Case Studies on State and District Level Stakeholders Perspective on Home Based Newborn Care Program in Uttar Pradesh, India

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP (GOI, 2005, GOUP, 2013). The current article examines the role, work & approach of ASHAs through the feedback of the program managers at district & state level. Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. It is to be noted that National Rural Health Mission was rolled out in April 2005 but it took about one to two years for the states to hire ASHAs and put things in place right from the state to the village level (GOUP, 2013). In this article, a comprehensive feedback is elicited from the program managers of newborn care program at the district & state level. The current study explores some of the crucial variables on the performance of ASHAs through the feedback of program mangers on the role of ASHAs in newborn & child health programs followed by their role in Home Based Newborn Care program. The article also includes the feedback of the program mangers on the work & approach of ASHAs. That’s how the perception of the program managers in the state of UP is included in this article. The program managers responded about the performance of ASHAs based upon their experience in the work by ASHAs on Janani Surakhya Yojana (JSY), New Born Care (NBC) & Routine Immunization (RI) as these are the frontline programs for the states. They were purposefully selected as respondents as they were the nodal persons for rolling out newborn care related programs. The relevance of the study assumes significance as data on the details of the program awareness of managers on child health & newborn are not included in many surveys. Further, feedback details on the health personnel’s performance is usually not collected from the nodal officers looking after the programs at district & state level. Such responses that collect feedback on the work & approach of ASHAs including the awareness of the program managers are not the focus in very large-scale health surveys. Such feedback on work & approach of ASHAs including the opinion & knowledge of program managers about the current implemented programs come under the ambit of social audits. The audits gain more teeth when the feedback is solicited from the people who manage the programs (GOI, 2016). It is important to note that social audit is an integral part of the National Health Mission document but it is not a priority activity of NHM. Usually, the responses, knowledge of trained health personnel are assessed in many studies while neglecting the response & perception of the program managers of the public health system. Here in this article, the managers talk about their own knowledge about the current programs, give feedback on the work & approach of ASHAs including the performance of ASHAs in the child health & newborn care programs. All these are trapped in 5 case studies of 5 stakeholders in 4 districts and one at state level. Here also it is seen that usually in social audits, the trained health personnel become the respondents as part of evaluation of their timely actions in many other studies. The uniqueness of the current study is that those who manage the programs are the respondents through their case studies. These managers become the pivot around which the contents of the current article revolve. A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted among the program managers where one manager was purposefully selected in the respective districts & one at the state with the help of a pre-tested structured interview guide with only open-ended questions. These in-depth interview guide collected descriptive details as responded by managers. The qualitative data were conducted amongst the managers and a total of 5 respondents participated in the study through 5 case studies. The results reflected that among the operational programs, it was surprising to note that none of the policy makers in the four districts mentioned about the Facility Based Newborn Care programs. The state level manager gave the details about the child health & newborn care programs but hinted that Home-Based Newborn Care (HBNC) was recently at the forefront because of the emphasis on setting up Kangaroo Mother Care (KMC) centers at selected public health facilities. The knowledge of policy makers about the role of ASHAs in the roll out of newborn related program was poor across all the districts except the state level. Further, it was imperative that the management of program related information was not at all the priority of the program managers. ...............