Using nonpneumatic anti-shock garment for postpartum hemorrhage management and referral at the public health facilities: A pilot study in two districts of Bihar.

BACKGROUND: Nonpneumatic anti-shock garment (NASG) is a first-aid device that can save lives of women experiencing postpartum hemorrhage (PPH). OBJECTIVE: The aim was to explore the feasibility of implementation of NASG intervention at select public health primary care facilities in two high priority districts of Bihar. METHODS: Qualitative design was used to document the NASG implementation process. In-depth interviews were conducted with health-care providers in November-December 2015. These healthcare providers were chosen purposively based on their involvement in the use of NASG. The implementation process of NASG, process of training for its use, challenges faced during the rollout of implementation and the recommendations for improving the implementation were explored. RESULTS: Initially, a baseline study was conducted to assess the knowledge and skills of health-care providers regarding diagnosis and management of PPH. Implementation consisted of orientation and training of service providers on the identification of PPH cases and usage of the NASG garment during referrals. The interviews with stakeholders reflected that even after training and appropriate introduction of the practice of using the NASG bag, the initiative did not make a difference in ameliorating the situation of PPH management in the health facilities over 6 months. CONCLUSION: This study provides lessons for implementation and scaling up of NASG in public health systems, not only in Bihar but also other similar settings. It also calls for robust implementation research studies to generate evidence on the use of NASG at the primary health-care facilities as an intervention in program settings.

Rolling out of kangaroo mother care in secondary level facilities in Bihar-Some experiences.

BACKGROUND: Preterm birth is one of the leading causes of under-five child deaths worldwide and in India. Kangaroo mother care (KMC) is a powerful and easy-to-use method to promote health and well-being and reduce morbidity and mortality in preterm/low birth weight (LBW) babies. OBJECTIVE: As the part of the roll-out of India Newborn Action Plan interventions, we implemented KMC in select facilities with an objective to assess the responsiveness of public health system to roll out KMC. METHODS: KMC intervention was implemented in two select high priority districts, Gaya and Purnea in Bihar over the duration of 8 months from August 2015 to March 2016. The implementation of intervention was phased out into; situation analysis, implementation of intervention, and interim assessment. KMC model, as envisaged keeping in mind the building blocks of health system, was established in 6 identified health-care facilities. A pretested simple checklist was used to assess the awareness, knowledge, skills, and practice of KMC during baseline situational analysis and interim assessment phases for comparison. RESULTS: The intervention clearly seemed to improve the awareness among auxiliary nurse midwives/nurses about KMC. Improvements were also observed in the availability of infrastructure required for KMC and support logistics like facility for manual expression of breast milk, cups/suitable devices such as paladi cups for feeding small babies and digital weighing scale. Although the recording of information regarding LBW babies and KMC practice improved, still there is scope for much improvement. CONCLUSION: There is a commitment at the national level to promote KMC in every facility. The present experience shows the possibility of rolling out KMC in secondary level facilities with support from government functionaries.