Home-Based Newborn

Care[HBNC]
Dr STEFI M S
JUNIOR RESIDENT 2
MENTOR: Dr SURENDRA BABU D
DEPT OF COMMUNITY MEDICINE
ESIC MC, SANATHNAGAR

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OUTLINE
• Introduction • Skills and support for ASHA
• Statistics • Home Visits
• Child health goals • Forms to be filled
• History • IEC materials
• Introduction • SWOT analysis
• Rationale for HBNC • References
• Objectives and Key Activities of
HBNC

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INTRODUCTION
• As per Census 2011, the share of children (0-6 years) accounts for 13% of the total
population in the Country.

• Child survival cannot be addressed in isolation as it is intricately linked to the health of

the mother, which is further determined by her health and development as an
adolescent.

• Therefore, the concept of Continuum of Care, which emphasizes care during critical
life stages to improve child survival, is being followed under RMNACH +N.

• Another dimension of this approach is to ensure that critical services are made
available at home.

• HBNC and HBYC are programs launched to incentivize ASHA to provide Home Based
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Care.
STATISTICS
CHILD MORTALITY TRENDS-
CHILD MORTALITY TRENDS- SRS
NFHS
45

40 39
37 36
34 33 35
35
32 32
30
30 28

25 24 23 23
22
20
20

15

10

0
NMR (SRS) IMR (SRS) U5MR (SRS)

2016 2017 2018 2019 2020

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Deaths per 1,000 live births.
STATISTICS
Current
Child Health Indicator status- Telangana Highest Lowest
INDIA

IMR (Infant Mortality

28 21 43 in MP 6 in Kerala
Rate)

Neonatal Mortality rate 20 15 31 in MP 4 in Kerala

Under 5 Mortality Rate 32 23 51 in MP 8 in Kerala

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Deaths per 1,000 live births.
Child health goals
Current SDG 3.2
Child Health Indicator NHP Target
status Target

IMR (Infant Mortality Rate) 28 28 by 2019 -

Neonatal Mortality rate 20 16 by 2025 12 by 2030

Under 5 Mortality Rate 32 23 by 2025 25 by 2030

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Deaths per 1,000 live births.
 HISTORY
• Based on Gadchirolli model of SEARCH
• Society for Education, Action and Research in Community Health
• Provides healthcare to the rural and tribal people in Gadchiroli district,
empowers the communities to take care of their own health and conducts
high-quality research to shape the local, national and global health policies.
• Established in 1985
• Newborn mortality was recognized as the main challenge
• Developed an approach of training village health workers to provide
mother and newborn care at home. Conducted the Home-based neonatal
care field trial, (1993 – 98)
• Published in the Lancet, (1999)
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19/06/2024 8
CHILD MORTALITY- causes

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 CHILD MORTALITY- When?

• The denominator is the total number of deaths in the entire neonatal period
while numerator is the number of deaths on a given day

Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific
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neonatal deaths in developing countries. J Perinatol. 2016 May;36(Suppl 1):S1–11.
Effective interventions to reduce neonatal mortality

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Rationale
• Institutional delivery-
• Where the baby and mother are discharged after 48 hours.
• Newborn has crossed the critical first day.
• Remainder of the first week and month during which neonatal mortality could
be as high as 54%, and for which care must be provided.
• Return home within a few hours after delivery-
• Home based newborn care needs to be available to tide them over the first day
and thereafter.
• Home deliveries.
• Current status: 11% (NFHS 5)

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Provider of HBNC
• The AWW, the ANM and the Medical officers.
• The main vehicle to provide is the ASHA.
• Reasons :
• Resident and available in every village.

• Equipped with the skills and support to provide such care.

• More likely to visit the newborn and postpartum mother at home than the ANM or
AWW, and is also more likely to be consulted for care of the sick child.
• Supported and guided by the health system which is directly responsible for
newborn and child survival.
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This relationship with the health system is essential for facilitating referral. 13
Objectives of HBNC
The major objective of HBNC is to decrease neonatal mortality and
morbidity through:
• The provision of essential newborn care to all newborns and the
prevention of complications
• Early detection and special care of preterm and low birth weight
newborns
• Early identification of illness in the newborn and provision of
appropriate care and referral
• Support the family for adoption of healthy practices and build
confidence and skills of the mother to safeguard her health and that of
the newborn.
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 KEY ACTIVITIES
1. Care for every newborn through a series of home visits by ASHA in the first
six weeks of life.
2. Information and skills to the mother and family of every newborn to ensure
better health outcomes.
3. Examination of every newborn for prematurity and low birth weight.
4. Extra home visits for preterm and low birth weight babies.
5. Early identification of illness in the newborn and provision of appropriate
care at home or referral.
6. Follow up for sick newborns after they are discharged from facilities.
7. Counselling the mother on postpartum care, recognition of postpartum
complications and enabling referral.
8. Counselling
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 Skills needed by ASHA
1. Mobilize all pregnant mothers and ensure that they receive the full package of
antenatal care.

