Report

Final evaluation of the Community Based Newborn Care programme in Ethiopia

by Dr Bilal Avan and Dr Della Berhanu

published 19 August 2019

In 2013 the Ethiopian Government introduced the Community Based Newborn Care (CBNC) programme to improve maternal and newborn health outcomes. The programme has nine components, including the innovative step of antibiotics provision by community health workers for young infants with very severe disease. IDEAS was requested to conduct an evaluation of the CBNC programme and the final findings have now been released.

The overall evaluation plan included baseline, quality of care and follow up surveys, as well as two qualitative studies. It was conducted in collaboration with JaRco Consulting, based in Ethiopia.

At the community level, there were remarkable changes between 2013 and 2017 for facility delivery and antiseptic use for cord care in facility deliveries. There was also an increase for: one ANC visit, four ANC visits, care for newborns with a breathing problem, delayed bathing for home deliveries and skin-to-skin care. In contrast, postnatal checks in the first six weeks were very low and had even decreased since baseline. At baseline and follow-up, some newborns delivered in a facility and almost all newborns delivered at home were not weighed, indicating that preterm and low birthweight babies are likely to be missed at birth. Although not universal, in 2017 more young infants with symptoms for very severe disease were receiving antibiotics than in 2013. However, not all children that got amoxicillin also received gentamicin.

When correlating these community-level findings with the health system readiness findings, most supportive supervisory visits to health posts covered antenatal care and promotion of facility delivery, potentially contributing to the high coverage of these services. Very few addressed newborn and sick young infant care. The referral means and communication between health posts and health centres were poor. This has potentially led to missed opportunities for HEWs to provide postnatal checks for the increasing numbers of women who delivered at facilities. The lack of thermometers and infant scales also meant that HEWs were unable to provide CBNC services, which could potentially explain the incomplete records for sick young infants observed in the register reviews. On the day of the survey, almost 80% of health posts had amoxicillin and only one third had gentamicin, which correlates with a higher proportion of young infants with symptoms of very severe disease being provided with 7-day amoxicillin, but had incomplete or no gentamicin concurrently given. Register reviews showed similar findings.

The final report contains recommendations to improve the CBNC programme based on the observed gaps.

Authors

Dr Bilal Avan

Associate Professor

Dr Della Berhanu

Former IDEAS Ethiopia Country Coordinator and Research Fellow