Indian Newborn Action plan

1. Indian Newborn Action Plan
Dr Medha Sharma
MBBS ,MD Community medicine
23-09-2023 1

2. • 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 India Newborn Action Plan (INAP) is India’s committed response to the
Global Every Newborn Action Plan (ENAP).
• Launched in September 2014
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3. Milestones in Child Survival Programmes in
India
1992
• Child
Survival &
Safe
Motherho
od
Programm
e (CSSM)
1997
• RCH I
2005
• RCH II
2005
• National
Rural
Health
Mission
2013
•
RMNCH
+A
Strategy
2013
• National
Health
Mission
2014
• India
Newborn
Action Plan
(INAP)
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4. INAP lays out a vision and a plan for India
To end preventable
newborn deaths
Accelerate progress
Scale up high-impact yet cost
effective interventions.
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5. INAP supported by
Goals
Strategic intervention
Packages
Priority actions
Monitoring framework
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6. Goal
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7. Goal 1: Ending Preventable Newborn Deaths to achieve “Single Digit
NMR” by 2030, with all the states to individually achieve this target by 2035
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8. Goal 2: Ending Preventable Stillbirths to achieve “Single Digit SBR” by
2030, with all the states to individually achieve this target by 2035
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9. Principles
• Identifies major guiding principles under the overarching principle of
integration:
• Equity
• Gender
• Quality of care
• Convergence
• Accountability
• Partnerships
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10. Principles
• Reducing disparities in health care access
Equity
• Strategies and actions for girl child’s survival and health
Gender
• Strengthening capacities for task-shifting & multi-skilling
• Ensuring quality for trainings
• Supportive Supervision
Quality of care
• To address newborn health, MOHFW needs to work in synergy with different departments
in India like WCD, Edu. etc
Convergence
• With Panchayati raj, self help group, private sector, academic institution
Partnership
• Strong governance can ensure accountability and transparency in health systems
• Meas. Impact of good Governance involve CP in decision making , regular audits of clinical
services & strengthening of Civil Registration system.
Accountability
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11. INAP & Its Emergent need 2014
44%
59%
0% 20% 40% 60% 80%
Neonatal Death
Under-5 Child
Reduction in NMR & U5MR
42%
58%
Contribution of neonatal deaths to under-
5 deaths
Contribution -
Neonatal death to
under 5 death
(1990)
Contribution -
Neonatal death to
under 5 death
(2012)
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12. Situational analysis 2014
68
63
58
55
53 53
47
69
59
53
44
40
37 37 35 33
29
0
10
20
30
40
50
60
70
80
2000 2002 2004 2007 2008 2010 2012
Child deaths in India for years 2000- 2012 Infant mortality rate
Under 5 mortality
rate
Neonatal mortality
rate
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13. Causes of neonatal Deaths in India
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14. Timing of Deaths
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15. 23-09-2023 17

16. Action Plan
Strategic approach
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17. Strategic Intervention Packages
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18. Priority action
1. Pre conceptional and antenatal care
1. Delaying age at 1st pregnancy
2. Train service providers and availability of commodities of FP
3. Provide PPIUCD
4. Train an adequate numbers of ANMs (including ANC component)
5. Scale up nutritional interventions (Folic acid ,Ca & IFA)
6. Strengthen convergence for nutrition counselling
7. Screening of high-risk pregnancies
8. Malaria interventions for pregnant women in endemic area
9. Promote counselling and birth preparedness
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19. Priority action
2.Care during labour & child birth
1. Strengthen public health facilities
2. MCH wings in high case load
facilities
3. Trained health workers at all delivery
points.
