Home Based Care for Young Child (HBYC)

Strengthening of Health & Nutrition through Home Visits

OPERATIONAL GUIDELINES
April 2018

A Joint Initiative of Ministry of Health and Family Welfare &

Ministry of Women and Child Development
Home Based Care for Young Child (HBYC)

Strengthening of Health & Nutrition

through Home Visits

Operational Guidelines

Home Based Care for Young Child (HBYC) Operational Guidelines 1

 Jagat P

Message

MessageNutrition is central to the achievement of National and Global Sustainable Development G

for investing in Nutrition is well recognized as well as crucial for the fulfillment of human
Nutrition is central to the achievement the of most
National and children.
vulnerable Global Nutrition
Sustainable Development
is acknowledged as oneGoals.
of the most effective entr
The rationale for investing in Nutrition is well recognized
development, poverty Jagat
and reduction
crucial for
and Prakash
upholding
economic Nadda
basic human
development andrights
with high economic return
of the most vulnerable section especially children. Nutrition is acknowledged as one of the most
Childrenpoverty
effective entry points for human development, in India continue
reductionto suffer
and from under-nourishment
economic development despite
withpositive changes the co
over the years. The window of opportunity to address this problem is only till the first two
high economic returns.

Message Improving the health of mother and children continues to be our top priority. Taking
Children in India continue to suffer from importance
under-nourishment
of nutrition indespite positive
child survival changes theGovernment
and development, country of India has recent
has witnessed over the years. The windowinitiatives
of opportunity toPOSHAN
such as the address Abhiyaan
this problem is onlyBharat
and Swachh till the first
Mission.
two years of life. Improving the health of mother and children continues to be the top priority. Taking
utrition is central to the cognizance
achievement ofimportance
of the National and GlobalTo
of nutrition go a step
inSustainable
child further
survival to address
Development
and undernutrition,
development, Goals. aThe
novelrationale
Government initiative
of Indiacalled
has Home Based Care f
(HBYC) is being launched. The objective of Home Based Care for Young Child (HBYC
investing in Nutrition is well recognized
recently as well
launched several as crucial
initiatives forthe
such as thePOSHAN
mortality fulfillment
and morbidity of
Abhiyaan,human
and improve rights,
Pradhan Mantri especially
nutrition status, growthof
Surakshit Matritva
and early childhood deve
Abhiyan and Swachh Bharat Mission.
e most vulnerable children. Nutrition is acknowledged as one of the
children most
through effective
additional entryby points
home visits for human
our community health worker, the ASHA and A
velopment, poverty reduction and economic development and with high economic returns.
To go a step further to address undernutrition,
I urge a
allnovel initiative
the states to comein the form
together of operational
to implement guidelines
Home Based Care of the Young Children
that all our young children are provided effective
for Home Based Care for Young Child (HBYC) has been launched. The objective of Home Based Care for home based care.
ildren in India continueYoung
to suffer from
Child under-nourishment
(HBYC) despite and
is to reduce child mortality positive changes
morbidity the country
and improve has witnessed
nutrition status, growth
The opportunity is now and we cannot let it be squandered to improve the health of our futu
er the years. The windowandofearly
opportunity to address this
childhood development problem
of young is
children only till
through the first
additional two
home years
visitsof
bylife.
our community
us all come together to realize the mission of our Hon’ble Prime Minister of India to eradi
health worker, the ASHA and Anganwadi worker. This is
undernutrition bythe
2022.first kind of initiative in world where the
proving the health of community
mother and health workers will be providing preventive services at the doorstep of the beneficiary
children continues to be our top priority. Taking cognizance of the
starting at the age of 3 months till the 2nd year of life
portance of nutrition in child survival and development, Government of India has recently launched several
tiatives such as the POSHAN
I urge allAbhiyaan and
the states to Swachh
come Bharat
together Mission.Home Based Care of the Young Child (HBYC) and
to implement (Jagat
ensure that all our young children are provided effective home based care.
go a step further to address undernutrition, a novel initiative called Home Based Care for Young Children
BYC) is being launched. Let The
us allobjective
come together to realize
of Home the mission
Based Care forof our Hon’ble
Young Prime(HBYC)
Child Minister of
is India to eradicate
to reduce childthe
problem of undernutrition by 2022.
ortality and morbidity and improve nutrition status, growth and early childhood development of young
ildren through additional home visits by our community health worker, the ASHA and Anganwadi worker.

rge all the states to come together to implement Home Based Care of the Young Children (HBYC)
(Jagat and ensure
Prakash Nadda)
at all our young children are provided effective home based care.

e opportunity is now and we cannot let it be squandered to improve the health of our future generations. Let
all come together to realize the mission of our Hon’ble Prime Minister of India to eradicate the problem of
dernutrition by 2022.
 Foreword
Investing in the early years of life is one of the most effective investments that we can make to create the
human capital that contributes towards economic growth. Undernutrition in young children continues
to be a major public health problem in India. Although the level of malnutrition has slightly decreased
as per the NFHS 4 survey, but the decline is not sufficient to eradicate the menace of malnutrition in a
time bound manner. Malnutrition is a multifaceted problem and the key reasons for malnutrition setting
in early life are sub optimal infant & young child feeding practices & child care, childhood illnesses, poor
vaccination coverage, low birth weight, and lack of awareness.

Government of India has accorded high priority to the issue of nutrition especially among the women
and children. The interventions to bring about improvement in the nutritional status and survival of
children are delivered by two key frontline workers of the Ministry of Women and Child Development
and Ministry of Health & Family Welfare that is Anganwadi worker and ASHA.

To address the very important issues of child nutrition and early child development it has been decided
to implement the Home Based Care of Young Child (HBYC) for children in the age group of 3-15 months.
HBYC shall ensure the continuum of care from the time of birth and help us meet the objective for
adequate complementary feeding, growth monitoring, vaccinations and sickness related counselling
in early childhood.

This Operational Guideline has been developed to facilitate the implementation of Home Based Care of
Young Child in states and districts. We hope that the States will take this up on a priority basis so as to
strengthen the efforts of Government of India in tackling the burden of child malnutrition and related
child mortality in the country.

Rakesh Srivastava Preeti Sudan

Secretary (MWCD) Secretary (MOHFW)
Message from
Mission Director
The most critical elements of child, adolescent and adult health, wellbeing and productivity take shape
during the early years and in particular the first 1000 days. Preventive and promotive interventions in
the early years achieve more and cost less than remedial interventions at later ages.

National Health Policy (NHP) 2017, through a preventive and promotive health care orientation in
all developmental policies, and universal access to good quality health care services, envisages the
attainment of the highest possible level of health and wellbeing for all at all ages.

Nutrition being central to the achievement of other National and Global Sustainable Development
Goals and thus it is critical to prevent undernutrition as early as possible to avert irreversible cumulative
growth and development deficits that compromise maternal and child health and survival and
undermining gender equality. Numerous gaps and barriers are still observed in the delivery and
practice of Infant and Young child feeding (IYCF) recommendations.

