Performance in key new born care practices among ASHAs of Uttar Pradesh, India
Dr. Tridibesh Tripathy
When ASHAs were introduced in NRHM in 2005, one of their primary mandates were to track deliveries and visit homes of newborns as the first program and counsel and deliver relevant messages as envisaged under the Comprehensive Child Survival Program (CCSP) way back in 2008 in Uttar Pradesh. Since then, tracking of all the deliveries and the related messages given by ASHAs on newborn care to mothers during pregnancy and in the first month after delivery are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP. The current study explores four of the crucial variables of the performance of the ASHAs on newborn care in relation to both institutional and home deliveries in four districts of UP. The four variables are bathing, weighing, initiating breastfeeding, pre-lacteals and advise on discarding the first milk of the lactating mother. These cover the thermal care and, food aspects of Home-Based Newborn Care (HBNC). Through this profile, the content and type of newborn care messages given by ASHAs in their coverage area is tracked for assessing their performance in relation to HBNC. The relevance of the study assumes significance as data on the details of activities like the content, timing and quality of messages on these newborn care practices is not assessed with relation to all deliveries. Hence, the performance of ASHAs on this aspect is not tracked in various studies available in the public domain. A total of four districts of Uttar Pradesh were selected using purposive sampling for the study and the data collection was conducted in the selected villages of the respective districts using a pre-tested structured questionnaire with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study. The content of message deliveries by ASHAs in the 4 districts in their catchment area was assessed. Most of the ASHAs across 4 districts told the mother to bathe the child within 4-7 days after delivery. About 2% of ASHAs in Barabanki district advised to bathe the child immediately after delivery. Regarding weighing the newborn, from the mother child card it was seen that more than 90% of ASHAs across all the four districts replied that the weight of the newborn that they weighed last was 2.5 to 3 kilograms. Among the four districts, only 5% of ASHAs in Gonda told the mothers to breastfeed within 1-4 hours and the rest informed to do the activity within an hour of delivery. The knowledge of ASHAs regarding pre-lacteal feeding to newborns in Gonda was the poorest among the 4 districts. About 64% of ASHAs in Gonda advised the mother to discard the first milk before the child was put to the breast for the first time. Majority of ASHAs advised the mother to continue breastfeeding the newborn exclusively up to 6 months of age. There was large variation in the knowledge and practice of ASHAs regarding the pre-lacteal feeding practices. This shows that there is an urgent need to reorient ASHAs on the essential newborn care messages in relation to all deliveries especially for home deliveries. This can be done by using the structured mentoring and coaching approach, both, onsite/in-field and facility based by the supportive supervision structure of ASHA Sanginis, ANMs and Medical Officers for better adherence on delivery of the content, timing and quality of messages on newborn care to the prospective mothers and their family members in the community.