5. Establish Quality Assurance
mechanism at each level
6. Institutionalize referral mechanism
7. Improving management of preterm
labor
8. Supportive supervision
9. Generate awareness on JSSK
entitlements, promote community
participation
10. Sound surveillance system for
tracking stillbirths
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20. Priority action
3.Immediate newborn care
1. Establish fully functional NBCCs at all delivery points
2. NSSK-trained staff
3. Standardized protocols for essential newborn care
4. Develop Quality Assurance mechanisms
5. Regular quality audits
6. Availability of Vit k injection
7. Strengthen counselling for breastfeeding, postnatal care, and community and
home care practices
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21. Priority action
4.Care of healthy new born
1. Rational deployment of ASHAs
2. Capacity-building of ASHAs
3. Ensure uninterrupted supply of ASHA HBNC kits
4. Ensure timely payments of HBNC incentives for ASHAs
5. Monitoring of HBNC visits, with regards to quality and
coverage
6. Implementation of standardized norms
7. Ensure availability of vaccines and logistic support for
immunization at all delivery points.
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22. Priority action
5.Care of Small and Sick Newborn
• Standardized clinical guidelines at all levels
• Fully functional NBSU& SNCU
• Upgrade NICU (ventilation & surgeries)
• Operationalize SNCU monitoring software's
• Institutionalise network of regional / state FBNC collaborating
centres & Medical colleges
• Ensure timely availability of logistics & drugs
• Quality training
• Develop quality assurance mechanism
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23. Priority action
6.Care beyond newborn survival
1. Screening of birth defects and developmental delays.
2. Deploy mobile health teams
3. Establish fully functional District Early Intervention Centers (DEICs)
4. Institutionalize a robust referral mechanisms
5. Establish center of excellence at tertiary care hospitals for management of birth
defects
6. Follow up of all sick/high-risk newborns discharged from the SNCU for a period
of one year by ASHAs
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24. Bottle neck analysis
• India used a systematic and standard approach , to analyze the challenges and
implementation issues for newborn health packages.
• The BNA tool analyzed nine interventions.
• Each intervention was reflected in a “tracer interventions” used as “proxy
indicator”
• The BNA has helped to get a clear understanding of the gaps and challenges with
regards to two specific aspects viz. human resources for health, and quality of
care.
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25. Bottle neck analysis
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26. Indicators
Impact Level Indicators • Birth registration
• Stillbirth rate
• Early neonatal mortality rate
Pre-Conception &
Antenatal Care
• Births to women aged 15 -19 years out of total births (Teenage pregnancy)
• % of pregnant women who received full ANC
Care during Labour and
Child Birth
• % of safe deliveries
• % of preterm births
• C- section rate
Immediate
Newborn Care
• % of newborns
• BF within one hour of birth,
• Receiving vitamin K at birth
• Weighed at birth
• % of LBW babies
Care of
Healthy Newborn
• Percentage of newborns received
• schedule of home visits
Monitoring & Evaluation Framework
• -
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27. 64
78
44
23
79.2
88
41
18
% of First trimester
registeration pregnancy
% of Institutional deliveries % of NB BF with in one
hour
%of LBW
Indicators
2013 2020
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28. Coverage Targets
2017 2017
target
2020 2020
target
2025
target
2030 target
Safe delivery (institutional + home delivery by SBA) 81 90 88 95 95 95
Initiation of breastfeed with in one hour 45 75 41 90 90 90
Women with preterm labour receiving atleast one dose of
antenatal corticosteroids
75 90 95 95
Babies born in health facilities with birth asphyxia received
resuscitation (%)
75 90 95 95
Babies received complete schedule of home visits under
HBNC by ASHA (%)
50 75 95 95
Newborn with sepsis in the community received
Gentamicin by ANM (%)
50 75 75 75
Newborn discharged from SNCU followed until age one (%) 35 50 75 75
Newborn with low birth weight/ Prematurity managed