Ensuring nurturing care is a multi-sectoral issue and requires co-ordinated action across sectors as
the risk factors are spread across sectors. Ministry of Women and Child Development and Ministry of
Health and Family Welfare have joined hands in taking forward the home visits conducted by ASHA
in imparting the key messages regarding nutrition, play and communication placing families at the
centre of nurturing care for young children during the critical first two years of life. It is envisaged that
ASHA, Anganwadi worker under the close supervision of ANM will work as a team in true spirit.

I earnestly hope that this operational guideline on Home based care of young child ably prepared by
Child health Division along with the experts will go a long way in guiding both programme managers
and service providers in taking the agenda forward.

Shri Manoj Jhalani

ASMD NHM
Preface
During the last decade, the country has made commendable achievements in reducing the mortality
rates of mothers and children. India’s under-five mortality rate showed a huge decline of 69% during
the period 1990-2016. As per the NFHS-4 survey level of malnutrition has slightly decreased but the
decline is not sufficient to eradicate the menace of malnutrition in a time bound manner.

Under-nutrition in young children continues to be a major public health problem in India. It restricts
survival, growth and development of children and also contributes to morbidity and mortality in
vulnerable population. Status of nutrition also has a close linkage with optimum WASH practices at
individual and community level. An increasingly global digital world places even greater premiums on
the capacities that originate in early childhood, such as the ability to reason, learn, communicate and
collaborate.

Success of Home Based Newborn Care Programme has proved that home visits can support parents
and caregivers to provide nurturing care for newborn. It paves way for extending this platform for
delivering services from multiple sectors play across to protect, promote and support early childhood
development and create an enabling environment.

In this regard, it has been decided to expand the home visits by ASHA, ANM and AWW into second year
of life. This will also serve as a link to Swachh Bharat Mission by improving the hand washing practices
in the community and increasing awareness about hygiene.

I sincerely hope that the operational guideline of Home Based Care for young children (HBYC) will enable
the states to implement and ensure that all young children are provided home based care through a
series of visits by the ASHA, ANM and AWW and ensuring that they have the skills and support to do so.

Ms. Vandana Gurnani

JS RCH
Acknowledgement
India witnessed a higher decline in maternal and child mortality compared to global averages since
the inception of National Health Mission (NHM). With the NHP 2017 in place, there is an unprecedented
opportunity to build upon the gains made in the last ten years and achieve Sustainable Development
Goals.

Malnutrition continues to be the underlying cause of death in 35% among children under the age of
five years. The interaction between undernutrition and infection can create a vicious cycle of worsening
illness and deteriorating nutritional status. Interventions promoting infant and young child feeding are
known to improve child survival, growth and intellectual development. Numerous gaps and barriers
are observed in the delivery and practice of IYCF recommendations. Research points to the benefits of
integrated delivery platforms, notably combining nutrition interventions with support for parents in
promoting play-based learning.

To fill the design gap in the present health and nutrition programmes for children, the Government of
India is now implementing Home based care for Young Children (HBYC) through a series of structured
home visits schedule by ASHAs to all children attaining the age of 3 months onwards with an objective
to ensure counselling for complementary feeding, growth monitoring, vaccination, WASH practices
and sickness related counselling.

The guidelines have been developed under the able leadership of Dr . Vinod Paul, Member Niti Aayog
and supported by Ms. Vandana Gurnani, RCH and Dr. Rajesh Kumar Joint Secretary, MWCD. I place on
record special acknowledgement of the efforts of JHPIEGO-NIPI team especially Dr. Harish Kumar for
developing the Operational Guidelines on Home based Care for Young Children (HBYC).

I sincerely thank my colleagues Dr. PK Prabhakar and Dr. Sila Deb, Deputy Commissioners, Child
Health Division, child health consultants- Dr. Nimisha, Dr. Vishal and technical experts from NHSRC,
WHO & UNICEF, academicians, and non-governmental organizations for their valuable and
constructive suggestions for the preparation of this document.

I earnestly hope that this document will guide the service providers, managers and other stakeholders
working at all levels of the health system in bringing a focus on childhood nutrition and ECD and
provide a strong nurturing environment for all children of our country.

Dr. Ajay Khera

Deputy Commissioner
 List of
Contributors
Vision
Dr. Vinod Paul, Member Niti Aayog
Ms. Preeti Sudan, Secretary, MoHFW
Mr. Rakesh Srivastava, Secretary, MoWCD

Guidance
Mr. Manoj Jhalani, Additional Secretary and Mission Director, National Health Mission
Ms. Vanadana Gurnani, Joint Secretary, MoHFW
Dr. Manohar Agnani, Joint Secretary, MoHFW
Dr. Rajesh Kumar, Joint Secretary Anganwadi Services and Mission Director
Dr. Ajay Khera, Deputy Commissioner in Charge Child Health, MoHFW
Mr. K. B. Singh, Director Anganwadi Services and Executive Director, POSHAN Abhiyaan

moHfW
Dr. P. K. Prabhakar
Dr. Sila Deb
Dr. Arun Singh
Dr. Renu Srivastava
Dr. Nimisha Goel
Dr. Vishal Kataria
Dr. Ashalata Pati
Dr. Prashant Soni

Jhpiego NIPI Team

Dr. Harish Kumar
Dr. Ashfaq Ahmed Bhat
Dr. Deepti Agarwal
Mr. Rajat Khanna

NHSRC Team
Dr. Rajani Ved
Dr. Garima Gupta

Other Experts
Dr. Gagan Gupta, UNICEF
Dr. Sachin Gupta, USAID
Dr. Rajeev Gera, IPE Global
Dr. Sebanti Ghosh, Alive & thrive
Mr. Sharad Kumar Singh
 List of
ABBREVIATIONS
ANC Ante Natal Care
ANM Auxiliary Nurse Midwives
ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker
BCG Bacille Calmette Guerin
CMHO Chief Medical Health Officer
DPT Diphtheria, Pertussis and Tetanus
ECD Early Child Development
EFT Electronic Fund Transfer
HBYC Home Based Care for Young Child
HBNC Home Based Newborn Care
IFA Iron Folic Acid
IMR Infant Mortality Rate
IYCF Infant and Young Child Feeding
LBW Low Birth Weight
MCP Mother and Child Protection
MCTS Mother and Child Tracking System
MDG Millennium Development Goal
MOIC Medical Officer in-charge
MoHFW Ministry of Health and Family Welfare
NFHS National Family Health Survey
NGO Non-Government Organization
NHM National Health Mission
NHP National Health Policy
NRC Nutrition Rehabilitation Centre
NRHM National Rural Health Mission
OPD Out Patient
ORS Oral Rehydration Solution
PCTS Parent and Child Tracking System
PHC Primary Health Center
PIP Programme Implementation Plan
SBCC Social Behavior Change Communication
SBM Swachh Bharat Mission
SNCU Special Newborn Care Unit
SRS Sample Registration System
VHND Village Health Nutrition Day
VHSNC Village Health Sanitation and Nutrition Committee
WASH Water Sanitation and Hygiene
TABLE of
CONTENTS

Section 1
Introduction and Rationale 18

Section 2
Objectives 23

Section 3
Operational Strategy 24

Section 4
Capacity Building 26

Section 5
Supportive Supervision 27

Section 6
Institutional Arrangement 28

Section 7
Monitoring and Evaluation 30

Section 8
Estimated Budget 31

Annexure 33
 SECTION 1
Introduction &
rationale
Improving the health of mother and children continues to be a priority under National Health Mission
(NHM) as is reflected in National Health Policy 2017. Taking congnizance of the importance of nutrition
in child survival and development, Government of India has recently launched POSHAN Abhiyaan which
has set the targets to prevent and reduce stunting & undernutrition amongst children in the age group
of 0-6 years by 2% per year and reduce the prevalence of anemia among young Children (6-59 months)
by 3% per year. Child nutrition also has close linkage with optimum WASH practices at individual
and community level. To accelerate the efforts towards achieving universal sanitation coverage and
optimum WASH practices at community level, the Hon’ble Prime Minister of India launched the Swachh
Bharat Mission(SBM) in 2014.

