Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Market mechanisms for newborn health in Nepal

Authors: Karsten Lunze, Rosie Dawkins, Abeezer Tapia, Sidharth Anand, Michael Chu, David E. Bloom

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

Login to get access

Abstract

Background

In Nepal, hypothermia is a major risk factor for newborn survival, but the country’s public health care sector has insufficient capacity to improve newborn survival given the burden imposed by distance to health facilities and cost. Low-cost technology to provide newborn thermal care in resource-limited environments exists, but lacks effective distribution channels.
This study aims to develop a private sector distribution model for dedicated newborn thermal care technology to ensure equitable access to thermal protection and ultimately improve newborn health in Nepal.

Methods

We conducted a document analysis of newborn health policy in Nepal and a scoping literature review of approaches to newborn hypothermia in the region, followed by qualitative interviews with key stakeholders of newborn health in Nepal.

Results

Current solutions addressing newborn hypothermia range from high-technology, high-cost incubators to low-cost behavioral interventions such as skin-to-skin care. However, none of these interventions  are currently implemented at scale. A distribution model that provides incentives for community health volunteers and existing public health services in Nepal can deliver existing low-cost infant warmers to disadvantaged mothers where and when needed. Newborn technology can serve as an adjunct to skin-to-skin care and potentially create demand for newborn care practices.

