HBNC+: Improving Quality of Care for Child Survival and Development
The Home Based Newborn Care Plus (HBNC+) innovation packages multiple evidence-based interventions for improving survival and development of infants through incentivized structured home visitation by the community health worker, ASHA (Accredited Social Health Activist), at 3,6,9 and 12 months. HBNC+, targeting the key causes of childhood deaths, aims to reduce pneumonia and diarrhoea-related morbidity and prevent malnutrition through a set of evidence-based interventions.
- Promoting Exclusive Breastfeeding for 6 months
- Ensuring continued breastfeeding and complementary feeding from 6 months
- Promoting routine immunization
- Providing counselling for handwashing
- Facilitating prophylactic distribution of oral rehydration solution (ORS) and iron and folic acid (IFA) syrup
- Ensuring regular growth monitoring
- Promoting Early Child Care and Development (ECCD)
- Tools: Training materials for ASHAs and supervisors, operational guidelines and an online monitoring and analysing mechanism
- Capacity Building: 20,327 field functionaries trained under HBNC+ and 856 (100%) ASHA Supervisors / Facilitators trained under HBNC+ and SNCU+
- Supportive Supervision: 58,075 Supportive Supervision Visits conducted
- Home Visitation:
- Approximately 1 million home visits provided to 3,17,157 infants (67% Coverage against Mother Child Tracking Software)
- Around 150,000 Infants received complete 4 visits under HBNC+
- Around 600,000 ORS packets distributed and 3,51,912, IFA bottles distributed
Internal periodic monitoring exercise: Four rounds of district level validation exercises conducted by the project team have revealed substantial improvements in child care practices against baseline findings.
District-level baseline and validation exercise findings
|Indicators (%)||Baseline (Oct-Dec 13)||Periodic Monitoring Exercises 2014 – 2016|
|Oct 2014||April 2015||Oct 2015||April 2016|
|Households with infants received home visits by ASHA||29||95||98||97||98|
|Infants with an immunization card||67||90||79||86||91|
|Exclusive breastfeeding rate||72||64||81||83||89|
|ORS use rate during infancy||41||67||83||90||79|
|Age appropriate immunization||60||–||81||84||79|
|Timely initiation of complementary feeding||45||69||77||80||83|
|Infants provided bi-weekly Iron supplementation||—||6||60||61||55|
A case-control study done in Rajasthan by an independent research agency demonstrated that HBNC+ has demonstrated significant improvements in key indicators. 81%
- Difference between percentage of current exclusive breastfeeding rates for 0 to 5 month infants between project (73%) and non-project (65%) areas is statistically significant.
- Generally, there is a decrease in current exclusive breastfeeding rates, with increase in age of infant. The difference between current exclusive breastfeeding rates for children of age 3 months and 5 months is 19 percentage points in project areas as compared to 31 percentage points in non-project areas (difference is statistically significant). This shows that more mothers continue to breastfeed in project areas as compared to non-project areas.
- 29 and 26 percentage points more mothers in project areas received counselling on exclusive breastfeeding and complementary feeding respectively.
- 23 and 29 percentage points more families with children more than 6 months of age received ORS packets and IFA syrup from ASHAs in project areas respectively.
An operational research through INCLEN is ongoing for designing systems for implementation including package contents and identifying bottlenecks for scalability purpose.
The HBNC+ innovation is planned to be scaled up in the states of Bihar and Madhya Pradesh across all districts. Madhya Pradesh will scale up the innovation in its current form, while Bihar will focus the innovation package on low birth weight infants. Rajasthan and Odisha intend to scale up the innovation in 10 and 3 districts, respectively.
There is a potential case for countrywide scale up of HBNC+:
- Tasks are doable: 70% HBNC+ children registered in MCTS reached in 2.5 years
- Significant increase in coverage of essential interventions
- High potential of reducing mortality (9.8%) and improving nutrition as data extrapolated from List (Lives Saving Tool)
- Streamlining of financial flow to ASHA.
- Platform can be used for adding interventions.