Significant decline in child mortality has been registered in last decade and under five mortality in
India currently stands at 39 per 1000 live births (SRS 2016). One third of under five child deaths are
due to preventable causes such as diarrhoea, pneumonia and measles. Nearly 35% of child mortality is
attributable to undernutrition. It also poses irreversible hindrance to children’s cognitive development
and physical growth while increasing their susceptibility to childhood infections. All these factors
culminate in diminished learning capacity and poorer school performance among children, finally
affecting adult productivity and thus resulting in economic loss to the country. As per Global Nutrition
Report 2017, Investing in this area offers a $16 return for every $1 invested. Thus there is a need for
focussed attention on the strategic interventions for achiveing National Health Policy Goals, Sustainable
Development Goals and also to achieve the target of POSHAN Abhiyaan.

A close look at the determinants of undernutrition reflects that suboptimal Infant & Young Child Feeding
(IYCF) practices at community level is one important determinant of undernutrition in children. Latest
national survey (NFHS- 4) reports early initiation of breastfeeding among children under 3 years of age is
41.6% although insititutional delivery stands at around 80%. Status of children age 6-8 months receiving
solid or semi-solid food and breastmilk dropped from 52.6% (NFHS-3) to 42.7% (NFHS-4) (Table- 1).
Table-1: Changes in child health and nutrition indicators over last decade.

Indicators NFHS III NFHS IV

(2005-06) (2015-16)
Children 12-23 months fully immunized (%) 43.5 62.0
Children with ARI/fever sought treatment/advise in last 2weeks (%) 64.2 73.2
Children with diarrhea received ORS in last 2 weeks (%) 26.2 50.6
Children under 3 years breastfed within one hour of birth (%) 23.4 41.6
Children under age 6 months exclusively breastfed (%) 46.4 54.9
Breastfeeding children age 6-23 months receiving an adequate diet (%) -- 9.6
Children age 6-8 months receiving solid or semi-solid food and breast milk (%) 52.6 42.7
Children under 5 years who are underweight (weight-for-age) (%) 43.0 35.7
Children age 6-35 months who are anaemic (%) 79.2 58.4
Institutional births (%) 38.7 78.9

18 Home Based Care for Young Child (HBYC) Operational Guidelines

 State Variation in Children Receiving Adequate Diet

The proportion of children age 6–23 months who received adequate diet in 2016 was very low, ranging
from 0 to 31 percent. Nationally, percentage of children receiving adequate diet continues to be
less than 10%, although some states have shown improvement (Figure 1). Only in Tamil Nadu and
Puducherry did more than 30 percent of children receive an adequate diet. Adequate diet in a child
6-24 months is defined as a child fed either breastmilk/source of dairy; and age-appropriate
number of food groups and age-appropriate number of meals per day.

Numerous gaps and barriers observed in practice of IYCF include poor awareness on feeding
practices and inadequate knowledge on timing and quality of complementary feeding.

Figure 1: State variation in children receiving adequate diet

48.1

50
Adequate diet 2006 Adequate diet 2016
45

40
33.2
33

30.7
35
28.9

27.9

30
Percentage

23.6
23.5
23.1
21.4
21.4

25

19.8
19.2
19.6
18.8

18.6
17.1

20
14.6
14.5

14.4
14.2

14.6

13.9
13.9
11.8

11.7
10.9

10.9

15
12
10.4

9.77
9.21

8.91
9.6
7.58

7.26

8.9
7.07
6.96
8.5
8.5

6.66
8.2

6.46

6.01

7.6
5.86
7.5

7.5
7.2

10
6.6
6.5
5.9

5.9

4.13
5.8

5.3
5.2

3.43
3.4

0
DELHI

UTTARAKH

RAJASTHAN
ARUNACH

ASSAM

MIZORAM
SIKKIM

CHATTISG
PUNJAB

JHARKHAND
MAHARAS

NAGALAND
KERALA

GOA
TRIPURA

MANIPUR
ODISHA

KARNATAKA

INDIA

BIHAR
MADHYA
HARYANA

MEGHALAYA
HIMACHAL

TAMIL
UTTAR

ANDHRA

JAMMU &
GUJARAT

WEST

Exclusive Breastfeeding Faltering from 2-3 Months of Age.

The median duration of exclusive breastfeeding is shown to be 3 months for boys and 2.8 months for
girls. Lack of breastfeeding or faltering in exclusive breastfeeding from age of 3 months onwards plays
as one important risk factor of the diarrhoea and pneumonia related morbidity and mortality during
this first two years of life (Figure 2).

Home Based Care for Young Child (HBYC) Operational Guidelines 19

Figure 2: Status of exclusive breastfeeding by age of young children, NFHS4: 2015-16
Exclusive Breast Feeding Status & age of children in months-NFHS-3 and NFHS-4

72

69
58.4

50.9

41.5

20.7
17
9.7

<2months 2-3 months 4-5 months 6-8 months

NHFS-3 NFHS-4

Lack of breastfeeding or faltering in exclusive breastfeeding from age of 3 months onwards plays as one
important risk factor for undernutrition and sickness during this first two years of life.

Importance of Early Childhood for Better Nutrition and Development

Analyses, using the WHO Growth Standards, confirm the importance of the first two years of life as a
window of opportunity for growth promotion (Figure 3). These findings highlight the need for early-
life interventions to prevent the growth failure that primarily happens during the first two years of life,
including the promotion of appropriate infant feeding practices.

Figure 3: Importance of early childhood for better nutrition and development

Time of growth faltering

(WHO:2013)

20 Home Based Care for Young Child (HBYC) Operational Guidelines

Early childhood also is the most rapid period of development in human life. The years from conception
through birth to first few years of age are critical to the complete and healthy cognitive, emotional and
physical growth of children. This in turn ensures optimum health and wellbeing in adult life.

Lancet 2013 analysis shows that 72% of diarrhoea associated deaths and 81% of pneumonia associated
deaths occur in the first two years of life indicating that an increased emphasis on prevention and
treatment is required in children in this age group.

Global evidence shows that community-based intervention packages can reduce 27 percent of the child
mortality indicating scaling up of community-based care through packages which can be delivered
by a range of community workers. This in turn enables mothers to practice appropriate health and
nutrition related behaviors including increased risk perception of childhood illnesses. Within Indian
context, the health system contact between four months to second year of life of the young child is
a ‘missed opportunity’ for promotion of various child caring and development practices during this
crucial period.

