Aama Surakchhya Program and Antenatal Incentive Program
Aama surakchhya program now includes:
- Incentives to mothers: A cash payment after delivery at health facility (state and listed nonstate).
- 1,500 in mountain areas, NRs.1,000 in hill areas and NRs.500 in the tarai.
- Free delivery services: A payment to health facility for the provision of free care.
- Normal delivery at health facility with 25 and more beds Nrs.1,500 and health facility with less than 25 beds NRs.1,000; Complication NRs.3,000; C-Section NRs.7,000. This covers cost of all required drugs, supplies, instruments, and a small incentive to health workers NRs.300. This provision does not require individual claims from health workers; however, institution requires submitting the claim.
- Incentive to health workers for home delivery has been reduced to NRs.200 from NRs.300 to discourage the home delivery.
- Aama Surakchhya program is being implemented by 52 non-state hospitals.
Antenatal Incentive Program
- A mother gets NRs.400 if she completes 4 ANC visits as per the ANC protocol, institutional delivery and 1st
Antenatal care services include:
- At least four antenatal check-ups: first at 4th month, second at 6th month, third at 8th month and fourth at 9th month of pregnancy;
- Monitor blood pressure, weight and Fetal heart rate;
- Provide information, education and communication (IEC) and behavior change communication (BCC) for danger signs and care during pregnancy, delivery, postnatal and immediate newborn care for both mother and newborn and timely referral to the appropriate health facilities;
- Birth preparedness and complication readiness (BPCR) for both normal and obstetric emergencies (delivery by skilled birth attendants, money, transportation and blood);
- Detection and management of complications;
- Provision of tetanus toxoid (TT) immunisation, iron tablets, deworm to all pregnant women and malaria prophylaxis where necessary.
Delivery care services include:
- Skilled birth attendants at delivers (either home-based or facility-based);
- Early detection of complicated cases and management or referral after providing obstetric first aid by health worker to appropriated health facility where 24 hours emergency obstetric services available;
- Obstetric first aid at home and/ or HP/ SHP if complication occur, using Emergency Obstetric Care Kit (EOC kit);
- Identification and management of complications during delivery and referral to appropriated health facility as and when needed;
- Registration of births and maternal and neonatal deaths.
Postnatal care services include:
- Three postnatal visits: First visit within 24 hours of delivery, second visit on the third day and third visit on seventh day after delivery;
- Identification and management of mother’s and newborn in complications of postnatal period and referral to appropriate health facility as and when needed;
- Promotion of exclusive breastfeeding;
- Personal hygiene and nutrition education, post-natal vitamin A and iron supplementation for the mother;
- Immunisation of newborns; and
- Post-natal family planning counseling and services.
Newborn Cord care with Chlorhexidine
The current neonatal mortality rate of 33 per 1000 live births in Nepal translates to around 23,000 neonatal deaths per year (NDHS 2011). Studies have shown that immediate cleansing of umbilical cord with 4 percent chlorhexidine (Kawach) reduces cord infection and reduces neonatal mortality by about 23 percent. DoHS endorsed a pilot Kawach program in four districts. Based on the results of the pilot program, use of 4 percent Kawach to prevent Umbilical cord infection on newborn program has been approved from MOHP for scale up at notional level in a phase wise manner.
Emergency Obstetric Care
Basic Emergency Obstetric Care (BEOC) covers management of pregnancy complications by assisted vaginal delivery (vacuum or forceps), manual removal of placenta, removal of retained products of abortion (manual vacuum aspiration), and administration of parental drugs (for postpartum haemorrhage, infection and pre-eclampsia/ eclampsia), resuscitation of newborn and referral. Comprehensive Emergency Obstetric Care (CEOC) includes surgery (caesarean section), anaesthesia and blood transfusion along with BEOC functions.