Neonatal Health Care Strategy and level of Neonatal Care System of Nepal

Since the 1990s, the Nepalese government has never stopped prioritizing the health of mothers and children. Maternal and child health care have been emphasized in a number of national health policies and plans since 1991, including the National Health Policy, the Second Long-Term Health Plan (1997-2017), periodic health plans, health sector plans I (2004-2009), II (2010-2015), and III (2015-2020), and the recently endorsed National Health Policy (2014). With the help of these government-wide policies, Nepal was able to successfully expand its efforts to improve mother and child health by bridging the gap between home- and institutional-based care.

Improved access to quality basic and comprehensive emergency obstetric and newborn care (BEMONC and CEMONC), increased availability of skilled attendance at birth, and strengthened referral services, particularly for poor and vulnerable populations, were emphasized in the National Safe Motherhood Policy (1998) and the Nepal Safe Motherhood Programme (2002-2017). In 1997, a community-based approach called the Integrated Management of Childhood Illness (CB-IMCI) was introduced to further increase the survival rates of children less than five years old. Community health workers are the program's key innovation; they treat and refer patients in need for the three leading causes of death in children: pneumonia, diarrhoea, and Acute Respiratory Illness. In 2009, the CH-IMCI package was expanded to include guidance on newborn care management, specifically for preventing and treating local bacterial infection and the possibility of severe bacterial illness. To increase infant health and survival, the Ministry of Health unveiled the "National Neonatal Health Strategy" in 2004. As authorized by the National Safe Motherhood and Newborn Health Long Term Plan, the government acknowledged the need of focusing on newborn health in 2006 as part of safe motherhood programs (2006-2017). In 2007, a Coty Based Newborn Care Package (CB-NCP) was developed with the aim "to improve the wth and survival of newborn newborns," drawing on learning from the Coty Based Infant Mortality Reduction Initiative (CB-IMCI) and the Lancet Neonatal Survival Series. In 2014, the Ministry of Health (MoHP) began implementing the use of chlorhexidine gel (CHX 4%) on newborns and has continued this practice to this day. This package enhanced the capacity of community health workers to prevent and manage critical treatment to newborns and refer complications to health. As a result of randomized trials demonstrating chlorhexidine gel's efficacy in reducing infection rates and increasing neonatal survival in low-income countries like Nepal, it has been standard practice to use the product.

Nepal's Every Newborn Action Plan (NENAP)

In recent decades, both globally and in Nepal, the mortality rate for children has dropped dramatically. Yet, every year, 2.9 million infants die in their first month of life, and an additional 2.6 million are stillborn throughout the world. Roughly 3 out of 5 newborns in Nepal don't survive the first 28 days of life.

Nepal's government is dedicated to saving kids' lives and putting an end to needless infant and young child mortality. The Every Newborn Action Plan (NENAP) of Nepal was created in 2016 in response to the need to improve maternal health, decrease infant mortality, and stop stillbirths.

Vision

A Nepal in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential.

Goal

Goal 1:
Reduce preventable newborn deaths in every province to less than 11 newborn deaths per 1000 live births by 2035

Goal 2:
Reduce preventable stillbirths in every province to less than 13 stillbirths per 1000 total births by 2035.

In order to improve newborn health and reduce the number of stillbirths by the year 2035, the plan lays out a clear vision. The NENAP is embedded into the larger National Health Sector Strategy and follows the National Health Policy's (2014) Universal Health Coverage concept (NHSS, 2015-2020) NENAP adopts four strategic directions or approaches outlined by NHSS: equity; quality, mult sectoral approach and reform.

The goal of the plan is to provide everyone with access to high-quality medical care, with a focus on those in need at the most vulnerable moments of their lives, such as pregnancy, delivery, and the first few weeks of a newborn's life. The plan acknowledges that enhancing maternal and infant health is a necessary condition for national prosperity and that doing so necessitates both a more robust health system and steadfast collaboration amongst a wide range of multi-sectoral players.

Strategic directions or approaches of NENAP

1. Equitable Utilization of Health Services:
   Reducing obstacles to access and utilization of health services, especially for underprivileged people, will be essential to achieving universal health coverage. With this expansion of the free package of services, more people will be able to get the care they need—including the critical treatment for newborns that are presently too expensive for them.
2. Quality for All:
   Basic quality requirements for health care services must be met. It will call for client-focused, multi-level provider collaboration across numerous public and private service settings. Clients will receive the most effective services possible if we strengthen evidence-informed programs and treatments.
3. Multi-sectoral Approach:
   Basic quality requirements for health care services must be met. It will call for client-focused, multi-level provider collaboration across numerous public and private service settings. Clients will receive the most effective services possible if we strengthen evidence-informed programs and treatments.
4. Reform:
   To better serve the public's health care requirements and lessen health disparities, the Ministry of Health and Population (MoHP) must undergo reform. Local governments will be given more control over decisions like planning and allocating funds. The government and business sector will work together in innovative ways to improve health care delivery.

Free Newborn Care Package:

There is still a significant problem with infant mortality and stillbirth in countries that are developing. Poverty, inequity in care, underserved, and a difficult-to-reach population are all obstacles to providing adequate care for newborns. In fiscal year 2072/73, the government of Nepal implemented a free newborn care (FNC) service package in all publicly funded hospitals to help alleviate this problem. All government hospitals are required to provide free maternity and infant care as part of this package.

Its primary goal is to ensure that low-income mothers and their newborns have access to necessary health care. The FNC package's end objective is to cut down on infant mortality by improving parents' access to necessary care for their newborns and reduce newborn death.

The "package 0" referred to the newborn care activities on government's free health services and "package A" are offered through the newborn corners in the birthing centers. The last two packages "package B" and "package C" are meant for the "special newborn care unit" (SNCU) and the "neonatal intensive care unit" (NICU).

The FNC program makes the provision of disbursing cost of care to respective health institutions required for providing free care to inpatient sick newborns. As per the FNC Guideline, the cost per care will be disbursed in line with the packages of care provided by the institutions.