Home-Based Newborn Care (HBNC) Visit Schedule for Home Deliveries
Under the HBNC guidelines in India, newborns delivered at home should receive 6 postnatal home visits from Accredited Social Health Activists (ASHAs). 1, 2
Visit Schedule and Coverage
The HBNC program, introduced by the Government of India in 2011, mandates six home visits for all newborns, with ASHAs receiving cash incentives for completing these visits. 1, 3
Coverage data from rural India demonstrates that 74.1% of newborns received all six designated home visits from ASHAs, while only 3.6% received no visits at all. 2
The frequency of home visits decreases as the age of the baby increases, with ASHAs making more intensive visits in the early neonatal period when mortality risk is highest. 1
Purpose and Content of HBNC Visits
The HBNC strategy specifically targets the burden of newborn deaths in the first week of life by providing a continuum of care for both newborns and postnatal mothers. 1
During these visits, ASHAs screen approximately 95% of newborns for signs of sickness, identifying 12.9% as requiring additional care or referral. 2
Core services provided include examination of the newborn (44.6% of visits), breastfeeding counseling (57.1%), general baby care counseling (39.2%), and immunization counseling (49.2%). 4
Essential newborn care practices covered include safe breastfeeding, cord care, eye care, wrapping the baby, kangaroo care, delayed bathing, and hand washing. 3
ASHA Role and Accountability
ASHAs serve as the primary community-based facilitators for the HBNC program, with their presence documented at 84.3% of deliveries in rural areas. 2
All ASHAs are aware of the schedule of home visits and understand that the number of visits is the same (six visits) regardless of whether delivery occurred at home or in an institution. 1
Some states like Assam have implemented an HBNC voucher system to improve accountability, validate home visits, and empower the community to track service delivery. 4
Important Implementation Considerations
Despite the standardized six-visit schedule, actual coverage varies significantly by region, with knowledge gaps existing between what ASHAs counsel and what mothers actually practice. 3
Cultural beliefs and traditional birth attendants significantly influence maternal adoption of safe newborn care practices, with only 60% of mothers adopting three or more safe practices despite ASHA counseling. 3
Lack of supervision by auxiliary nurse midwives, delayed referral systems, and transportation challenges represent major barriers to program effectiveness. 3
Uninterrupted supply of program materials (such as vouchers), periodic resensitization of health workers, and increasing community awareness are essential for sustained program success. 4