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Operational Challenges in Home-Based Newborn Care (HBNC) Program Delivery in Delhi: A Qualitative Study
Pragya Sharma1, Ajanya Vattaparambil1, Ritika Bakshi2
1Room No 328, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
Objective:
To understand the operational challenges in the effective implementation of the home-based newborn care (HBNC) program based on qualitative assessment of the stakeholders.
Methods:
Interviews were conducted among various stakeholders [Accredited Social Health Activists (ASHAs), Auxillary Nurse Midwives (ANMs), medical officers, beneficiaries, ASHA coordinators, district program officers, nodal officers] of all the 11 districts of Delhi. Data management was done using NVivo 11 software and analyzed using inductive content analysis.
Results:
The knowledge of the HBNC program was satisfactory with a lack of specific and regular training on the subject. The lack of trust in quality of the HBNC kit, ineffective referral systems, and lack of on-the-job field monitoring and supervision of ASHAs were the major challenges in the program implementation. Migration of beneficiaries, myths, and cultural practices in the society along with administrative work overload affected the performance of the program.
Conclusion:
Regular training for ASHAs, quality assurance, and testing of kits are required for better HBNC service delivery. Framework for supportive supervision and procedural support in establishing referral linkages for sick newborns is essential for the effective implementation of the program.
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