Community and Home-Based Interventions in Nepal
Impact of community- and home-based interventions for improved newborn care practices in Nepal (completed)
Over the last few decades Nepal has made great strides in reducing child mortality. Advances in neonatal health have, however, been limited and prompted the Government of Nepal to develop the Community-Based Newborn Care Package (CB-NCP). This program comprises a broad range of activities to promote behavior change, institutional delivery or clean home delivery, postnatal care including care of low birth weight newborns, management of newborn infections, prevention of hypothermia, recognition of asphyxia, initial stimulation and resuscitation, and use of chlorhexidine for cord care. Implementation in 10 out of 75 districts of Nepal started in 2007.
In the context of his PhD research, Dr. Deepak Paudel (CIHLMU) in cooperation with Prof. Dr. Eva Rehfuess (Institute for Medical Informatics, Biometry and Epidemiology, LMU), Prof. Ishwar Shrestha (Department of Community Medicine & Public Health, Tribhuvan University) and Prof. Matthias Siebeck (Department of Surgery, LMU) undertook an evaluation of the impact of the CB-NCP on essential practices to improve neonatal health using a mixed-method quasi-experimental approach. Impact was assessed by comparing progress in propensity score-matched intervention and comparison areas, utilizing data from existing nationally representative surveys and from the Nepal Ministry of Health’s management information system. The views of program beneficiaries, important family and community members and service providers obtained through focus groups and key informants are used to distil factors that enable or restrain improvements in newborn health. Quantitative findings across multiple data sources and qualitative findings are triangulated to offer a holistic evaluation of the CB-NCP.
The results of this research were published and disseminated to inform government stakeholders and donors. This study did not identify significant improvements in newborn care practices and raises concerns regarding CB-NCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness program and to the strengthening of newborn components in the training of skilled birth attendants. Lessons learned from the evaluation of this complex health intervention are being considered while designing, implementing and monitoring of public health programs.