Conclusion

Harnessing market forces could promote public health by raising awareness of newborn challenges, such as newborn hypothermia, and triggering demand for appropriate health technology and related health promotion behaviors. Market approaches to promoting public health have been somewhat neglected, especially in economically disadvantaged and vulnerable populations, and deserve greater attention in Nepal and other settings with limited public health service delivery capacity.
Literature
1.
2.
3.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969–87.CrossRefPubMed
4.
Oza S, Cousens SN, Lawn JE. Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob Health. 2014;2(11):e635–44.CrossRefPubMed
5.
WHO. Thermal protection of the newborn: a practical guide. Geneva: Maternal and Newborn Health/ Safe Motherhood Unit, Division of Reproductive Health, World Health Organization; 1997.
6.
7.
Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Risk of mortality associated with neonatal hypothermia in southern Nepal. Arch Pediatr Adolesc Med. 2010;164(7):650–6.CrossRefPubMed
8.
Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environments. J Perinatol. 2012;32(5):317–24.CrossRefPubMed
9.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900.CrossRefPubMed
10.
Johanson RB, Spencer SA, Rolfe P, Jones P, Malla DS. Effect of post-delivery care on neonatal body temperature. Acta Paediatr. 1990;81(11):859–63.CrossRef
11.
Johanson RB, Malla DS, Tuladhar C, Amatya M, Spencer SA, Rolfe P. A survey of technology and temperature control on a neonatal unit in Kathmandu, Nepal. J Trop Pediatr. 1993;39(1):4–10.CrossRefPubMed
12.
Manandhar N, Ellis M, Manandhar DS, Morley D, de L Costello AM. Liquid crystal thermometry for the detection of neonatal hypothermia in Nepal. J Trop Pediatr. 1998;44(1):15–7.CrossRefPubMed
13.
Ellis M, Manandhar N, Shakya U, Manandhar DS, Fawdry A, Costello AM. Postnatal hypothermia and cold stress among newborn infants in Nepal monitored by continuous ambulatory recording. Arch Dis Child Fetal Neonatal Ed. 1996;75(1):F42–5.CrossRefPubMedPubMedCentral
14.
Mullany LC, Katz J, Khatry SK, Leclerq SC, Darmstadt GL, Tielsch JM. Incidence and seasonality of hypothermia among newborns in southern Nepal. Arch Pediatr Adolesc Med. 2010;164(1):71–7.CrossRefPubMedPubMedCentral
15.
WHO. Managing newborn problems: a guide for doctors, nurses, and midwives. Geneva: Integrated Management of Pregnancy and Childbirth, World Health Organization; 2003.
16.
Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E, de Graft Johnson J, von Xylander S, Rafique N, Sylla M, et al. Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet. 2014;384(9941):438–54.CrossRefPubMed
17.
Wirth M, Thairu L, Lunze K. Low-cost technologies that can save the lives of newborns: designing promising innovations for developing countries. Global Health and Diplomacy. 2012;2(2):5.
18.
Thairu L, Wirth M, Lunze K. Innovative newborn health technology for resource-limited environments. Tropical Med Int Health. 2013;18(1):117–28.CrossRef
19.
Bhat SR, Meng NF, Kumar K, Nagesh KN, Kawale A, Bhutani VK. Keeping babies warm: a non-inferiority trial of a conductive thermal mattress. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F309–12.CrossRefPubMed
20.
21.
22.
Jha N, Karki P, Das BP, Chapagain N. Social health insurance: a knowledge-do gap in eastern Nepal. Kathmandu Univ Med J (KUMJ). 2007;5(2):268–72.
23.
24.
25.
Miles MB, Huberman AM, and Saldaña J: Qualitative data analysis. SAGE Publications. Thousand Oaks, CA. ISBN 978-1452257877. 2014.
26.
27.
28.
29.
30.
31.
Paudel D, Shrestha IB, Siebeck M, Rehfuess EA. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality. BMC Public Health. 2014;13:1239. doi:10.​1186/​1471-2458-13-1239.CrossRef
32.
Smith SL, Neupane S. Factors in health initiative success: learning from Nepal's newborn survival initiative. Soc Sci Med. 2011;72(4):568–75.CrossRefPubMed
33.
34.
Schwarz D, Sharma R, Bashyal C, Schwarz R, Baruwal A, Karelas G, Basnet B, Khadka N, Brady J, Silver Z, et al. Strengthening Nepal's female community health volunteer network: a qualitative study of experiences at two years. BMC Health Serv Res. 2014;14:473. doi:10.​1186/​1472-6963-14-473.CrossRefPubMedPubMedCentral
35.
Suvedi BK. Nepal’s newborn health strategy: the way forward to achieve MDG-4. Family Health Division, Nepal Ministry of Health & Population, Kathmandu, Nepal 2008.
36.
Nepal Ministry of Health. National Neonatal Health Strategy. Kathmandu: Family Health Division, Ministry of Health, Government of Nepal; 2004.
37.
Gurung G. Practices on immediate care of newborn in the communities of Kailali district. Nepal Med Coll J. 2008;10(1):41–4.PubMed
38.
Sreeramareddy CT, Joshi HS, Sreekumaran BV, Giri S, Chuni N. Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey. BMC Pregnancy Childbirth. 2006;6:27.CrossRefPubMedPubMedCentral
39.
