Informed decisions for actions in maternal and newborn health

Community-based newborn care

Community-based newborn care

Mother and newborn, EthiopiaCommunity-based newborn care (CBNC) in Ethiopia is a national package that aims to improve newborn survival through the Health Extension Programme. This will involve implementing a newborn care package along the continuum of care from pregnancy to post-birth through community frontline workers, including improving sepsis management (care for and treatment of a newborn with a potentially deadly bacterial blood infection).

What is CBNC?

In Ethiopia, approximately 90% of births still take place at home. In 1000 live births, 37 newborn babies will die1. Given the limited care for newborns in rural health facilities and inadequate newborn care seeking practice, scale up of essential newborn care in communities and primary health facilities is a promising way forward. 

The goal of the CBNC programme is to reduce newborn and child mortality through strengthening the government’s Primary Health Care Unit and Health Extension Programme.

This goal will be achieved by improving links between health centres and health posts and the performance of Health Extension Workers, to improve the 4 C’s across the continuum of care from pregnancy to post-pregnancy and the newborn:

  1. Prenatal and postnatal Contact with the mother and newborn;
  2. Case-identification of newborns with signs of possible severe bacterial infection;
  3. Care, or treatment that is appropriate and initiated as early as possible; and
  4. Completion of a full 7-day course of appropriate antibiotics.

The 4 C’s will be operationalised through the scaling-up of 9 community-based maternal and newborn components:

  1. Early identification of pregnancy
  2. Provision of focused antenatal care (ANC)
  3. Promotion of institutional delivery 
  4. Safe and clean delivery including provision of misoprostol in case of home deliveries or deliveries at health post level
  5. Provision of immediate newborn care, including application of chlorhexidine on the cord
  6. Recognition of asphyxia, initial stimulation and resuscitation of the newborn baby
  7. Prevention and management of hypothermia
  8. Management of pre-term and low birth weight neonates, and
  9. Management of neonatal sepsis and very severe disease at community level.

CBNC will further strengthen the Ethiopian health system coordination to deliver MNH services, especially community based sepsis management.

Where will CBNC be implemented?

Intervention sites for CBNC. Phase I sites are in green, phase II sites are in grey.

CBNC will be implemented in two major phases.

  • Phase I will be implemented in 7 zones across 4 regions of Ethiopia (Amhara, Tigray, Oromia and SNNP) by the end of 2013. In these 7 zones a total population of over 11 million will benefit from the interventions, with 2.6 million women of reproductive age and almost 400,000 expected deliveries expected per year.
  • Phase II will see the scale-up of CBNC to the remaining zones in the 4 regions in 2014 and beyond, and will be refined on the basis of learning and experiences from the evaluation in the initial seven zones.

1. The Ethiopia Demographic and Health Survey, 2011.