Achieving and sustaining impact at scale for a newborn intervention in Nepal: a mixed-methods study

Saving Neonatal Lives for a Quarter

“…Since we control for time-and district fixed effects, identification relies on the absence of time-varying omitted factors correlated with the timing of treatment. Regressing the treatment indicator on observable characteristics, we find that, other than the expected positive correlation between CHX-NCP and CB-NCP, the program on which CHX-NCP "piggy-backed" (Hodgins et al, 2019), the treatment is only weakly correlated with observable characteristics. 12 Among the sample of births predicted to take place in an institution, treated babies are significantly less likely to be found in rural areas, to be their mother's third born and more likely to have a mother with an ethnicity from the residual "other" group.…”

“…The scaled-up intervention consisted of a single CHX gel application on the day of birth to all newborns irrespective of place of birth. For home births, CHX gel doses were distributed to pregnant women during antenatal care visits in the last two months of pregnancy (Hodgins et al, 2019). 8,9 The CHX training of health workers lasted between three hours and one day and to reduce costs and increase program sustainability, training and monitoring activities were integrated into broader maternal and newborn health programs, and in particular into the Community-Based Newborn Care Program (CB-NCP) (JSI Research & Training Institute, 2017;JSI, 2017;Hodgins et al, 2019).…”

“…Estimates of actual CHX application in program districts vary much and, for home deliveries, an important limitation is that there is no record of application and that maternal recall is unlikely to be reliable for non-salient events (Beckett et al, 2001). 10 Coverage estimates suggest that it may have peaked in 2014/2015, as estimates range from 75 percent of home deliveries and 96 percent of facility deliveries (HIMS (2014), as cited in Khanal (2015)) to 75 percent of all births according to Department of Health Services (2015) to only about 40 percent of home births and 90 percent of facility births in 2017 according to Hodgins et al (2019) so that estimates presented in this study should be interpreted as intention-to-treat effects -arguably the parameter of interest from a policy point of view. The coverage is however consistently estimated to be higher among health facility deliveries, so that heterogeneity in treatment intensity cannot account for the larger decrease in NMR observed among predicted home births.…”