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Family Participatory Care:A Gateway to Nurturing Small &
Sick Newborns
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IV swellings common!!
Tubes/probes often misplaced!!
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Common scene outside the neonatal unit…..
Parent Attendants lined waiting………… !!
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“Can we start ‘engaging ’ the waiting
parent-attendants as nursing aides for
their own babies?”
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Allowing parents to come in ….
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“Involving parents”: as nursing aides
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“Using” parents: to overcome HR constraint
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WHAT DID WE SEE?
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P-A as nursing aides…. • Parents
• Babies
• Nurses
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Modern Neonatal Care: Gaps▪Less Attention tooSick babies’ developmentoPsychosocial needs of family
▪Parental involvement in care/decision making is: limited.
▪Universal human workforce shortages: compromised QoC.
▪Lack of continuum of care at home.
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RCT Outcomes
No ↑ in Infection↓Hospital stay ↑ Breast feedingFeasible & Safe
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Scope of Mother/Parental Involvement in a Nursery (SNCU)
Entry Protocol (Session I)
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Scope of Mother/Parental Involvement in a Nursery (SNCU) contd….
Developmentally Supportive Care (SESSION II)
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Scope of Mother/Parental Involvement in a Nursery (SNCU) contd….
Developmentally Supportive Care : Feeding (SESSION II)
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Scope of Mother/Parental Involvement in a Nursery (SNCU) contd….
Kangaroo Mother Care (Session III)
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Scope of Mother/Parental Involvement in a Nursery (SNCU) contd….
Preparation for Discharge and care at Home (SESSION IV)
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Institutionalising Family Centred Care: The ProcessInduction at Admission
& Identification of Primary Care Provider Daily Trainings Scheduled
Demonstrations and Practice
1
2
3
Supervised Learning
4
Peer To Peer Learning
5
Independent Doing
6
Discharge Counseling
Continuum of Care at home
7
8
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Mother became our point of focus!!
That was easy!!
•Mother already sold to the concept!
•Much easier to define what mother is expected to do and…she will do.
About Implementation of FCC…..
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“Initially too much focus on training sessions and ensuring mothers must attend!!”
Mothers attending training sessions religiously but mothers still not seen to be engaged in bedside care!!
Focus shifted from ‘trainings’ to seeing mother’s involvement in bedside processes of care”
Need of supervision -----Role of provider!!
About Implementation of FCC…..
Lesson 1
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“Mothers involved in care but sometimes seen to be engaged doing what was beyond her defined scope!!!….”
??Task shifting by the provider
• Important to define what mother will not do eg.(Nothing pertaining to Oxygen regulation/IV canulae/ fluids/ Drugs/
Medications/Orogastric tube related feeding or else/ CPAP/ Endotracheal tube related)
Monitoring of Mother : Role of provider!!
About Implementation of FCC…..
Lesson 2
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“Trainings not happening regularly!!….Staff changes….new people… not aware of FCC”
Need of periodic sensitization of staff (one and all !!)
(…….Role of provider!!)
About Implementation of FCC…..
Lesson 3
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So….What was not so easy??
“Selling the concept to doc/ nurse !! “
About Implementation of FCC…..
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Provider needs to be focus of attention for effective implementation of the program!!
Lesson 4
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About Implementation of FCC…..
Challenges w.r.t. heath care providers• Accepting P-A as a co-partner in care !
• Diminished authority?
• Watch Dog Effect!!
(Uneasiness because of being constantly watched!)
• Tendency to task shift!!
• Expected to deliver a standard of care that an empowered parent now is aware of and expects from him !!!
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Identifying Champions & Getting health careprovider on board is the most important!!!
About Implementation of FCC…..
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Monitoring
In hospital
• Nurses performance.
• Adverse events /HAI
After Discharge
• EBF rate at 3/ 6 months
• KMC continuing rate
• No. of rehospitalisations
• Post D/S mortality
• Growth & Devt.
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Results achieved in 5 Model FPC centres
46%
2%
58%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
% Mother conducted at least 1 facilityfollow up visit
% Mothers providing KMC at home
Before FPC
After FPC
Adherence especially KMC Significantly improved
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Improved Adherence with addition of community component in 5 FPC centres
58%55%
71%73%
65%68%
89%84%
% Compliance with health facilityfollow up
% Compliance with PrescribedDrugs
% Exclusive breastfeeding % KMC Practice Rate
Facility FPC Facility & Community FPC
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Madhya Pradesh(51 Districts)
Bihar (Nalanda)
Orissa( 30 Districts)
Rajasthan(33 Districts)
Andhra Pradesh
Translation in Public Health Country Scale up2014- till date
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Phenomenal Scale up of FPC in India!!!
