Student Dissertation

Agency : ASHA, Home Base Newborn Care, Newborn Care Services, HBNC Performance

Objective : The main objective of the study was to review the role/ responsibilities of ASHA for providing HBNC services . The specific objective were to assess the knowledge of ASHA in relation to role/ responsibility for HBNC services. The study also aimed to asess ASHA’s performance in terms of services provided and to identify areas of improvement in effective implementation of the HBNC services provided by ASHA.

Background : Each year, of the almost 27 million infants born in the country, 0.88 million die before they complete one month of their life and a total of one million die before the first birthday.Various studies on distribution of Neonatal deaths reveal that the most vulnerable time in the newborns life is during birth and the first week of life. For this, effective interventions for the care of the mother and the baby during and immediately after delivery and in first few weeks of life is essential. Home based New born Care is one such intervention, aimed at improving new born survival by providing Care for both the mother and newborn from conception till the first 42 days after delivery at the home/community levels, institutions where delivery takes place and again at home after discharge from the facility by means of ASHA workers who act as connecting link between the health services and the community.

Methodology : The study was a descriptive cross sectional study conducted on a sample size of 102 ASHA’s that were randomly chosen from three blocks in district Kheda, Gujarat, selected on criteria of HBNC performance based indicators reported at the district level. A predesigned semistructured questionnaire was undertaken for the study.

Findings : The results showed that although majority (95.10%) of the ASHA had been provided basic training in HBNC modules ( 6 & 7 ), three fourth of them ( 75% ) could not identify/ enlist general danger signs in fever amongst newborns. The number of visits to be provided in institutional delivery was clearly known to 69.6% of ASHA’s, however, the number of visits to be given in home delivery was not as clear. 61.8% of ASHA were providing tab PCM to mothers reporting fever even less than 100F during antenatal period as against only 28.4 % of them providing it for preferred range of fever. The knowledge of ASHA with regard to criteria for low birth baby was not adequate as only 41.2 % of them considered babies less than 2.5 kg as LBW baby. Majority of ASHA had correct knowledge about minimum number of breast feeds ( 69%) to be given to new born and minimum number of meals to to be taken by pregnant women. The examination of newborn at home by ASHA did not cover all essential signs/ symptoms as only 26.5 percent of the ASHA were examining the eyes in newborns. Level of alertness (20%) and redness in umbilicus (20.6%) were the least examined features in new born.

Recommendations :

The study clearly shows that although the ASHA‘s were adequately trained, the level of knowledge of ASHA was found to be optimum. Thus, the HBNC strategy’s success in reducing neonatal mortality ultimately depends on ASHAs making timely home visits and properly identifying, treating, reporting and referring sick infants. Improving ASHAs’ ability to correctly assess and classify illness requires strengthening their skills, improving the clarity and usability of HBNC formats as decision support tools, and ensuring ongoing supportive supervision.