INDIAN NEWBORN ACTION PLAN AND OTHER INITIATIVES TO REDUCE NEONATAL MORTALITY RATE

1. INDIA NEWBORN ACTION PLAN
DR MANISH CHOUDHARY
PG 1ST YEAR RESIDENT
JLN MEDICL COLLEGE AJMER

2. Introduction
The India Newborn Action Plan (INAP) is India’s committed in
response to the Global Every Newborn Action Plan (ENAP),
launched in June 2014 at the 67th World Health Assembly, to
advance the Global Strategy for Women’s and Children’s
Health. The ENAP sets forth a vision of a world that has
eliminated preventable newborn deaths and stillbirths.
It is an action plan to end preventable deaths is a roadmap for
change . It sets out avision and proposes a goal and targets to end
newborn deaths from preventable causes.

3. • India has been at the forefront of the global effort to
reduce child mortality and morbidity. Its continuous
commitment and ongoing efforts have resulted in a 59%
reduction in under-5 (U5) child mortality since 1990.
• Programmes and initiatives by GOI lead to a significant
reduction in the number of neonatal deaths - from 1.35
million in 1990, to around 0.76 million in 2012.

4. But while neonatal deaths reduced by 44%, child deaths
(under 5 years) reduced by 59%. As a result, the
contribution of neonatal deaths to under-5 deaths
increased from 41% in 1990 to 56% in 2012, which is
higher when compared to the contribution observed
globally (44%). During the same period, the global under-5
death rate reduced by 50%, and the global neonatal
mortality rate by only 37%.

9. WHEN DO NEWBORNS DIE?
About half of child deaths occur in the
neonatal period.It is estimated that around 40%
of all stillbirths and neonatal deaths take place
during labour and the day of birth, i.e.
approximately within 48 hours. About three-fourths
of the total neonatal deaths occur in the first week
of life, with the first 24 hours accounting for more
than one-third (37%) of the deaths occurring
during the entire neonatal period.

10. DISTRIBUTION OF NEONATAL DEATHS - DAY 1 TO 7
39.3
7.3
10.2
6.2 5.5
2.8 2.8
0
5
10
35
30
25
20
15
40
45
Day1 Day2 Day3 Day4 Day5 Day6 Day7

11. DISTRIBUTION OF NEWBORN DEATHS IN THE FIRST WEEKS
74.1
12.6
10
3.1
0
10
20
30
40
50
60
70
80
Week1 Week2 Week3 Week4

12. WHAT DO NEWBORN DIE OF ?

13. Cause of neonatal deaths
in India

14. •Key Highlights of India
Newborn Action Plan
(INAP)

16. The two specific goals of INAP are:
Goal 1: Ending Preventable Newborn Deaths to achieve
“Single Digit NMR” by 2030, with all the states to
individually achieve this target by 2035
Goal 2: Ending Preventable Stillbirths to achieve “Single
Digit SBR” by 2030, with all the states to individually achieve
this target by 2035

17. Strategy intervention packages Six pillars
of INAP
Preconcep
tion
Antenatal
care
Care during
labor
Childbirth
Immediate
Newborn
care
Care of
healthy
Newborn
Care of
Small
&
Sick
newborn
Care
beyond
Survival

18. Pre-Conception and Antenatal Care

19. Care during Labour and Childbirth

20. Immediate Newborn Care

21. Care of Healthy Newborn

22. Care of Small and Sick Newborn

23. Care beyond Newborn Survival

24. Monitoring and evaluation Framework
• It is imperative to have a better comprehensive
information system for monitoring and assessing
progress towards the targets identified under INAP. The
Government of India has established a web-based
tracking system (Mother and Child Tracking System) to
track every pregnant woman and child till the age of 2
years.

25. • The success of the India Newborn
Action Plan hinges on active
participation and commitment by the
states to attain the vision of ending
preventable deaths of newborns and
stillbirths. This would translate into
achieving Single Digit NMR and
Single Digit SBR by 2030.

26. Milestones in Child Survival Programmes in India
1985 – UIP
1992 – Child Survival and Safe Motherhood Programme (CSSM)
1995 –NMBS
1997 – RCH I
2004 –IMNCI
2005 – RCH II
2005 – National Rural Health Mission
2013 – RMNCH+A Strategy
2013 – National Health Mission
2014 – India Newborn Action Plan (INAP)

27. UNIVERSAL IMMUNISATION PROGRAM
Universal Immunization Programme is a vaccination program launched
by the Government of India in 1985. It was started with vaccine against
6 VPD’s –DPT, TB, MEASLES , POLIO and TETANUS vaccine to
women.
It became a part of Child Survival and Safe Motherhood Programme in
1992 and is currently one of the key areas under National Rural Health
Mission (NRHM) since 2005. The program now consists of vaccination
for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough),
tetanus, poliomyelitis, measles, hepatitis B, diarrhoea, Japanese
encephalitis, rubella, pneumonia (Heamophilus Influenza Type B) and
Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis). .

28. CHILD SURVIVAL & SAFE MOTHERHOOD
The first public health initiative in India that covered
the health of newborns
Strategies for improved neonatal survival
 Antenatal care to all pregnant women
 Promote safe delivery
 Assist establishment of breathing at birth
 Maintain newborn’s warmth
 Promote early exclusive breastfeeding
 Prevention of infection
 Early detection and referral of high risk newborns
 Promote birth spacing

29. NATIONAL MATERNITY BENEFIT SCHEME
 National Social Assistance Programme.
 Toensure all BPL women get cash
assistance 8-12 weeks prior to delivery
 Rs. 500 per birth irrespective of no. of
children and age of the women*
 Focus – Provision of nutrition support during
pregnancy

30. REPRODUCTIVE & CHILD HEALTH I
 Integration of
 CSSM
 Family welfare program
 Adolescent Health
 Prevention of RTI & STI

31. IMNCI
WHO/UNICEF developed a new approach to tackling the
major diseases of early childhood called the Integrated
Management of Childhood Illnesses
IMNCI is an Indian adaptation of the Integrated
Management of Childhood Illness approach, a globally
accepted model which has been tested in several
countries.
The IMNCI strategy addresses the major causes of
under-five morbidity and mortality which are
responsible for more than 90% of the mortality, namely
pneumonia, neonatal problems, diarrhoea, malaria,
measles and malnutrition.