There is a narrow window of opportunity between 6 months and 2 years to prevent malnutrition in
children

Current Gap in Health System Contacts During Early Childhood

The Ministry of Health and Family Welfare is presently implementing Home Based Newborn Care
(HBNC) since 2011 through ASHAs who have reached more than 1.1 crore newborns during 2017. The
roll out of HBNC has demonstrated that ASHAs are able to provide home based care through defined
number of structured visits. However, these structured visits end on the 42nd day after birth. Beyond
this, ASHAs only conduct household visits to mobilize children for immunization or in case when the
child needs healthcare services for management of illnesses or malnutrition. This means that there is no
household contact with the child by the ASHA unless the family reports a childhood illness.

Figure 4: Existing Health System contacts and proposed visits under HBYC

Home Based Care for Young Child (HBYC) Operational Guidelines 21

Summary of Problems

• Slow Progress in Child Feeding Practices countrywide

• Nationally, percentage of children receiving adequate diet continues to be less than 10%
• Exclusive Breastfeeding Faltering from 2-3 months of age
• F irst 2 years are critical for inproving nutrition, promoting development and reduction of
diarrhoea and pneumonia
• No contact with health system during critical window period of 6 months to 2 years

Considering the influence of diarrhoea, pneumonia, undernutrition and the importance of WASH related
interventions on overall child survival and development, addressing this gap in health system contact is
crucial. Therefore, additional home visits by ASHA between 3 and 15 months are proposed under Home
Based Care of Young Child (HBYC) to fill this gap. The household visits would also provide another platform
to improve early childhood development through play and communication, optimal nutrition, hygienic
environment and health services.

Home visits by ASHA starting from 2- 3 and continuing in second year till 15 months are
proposed under Home Based Care of Young Child (HBYC) to plug the gap between health
system contacts with family and provide platform to improve child nutrition, immunization,
development, hygiene practices and reduce common childhood illnesses such as diarrhea and
pneumonia

22 Home Based Care for Young Child (HBYC) Operational Guidelines

 SECTION 2
OBJECTIVES
The objective of Home Based Care for Young Child is to reduce child mortality and morbidity and
improve nutrition status, growth and early childhood development of young children through
structured, focused and effective home visits by ASHAs.

Purpose of Home Visits

The purpose of the additional home visits by ASHAs are promotion of evidence based interventions
delivered in four key domains namely nutrition, health, child development and WASH (water, sanitation
& hygiene). The domain specific actions are listed in Table 2.
Table 2: Domain specific actions under HBYC

KEY DOMAINS SPECIFIC ACTIONS

NUTRITION Exclusive breastfeeding for six months
Adequate complementary feeding from six months and continued
breast feeding up to two years of age
Iron and folic acid (IFA) supplementation
Promote use of fortified food
HEALTH Full immunization for children
Regular growth monitoring
Appropriate use of Oral Rehydration Solution (ORS) during diarrhoea
episodes
Early care seeking during sickness
CHILD DEVELOPMENT WASH Age appropriate play and communication for children
WASH Appropriate hand washing practices

Salient features of Home Based Care of Young Child programme

• Convergent action by MWCD & MoHFW, leveraging existing community level platforms.
• Evidence based interventions for child health & nutrition , bundled as a service package.
• Convergence and integration across interdependent domains of Health, Nutrition, WASH & Early
Childhood Development.
• Five additional home visits by ASHA in coordination with AWW starting from 3rd months and extending
into 2nd year of life (in 3rd, 6th, 9th, 12th and 15th months).
• Additional incentive of INR 250/- for five visits to be provisioned for ASHA under NHM and disbursed
using existing ASHA payment mechanisms
• SBCC (Social Behaviour Change Communication) plan to focus on addressing adverse social norms in
health care seeking especially for the girl child.

Home Based Care for Young Child (HBYC) Operational Guidelines 23

 SECTION 3
OPERATIONAL
STRATEGY
Existing Home Based Newborn Care (HBNC) comprising of six home visits in case of institutional
delivery (Days 3,7,14,21,28 and 42) and seven visits in case of home delivery with an additional visit
for home delivery on day 1 (Day 1,3,7,14,21,28 and 42) will be continued as per the current operational
guidelines. In case of SNCU discharged babies, day of discharge will be counted as day 1 of home visit
schedule and the six remaining visits shall be completed as per schedule.

Under Home Based Care of Young Child (HBYC) programme, the additional five home visits will be
carried out by ASHA with support from Anganwadi workers. From 2-3 month onward ASHAs will
provide quarterly home visits (3rd, 6th, 9th, 12th and 15th months) and ensure exclusive and continued
breastfeeding, adequate complementary feeding, age-appropriate immunization and early childhood
development. The quarterly home visits schedule for low birth weight babies, SNCU & NRC discharges
will now be harmonized with the new HBYC schedule.

Anganwadi workers will continue to provide ‘Take Home Ration’ and nutrition-specific counselling to
mothers. In addition, she will record weight of the young children and monitor growth and development
using MCP card as per guidelines. Based on the growth chart, underweight children will be identified and
taken up for further management. Age appropriate tasks for ASHAs and AWWs to be performed under the
HBYC visits are presented below.
Table 3: Tasks for ASHAs and AWWs under HBYC

Home Visits ASHA AWW

At 3rd Month  Support for exclusive breastfeeding  Monthly weighing of infants
 Counsel on hand washing practices  Weight recording and plotting on
 Appropriate play and communication growth chart
 Check immunization status  Detect underweight children &
 Check weight recording in MCP card; identify take further action
growth faltering  Counsel mother for exclusive
breast feeding
At 6th, 9th,  All above activities PLUS  ‘Take Home Ration’ and nutrition-
12th and 15th  Counsel on initiation of complementary specific counselling to mothers
Months feeding & continued breastfeeding  Monthly weighing and
 Age appropriate & adequate complementary supplementary food from AWC
feeding for children  Counselling regarding
 Age appropriate play and communication complementary feeding
 Ensure full immunization  Weight recording on growth chart;
 Distribution of prophylactic IFA and ORS and detect underweight children &
counselling for their appropriate usage take further action
 Depot holder for ORS & Zinc  Record length/height
 Counsel for deworming of children
above 1 year of age

24 Home Based Care for Young Child (HBYC) Operational Guidelines

 Figure 4: Age-appropriate interventions to be promoted during HBYC home visits

Add variety of
food from family
pot, booster
Increase amount
vaccination
of CF, give feeds
adequate in quality
Increase & quantity
Initiate frequency of CF,
complementary measles vaccine
feeding (CF),
introduce IFA
Promote syrup
Exclusive
Breastfeeding

15
12 Months
9 Months
6 Months
During home visits most of the
3 children are likely to be healthy. Complete the assigned tasks using new
Months
Months
Mother & Child Protection1st(MCP)
visit
Card (Annexure-1)
2nd visit
and age specific
3rd visit
job aid (Annexure-2).
4th visit 5th visit
Provide age
specific nutrition counselling as per Annexure-3.
Monitor growth & promote ECD at each visit using MCP card

During
If child is foundhome
sickvisits most ofthe
complete the assessment
children are likely to be
including
healthy. Complete the assigned tasks using age specific
referral as per Annexure-4.
job aid (Annexure-1). Provide age specific nutrition
counselling
Additional financialasincentive
per Annexure-2.
for ASHA