2. Undertake birth planning and birth preparedness with the mother and family to
ensure access to safe delivery.

3. Provide newborn care through a series of home visit.

4. Assessing if the baby is high risk (preterm or low birth weight).

5. Detect signs and symptoms of sepsis, provide first level care and refer the baby
to an appropriate center , after counseling the mother to keep the baby warm.
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Skills needed by ASHA

6. Recognize postpartum complications in the mother and refer

appropriately.

7. Counsel the couple to choose an appropriate family planning method.

8. Use the checklist for first Visit to the Newborn and Home visit form to
remind her to ask the key questions and ensure that she follows the steps
of examination and counseling the mother.

9. Provide immediate newborn care, in case of those deliveries that do not

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Skills needed – Newborn Care at Home
1. Weighing the newborn
2. Measuring newborn temperature
3. Ensuring warmth
4. Supporting exclusive breastfeeding
• Teaching the mother proper positioning and attachment for initiating and maintaining
breastfeeding.
5. Diagnosing and counselling in case of problems with breastfeeding
6. Promoting hand washing
7. Providing skin, cord and eye care
8. Health Promotion and counseling mothers and families on key messages on
newborn care which includes discouraging unhealthy practices such as early
bathing, and bottle feeding.
9. Ensuring identification and prompt referral of sepsis or other illnesses.
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Skills needed – LBW or Preterm
• Assessing if the baby is high risk (preterm or low birth weight)

1. Increasing the number of home visits,

2. Monitoring weight gain,

3. Supporting and counseling the mother and family to keep the baby
warm and enabling frequent and exclusive breastfeeding,

4. Teaching the mother to express breastmilk and feed baby using cup and
spoon or paladai, if required.
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Support for ASHA
• Support to ASHA to ensure positive newborn health outcome
• Rs 250/ Newborn
• Six visits in the case of institutional delivery (Days 3, 7, 14, 21, 28 and 42)
• Seven visits in the case of home delivery (Day 1, 3, 7, 14, 21, 28, and 42)
• Five visits in case of caesarian section  Day 7 to Day 42 
• Delivery at maternal house – 2 ASHAs undertake HBNC visits
125  3 visits
250  5 visits
• *Newborn discharged from SNCU – Completing remaining visits- full incentive.
• *Additional 50rs/monthly visit for follow up of LBW babies[2 year ] and babies
discharged from SNCU [ 1 year ]
• * This has been clubbed with HBYC now.
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ENSURING FIELD LEVEL SUPPORT
• ASHA facilitator – visit twice monthly – monitoring and support

• ANM – mentor and support

• Village health and nutrition day – Immunization –review of coverage

and quality of care provided by ASHA , ANM – monitored by MO

• Monthly review meeting at PHC level

• Refresher training every 3 months

• ASHA kit should be replenished regularly

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ASHA kit for HBNC
• Digital watch • Gentian Violet Paint
• Syp paracetamol
• Digital thermometer
• Syp cotrimoxazole
• Neonatal weighing scale- Tubular
spring type with sling • Consumables:
• Cotton
• Sling of the weighing scale • Gauze
• Blankets for neonates: two per • Soap and case
ASHA
• Baby feeding spoon
• Medicines :
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ITEMS TO CARRY - HOME VISIT
• ASHA Diary/Register:
To maintain a list of all newborns and young children (up to 15
months of age) in your area.
• HBNC Cards:
To record details of services you have provided. This will also serve as
the basis for your incentive payment. Also record visits in the MCP
card.
• HBNC Kit:
• MCP Card:
Carry at least one MCP card to help you explain the key messages (in
case the mother cannot find the child’s MCP card)
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On the day of birth
• Ask • Check & Record
• Well being of mother & baby • Bleeding, consciousness and
• Whether breastfeed initiated or not? temperature (in mother)
• Feeding forcefully or not? • If baby attaching well to the breast
• Baby's weight
• Baby's temperature
• Condition of cord and eye, body tone
& cry
• Any congenital abnormality?

