Thanks for supporting our mission of saving newborn lives. Your support is crucial in delivering our intervention of building capacity in India’s public health care system to provide a simple, cheap and well-evidenced intervention called Kangaroo Care.
Updates from Pilot Programs
Two-Month Pilot Update
We have provided KMC to over 275 vulnerable and sick newborns. Approximately 35% of these newborns were admitted to specialized neonatal care units (SNCUs) or Neonatal Intensive Care Units (NICUs) and were receiving treatment for other serious complications such as hypoglycemia, jaundice, birth asphyxia, serious infections, or were on feeding tubes. Around 65% of the low birth weight and preterm newborns were identified in Postnatal Care (PNC) wards and were receiving no care.
Learnings, Failures, and Realizations
Due to our prioritization of working in districts with high neonatal mortality rates, we ended up operating in districts with a significant number of tribal and nomadic communities. This has been a significant learning experience for us, as working with nomadic tribes presents its own set of challenges for which we was underprepared. Coincidentally (and expectedly), some of the nurses hired were also from these tribes, and they have played an integral role in communicating with these families, contributing to our successes. If Ansh scales up, we plans to prioritize not only hiring from the same district but also recruiting nurses from within the communities residing in these districts.
Orientation and retraining sessions were conducted for Yashoda Mas (women providing breastfeeding support to new mothers, a government-run program) in the Pali district due to their uncooperative and difficult behaviour. Despite efforts to foster understanding by introducing our organization, facilitating proper introductions to our nurses, and providing retraining by the hospital's lactation counselor, we did not observe a significant change in their attitude towards the program and their job responsibilities. Surprisingly, similar challenges with the same group of women (Yashoda Mas) were encountered in the Baran district. We are exploring additional strategies to work with them.
Collaborating with the district government has been an interesting experience. While they appear to be supportive of the KMC programs and doctors also demonstrate high KMC awareness, there are still challenges with implementation and taking action. However, we have gained a better understanding of their needs and preferences, aiding us in strategizing how to foster positive and strong relationships with them.
Both districts changed the key government stakeholders for the KMC program this week. Recognizing the dynamic nature of governmental structures, particularly the frequent changes in personnel, we acknowledge the importance of building relationships with the state government, alongside local government and authorities and the lack of effort in it so far. This strategic shift aims to ensure continuity and stability in partnerships, considering that state-level personnel changes are less frequent than those at the local level.
Positive Spillover Effects
In addition to providing Kangaroo Care, a proven life-saving intervention, we have observed several ancillary benefits:
Community Awareness: When our nurses provide counselling to individual families enrolled in our program on neonatal care and danger signs in the Post Natal Care wards, we see that mothers and families around the target family form groups and try to listen in. They would also ask questions, for example “Can we put oil on the umbilical cord” and say things like “we never knew this, no one told us this”. They would listen in to training sessions on Kangaroo Care and when inquired if their baby is also Low Birth Weight or premature (and might have been missed by our program nurses), they respond with saying that they know a lot of women in their communities who give birth to such babies and would like to go back home and share it with them.
Breastfeeding Support: Our team of nurses ended up extending breastfeeding support to numerous mothers outside the program in January, prompting us to start tracking the number of mothers assisted. Proper nutrition and breastfeeding counseling promote breastfeeding, which offers numerous benefits to both the baby and the mother. In February alone, in Pali (one of the two pilot districts), we provided breastfeeding counseling to 432 women not enrolled in our program at no additional cost.
Neonatal Care and Group Counselling: One of the experimental components of our program was to install TVs and play videos on essential newborn care in one of the pilot hospitals. We had tried to compare various components of the model to see what is cost-effective and impactful, and can be scaled up easily (for example, new fowler beds vs bed rests that can be put on existing beds for mothers to sit and provide KMC; bed rests seem to be working just fine and we have had no complaints). TVs on the other hand have become very popular and the families enjoy watching the Global Health Media videos which cover life-saving interventions, danger signs, and breastfeeding promotion. Over 1200 families with newborns have watched these videos during their stay at the hospital. For the other site, we have started running group counselling sessions. We plan to explore how we can better understand the impact of these videos and group counselling.
Infection Control and Prevention (IPC): While progress has been made in improving IPC practices, there is still room for improvement. For instance, in Baran, cleaning of the wards and rooms where newborns stay has increased to twice a day, up from once a day (that too not all days), before the pilot. Collaboration with hospital doctors has been crucial in achieving this, though the current IPC situation is still far from meeting the IPC protocols set by the government and recommended by WHO. We are working with the IPC committees, government incharges and other key stakeholders on this.
Advocacy for Implementation of Government Policies: Based on data, conversations, and hospital observations, we advocate for changes to hospital protocols that could enhance neonatal survival. Usually these changes are already a part of existing government guidelines and policies that, if followed, could significantly impact outcomes. For example, one policy mandates that babies below 1500 g not be discharged from the hospital, yet a significant number were being discharged. On further analysis, we also observed a high number of deaths and hospital readmissions for these cases. Last week, based on the data and reports we provided to the hospital, the hospital has agreed to not discharge such babies and has not since. We are closely monitoring this.
Referral of critical cases: So far, over 20* infants have been referred to or taken to intensive care units by our program staff and nurses. These babies were found to be showing serious danger signs, such as birth asphyxia, severe/pathological jaundice, severe infection, severe hypothermia, seizures, and were at risk of passing away. Unfortunately, the hospital doctors were not able to save all of the infants we referred to them, however, all were provided with life saving interventions and a good number of these babies are now healthy and thriving.
*This number only includes the babies that were severely ill and were not receiving any medical attention at the time of referral. They are usually found in postnatal care wards. Our staff also refer babies who are not severely ill but require medical attention, such as babies unable to feed, babies with low grade fever, babies with non-pathological jaundice etc.
Note: No additional investments in terms of costs or human resource has been made for any of the above interventions. This might change after the pilots if anything stands out to us during data analysis in terms of impact. These activities are undertaken by the staff hired for the KMC program. We have conducted extensive interviews with our nurses to understand if they feel highly burdened in terms of responsibilities, in addition to gaining other insights. We plan to start analysing these interviews from next week.
Next Steps
We plan to publish the pilot results sometime in April, which will include an estimate of baseline neonatal mortality (before we started our program), neonatal mortality in the infants that received KMC and were part of our program, and overall cost-effectiveness of the pilots. Around 125 babies out of 275 babies are now one month old, and some initial data is suggestive of reduction in neonatal deaths before and after the program.
Uncertainty update: We were worried that a huge number of babies won’t be reachable once they leave the hospital (do not pick up their phones/ give wrong phone numbers/move away), however, only 7% were not reachable at the final one month follow-up (9 out of 125 cases). Additionally, we have identified a way to contact the government community healthcare workers (ASHAs) of the regions from where these babies are from, and ask them to visit these families. We still hope to be able to get the data and updates on most of these babies.
Fundraising Gaps
Currently we have a funding gap of $215,000 and runway till June 2024. We will not be able to run these programs beyond June. So far, we have deprioritized fundraising and have been exclusively focusing on the pilot programs. From March onwards, fundraising will become one of the main priorities. We are still waiting for pilot results to plan any scale up activities and start engaging with the state and national government. Please reach out to us if you would like to learn more, have any leads or donate.