The ACCESS Health Infant Care Improvement Project studied factors that influence infant care in the Indian states of Bihar and Odisha (Orissa). Our research identified a wide range of challenges related to delays in seeking care and lack of provider and facility availability and preparedness. Additional problems included lack of trust in the system and lack of knowledge of what services were available. We found that the greatest opportunity for change is through primary care. ACCESS Health developed neonnatal health delivery systems to reduce infant death in Bihar and Odisha, two of the five states in India with the highest rates of child deaths. The project was initiated at the request of the Norway India Partnership Initiative.
More children die in India under the age of five than in any other country. Sixty percent of these deaths occur in just five of the twenty nine Indian states. Seventy percent of those that die young are infants. ACCESS Health India conducted a series of consultations, facility surveys of public and private providers of neonatal services, and focus groups with new mothers. Our research considered several factors influencing infant care, including the challenges identified by those working to reduce infant mortality at the state level, the decision making processes of low income families about when and where to seek infant care, and the processes in different types of neonatal facilities.
As mentioned above, we found that the weakest link was the point of entry into the healthcare system: primary care. Based on our analysis, we designed an outpatient care model for neonatal care that connects newborns and their mothers to higher levels of care. Triage and well designed referral pathways are critical. The proposed primary care network includes public and private providers that are selected based on infrastructure, staffing, and the commitment to improve quality of care.
We presented the initial plan in three districts of the states of Bihar and Odisha. The state governments accepted our proposed models and included them in the Program Implementation Plan that they sent to the government of India in 2013.
The ACCESS Health Infant Care Improvement Project was funded by the Norway India Partnership Initiative.
Our partners for this project included the A. N. Sinha Institute of Social Studies in Patna, the Bihar Department of Health and Family Welfare, the Odisha Department of Health and Family Welfare, the Indian School of Business, and Vishwa Yuva Kendra in Angul.