Transcript CHX presentation for visitors Aug 2013

Innovation in reducing neonatal death
using Chlorhexidine in Nepal- a case study
Saving Lives at Birth a Grand
Challenge for Development
• This is three year project to scale up use of
Chlorhexidine at national level
• The project aim to reduce neo-natal death
cased by infection by using Chlorhexidine
immediate after cord cutting
• This in one of the innovation project under
USAID health , science and technology.
2
The Nepal Context- Child Mortality
180
160
Under five mortality rate
153
Infant mortality rate
140
Neonatal mortality rate
120
100
118
102
79
80
60
91
64
46
50
39
40
20
61
48
33
Less improvement with neonatal
mortality and no change from 2006-2011
0
1991
3
Marked decline in infant and
child mortality
1996
2001
2006
54
46
54
34
33
2011
16*
2015
Source: NDHS&NHSP*
Other
Congenital
Anomaly
Severe
infections
42%
Pre term/
LBW
Birth Asphyxia
Injury
3 – 4 children die every hour
63% of deliveries occur at home
Child birth considered an impure and dirty process
Nepal Context – Policy
Strategies to reduce neonatal mortality
Expansion of community-based neonatal
care program
Promote institutional delivery and Skilled
Birth Attendant
7
Nepal policy for CHX used
• Chlorhexidine will be applied to each
newborn irrespective of facility and home
birth.
• Nepal is using single dose resume immediate
after cord cutting as a part of essential
newborn care followed by clean and dry cord
care practices.
• CHX is not stand alone program it is integral
part of essential newborn care.
8
Why Nepal Accepted Chlorhexidine Cord Care
Addressing a problem with high population health burden
Efficacy
Low cost
Simplicity
Safety
Acceptability
Low regulatory requirements
Health system compatibility
Scalability
Commercial viability
9
Nepal: A Living University for Chlorhexidine Cord
Care
2007
• 1st consultative meeting in Nepal
• Non-inferiority trial of CHX gel compared to
aqueous
2008-09 • Gel versus aqueous community acceptability
study
2009-11
• Pilot program in four districts
Nepal: A living university for Chlorhexidine cord care
• Coverage and compliance study
• CHX international meeting at Banke,
Nepalgunj
• Approval from MoHP for national level
2009-11
scale up
• Government of Nepal with strong support of
JSI and other partners working together to
scale up at national level
Nepal: A Living University for Chlorhexidine Cord
Care
• Providing technical and product Supply
to neighboring Asian and several African
countries for doing formative work and
preparing to pilot
2012 • Providing a learning platform to many
Onwards
international visitors
• Providing technical support to other
implementing partners
Completed and Active Districts: 41
Planned: Entire Country (75 districts)
Impact
Communitybased programs
Misoprostol
Program
Chlorhexidine
Chlorhexidine
integration
into
integration
ongoinginto
ongoing
programs
programs
Health Facility
Delivery
Skilled Birth
Attendant
Training
Success through Integration
14
Key to Program Success in Nepal
Benefit of conducting the first RCT in Nepal
Government leadership since inception of the program
Local manufacturer (Lomus Pharmaceutical) producing
a good-quality product
Partners and professional organisation involvement
since beginning to scaling up
Nepal – member of global Chlorhexidine working
group
15
Supply of 7.1%w/v Chlorhexidine
in Nepal
3 gram of 7.1% Chlorhexidine
digluconate gel tube - Nepali brand name
Kawach.
Pictorial instruction inside box.
Current price is Rs.18 ($0.23) for
Government.
Supply is ensured through the
government logistics supply system.
Job aid to counsel mother
Doll as a Interpersonal Communication Tool
Ensuring Sustainability
Chlorhexidine added in Essential Drug List of Nepal
Chlorhexidine cord care is a part of an essential newborn
care
Government of Nepal included Chlorhexidine procurement
in multi-year procurement plan
Included in routine health information system for
recording and reporting
Thank you