Gadchiroli Model of Home-based Newborn Care

From Shodgram to Home-based Newborn Care (HBNC) and finally, to Accredited Social Health Activist (ASHA), the Gadchiroli Model has been thoroughly researched, evolved, adapted, and replicated. Backed by stats and results, the model is deemed fit to comply with the needs of the marginal rural population while respecting their socio-cultural needs.

A new archetype  of Home-based Newborn Care of Shodgram; Image Source: Blog 4 Global Health

Based on the Gandhian philosophy of Gram Swaraj (self-governance), a doctor couple exemplifies the quote “Think globally, act locally,” to its true meaning. After graduating from Johns Hopkins University, USA, Dr Abhay Bang and Dr Rani Bang’s goal was to create a community health institution that would both treat the local populace and conduct research that would benefit the entire community.

SEARCH (Society for Education, Action, and Research in Community Health), an NGO founded by Dr. Abhay and Dr. Rani Bang in Shodgram (Gadchiroli, Maharashtra) in 1985 has changed the lives of the tribal people through its community health projects. The health center run by the duo in Shodhgram provides accessible and empathetic services to the people, especially tribals that form 40% population of the region. It has also developed innovative solutions to the most pressing community health issues.

Noting the treatment of women and the way pregnancies were handled in this below-poverty region, the doctor couple started the Home-based Newborn Care (HBNC) program at an experimental level to curb the situation. The program was divided into four phases*-* the baseline phase (1993 to 1995), the observational phase (1995 to 1996) and the 7 years of intervention (1996 to 2003).

The remote village of Gadchiroli is home to the Adivasis of Gond tribe and their socio-cultural norms are deeply anchored in their tribal religious belief system. For locals to participate in the field trials, the NGO understood that they must abide by and respect the indigenous belief systems and manoeuvre through them. Therefore, the Gadchiroli Model of HBNC emphasises participation and community empowerment. It acknowledges that the neighbourhood has a significant impact on babies' general well-being.

The concept employs neighbourhood health workers and trains them to offer fundamental infant care and instruct families in neonatal and postnatal health practises. This helped the local women to participate in the endeavour and earn a decent living for themselves,  a step taken to involve the community. These local healthcare workers are specifically chosen from the neighbourhoods involved in the field trials to ensure that they are familiar with the customs, language, and culture of the area, which aids in establishing rapport and trust with the families.

As part of the approach, community health professionals are taught how to provide essential newborn care services such as resuscitation, thermal care, breastfeeding assistance, infection prevention and treatment, and referral of unwell babies during home visits. These services are imperative to reduce neonatal mortality and improve newborn health.

The field trials collected statistics regarding neonatal mortality and post-natal diseases. The stats, when compared with the data acquired from different phases of the model, a significant improvement was noticed. The results proved the model to be highly successful compared to the control area, because the model helped in decreasing infant and neonatal mortality in the intervention area by 44% and 62%, respectively. This field research and results received international attention and therefore, this model was adopted and replicated by the government of India, Ethiopia, Pakistan, Bangladesh, and Nepal.

Although the Gadchiroli Model did not provide prenatal care to mothers, which is extremely important, the model’s use of technology to improve healthcare delivery is still crucial. Digital platforms and mobile health apps are used to track growth metrics, keep track of newborns' health, and provide timely reminders for immunisations and follow-up appointments.

Dr. Abhay and Dr. Rani Bang received the Padma Shri award for their Gadchiroli Model of Home-based Newborn Care, one of the highest citizen awards in India. Later, the Ministry of Health and Family Welfare as a part of India's National Rural Health Mission, adopted the HBNC model. It was named - Accredited Social Health Activist (ASHA), started in 2005, and the mission was to be fully implemented by 2012. ASHA aims to connect the marginal populations to the healthcare system to achieve the "Asha (hope) in every village" goal for India.