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On the day of birth
• Refer • Counsel the mother
• Mother: • About colostrum & importance of
• If she is using more than 5 pads in a exclusive breastfeeding
day, has fever more than 102◦F, foul • Do not bathe the baby and clothe the
smelling discharge and losing baby in 1-2 layers (summer) and in 3-4
consciousness. layers (winter) to maintain temperature
• Baby: • Not to apply anything to keep cord dry
• Weak cry or limp, not feeding well, & clean
weight <1800g, difficulty in breathing, • Apply antibiotic (tetracycline) in baby’s
hot or cold to touch. eye in case of swollen eye/discharge

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On subsequent visits
• Ask • Check MCP card for birth dose of
• Whether she is having adequate food and vaccines (given or not)
breastfeeding the baby? • Cracks or redness on skin folds or
• Check & Record pustules
• Mother: • Oozing umbilicus; eye discharge
• Excessive bleeding, high temperature • Yellowness in eyes or skin
or foul-smelling discharge. • Signs of sepsis
• Cracked nipples/painful or engorged • Provide care for skin, cord and eyes.
breasts. • If weight not increasing, check for
• Baby adequacy of feeding.
• Measure and record weight in the
checklist
• Measure and record temperature of
newborn
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On subsequent visits
• Counsel the mother:
• Have food more than 4 times per day.

• Cracked nipples: keep breast clean and lubricated.

• Engorged breasts : more frequent BF or expressing milk.

• Hard breasts: Warm compression and gentle massage.

• Washing hands with soap and water after defecation and changing the diapers of
the baby.
• Keeping the baby away from people who are sick.

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On subsequent visits
• Counsel the mother:
• Not to bathe the baby for 48 hours

• Not to start bottle feeding.

• If baby weighs <2.5 kg & temperature < 97◦F, counsel about keeping baby warm
(maintain room temperature, provide skin to skin contact and frequently feed the
baby).
• Explain danger signs

• Inform parents that under Janani Shishu Suraksha Karyakaram free treatment and
transport is provided.
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Mother-
Newborn Home
Visit Card

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First
examinat
ion of the
Newborn

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First
examinat
ion of the
Newborn

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Home
Visit
Form

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Home
Visit
Form

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Home
Visit
Form

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Home
Visit
Form

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IEC
Material

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COMPARISON WITH HBYC

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SWOT ANALYISIS
Strengths Weaknesses
• Utilizing existing network of ASHAs • Quality of care
• Provide continuum of care • Challenges in ensuring ASHAs have adequate
• Supported by RMNCAH+N skills

SWOT
Opportunities
• Pair with other national programs
• Better contact between community and health Threats
system
• Screening for other diseases in other members of • Funding constraints
the house. • Change in policy
• Communication of health related information • Change in governments
• Use of technology • Lack of manpower

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References
1. Child Health :: National Health Mission [Internet]. [cited 2024 Apr 14]. Available from:
https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=819&lid=219
2. Child Health Programmes :: National Health Mission [Internet]. [cited 2024 Apr 14]. Available from:
https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1179&lid=363
3. HBNC & HBYC Resource Material :: National Health Mission [Internet]. [cited 2024 Apr 14]. Available from:
https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=1416&lid=769
4. The Registar General of India. India - SAMPLE REGISTRATION SYSTEM (SRS)-CAUSE OF DEATH IN INDIA 2017-2019
[Internet]. 2023 [cited 2024 Apr 14]. Available from: https://censusindia.gov.in/nada/index.php/catalog/44752
5. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on
neonatal mortality: field trial in rural India. Lancet. 1999 Dec 4;354(9194):1955–61.
6. MoHFW. Revised_HBNC-OG-2014-English.pdf. National Health Mission; 2014.
7. The Registar General of India. SRS_Bulletin_2020_Vol_55_No_1.pdf. Office of the Registrar General & Census
Commissioner, India (ORGI);
8. Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of
timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol. 2016 May;36(Suppl 1):S1–11.
9. IIPS, MoHFW. NFHS-5. International Institute for Population Sciences; 2021.
10. National Health Mission. HBYC-Posters-English.pdf. National Health Mission;
11. National Health Mission. HBNC_&_HBYC_Jobaid_for_ASHA.pdf. National Health Mission;
12. HBNC & HBYC Resource Material :: National Health Mission [Internet]. [cited 2024 Apr 14]. Available from:
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https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=1416&lid=769
 THANK
YOU

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