In the mid way of 2000 and 2015, the analysis of Millennium Development Goals (MDGs) in developing world shows encouraging progress signs particularly in child health, but very less or no notable achievements in neonatal health (WHO, 2009). The proportion of neonatal deaths – deaths within the first 28 days of life – is expected to increase due to decline in burden of post-neonatal deaths (UN, 2009; USAID, 2008; WHOSIS, 2010). As per the WHO Statistics (2009), the progress on health-related MDGs shows about 37% of under-five (U-5) mortality occurs in the neonatal period, with most deaths within the first week i.e. early neonatal period. Over one million neonates die within their first 24hours of life due to lack of quality care, annually, worldwide (UNFPA, 2008). In Nepal, Neonatal Mortality Rate (NMR) is 32 per 1000 live births in 2004 (WHO, 2009).
Fig 1 Continuum of care
Source: Kerber et al., 2007
The basic principle of developing strategies to address Neonatal Health Care (NHC) revolves round the ‘continuum of care’. Throughout the lifecycle as shown in figure 1, including adolescence, pregnancy, childbirth and childhood, the care ought to be provided as a seamless continuum that spans the home, the community and health centre, locally and globally (Save the Children [StC], 2006). Hence, reducing child mortality is more dependent on tackling neonatal mortality or in other words, managing the NHC. 2.
KEY CONCEPTS AND ISSUES
In Nepal, most of the deliveries take place at home with delayed care-seeking behavior; the NMR remains high in rural areas, frequently associated with cessation of suckling and shortness of breath (Mesko et al., 2003). While the Department for International Development [DFID] (2009) report reveals that, the factors causing poor maternal outcomes and ultimately resulting high NMR are poor and delayed transportation arrangements, weak financial status, long distance to health centre, and even needing permission to seek care. As the survival of the newborns, older than a month is progressing quickly, there has been transformed concern in interventions assumed to improve neonatal survival. The questions about the new interventions: “providing thermal care to the newborn, postnatal care to the mother and newborn, and counseling on infant and maternal health care to mothers” has been added in the Demographic Health Surveys (DHS) of Nepal, along with Bangladesh, India, Indonesia, and the Philippines, to address antepartum, intrapartum, and postnatal interventions for the NHC (USAID 2008). Moreover, the target to reduce NMR from 34 to 30 per 1000 live births by 2010 has been set in the new Three Years Interim Plan (TYIP) for health 2008-10 (TYIP 2008-10, 2008). Pertaining to the revised target associated with neonatal mortality and to combat delays in seeking, reaching and receiving care, the Department of Health Services, Nepal (DoHS 2006/07, 2008) has postulated three major strategies: * To promote birth preparedness and complication readiness including raising awareness, improving the availability of funds, transport and blood supplies. * To promote use of skilled birth attendants at every birth, either at home or in a health facility. * To make provision of 24-hour emergency obstetrics care services (basic and comprehensive) at selected public health facilities in every district.
STRENGTHS AND WEAKNESSES
The strengths and weaknesses of the NHC in Nepal can be reflected in broad spectrum, by analyzing the strengths and weaknesses of the National Health Policy and current heath services, in general. 4.1. Strengths
4.2.1. Health as citizen’s right
The Ministry of Health and Population (MoHP) aims to create a new healthy Nepali society, working in alignment with the prime objective of “bringing about a meaningful change in the overall health” as per the guidelines issued by the Government of Nepal (GoN)...