Medicare for the baby

The use of a carefully planned medical care kit and a set of well designed medical techniques has led to a decline of more than 60 per cent in the mortality rates among newborn babies in villages in Gadchiroli district of Maharashtra. In a study conducted in association with the Society for Education, Action and Research in Community Health (search), a Maharashtra-based non-governmental organisation (ngo), 39 villages of the district were selected for implementing the programme for neonatal care. Three years later, the programme showed excellent results. Neonatal mortality rate fell by 62.2 per cent and the infant mortality rate by 45.7 per cent (Lancet , Vol 354, p1955)

Before the programme began in 1995, the ngo surveyed 100 villages in the district and collected information on mortality rates related data for two years: 1993-1994. The data showed that most neonatal deaths occurred because of premature births, birth asphyxia or injury, and infections. Analysis showed control of pneumonia, septicaemia and meningitis, collectively called sepsis, needed to be the key focus of the programme. Accordingly the ngo devised a small kit and trained dais (midwives) or local female health workers in 39 villages in home-based neonatal care as well maintaining detailed records of all pregnancies and births in their area of work. A simplified method to diagnose and treat neonatal problems, as per the recommendations of the National Neonatology Forum of India, was imparted to the midwives. Treatment of sepsis by the midwives , health education for the pregnant women and the grandmothers via the health workers and constant monitoring formed the backbone of the programme. By the end of the second year of the programme, 93 per cent of the newborns received the home-based care through the dais.

In three years, the 39 villages showed remarkable improvement as compared to the 47 control villages that had also been surveyed but where the programme had not been implemented. Media reports say the government of Maharashtra is contemplating implementation of the techniques used by search through out the state.