• FPC Scaled up in 69 FPC centres with country budgets in one year
Qualitative & Quantitative Assessment of FPC in 38 facilities in India
Objective:
❖ Assess the current status of FPC
implementation
❖ Bottlenecks & challenges in
quality implementation of FPC.
• Toolsa) Health Provider-Interview b) Facility checklistc) Data verification d) Client satisfaction &
knowledge
43 submitting
reports
69 Facilities Training
conducted
38 Assessed
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Phenomenal Scale up of FPC in India!!!
• FPC Scaled up in 69 FPC centres with country budgets in one year
14,034
5,863
47,741
20,362
Parents attended FPC sessions Parents attended KMC session
5 Model Centres sinceJan 2016
69 FPC Centres sinceApril 2017
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FPC Assessment-QoC(providers feedback N=38) S
N
Qualitative Opinion of
Doctors and Nurses (N=38)Improved
No
ChangeNot Sure
1.Quality of care since
starting FPC in the facility 97% -
3%
2.Breast feeding practices in
the facility 97% 3%
3. KMC practices in the facility 100% -
4.Nosocomial infections in
the facility 34% 39% 27%
5.Follow up of discharged
cases in the facility 74% 26%
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Summary of Findings
• Most moms suggested FPC should start!!!!.
• Enabling logistics available at most places.
• 72% eligible NB were receiving FPCat fnal units
• 53% of Doctors /Nurses)were trained on FPC.
• Most facilities had regular FPC sessions but
training not well structured.
• Breast feeding & KMC practices have increased.
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FPC Assessment-Quality of Care(providers feedback N=38)
S NQualitative Opinion of Doctors and
Nurses (N=38)Improved No Change Not Sure
1.Quality of care since starting FPC in
the facility 97% -
3%
2.Breast feeding practices in the
facility 97% 3%
3. KMC practices in the facility 100% -
4. Nosocomial infections in the facility 34% 39% 27%
5.Follow up of discharged cases in the
facility 74% 26%
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FPC Assessment-Facility observation
79%
72%
95%
84%
100%95%
42%
97%
0%
20%
40%
60%
80%
100 %
120 %
0
100
200
300
400
Family memberallowed in SNCU
(N=240)
Family membersobserved
providing FPC(N=190)
Adequatesupplies for
hygeine entryprotocols
(N=38)
Chairs availablefor familymembers
(N=38)
Training spaceavailable (N=38)
Availability ofAV equipment
(N=38)
Structuredtraining sessionplan displayed
(N=38)
FPC DataRecording
Started (N=38)
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Summary of Findings• Almost all the mothers suggested FPC should start everywhere !!!!.
• All units were functional for FPC (72% eligible newborns receiving FPC)
• 53% of clinical staff (Doctors and Nurses) were trained on FPC.
• Enabling logistics available at most places.
• In most of the facilities FPC sessions happening regularly but training
not well structured.
• Breast feeding & KMC practices have increased.
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Learnings & challenges!
❖ FPC is doable in public health framework
❖ Winning strategy for improving KMC & empowering families
❖ Convincing key stakeholders: single most important step!
❖ Identifying a champion at each institutional level
❖ Integration with FBNC
❖ Scale up support
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Neuro-developmental Outcome at 1 year with FCC
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Neuro-developmental Outcome at 1 year with FCC: Conclusions
• Slightly lower rates of adverse neuro-developmental outcomes in the present study set against a backdrop of FCC compared to pre FCC period from the same unit or similar population datasets from district SNCUs
• Cause effect relation cannot be established but the study generated a hypothesis that is worth testing through RCTs
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EC
At Community : Empowerment: Linkage for Continuum of Care
At Facility : Nurturing Care
Through learnt competencies: Involvement in Processes of Care
Family Centred Care
Small or Sick Newborn at Facility
Optimising Early Childhood Development
LINKAGE BETWEEN FCC & ECD
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Family Centred Care is……
• A humane way to care:A Gateway to Nurturing Small & Sick NBs
• Creates opportunity for lifelong bonding.
• A family’s right to a respectful care : Need to protect, support & promote!
• A winning strategy for KMC scale up
• Operational feasibility & acceptability in Indian health care setting seems promising.
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Family Centred Newborn Care holds the key for developing social
accountability of health & may help achieve Sustainable Development Goals.
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Acknowledgement• NIPI
• USAID-ASSIST & INCLEN
• National and state governments
• Babies & families for participation & consent for pictures
• Our unit staff /doctors and RML Hospital