ASHAs will be provided

If child is found financial incentive
sick complete and the additional
the assessment including
referral
commodities as per Annexure-3.
namely ORS packet and Iron Folic Acid syrup.
Each ASHA will be entitled for a sum total of INR 250 for
completion of 5 additional home visits for each young child
as per the recommended schedule. In case of more than one
child like twins/triplets the amount of incentive will be
Additional financial incentive for ASHA
provided per child. The payment will be given after validating that age appropriate vaccination is
completed andwill
ASHAs recorded alongfinancial
be provided with the weightand
incentive in MCP card. It iscommodities
the additional also desirable that ORS
namely at least 10%
packet home
and Iron
visits areFolic
dulyAcid
verified
syrup.byEach
the ASHA
ANM/will
ASHA Facilitator
be entitled for aafter checking
sum total of INRthe
250required documentation.
for completion The
of 5 additional
home visits for
existing mechanism each young
of payment child aswill
to ASHAs perbe
thefollowed
recommended
to ensureschedule.
timelyInpayment.
case of more than oneASHAs
In addition, child
like twins/triplets the amount of incentive will be provided per child. The payment
shall also receive the specified share of team based incentive under domain of child health and nutrition will be given after
validating that age appropriate vaccination is completed and recorded along with the weight in MCP
as per the guidelines
card. It is alsoissued
desirableby that
MoHFW.
at least 10% home visits are duly verified by the ANM/ ASHA Facilitator
after checking the required documentation. The existing mechanism of payment to ASHAs will be
followed to ensure timely payment. In addition, ASHAs shall also receive the specified share of team
based incentive under domain of child health and nutrition as per the guidelines issued by MoHFW.

9|Page

Home Based Care for Young Child (HBYC) Operational Guidelines 25

 SECTION 4
CAPACITY
BUILDING
A defined set of skills will be required by ASHA and AWW to conduct effective home visits and fulfill the
specified objectives. Many of the skills to deliver relevant information and services through home visits
is taught to ASHAs in Modules 6 & 7. In order to reinforce existing skills and provide new set of skills, an
additional round of 3 days training shall be conducted with adequate hands on practice.

Refresher trainings should also be held periodically to ensure knowledge and skill retention. The supply
of HBYC cards (Annexure-4), ORS and IFA syrup should be replenished regularly, as per requirement.

In addition, joint training of front line workers – ASHAs, ANMs and AWWs will be conducted to bring
about role clarity and build synergy of actions. The content of the training package shall include new
skills required for accomplishing tasks such as promoting ECD, IFA supplementation and reinforcing
ORS use, complementary feeding, and hand washing etc. specified under HBYC. The training package
for the same shall be developed under the guidance of MoHFW by NHSRC and the experts and other
stakeholders.

ASHA, AWW and ANM shall require the following additional skills for conducting HBYC:
• Communication and counselling skills for motivating families for behaviour change of recommended
practices and deliver age appropriate messages (regarding hygiene, IYCF, play & communication,
Iron supplementation etc.) The ASHA is expected to be equipped with appropriate job aids to
impart key messages.
• Age appropriate play and communication
• Use of MCP card for weight measuring and recording on growth chart for detecting growth faltering
• Providing ORS and IFA & demonstration of their correct usage and dose
• Documentation of skills for correct recording & reporting as required under the programme

Special focus needs to be given to the new MCP Card in capacity building and implementation
(Annexure-5).

26 Home Based Care for Young Child (HBYC) Operational Guidelines

 SECTION 5
SUPPORTIVE
SUPERVISION
The supportive supervision to both AWW and ASHA shall be provided by respective supervisors from
Anganwadi Services and NHM. As the tasks are to be jointly accomplished BY ASHA and AWW, the ANM,
ASHA Facilitator and Anganwadi Services Supervisor will also be included in two days joint training
programme to enhance their supervisory skills.

The supervisors during their routine visit should review and provide ‘on the job’ mentoring support
using supervisory checklists. Each supervisor should ensure that at least one visit in each quarter is
provided to each ASHA & AWW under their supervision. This means that on an average 6-7 workers
will be visited each month. Planning for joint supportive supervision should also be carried out during
monthly review meetings to develop a calendar of villages to be visited by each supervisor.

ANM should undertake joint home visits with ASHAs to at least 10% newborns in her sub centre
area. She should review the HBYC forms filled by ASHAs and also mentor and support the ASHAs in
completing the tasks effectively. The platform of Village Health and Nutrition Day should be used by
ANM to review the coverage and quality of care provided by ASHAs to young children. This activity of
ANM should be monitored by Medical Officer and reviewed at district level.

Monthly review meetings at the level of the PHC are to be held for problem solving and building the
linkages for referral support. At the village level the ASHA is to be supported by a functional Village
Health, Sanitation and Nutrition Committee (VHSNC) /Women’s health committee. Any grievances are
to be addressed promptly through grievance redressal mechanisms for ASHA.

Home Based Care for Young Child (HBYC) Operational Guidelines 27

 SECTION 6
INSTITUTIONAL
ARRANGEMENTS
Actions at the National level

Under POSHAN Abhiyaan a National Council on India’s Nutritional Challenges has been set up for review
of all nutrition related programmes. The committee will also review the progress of the Home Based
Care for Young Child. Similar committees at state and district level with involvement of all stakeholders
would also be constituted.

A technical unit under the overall guidance of MoHFW shall also be established at NHSRC for developing
and dissemination of the Home Based Care for Young Child guidelines, training packages, job aids and
communication materials. Capacity building of front line workers (FLWs) and regular hands-on-support
will be provided by NHSRC through leveraging existing ASHA system. Budget for different activities will
be proposed by the States under appropriate budget heads in the PIP for approval by relevant ministry.

Actions at the State level

1. Coordinated planning between NHM and Anganwadi services for activities such as training, printing
(training packages, job aides, formats, checklists and reporting formats), additional incentives and
commodities and prepare budget proposal.
2. Ensure smooth flow of funds to districts and blocks for timely procurement of commodities and
incentive payment.
3. Ensure that State Level Resource Center are in the state of preparedness for providing training
support to district and block level trainings. The progress of District Training Plan is to be monitored.
4. Establish systems to monitor the services delivered and young children reached through HBYC.
Regular review of implementation status of HBYC during monthly and quarterly review meetings.

Actions at District level

1. Similar to the state level activities, the district ASHA cell in coordination with Anganwadi Services
at district level shall plan for convergent activities with role clarification of the village health team.
2. Regular monitoring and review of the implementation status during Block meetings again in
coordination with Anganwadi Services team. Report in designated formats (Annexure-6) to the
state at specified periodicity.
3. District ASHA Training Center to undertake trainings, develop training micro-plan and monitor
progress of trainings, their quality and timely conduct and completion.
4. Review the stocks and ensure availability and supply of essential commodities in time sync with
ASHA trainings.
5. Ensure availability of funds by coordinating with the State counterpart and review the ASHA
incentive payment mechanism to accommodate additional payments timely for HBYC and
implement activities for community mobilization.

