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Mothers Child. 1989;8(2 Suppl):3-4.

Improving neonatal care: women as health providers.



In a project in India, women play a major role in efforts to provide pregnant women with prenatal care, safe deliveries and reduce perinatal mortality. Undertaken in 1986 with the support of the Ford Foundation and the State government of Tamil Nadu in the Kanchipuam district, it demonstrates the feasibility of establishing a low-cost neonatal care unit at a rural district hospital to make services for neonates accessible to families living in the surrounding rural areas. Design of the project was based on changes implemented at a government hospital used for training medical staff, the Institute of Child Health in Madras, where mothers were admitted with their babies to provide dad-to-day care. While the new unit, which contained 10 cots, was prepared, training was given to a range of health providers including medical officers, pediatricians, obstetricians, nursing personnel and paramedical staff from the rural hospital by a neonatologist and a medical officer trained in neonatology. Anganwadi workers (local women who ran the preschool child care centers) who had completed high school were selected to be trained as a new category of workers called neonatal nursing aides. Month long initial training and refresher courses were given. Operations were begun in July 1987 and referral links established to the district hospital from the subcenter and primary health center levels. A project extension team undertook a neonatal morbidity and mortality survey covering a population of 10,000 in the 2 subcenter areas as well as information on traditional practices of neonatal care to identify harmful practices. TBAs in the population conduct 53.9% of deliveries, auxiliary nurse midwives/multipurpose workers 13.2% and doctors 20%. Home delivery was the major mode. Current training for TBAs was reviewed and shifted from the primary health center to the hospitals to give experience with complicated cases and the results of traditional practices These practices were modified and the TBAs helped put together a kit for their own use. Several were observed in the field following training and showed improved care and knowledge.

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