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.
This month’s highlights include
Both pilots were launched (Pali: 26th of December, Baran: 9th of January) and we are now operating 24 hours a day 7 days a week in two public hospitals.
Pilot Program Updates: Ansh has already reached over 120 vulnerable and sick newborns.
Introducing our data collection cool, in partnership with Dimagi
In addition to providing life-saving interventions to over 120 vulnerable newborns, we have also identified and regularly engaged with the Infection Prevention and Control Committee for Maternal and Newborn Health, undertook retraining of Yashoda Maas (women hired by the government to support new mothers with breastfeeding initiation and counselling), and ran counselling and behaviour change sessions with the team.
We serve newborns babies under the age of 28 days. Almost 50% of all deaths under the age of 5 are in newborns. More shockingly, over 80% of these newborn deaths are in Low Birth Weight and preterm babies: our beneficiaries.
Updates from Pilot Programs
Launching Baran Pilot: Training Conducted by Dr Shashi Vani and Dr Nikhil
We are extremely thankful to Dr Vani, a pioneer and champion of Kangaroo Mother Care, for travelling long distances to come to Baran, a town without any train station let alone airports. We commend her for her passion and dedication to saving newborn babies and for providing support to Ansh, be it as an advisor or a trainer.
Successes
Most of the uncertainties that Ansh had have been resolved:
1) Ansh can get access to highly burdened hospitals with high mortality and can get government support and approval to run its programs.
2) Doctors are not only cooperative but also go above and beyond to help the program succeed, especially in the Special Neonatal Intensive Care Units (SNCUs) and Neonatal Intensive Care Units (NICUs).
3) While the rest of the staff (hospital cleaners, hospital nurses, and other staff) were hesitant and initially treated the program staff as outsiders, with time, coordination and efforts made by the doctors, program staff and partner organisations, they have started warming up and working collaboratively with our teams. They have a much better understanding of the program and its objectives and are now friendlier and cooperative. The hospital administration and the doctors played a key role in facilitating this coordination.
Other barriers to Kangaroo Care were resolved through the model design, including but not limited to:
1) Staff Shortages in the hospital and availability of nurses for hiring: We have 12 program nurses in Pali Hospital and 11 in Baran Hospital.
2) Space: Establishing small KMC rooms in the SNCUs and NICUs and converting some space in the PostNatal Wards (PNCs) to be reserved for stable LBW or preterm babies.
3) Privacy: Introducing privacy screens and other measures to ensure comfort for caregivers.
4) Introducing sensitive weighing scales for correct identification, referrals and tracking of weight gain in low-birth infants.
Learning, Failures and Realisations
Things take time. Even with high-level planning, proper communication and protocol setting, the system will take a few weeks to understand and to be cooperative. Additionally, our initial plan was to train or run orientation sessions for the existing staff, however, we failed to convince the administration to allow us some time of the existing staff, even if done in multiple sessions and for very short durations. We also do see trust-building playing a major role in this and are exploring how we can shorten the time it takes for staff to trust and get acquainted.
Identification is difficult, especially in Pali due to a very heavy load. Even with our nurses making multiple rounds in all the PostNatal Care rooms to identify LBW or preterm babies, babies are being missed. Identification is not an issue in SNCUs or NICUs as KMC is done under the doctors’ guidance and the doctors themselves prepare a list of babies eligible for KMC (for example, a baby who needs treatment for hypoglycaemia will be advised for KMC differently than a baby who is receiving treatment for Jaundice). We are exploring strategies on how we can ensure that every baby who needs KMC gets KMC (for example, getting access to the Labor Room physical register to check for all babies born on a particular day and their birth weight).
As anticipated, the biggest challenge we face currently is behaviour change and providing persistent and continuous KMC. We are seeing a steady rise in the number of hours over the month and a huge difference in the number of hours from Day 1 and Day 30. We find these factors to be the major contributors to that: nurses feeling more confident and capable, having better coordination with the existing staff, introducing more behaviour change strategies, for example, communicating morbidities that are highly likely in LBW infants in addition to benefits of KMC, showing videos of KMC being done in famous government hospitals (for example AIIMS, SMS Hospital in Rajasthan etc.). We are continuously exploring more strategies and behaviour change communication that can employed by the nurses and are planning to regularly run online training sessions with experts and nurses.
Space is an issue, especially in PNC wards. What we have found to be true is that, majorly, it’s not the mothers wanting to leave, or the doctors pushing out women. It’s the fact that these hospitals have an exceptionally high delivery rate and there is not enough space or staff to take care of all of them. In terms of our program, we see that the mothers in PNC wards are discharged earlier than we would prefer them to be. We are redoing our follow-up strategy for such mothers to ensure continuous counselling and monitoring.
Some stories from the ground
All 100% of interviewed mothers said that they wouldn’t have known about KMC or done KMC if not for the program. Here are some translated quotes from the interviews:
“My baby was so small and was barely moving when he was born. After I started doing KMC, he became so much more active and started moving his legs and hands”
“I was very hesitant and didn’t understand how KMC could help my baby. But the next day, the nurse showed me his weight on the machine. My baby was gaining weight for the first time since he was born.”
“My baby feels so much more warmed up after I do KMC”
“My baby has been in the NICU for a week, and I wasn’t producing any milk. After doing KMC for one day, I started producing breast milk and could finally start feeding my baby”
Interestingly, over 90% of mothers did know that babies should be exclusively breastfed for the first 6 months. We believe this is due to strong awareness programs run by the government and counselling done during Antenatal Care visits. However, we did find gaps in knowledge around how frequently and for how long breastfeeding should happen.
We also had a father do KMC with a baby admitted in the SNCU and weighing 1200g in the same room as 3 other mothers. Mothers were not only comfortable but were happy to see a father help a mother with KMC. While positioning, the nurses used privacy screens. Once the positioning is set, the babies and the caregivers are usually covered by a blanket. The baby is now over a month old, is at home and weighs more than 1500g.
Introducing our App
Releasing the first looks of our data collection tool, developed with Dimagi through a pro-bono partnership:
For Nurses
For Monitoring and Evaluation Coordinators
Next Steps
For the scale-up of the program to other high-mortality and high-burdened district hospitals, we are trying to answer these questions:
1) Should this program even be scaled up?
do we have an impact, i.e. neonatal mortality reduction, that is cost-effective in line with the standards set by GiveWell?
2) If so, which model and model components are scalable and impactful?
for example, do we need beds (as done in the Baran model) or adding portable bed rests to existing beds (as done in the Pali model) is equally impactful and much more cost-effective
3) And who is in the best position, operationally and administratively, to scale up this program and model? Is it Ansh, is it the implementing partners, is it the government or is it a combination of any of these?
Fundraising
Currently, Ansh has a funding gap of $215,000 and we have enough funding to keep running Ansh and the programs till June 2024. It costs approximately $5000 a month to run the programs in one facility. Even if we save one life per facility a month, it makes us highly cost-effective, however current estimates of lives saved are much higher than 1. This is mainly because our intervention targets vulnerable and sick infants in heavily burdened and resource-constrained districts with a high neonatal mortality rate (NMR). Please reach out if you would like to learn more and donate.
Charity Entrepreneurship Visit
We had the pleasure of having Karolina Sarek (Co-Founder and Co-Executive Director), Samuel Hilton (Director of Research), and Aidan Alexander (Director of Programs) from the Charity Entrepreneurship Team visit our programs at the Baran District Hospital.