28 Home Based Care for Young Child (HBYC) Operational Guidelines

Table 4: Summary of activities at state and district level
Activities State level District level
Developing  Joint planning by NHM and  Joint planning by district level NHM &
joint action Anganwadi Services regarding Anganwadi Services
plan schedule of key activities, role clarity
- Orientation of key stakeholders
of front line workers, joint training
plan, and availability of commodities - Joint training and community
mobilization plan for the district
 Orientation of key stakeholders
 Printing of training packages,
job aides, formats, checklists and
reporting formats
Capacity - Ensure the preparedness of ASHA - District Resource Centre to gear up for
building resource centre to provide support training and HBYC related activities
for district and block level trainings of
- Develop training micro plan and accordingly
front line workers & supervisors.
review its own the preparedness for
- Advance planning by state team to conducting quality trainings
support the district resource centres
- Refresher trainings /reorientation for
for conducting training; ongoing
workers in each quarter
monitoring for quality of training
Commodities - Projection of annual requirement for - Timely procurement of commodities to
commodities, budgeting & approvals avoid stock outs
Funds - Timely approvals & allocation of funds - Timely payment of incentives
to districts; ensure smooth fund flow
to districts
Activities State level District level
Monitoring and - Regular monitoring of services - Regular monitoring of HBYC activities; data
Supervision delivered and children covered during analysis; review in monthly meetings
specified period in each district
- Develop joint supportive supervision plan
- Share reports at specified periodicity
- Share data at specified periodicity with state
with national counterparts
cell/teams
- State level review meeting to assess
progress and make mid-course
corrections

Table 5: Proposed timeline for key activities

Activity /Months 1 2 3 4 5 6 7 8 9 10 11 12
Planning & budget approvals
State & district level orientation
Printing
Capacity building
Home visits
Supportive supervision
IEC /BCC activities
Monthly reporting, incentive
payments

Home Based Care for Young Child (HBYC) Operational Guidelines 29

 SECTION 7
MONITORING AND
EVALUATION
The progress of implementation of the HBYC programme will be closely monitored at the national level
on monthly basis. The states are expected to provide details of the trainings and home visits conducted
under HBYC. The data collection system will maintain child wise tracking of young child provided HBYC
home visits and will be linked with RCH portal of Government of India.

A HBYC card will be filled by ASHA for each young child provided home visit under HBYC. These HBYC
cards will be collected, compiled and recorded in HBYC registers by ASHA supervisors in monthly ASHA
meetings. A web based child wise tracking and data collection system should be established in all states
as is being implemented by some states. In such a system child wise data is linked with RCH portal and
it also facilitates the verification of incentive payments to ASHAs for complete set of home visits.

Till the web based system is rolled out, a manual child wise data collection system collected by ASHA
and compiled by ASHA supervisors is suggested. The compiled data of each ASHA supervisors will be
collected by Block Data Entry Operator on monthly basis and will be entered in excel sheet. Compiled
excel sheets of HBYC will be further compiled at district for all the blocks. The data compilation will also
take place at state and national level on monthly basis. Analysis of the HBYC progress focusing on key
indicators will be conducted on regular basis at block, district, state and national level for identifying
the areas for improvement.

The outcome of the HBYC visits would be measured in terms of child health and nutrition indicators
which are specified in the team based incentive system for frontline workers by MoHFW. The team
based incentive system of MoHFW would be used as an evaluation mechanism for the performance of
frontline workers including ASHA under Home Based Care for Young Child programme.
Child Health and Nutrition Indicators for Team Based Incentives
1. (EBF) Exclusive breastfeeding >80% for infants (<6months)
2. Complementary feeding initiated > 80% for infants over six months of age
3. Children in the age group of 12-23 months who have received all due vaccines (BCG to Measles 1st dose)
before the first year of life >90%
4. Children in the age group of 24 months to 35 months who have received all due vaccines (up to Measles
2nd dose and DPT 1st booster) within 2 years of life >90%
5. Growth monitoring of all eligible children as per MCP cards >90%
6. Children six months to 59 months receiving bi-weekly doses of IFA syrup >90%
7. Awareness level about use of ORS/Zinc in Diarrhoea >80%
8. Awareness about Danger signs of pneumonia >80%
9. Severe underweight children referred to Nutritional Rehabilitation Centres >90%

In addition, evaluation of the HBYC will be integrated with the concurrent evaluation mechanisms
such as National Health Surveys, National Family Health Survey etc. Besides additional need based
evaluations in specific geographic areas such as aspirational districts will further guide and strengthen
the programme.

30 Home Based Care for Young Child (HBYC) Operational Guidelines

 SECTION 8
ESTIMATED
BUDGET
Estimated cost of Home Based Care for Young Child implementation includes cost of capacity building
of frontline workers, incentive payment to frontline workers and supervisors, IEC/ BCC activities and
cost for monitoring of the programme. An estimated cost of INR 2 Crore shall be required for an average
sized district with population of 15 lakhs which translates to INR 1000 per child for carrying out the
recommended home visits.

Estimated Budget details:

Estimated cost of HBYC implementation includes onetime cost of capacity building of frontline workers,
and recurring cost for incentive payment, IEC/ BCC activities, supportive supervision and monitoring
and supervision. An estimated annual expenditure of approximately INR 2.00 Crore will be incurred for
an average sized district with population of 15 lakhs in first year, which translates to less than INR 1000
per child in the first year and will comes down to less than INR 400 in subsequent years for the complete
set of 5 visits.

Assumption for an average sized district with population of 15 lakh:

1 Average Population 15,00,000

2 No. of Block 14
3 No of ASHAs in position (may vary depending on vacancies) 1,350
4 No of ASHA Supervisors ( 1 per 20 ASHAs may vary depending on vacancies) 60
5 No of expected annual live births in the district (19.3 birth rate per 1000 population 29,000
as per Census 2011 and estimated for 2016)
6 Approx. number of young children to receive 5 completed visits /year/ASHA 23,200
(Assuming 80% coverage)
7 Expected training load in one district (1,350 ASHAs +1,190 AWWs,+60 ASHA 2,700
Facilitator +100 ANMs)
8 Expected number of training batches @ 30 participants per batch (2,700 / 30) 90

Home Based Care for Young Child (HBYC) Operational Guidelines 31

Normative estimation of budget in an average sized district with population of 15 lakh:

Sr. No. Particulars Amount in INR

1. One time cost:
*Training budget at District level (ASHA, AWW, ANM and Supervisors with 1,05,57,000
batch size 30 for 3 days) (@ 90 Batches x 1,17,300 per batch training)
2. Recurring cost (annual):
IEC materials and printing (Posters, Banners, Stickers, AV, HBYC cards & registers 15,19,000
@ 100,000 per block and printing of HBYC cards & registers)
Monitoring (Data collection cost of HBYC (@23,200 children per year x 5 entries 7,80,000
per infant x INR 5 per entry ) + Cost for periodic assessments (@ 1,00,000 per
periodic assessment every 6 months in one district)
Total annual incentive to Supervisors (60 Supervisors @ 500 per month*12 3,60,000
months)
Total annual incentives to ASHAs (23,200 infants @ 250 per child (INR 50 X 5 58,00,000
visits))
Total 1,90,16,000

* The budget for ASHA training is already provisioned under NHM and the same may be used.

