Intro

My name is Sweta Saxena (Duke class of 2009) and I'm participating in the DukeEngage program for the summer of 2008. I'm in Pune, Maharashtra, India with another student from Duke, Rashmi Bhat (class of 2010). We are working with Deep Griha Society (www.deepgriha.org) to implement/improve the SureStart program (see background information below) and to help implement an electronic health record system as a side project. I'll be working with the Deep Griha SureStart leaders from mid-May to mid-July. I'll try and update as much as possible (I don't know how often I'll have internet access) and I will try and put up some pictures soon.Background Info: India’s current healthcare system to deliver newborn care involves both public and private sectors. The public sectors are compromised of primary health centers, community centers, referral units and district hospitals. More than 80% of the qualified doctors work in the private sector leaving those who can’t afford private healthcare to turn to local unqualified practitioners with inadequate training. Without access to skilled birth attendants (SBAs), most newborns die because of infections, low birth weight and birth asphyxia because the first week of life remains the time of lowest coverage of care even though it is the time of greatest risk for the neonates and mothers. Family and community outreach programs have been shown to reduce neonatal mortality rates up to 40%. In Maharashtra India, home based neonatal care with village health workers, counseling, clean delivery, cord care and increasing proper breastfeeding has resulted in a decrease in mortality rates. A report on the state of India’s newborns was prepared in 2004 by the National Neonatology Forum, Department of Family Welfare/Ministry of Health and Family Welfare, the Government of India, UNICEF India, World Bank, Save the Children and Save Newborn Lives. It reported that India has the biggest newborn health challenge than any other country because 20% (about 26 million) of the worlds infants are born in India and more than one third of the deaths that do occur, happen on the first day of life. 1.2 million of these 26 million die in the first four weeks of life, which compromises 30% of the 3.9 million neonatal deaths worldwide. By 2010, the National Population policy calls for a reduction in infant mortality rates to less than 30% per 1000 live births. In order to accomplish this, care at the time of birth is one of the issues that need to be focused on. Save the Children found that attention needs to paid to skilled and clean care at delivery, keeping the newborn warm and dry by wrapping them immediately including the head, early initiation of exclusive breast feeding within one hour of birth, eye care, ability to recognize danger signs and complications, resuscitation of asphyxiated babies, and special care for low birth weight babies. The Bill and Melinda Gates Foundation responded to the call for action on the high neonatal mortality rates and the Millennium Development Goals. The foundation is funding a program known as SureStart through PATH to support care for the newborn in the home and implement preventive healthcare measures for the newborn. Its purpose is to reduce maternal and newborn mortality rates in Uttar Pradesh and Maharashtra through community involvement. There are four main activities that the program will be focusing on: 1) increasing access to SBAs at birth, 2) building community networks of trained health workers to assist the SBAs in providing home-based care and attending to the newborn as well as the mother, 3) developing community savings programs to help cover the cost of potential hospital referrals for the mother and the newborn, and 4) developing links among the communities so that lessons concerning newborn care can be shared.