Chief, UNICEF, Guwahati, Assam, India.
Associate Professor, Department of Community Medicine, Tezpur Medical College, Tezpur, Assam, India.
Indian J Public Health. 2020 Jan-Mar;64(1):66-71. doi: 10.4103/ijph.IJPH_188_19.
An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community.
This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam.
A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers.
Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns.
HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.
印度阿萨姆邦引入了一种创新的家庭新生儿护理（HBNC）代金券制度，旨在改善认证社会卫生活动家（ASHA）的家访，增强其责任感，并赋予社区权力。
本研究旨在评估阿萨姆邦 HBNC 代金券计划的有效性。
2018 年在阿萨姆邦的 4 个地区进行了一项混合方法研究。通过家访对 836 名哺乳期母亲进行了一项定量研究，并对她们进行了访谈。还进行了一项定性研究，对各种医疗保健服务提供者进行了深入访谈。
在 836 名哺乳期母亲中，有 65%接受了 HBNC 代金券；45.6%在出院时收到，5.3%在产前护理时收到。只有 14.5%的哺乳期母亲了解 HBNC 代金券作为验证 ASHA 家访的工具的目的。ASHA 在 HBNC 访问期间通常提供的服务包括检查新生儿（44.6%）、母乳喂养咨询（57.1%）、婴儿护理咨询（39.2%）和免疫接种咨询（49.2%）。代金券制度改善了激励支付制度，但正如 ASHA 所述，不间断的供应是一个问题领域。辅助护士助产士和 ASHA 主管表示，代金券制度改善了 ASHA 的家访、支付制度，并增加了对新生儿危险迹象的识别。
作为一种创新方法，HBNC 代金券系统被发现是有效的。不同地区的服务覆盖范围有所不同。需要持续不断地提供代金券、定期对卫生工作者进行使用方面的再培训，并提高社区的认识。
