Nepal –Peer-support groups and community volunteers improve newborn care in rural communities

BACKGROUND. In Nepal, neonatal mortality has remained high and stagnant. THE PROJECT. Since 2007, Plan International, a child-centered humanitarian organization, has implemented a USAID-funded Child Survival project in the Sunsari and Parsa districts (tot pop 1,200,000) to reduce the morbidity and mortality among neonates. One project strategy was to link female community health volunteers (FCHVs) with the formal government health system through the Pregnant Women's Group (PWG). PWGs are peer-support organizations comprising 8-15 neighboring pregnant women who meet monthly with the facilitation of the FCHV and the government front-line health worker; they discuss their pregnancies, danger signs, how to prepare for delivery and basic newborn care. FCHVs raise awareness on immediate care and danger signs of newborns, carry out home visits to newborns, and provide early case management and referral of sick newborns to government health workers. RESULTS. The project helped organize 361 PWGs and a similar number of FCHVs. In three years (2007 to 2010), the project achieved (1) an increase of 22 percent points in skilled birth delivery (from 45 % to 67%); (2) an increase of 17 percent points in detection and treatment of neonates with possible bacterial infection (from 36% to 53%); (3) an increase of 24 percent points of pregnant women with four prenatal visits (from 29% to 53%). CONCLUSIONS. Based on this and similar experience, the Ministry of Health has expanded a community-based newborn program to thirteen more districts.