National Program on Child Health

Anil RegmiMedical Student

Nepal has been successful in achieving millenium development goal (MDG) 4 of reducing the under-five mortality rate (U5MR) by two-thirds from the level in 1990 

about two in five neonatal deaths occur on the first day after birth

more than 8 out of 10 neonatal deaths occurring in the first week of life 

most common causes of neonatal mortality are neonatal sepsis, birth asphyxia, hypothermia, low birth weight, and prematurity-related conditions

Whereas for under 5 mortality is due to diarrhea, pneumonia, malnutrition, malaria.

Present Scenario

National Safe Motherhood Program (NSMP). Community-Based Integrated Management

of Childhood Illness (CB-IMCI). Bi-annual supplementation of Vitamin A. National Program on Immunization. Community-Based Newborn Care Program

(CB-NCP)

Policies and Programs for Newborn Health in Nepal

Strategies: Promoting birth preparedness and

complication readiness including awareness raising and improving the availability of funds, transport and blood supplies.

Encouraging for institutional delivery. Expansion of 24-hour emergency obstetric

care services (basic and comprehensive) at selected public health facilities in every district.

National Safe Motherhood Program (NSMP)

Major Activities:1. Birth Preparedness Package and MNH Activities

at Community Level2. Rural Ultra Sound Program3. Uterine Prolapse4. Human Resource5. Emergency Referral Fund6. Safe Abortion Services7. Aama Program Safe Delivery Incentive Program (SDIP). Free institutional delivery care. Incentive to health worker for home delivery and Incentive to women for 4ANC visits

Initiated from Mahottari district in 1997 as IMCI

In 1999 merged with CBAC to be CB-IMCI. In FY 2009/2010 CB-IMCI covers all 75

districts. It is a program integrated package of child

survival intervention and address major illness like, pneumonia, diarrhea, measles, malaria and malnutrition.

Community-Based Integrated Management of Childhood Illness (CB-IMCI)

Nepal's national vitamin A program, started in a few districts in 1993.

In 2003 its coverage became nationwide. Given to all children 6 to 60 months of age. Vitamin ‘A’ campaign held every year in the second

week of April is being held in the first week of March. Dose: 6month-1year: 1lakh IU1year-5year: 2lakh IU Recently deworming is done along with Vitamin A

supplementation.

Bi-annual supplementation of Vitamin A.

World Health organization established a program called Expanded Program on Immunization (EPI) in 1974.

In Nepal started in1979 in three districts and was expanded to all 75 districts by 1989.

National Program on Immunization

It has been developed in 2007 with the goal to improve the health and survival of newborn babies.

Interventions Included in the Package Behavior Change Communication (BCC) Promotion of institutional delivery and clean delivery

practices in case of home deliveries Postnatal care Community case management of pneumonia/ Possible

Severe Bacterial Infection (PSBI) Care of LBW newborns Prevention and management of hypothermia Recognition of asphyxia, initial stimulation and

resuscitation of newborn baby

Community-Based Newborn Care Program (CB-NCP)

Policy guidelines have been developed, health workers have been trained, a logistics system has been established, and services are available from service outlets. However, inadequate number of skilled service providers service providers with poor skills, poor coverage and quality of care in available

services, poor and fragile system of logistics procurement

and its supply chain management.

Challenges in the Implementation of Newborn Health Interventions

MOH has not yet issued any guidelines for the management of preterm babies.Further more,  lack of appropriate policies and strategic

guidelines, funding gaps,poor infrastructure, and logistics as well as inadequate information inadequate referral links  poor infection prevention

Less referral  lower or inappropriate use of partographs in

the intra-partum period  socio-cultural differences  The poor infrastructure development of

Neonatal Intensive Care Units (NICU)  limited access to NICU services Although there is free delivery service provided

by MOH, but one have to pay for inpatient newborn care services in all hospitals.

Under-5 mortality rate (U5MR), 1990 142Under-5 mortality rate (U5MR), 2012 42U5MR by sex 2012, male 44U5MR by sex 2012, female

2015 (UN)

39

35.8

Infant mortality rate (under 1), 1990 99Infant mortality rate (under 1), 2012

2015 (UN)

34

29.4

Neonatal mortality rate 2012

2015 (UN)

24

22.2

Indices

Comparison with other countryWHO,2015Nepal: NMR: 22 IMR: 29 U5MR: 35India: NMR: 28 IMR: 39 U5MR: 52USA: NMR: 4 IMR: 6 U5MR: 11

THANK YOU!!!