The project has shown that FCHVs can successfully assess sick young infants in their villages using a standard algorithm.  If any one sign of Possible Severe Bacterial Infection (PSBI) is present, they initiate treatment with oral cotrimoxazole-P and facilitate referral to higher level health workers for injectable gentamicin. FCHV assessments compare very well with assessment by VHWs, who receive more training and are paid MOHP employees. Through analysis of records maintained by FCHVs and VHWs/MCHWs it has been determined that 14 % of under two-month olds and 11% of neonates in rural Morang experienced an episode of Possible Severe Bacterial Infection (PSBI); 23% of young infants have a local bacterial infection (LBI). This is a large burden of disease.   Management of infection has also been effective. Among the PSBI cases which started treatment with gentamicin, 91% received a full 7-day course of treatment.⁵

Using data from Bang, et al⁶  and these Nepal-specific findings, estimates of neonatal infections in the community were calculated. It appeared that in the intervention area under MINI 1, 80% of expected neonatal sepsis cases were treated through the MOHP system (FCHVs, VHW/MCHWs or health facilities) as compared to 35% in the non-intervention area.  These data compare favourably with the baseline figures of 5% and 6% respectively.⁷

The DPHO has described MINI proudly as a “pro poor” program as the more disadvantaged groups in the community are benefiting from this service. In the 21 intervention VDCs, people from the less privileged groups (LPG) represent 61% of the general population, according to the district census, and the data from the MINI program show that 62% of those who received services through MINI were from LPGs. This early contact may be beneficial for strengthening their ties with the formal health system for careseeking for older children and for utilization of other services provided through the DPHO.

 While MINI 1 was not designed to allow a rigorous analysis of neonatal mortality rates, the combination of increased utilization and access to services, in conjunction with high quality services and acceptance among community members, “suggest that the MINI model, as implemented in Morang, likely results in a reduction of all-cause mortality among young infants.” ⁸

MINI 1 has worked well, under DPHO management, with external assistance for training, logistics supply, monitoring and supervision and data analysis provided by the MINI team, and has answered the question “Can FCHVs and peripheral level health workers correctly identify and manage cases of neonatal sepsis at the community level?”  But the question to be addressed now is “How much external support is needed to maintain program performance or to initiate this model in other districts?” It is also assumed that although this model appears to work well in the relatively accessible areas of the Terai, it could not be successfully implemented in hill and mountain districts of Nepal.

Partner Interest - In the spring of 2006, the District Public Health Officer of Morang, formally requested financial and technical support from USAID’s bilateral project, Nepal Family Health Program (NFHP), for expansion of the intervention to the remaining 44 VDCs of the district. NFHP, with support from USAID, was able to respond and the approval process was expedited through the MOHP. Numerous disruptions occurred during the planning and implementation process, but by December 30th, 2006 all of the Health Facility staff, VHWs/MCHWs and  FCHVs have been trained for the expansion.

 
Representatives of the central level MOHP, Child Heath Division, Family Health Division, USAID, SCF/US  and partner organizations such as UNICEF, PLAN, MIRA (Mother and Infant Research Activity) have visited the MINI field area and observed trainings and MINI activities for the district-wide expansion of community-based management of infections in sick young infants. There is currently a great deal of interest in the MINI approach to managing neonatal sepsis, but the model is not ready for immediate replication.  MINI 2 will provide the mechanism to develop the model to be used for scaling up.