Osrin D, Tumbahangphe KM, Shrestha D, Mesko N, Shrestha BP, Manandhar MK, Standing H, Manandhar DS, Costello AM. Cross sectional, community based study of care of newborn infants in Nepal. BMJ. 2002;325(7372):1063.CrossRefPubMedPubMedCentral
40.
Falle TY, Mullany LC, Thatte N, Khatry SK, LeClerq SC, Darmstadt GL, Katz J, Tielsch JM. Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal. J Health Popul Nutr. 2009;27(1):53–61.PubMedPubMedCentral
41.
Borghi J, Ensor T, Neupane BD, Tiwari S. Financial implications of skilled attendance at delivery in Nepal. Tropical Med Int Health. 2006;11(2):228–37.CrossRef
42.
Ensor T, Clapham S, Prasai DP. What drives health policy formulation: insights from the Nepal maternity incentive scheme? Health Policy. 2009;90(2–3):247–53.CrossRefPubMed
43.
Fernald LC, Gertler PJ, Neufeld LM. Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's oportunidades. Lancet. 2008;371(9615):828–37.CrossRefPubMedPubMedCentral
44.
Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA. 2007;298(16):1900–10.CrossRefPubMed
45.
Morris SS, Flores R, Olinto P, Medina JM. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet. 2004;364(9450):2030–7.CrossRefPubMed
46.
47.
48.
Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365(9463):977–88.CrossRefPubMed
49.
Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N, Bahl R, Fogstad H, Costello A. Neonatal survival: a call for action. Lancet. 2005;365(9465):1189–97.CrossRefPubMed
50.
Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115(2 Suppl):519–617.CrossRefPubMed
51.
Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. “Kangaroo mother care” to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010;39(Suppl 1):i144–54.CrossRefPubMedPubMedCentral
52.
Conde-Agudelo A, Diaz-Rossello JL, and Belizan JM: Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003(2):CD002771; update in: Cochrane Database Syst Rev. 2011:(3):CD002771.
53.
Oza S, Cousens SN, Lawn JE. Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob Health. 2015;2(11):e635–44.CrossRef
54.
Pradhan YV, Upreti SR, Pratap KCN, CA K, Khadka N, Syed U, Kinney MV, Adhikari RK, Shrestha PR, Thapa K, et al. Newborn survival in Nepal: a decade of change and future implications. Health Policy Plan. 2012;27(Suppl 3):iii57–71.CrossRefPubMed
55.
Pradhan YV, Upreti SR, Kc NP, Thapa K, Shrestha PR, Shedain PR, Dhakwa JR, Aryal DR, Aryal S, Paudel DC, et al. Fitting community based newborn care package into the health systems of Nepal. J Nepal Health Res Counc. 2011;9(2):119–28.PubMed
56.
Hanson K, Gilson L, Goodman C, Mills A, Smith R, Feachem R, Feachem NS, Koehlmoos TP, Kinlaw H. Is private health care the answer to the health problems of the world's poor? PLoS Med. 2008;5(11):e233.CrossRefPubMedPubMedCentral
57.
58.
Ban B, Tuladhar S, Pant S, Suvedi BK. Review of health and health service improvements in Nepal. J Nepal Health Res Counc. 2012;10(21):76–81.PubMed
59.
60.
Ashe J. A symposium on savings-led microfinance and the rural poor. Journal of Microfinance. 2002;4(2):9.
61.
Patouillard E, Goodman CA, Hanson KG, Mills AJ. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. Int J Equity Health. 2007;6:17.CrossRefPubMedPubMedCentral
62.
63.
Garrett L. The challenge of global health. Foreign Affairs. 2007;86(1):16–38.
64.
Hodgins S, McPherson R, Suvedi BK, Shrestha RB, Silwal RC, Ban B, Neupane S, Baqui AH. Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal. J Perinatol. 2010;30(6):388–95. doi:10.​1038/​jp.​2009.​181.CrossRefPubMed
65.
66.
67.
Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM, Tamang S, Thapa S, Shrestha D, Thapa B, et al. Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet. 2004;364(9438):970–9.CrossRefPubMed
68.
Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health--a landscape analysis. BMC Pregnancy Childbirth. 2015;15:337.CrossRefPubMedPubMedCentral
69.
Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008;8:247.CrossRefPubMedPubMedCentral
70.
71.
Metadata
Title
Market mechanisms for newborn health in Nepal
Authors
Karsten Lunze
Rosie Dawkins
Abeezer Tapia
Sidharth Anand
Michael Chu
David E. Bloom
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1599-7

Other articles of this Issue 1/2017

BMC Pregnancy and Childbirth 1/2017 Go to the issue

Research article

Paradox of the institution: findings from a hospital labour ward ethnography

Research article

Quality and uptake of antenatal and postnatal care in Haiti

Research article

Fetal heart rate abnormalities during and after external cephalic version: Which fetuses are at risk and how are they delivered?

Research article

Carriage and serotype distribution of Streptococcus agalactiae in third trimester pregnancy in southern Ghana

Study protocol

A description of the methods of the aspirin supplementation for pregnancy indicated risk reduction in nulliparas (ASPIRIN) study

Research article

Being in limbo: Women’s lived experiences of pregnancy at 41 weeks of gestation and beyond – A phenomenological study