Home-Based Care For Young Child (HBYC)

Summary

Overview & Objectives: HBYC extends the HBNC program, targeting children aged 3 to 15 months to bridge the care gap up to the preschool period and reduce mortality from illnesses like diarrhea and pneumonia.
Service Delivery: ASHA workers conduct five scheduled visits at the 3rd, 6th, 9th, 12th, and 15th months, earning a performance-based incentive for completing the health checklist.
Nutrition & Growth: Interventions emphasize exclusive breastfeeding, timely complementary feeding (using MACS principles), and rigorous growth monitoring via WHO charts and MUAC tape to catch acute malnutrition.
Development & WASH: The program actively promotes Early Childhood Development (ECD) through stimulated play and communication, while emphasizing essential household Water, Sanitation, and Hygiene (WASH) practices.
Health & Referral: ASHAs track immunizations, provide prophylactic Vitamin A and IFA, distribute ORS/Zinc, and are trained to immediately refer children exhibiting danger signs like severe wasting (MUAC < 11.5 cm), lethargy, or fast breathing.

Introduction And Objectives

Program Overview: An extension of the Home-Based Newborn Care (HBNC) program, launched under the National Health Mission (NHM) by the Ministry of Health and Family Welfare (MoHFW), India.
Target Age Group: Children from 3 months up to 15 months of age.
Rationale:
- To bridge the critical gap in healthcare delivery between the end of the neonatal period (42 days) and the preschool period.
Core Objectives:
- Reduce child mortality and morbidity (specifically targeting diarrhea and pneumonia).
- Promote appropriate complementary feeding and prevent early-onset malnutrition.
- Ensure complete and age-appropriate immunization.
- Promote Early Childhood Development (ECD).
- Enhance Water, Sanitation, and Hygiene (WASH) practices at the household level.

Primary Provider: Accredited Social Health Activist (ASHA).
Visit Frequency: 5 dedicated household visits per child.
Schedule: At the 3rd, 6th, 9th, 12th, and 15th months of life.
Convergence: ASHA coordinates her activities with the Anganwadi Worker (AWW) and Auxiliary Nurse Midwife (ANM) during Village Health Sanitation and Nutrition Days (VHSND).
Incentive: The ASHA worker receives a performance-based incentive of Rs. 250 per child (Rs. 50 per completed visit), disbursed after ensuring all programmatic components are fulfilled.

Exclusive Breastfeeding (3rd-month visit): Reinforcing the absolute need for exclusive breastfeeding up to 6 months of age without any prelacteal or water supplementation.
Complementary Feeding (6th month onwards):
- Counseling on the timely initiation of complementary feeds precisely at 6 months.
- Educating caregivers on the MACS principles: appropriate Meal frequency, Amount, Consistency, and feeding locally available iron-rich and energy-dense Snacks.
- Promoting active and responsive feeding practices.
Growth Monitoring: Weight measurement and plotting on WHO growth charts to detect growth faltering early.
MUAC Screening: Routine screening using Mid-Upper Arm Circumference tape (from 6 months) to detect Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM).

Play And Stimulation: Educating parents on using safe, clean, household items as toys to promote cognitive and fine motor development.
Communication: Encouraging caregivers to engage in continuous talking, singing, and interacting with the child to stimulate language and socio-emotional development.
Developmental Screening: Active observation for age-appropriate milestones and identifying early developmental "red flags" for prompt referral to District Early Intervention Centers (DEIC) under the Rashtriya Bal Swasthya Karyakram (RBSK).

Immunization And Supplementation:
- Tracking the child's immunization status and identifying drop-outs.
- Mobilizing families to bring children for due vaccines during VHSND.
- Ensuring the administration of prophylactic biannual Vitamin A and bi-weekly Iron-Folic Acid (IFA) syrup (National Iron Plus Initiative) starting at 6 months.
Illness Management:
- Educating caregivers on identifying the danger signs of acute respiratory infections (ARI) and severe dehydration.
- Distributing prophylactic ORS packets and Zinc tablets for immediate home management of acute gastroenteritis.

Hand Hygiene: Demonstrating and emphasizing the importance of handwashing with soap at critical times (before preparing food, before feeding the child, and after defecation).
Safe Water: Counseling on boiling, chlorinating, or safely storing drinking water.
Sanitation: Promoting the immediate and hygienic disposal of child feces and actively discouraging open defecation in the household vicinity.

The ASHA is trained to immediately refer the child to a Primary Health Center (PHC), First Referral Unit (FRU), or Nutrition Rehabilitation Center (NRC) if she detects:
- Severe wasting (MUAC < 11.5 cm) or the presence of bilateral pitting pedal edema.
- Danger signs such as lethargy, active convulsions, or an inability to breastfeed/drink.
- Severe chest indrawing or tachypnea (fast breathing).
- Prolonged fever or persistent diarrhea.