO in 1992.

ii) The development of Home based Newborn Care program:

• Home Based Newborn and Child Care (HBNCC), pioneered by SEARCH / Gadchiroli in Maharashtra, is an internationally acclaimed model with demonstrated success in reducing neonatal and infant mortality by about 60 percent. HBNCC has been acknowledged at the national level as an effective and appropriate means to reduce neonatal mortality for a substantial proportion of India’s population, which has little access to facility based care. HBNCC delivered through a community level worker, comprises a comprehensive package of community mobilization, competency and skill based training, assessment, field supervision, service delivery, supportive follow up, evaluation and performance linked remuneration.
• Currently HBNCC is part of India’s National Rural Health Mission, the 11th and the 12th Five Year Plan as well as endorsed by WHO – UNICEF – USAID – Gates Foundation and supported by the Johns Hopkins University and Save The Children as a global policy.
• The Gadchiroli field trial (1995 – 2003) and the replication trials of the HBNCC convincingly demonstrated that a provider trained in the skills of Home Based Neonatal Care (HBNCC) including asphyxia and infection management and readily accessible for the first twenty-eight days of the newborn’s life can make a significant contribution to reduction in newborn deaths(4,5,6).

iii) The development of Home based Maternal Care program:

• Maternal mortality in India has rapidly declined in the past 10 years (from 460 to 212). In contrast, the incidence of maternal morbidities is high and frequent (Bang etal BJOG, 2005). Nevertheless, the same neither has been monitored nor addressed adequately (NFHS III). The situation continues to be so especially for post partum morbidities, even in the current national programmes for the rural and tribal population. The absence of post partum maternal care is irrespective of place of delivery because even in case of institutional deliveries the mothers are discharged or return home within 24 to 48 hours after delivery and thereafter there are no services available at village level.
• Hence SEARCH designed the Home-based Maternal Care model to addresses this gap efficiently by providing health care through CHW trained in HBNC. The technical contents of the model and interventions were based on rigorous literature review and evidence. This model of HBMC was tested by SEARCH during 2008 – 2011 in rural Gadchiroli and was found to be effective in reducing maternal morbidities by 42%.

Child and Neonatal health Care services at SEARCH’s Danteshwari Dawakhana (Hospital)

Sick Neonates and children who cannot be managed at community level by the female Arogyadoot are referred by them to SEARCH hospital and these sick neonates are managed in the NICU of the hospital. Older babies are managed at the OPD/IPD level as per requirement and referred to district hospital in Gadchiroli if required.

Training services

1. Training of state level trainers deputed by different states of India where HBNC services are being provided through ASHAs under NRHM. (On demand)

1. Training of Project managers responsible for managing the programme for HBNC through ASHAs (On demand)
2. Introductory awareness programmes on HBNC for visiting teams and groups sponsored by state/national/international agencies including NGOs (On demand)
3. Training for trainers or managers of agencies state/national/international agencies including NGOs desirous of initiating HBNC services in their region. These training programmes are tailored appropriately to meet their needs (On demand)

Research:
Data generated during provision of child health services is collected meticulously for closely monitoring the impact of the new-born and child health care services being provided and for identifying newer areas of research in the field of child health. A vital rate collection, collation and analysis system is in place for the purpose since 1986.

Advocacy:
Child death has been projected by SEARCH as a human rights issue since early nineties and SEARCH continues to draw the attention of the decision makers at state/national and international level through writing articles, delivering orations and lectures at meetings, seminars, conferences etc. at national and or international level