32 Home Based Care for Young Child (HBYC) Operational Guidelines

 ANNEXURE 1
JOB AID
Visit at 3-4 months of age

Ensure growth monitoring in the MCP card.

Counselled for Hand washing (mother)

Exclusive breast feeding till 6 months

Family Counselled how to play and

communicate with the child

Immunization Status checked

Home Based Care for Young Child (HBYC) Operational Guidelines 33

 Visit at 6-7, 8-9, 12-13 and 15-16 months of age

Ensure Growth monitoring in the MCP card

Counselled for Hand washing (Baby and

mother)

Breast feeding continued & nutritious food

in adequate amount using responsive
feeding:
 Between 6 to 8 months: 2 to 3
tablespoons of food at a time, 2 to
3 meals each day and offer 1 to 2
snacks between meals.
 At 10 months: half cup serving at a
time, 3 to 4 meals each day and offer
1 to 2 snacks between meals.
 At 12 mo nths: ¾ cup serving at a
time, 3 to 4 meals each day and offer
1 to 2 snacks between meals.
Family counselled for how to play and
communicate with the child

Family given IFA supplementation and ORS

and know how to use IFA & ORS

Immunization Status checked

34 Home Based Care for Young Child (HBYC) Operational Guidelines

 ANNEXURE 2
NUTRITION COUNSELLING
FEEDING RECOMMENDATIONS
Up to 6 Months of Age
 Breastfeed as often as the child wants, day and night, at least 8 times in 24 hours.
 Do not give any other foods or fluids not even water.
Remember:
 Continue breastfeeding if the child is sick.
6 up to 9 Months
 Breastfeed as often as the child wants.
 Start by giving 2 to 3 tablespoons of food. Gradually increase to 1/2 cups (1 cup = 250 ml).
- Mashed roti/ rice /bread/biscuit mixed in sweetened undiluted milk OR thick dal
with added ghee/oil or khichri with added oil/ghee.
- Add cooked vegetables also in the servings, OR
- Sevian/dalia/halwa/kheer prepared in milk, OR
- Any cereal porridge cooked in milk, OR
- Mashed boiled/fried potatoes
 Give 2 to 3 meals each day. Offer 1 or 2 snacks each day between meals when the
child seems hungry.
Remember:
 Keep the child in your lap and feed with your own hands
 Wash your own and child’s hands with soap and water every time before feeding
9 up to 12 Months
 Breastfeed as often as the child wants.
 Give at least half cup serving* at a time of
- Mashed roti/ rice /bread/biscuit mixed in sweetened undiluted milk, OR
- Mashed roti/rice/bread mixed in thick dal with added ghee/oil or khichri with added oil/
ghee.
- Add cooked vegetables also in the servings OR
- Sevian/dalia/halwa/kheer prepared in milk, OR
- Any cereal porridge cooked in milk, OR
- Mashed boiled/fried potatoes
 Give 3 to 4 meals each day. Offer 1 or 2 snacks between meals. The child will eat if hungry.
 For snacks, give small chewable items that the child can hold. Let your child try to eat the
snack, but provide help if needed.
Remember:
 Keep the child in your lap and feed with your own hands
 Wash your own and child’s hands with soap and water every time before feeding

* A good daily diet should be adequate in quantity and include an energy-rich food (for example, thick cereal porridge with
added oil); meat, fish, eggs, or pulses; and fruits and vegetables. Egg is a good snack where culturally acceptable.

Home Based Care for Young Child (HBYC) Operational Guidelines 35

12 Months up to 2 Years
 Breastfeed as often as the child wants.
 Offer food from the family pot
 Give at least 3/4 cup serving* at a time of:
- Mashed roti/rice/bread mixed in thick dal with added ghee/oil or khichri with added oil/
ghee.
- Add cooked vegetables also in the servings OR
- Mashed roti/ rice /bread/biscuit mixed in sweetened undiluted milk, OR
- Sevian/dalia/halwa/kheer prepared in milk, OR
- Any cereal porridge cooked in milk, OR
- Mashed boiled/fried potatoes
- Offer banana/biscuit/ cheeko/ mango/ papaya
 Give 3 to 4 meals each day. Offer 1 to 2 snacks between meals. Continue to feed your child
slowly, patiently.
 Encourage your child to eat.

Remember:
 Sit by the side of child and help him to finish the serving
 Wash your child’s hands with soap and water every time before feeding
2 years and older
 Give a variety of family foods to your child, including animal source foods and vitamin
A-rich fruits and vegetables.
 Give at least 1 full cup (250 ml) at each meal.
 Give 3 to 4 meals each day.
 Give 1 or 2 nutritious food between meals, such as: Banana/biscuit/ cheeko/ mango/papaya
as snacks

Remember:
 Ensure that the child finishes the serving
 Teach your child wash his hands with soap and water every time before feeding

36 Home Based Care for Young Child (HBYC) Operational Guidelines

 ANNEXURE 3
SICK CHILD
Annexure 4: SICKMANAGEMENT
Child Management
Sick Child Management-(for community-based treatment of child age 2 months up to 5 years)
1. Identify problems

Any DANGER SIGN or SICK but NOT a

ASK and LOOK
other problem to refer? Danger Sign?
ASK: What are the child’s problems? If not
reported, then ask to be sure.
YES, sign present Tick  NO sign  Circle 
 Cough for 21 days or
  Cough? If yes, for how long? __ days
more
  Diarrhoea (loose stools)?  Diarrhoea for 14  Diarrhoea (less
IF YES, for how long? ____days. days or more than 14 days
  Blood in stool AND no blood in
 IF DIARRHOEA, blood in stool?
stool)
  Fever (reported or now)?  Fever for last 7  Fever (less than
If yes, started ____ days ago. days 7 days)
  Convulsions?  Convulsions
  Difficulty drinking or feeding?  Not able to drink or
IF YES,  not able to drink or feed anything? feed anything
  Vomiting? If yes,  vomits everything?  Vomits everything
  Any other problem I cannot treat (for  Other problem to
example, problem breast feeding, injury, burn) refer:
If any OTHER PROBLEMS, refer.
LOOK:
  Chest indrawing? (FOR ALL CHILDREN)  Chest indrawing
IF COUGH, count breaths in 1 minute:
_______breaths per minute (bpm)
  Fast breathing:  Fast breathing
Age 2 months up to 12 months: 50 bpm or more
Age 12 months up to 5 years: 40 bpm or more
 Very sleepy or
  Very sleepy or unconscious?
unconscious
For child 6 months up to 5 years, MUAC
 Red on MUAC strap
strap colour: __________
 Swelling of both
  Swelling of both feet?
feet

 If ANY Danger Sign or  If NO Danger Sign,

2. Decide: Refer or treat child treat at home and advise
other problem,refer
(tick decision) caregiver
to health facility

GO TO next PAGE
25 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 37

 Child’s name: ___________________ Age:_______

 If NO Danger Sign,
 If ANY Danger Sign
treat at home and
3. Refer or treat child or other problem, refer
to health facility advise caregiver
(tick treatments given
and other actions)