33. REPRODUCTIVE & CHILD HEALTH II
 To reduce maternal and child morbidity and
mortality with emphasis on rural health care
 Integrated with NRHM
 Major strategies
 Essential Obstetric Care
 Emergency obstetric care
 Strengthening referral system

34. National Rural Health Mission
The National Rural Health Mission (NRHM) was launched on 12th April 2005,
to provide accessible, affordable and quality health care to the rural population,
especially the vulnerable groups.
The thrust of the mission is on establishing a fully functional, community
owned, decentralized health delivery system with inter-sectoral convergence at
all levels, to ensure simultaneous action on a wide range of determinants of
health such as water, sanitation, education, nutrition, social and gender
equality.
NRHM focuses on Reproductive, Maternal, Newborn, Child Health and
Adolescent (RMNCH+A) Services. The emphasis here is on strategies for
improving maternal and child health through a continuum of care and the life
cycle approach.

35. RMNCH+A
The RMNCH+A strategy is built upon the continuum of
care concept and is holistic in design, encompassing all
interventions aimed at reproductive, maternal,
newborn, child, and adolescent health under a broad
umbrella, and focusing on the strategic lifecycle
approach.
The RMNCH+A strategy promotes links between
various interventions across thematic areas to enhance
coverage throughout the lifecycle to improve child
survival in India.

36. • The “plus” within the strategy focuses on:
• Inclusion of adolescence as a distinct life stage within the
overall strategy.
• Linking maternal and child health to reproductive health and
other components like family planning, adolescent health, HIV,
gender, and preconception and prenatal diagnostic
techniques.
• Linking home and community-based services to facility-based
services.
• Ensuring linkages, referrals, and counter-referrals between
and among various levels of health care system to create a
continuous care pathway, and to bring an additive /synergistic
effect in terms of overall outcomes and impact.

37. What is Continuum of Care?
Continuum of care guides and directs patients over time through a
comprehensive array of health services spanning all levels and intensity of care. In
other words, that care might begin when someone is born and end with
supportive services to the family when he dies.

39. Other Interventions under
National Health Mission
focusing on newborns

40. JANANI SURAKSHA YOJNA
 Launched on 12th April 2005
Modification of National Maternity Benefit
scheme
Objective
Reducing IMR & MMR through increased
delivery at health institutions

41. NAVAJAT SISHU SURAKSHA KARYKRAM
 Navjat Shishu Suraksha Karykram (NSSK)
Launched on September 15, 2009
 Focuses on:
 Prevention of Hypothermia
 Prevention of Infection
 Early initiation of Breast feeding
 Basic Newborn Resuscitation
 Objectives: To train healthcare providers at
DH, CHCs and PHCs

42. JANANI SISHU SURAKSHA KARYKRAM
 JSSK supplements the cash assistance given to a
pregnant woman under Janani Suraksha Yojana and is
aimed at mitigating the burden of out of pocket expenses
incurred for pregnant women and sick newborns.
 Aims to offer completely free and cashless services,
including normal or caesarian delivery in all the
government hospitals.
 The scheme also envisages free treatment for a sick
new born (up to 30 days after birth) in any government
health institution in rural or urban areas & transportation
facilities

43. F-IMNCI
From November 2009 IMNCI has been re - baptized as
F-IMNCI, (F -Facility) with added component of:
Asphyxia Management and Care of Sick new born at
facility level, besides all other components included under
IMNCI
.

44. Facility Based Newborn Care (FBNC) (2011)-
Newborn care facilities at various levels of public health
services that includes Newborn Care Corners (NBCCs) at
all points of childbirth to provide immediate care; Newborn
Stabilization Units (NBSUs) at CHC/FRUs for management
of selected conditions and to stabilize sick newborns before
referral to higher centres; and Special Newborn Care Units
(SNCUs) at district/sub-district hospitals to care for sick
newborns (all types of care except assisted ventilation and
major surgeries)

45. HOME BASED NEWBORN CARE (HBNC)

46. KEY ACTIVITIES IN HBNC
 Care for every newborn through a series of home
visits in the first 6 weeks of life.
 Information and skill to the mother
 Examination of every newborn for prematurity
 Extra home visits for preterm and LBW babies
 Early identification of illness
 Follow up of sick newborns after they are
discharged from facilities
 Counseling the mother on postpartum care
 Counseling on family planning

47. HBNC
Home visits
Home deliveries: 1st, 3rd,7th, 21st, 28th and 42nd day
Institutional deliveries: 3rd, 7th, 14th, 21st, 28th and 42nd
 Services offered:
 Essential care of the newborn
 Examination of the newborn
 Early recognition of danger sign
 Stabilization % Referral
 Counseling of mother for Breastfeeding
 Warmth
 Care of the baby
 Immunisation
 Postpartum care & Use of family planning methods

48. Rashtriya Bal Swasthya Karyakram
(RBSK)(2013)
Screening of children with birth defects, diseases,
deficiencies, and developmental delays (including
disabilities) All children, ages 0 to 18 years targeted

49. THANK YOU