Effectiveness of introducing home-based newborn care (HBNC) voucher system in Golaghat District of Assam

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• 作者：Tulika Goswami Mahanta^a ; ^{drtulikagoswami@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Safikul Islam^b ; Ajit Kumar Sudke^c ; Veena Kumari^d ; Pranab Gogoi^e ; Tushar Rane^f ; Bhupendra N. Mahanta^g
• 关键词：Home-based newborn care (HBNC) ; Voucher system ; Innovation ; Effectiveness ; Assam
• 刊名：Clinical Epidemiology and Global Health
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：4
• 期：2
• 页码：69-75
• 全文大小：587 K

文摘

Neonatal deaths constitute two-thirds of infant deaths in India; 45% of the deaths occur within the first two days of life.¹

Methods

The primary objective was to assess the effectiveness of use of voucher system in HBNC in Golaghat District of Assam with a secondary objective to assess awareness and utilization of different maternal and child health related services. A community-based before/after intervention study was conducted in Golaghat District of Assam. Two-stage cluster sampling was used. All ASHAs (accredited social health activist) of the selected beneficiaries were assessed. All mothers who delivered were given a set of 6 HBNC double perforated numbered vouchers following baseline study and capacity building of ASHA. When the ASHA visits the baby and examines it using the standard recording format, mother/caregiver handed over the appropriate number of the voucher. The ASHA received the HBNC incentive only after all the six vouchers were submitted. Endline survey was done after 6 months of intervention. Rates, ratios and proportions were determined and chi-square test was done to assess the difference in knowledge and practices.

Results

A total of 582 and 650 caregivers and 174 and 182 ASHAs were assessed in baseline and endline. Only 68.2% know about birth preparedness, while 90.9% know about young infant and child feeding; 77.7% know about family planning and reproductive tract infection (RTI/STI) and 77.3% know the importance of safe delivery, while all know about immunization; 54.5% know about essential newborn care, 81.8% know the importance of home visit and all were unsatisfied with their incentives. Significant improvement was found in HBNC practices, antenatal and post-natal care, iron folic acid supply and immunization following introduction of voucher system (p < 0.05).

Conclusions

Introduction of HBNC was found to be an effective intervention tool to improve knowledge on different healthy behaviour related to mother and child health, especially neonatal health, awareness of different services available amongst beneficiaries and practice pattern improvement amongst both service provider and beneficiaries.