New Journal Article Examines Chlorhexidine Scale-up in Nepal

February 12th, 2020 | News


A recent article, Achieving and sustaining impact at scale for a newborn intervention in Nepal: a mixed-methods study, written by a team including JSI’s Leela Khanal and Penny Dawson, has been published in the Journal of Global Health Reports

In the late 2000s, the Government of Nepal was confronted with high newborn mortality, mostly due to infection. At the time, there was no global evidence that the use of antiseptic chlorhexidine for the care of the newborn cord stumps could reduce these deaths, although it had been shown on a local level. This article traces the evolution of Nepal’s chlorhexidine introduction and national scale-up, in which both government and partners made serious efforts to achieve and sustain high coverage.

In 2006, JSI began exploring the feasibility of scaling up the chlorhexidine intervention, and the Ministry of Health piloted the first chlorhexidine program in 2009. By 2017, with JSI support, the program was national, with chlorhexidine being applied to 90% of newborns in health facilities and about 40% of those born at home, an average of 70% nationwide.

This paper traces the evolution of chlorhexidine introduction and scale up and documents program performance once the program had reached national scale, in terms of “implementation strength” and population-level “effective coverage.”

The authors conclude that although chlorhexidine is a simple intervention, effort to ensure high coverage should continue. By focusing on reaching the poorest women, most of whom give birth at home; revising implementation plans; and continuing to involve managers and service providers, chlorhexidine program performance will be both sustained and improved.


Through the Chlorhexidine Navi (Cord) Care Program, JSI supported the scale-up of chlorhexidine gel in 100% of public facilities across Nepal, as well as in a number of private facilities. With the Ministry of Health, we trained more than 60,000 health workers in chlorhexidine counseling and application and later provided technical support to other countries that were interested in introducing and scaling-up chlorhexidine use.

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