If any danger sign, If no danger sign,

REFER URGENTLY to health facility: TREAT at home and ADVISE on home care:
ASSIST REFERRAL to health facility:  If Give ORS. Help caregiver give child ORS solution in front
Explain why child needs to go to health Diarrhoea of you until child is no longer thirsty.
facility. Give caregiver 2 ORS packets to take home. Advise to
give as much as child wants, but at least 1/2 cup ORS
FOR SICK CHILD WHO CAN DRINK,
solution after each loose stool.
BEGIN TREATMENT:
Give zinc supplement. Give 1 dose daily for 14 days:
 If Begin giving ORS solution
Age 2 months up to 6 months—1/2 tablet (total 5 tabs)
Diarrhoea right away.
Age 6 months up to 5 years—1 tablet (total 10 tabs)
Help caregiver to give first dose now.
 If Give first dose of oral  If Give oral antimalarial ACT.
Fever antimalarial ACT Fever Age up to 12 months—AS ½ SP 1/4
(in malaria area) Age up to 12 months— (malaria Age 12 months up to 5 years—AS SP and Primaquine 1 tablet D-1
AS ½ SP 1/4 risk) D2 and D3 1 tablet AS only
Age 12 months up to 5 years— Age 5 yrs up to9 yrs— AS SP and Primaquine 2, 1 .5 and 2
AS SP and Primaquine 1 tablets on D-1 D2 and D3 1 tablet 1 tablet AS only
Age 5 yrs up to9 yrs— Advise caregiver on use of a bednet (ITN).
AS SP and Primaquine 2,
1 .5 and 2 tablets
 If Give first dose of oral  If Give oral antibiotic (cotrimoxazole tablet—20/100).
Chest indrawing, antibiotic (cotrimoxazole adult Fast Give twice daily for 5 days:
or  Fast tablet—80/400) breathing Age 2 months up to 12 months—2 tablet (total 20 tabs)
breathing and Age 2 months up to 12 Age 12 months up to 5 years—3 tablet (total 30 tabs)
months—1/2 tablet Help caregiver give first dose now.
danger sign
Age 12 months up to 5 years—
1 tablet
For any sick child who can drink, advise to give  For ALL Advise caregiver to give more fluids and continue
fluids and continue feeding. children feeding.
Advise to keep child warm, if child is NOT hot treated Advise on when to return. Go to nearest health facility
with fever. at home, or, if not possible, return immediately if child
Write a referral note. advise on  Cannot drink or feed
Arrange transportation, and help solve other home care  Becomes sicker
difficulties in referral.  Has blood in the stool
 FOLLOW UP child on return at least once a Follow up child in 3 days (schedule appointment in item 6
week until child is well. below).
4. CHECK Age Vaccine  Advise
Birth  BCG  OPV-0 caregiver, if
VACCINES RECEIVED  
needed:
(tick  vaccines 6 weeks*   Penta 1   OPV-1
WHEN is
10 weeks*   Penta 2   OPV-2
completed, the next
14 weeks*   Penta 3   OPV-3+IPV vaccine to
circle  vaccines missed)
[Give OPV-4, if OPV-0 be given?
5. If any OTHER PROBLEM or 9 months   MR
WHERE?
not given at birth]
condition you cannot manage,
refer child to health facility, write referral note. (If diarrhoea, give ORS. Do not give
antibiotic or antimalarial.) Describe problem: _____________________________________
6. Counsel for Age appropriate feeding

26 | P a g e

38 Home Based Care for Young Child (HBYC) Operational Guidelines

 ANNEXURE 4
HBYC HOME
VISIT CARD
HBYC Home Visit Card
(To be filled by ASHA at the completion of each home visit.)
Name of Child: ................................................................... Date of birth: DD/MM/YY ...................................................................
Sex of Child (M/F): ............................................................
Name of village: ................................................................. Block/District: ............................................/.............................................
MCTS NO. ............................................................................. Contact No. (Mobile No.)- ....................................................................
Does mother have MCP card? (Y/N): .............................................................................

Please Tick (√) on completion of activity. Cross (X) if not able to complete activity.
Date of visit Whether the child is Immunization Provision of ORS Provision of IFA
(DD/MM/YY) in green zone (Y/N) received as per age packet (Y/N) Bottle. (Y/N)
leave blank if weight
is not recorded in
MCP Card)

3 Month
6 Month
9 Month
12 Month
15 month
Whether the child was referred to hospital for management of Sickness (Y/N)
Name and Signature of ASHA .............................................................................
Name and Signature of AWW .............................................................................
Signature of ANM.....................................................................................................
Date of submission of card: DD............................... /MM............................... YY...............................

Amount of Incentive paid to ASHA & date of payment.............................................................................

ASHA counter foil-HBYC
Name of Child: ........................................................................ Date of birth: DD/MM/YY .............................................................................

Sex of Child (M/F): .................................................................

Name of village: ...................................................................... Block/District: ...................................../.....................................

MCTS NO. ....................................

Name and Signature of ASHA ...........................................

Date of submission of card: DD........................................... /MM........................................... /YY...........................................

Amount of Incentive paid to ASHA & date of payment......................................................................

Home Based Care for Young Child (HBYC) Operational Guidelines 39

 ANNEXURE 5
Annexure 1-MCPC REVISED MCP Card
Revised MCP Card

19 | P40a g eHome Based Care for Young Child (HBYC) Operational Guidelines
20 | P a g e
Home Based Care for Young Child (HBYC) Operational Guidelines 41
21 | P a g e

42 Home Based Care for Young Child (HBYC) Operational Guidelines

22 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 43

23 | P a g e

44 Home Based Care for Young Child (HBYC) Operational Guidelines

24 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 45

25 | P a g e

46 Home Based Care for Young Child (HBYC) Operational Guidelines

26 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 47

27 | P a g e

48 Home Based Care for Young Child (HBYC) Operational Guidelines

28 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 49

29 | P a g e

50 Home Based Care for Young Child (HBYC) Operational Guidelines

30 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 51

31 | P a g e

52 Home Based Care for Young Child (HBYC) Operational Guidelines

32 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 53

33 | P a g e

54 Home Based Care for Young Child (HBYC) Operational Guidelines

34 | P a g e

Home Based Care for Young Child (HBYC) Operational Guidelines 55

 ANNEXURE 6
District Level
Reporting Format
(For Compilation of
data from Blocks)
District level MPR for HBYC

Name of the District

Date of reporting Month Year
No of Blocks Reported=

No. of ASHAs= No. of Supervisors=

No. of ASHAs trained this month= No. of Supervisors trained this month=

Indicator Achieved

Total no. of young children visited by ASHA

No. of young children visited at age of 2-3 months

No. of young children visited at age of 6 months

No. of young children visited at age of 9 months

No. of young children visited at age of 12 months

No. of young children visited at age of 15 months

No. of young children received ORS packet from ASHA

No. of young children received IFA syrup from ASHA

No. of young children who are underweight (Yellow)

No. of young children who are Severe Underweight (Red)

No. of young children referred for treatment

No. of severe underweight children referred to NRC

No. of ASHA reported shortage of ORS/IFA with them for
last one month
No. of ASHA received supervisory visits

56 Home Based Care for Young Child (HBYC) Operational Guidelines