with KMC at facility (%)
35 50 75 90
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29. Interventions under NHM
focusing on newborns
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30. Interventions under National Health Mission focusing on
newborns
Programme (Year) Objectives Status
Janani Suraksha Yojana
(JSY) (2005)
Safe motherhood intervention to
increase institutional delivery through
demand-side financing and
conditional
cash transfer
Expenditure on scheme has increased from Rs 38 crores to
FY 2005 -06 to Rs 1725 crores in FY 2021-22
Integrated
Management
of Neonatal and
Childhood Illnesses
(IMNCI) at the
community level and
F-IMNCI at health
facilities (2007)
Standard case management of major
causes of neonatal and childhood
morbidity and mortality Operationalized in >500 districts
• 26,800 M.O. and specialists trained under F-IMNCI
38
1725
FY 2005-06
FY2020-21
Expenditure
Crore
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31. Programme (Year) Objectives Status
Navjat Shishu Suraksha
Karyakram (NSSK)
(2009)
Basic newborn care and resuscitation
training programme
1.3 lakh health providers trained to date
Janani Shishu Suraksha
Karyakram (JSSK)
(2011)
Zero out-of-pocket expenditure for
maternal and infant health services
through free healthcare and referral
transport entitlements
FY 2020-21 >1.29 crore availed benefits
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32. Programme (Year) Objectives Status
Facility Based
Newborn
Care (FBNC) (2011)
 Newborn care facilities at various
levels
• Newborn Care Corners
(NBCCs) at all delivery points
• Newborn Stabilization Units
(NBSUs) at CHC/FRUs
• Special Newborn Care Units
(SNCUs) at district/sub-
district hospitals
548
914
1810
2579
14135
20337
2013
2020
FBNC
NBCC NBSU SNCU
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33. Programme (Year) Objectives Status
Home Based Newborn
Care (HBNC) (2011)
• Provision of essential newborn
care
• Special care of preterm and
LBW
• Early detection of illness
followed by referral
and support by ASHA worker
FY 2020-21 >1.33 crore newborn Home visited by ASHA
Rashtriya Bal
Swasthya
Karyakram (RBSK)
(2013)
Screening of children with
birth
• Defects
• Diseases
• Deficiencies
• Developmental delays
• All children, ages 0 to 18 years targeted
• More than 8 crore children screened and more than
10 lakhs children identified for tertiary care in 2013
12
133
0 20 40 60 80 100 120 140
FY 2013
FY2020-21
Lakh
10
161
0 50 100 150 200
FY 2013
FY2020-21
Lakh
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34. Initiatives for Strengthening newborn Care
(Guidelines)
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35. Policy decision to strengthen the maternal
health
• Distribution of Misoprostol by ASHAs in home delivery cases
• Calcium supplementation during pregnancy
• Screening for
• Gestational Diabetes
• Hypothyroidism
• Congenital Syphilis and Hepatitis B
• De-worming during pregnancy
• Ultrasonography during pregnancy
• Training of Surgeons for C- section
• 3-day hands-on training programme for intrapartum and newborn care
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36. GOAL & Current status
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37. Goal 1: Ending Preventable Newborn Deaths to achieve “Single Digit
NMR” by 2030, with all the states to individually achieve this target by 2035
29
24
21
15
9
29
23
22
0
5
10
15
20
25
30
35
2013 2017 2020 2025 2030
Neonatal Mortality Rate
Targets
Real Outcome
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38. Goal 2: Ending Preventable Stillbirths to achieve “Single Digit SBR” by
2030, with all the states to individually achieve this target by 2035
22
19
17
13
9
22
15
13
4
5
3
0
5
10
15
20
25
2013 2017 2020 2025 2030
Still Birth Rate
Target UNICEF Outcome SRS Outcomes
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39. Way Forward
• According to National Health account data
• FY 2018 -19= 1.28 % of GDP
• 1.35 % of GDP in 2017-18
Health expenditure
• This needs to be increase in Both quantity & Quality
Infrastructure & Systemic
changes
• Concerned ministries can collaborate with each other for coordination
, convergence & holistic integration
Integrated approach
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40. Way forward
• Consistency & Sustainability of ongoing efforts
Consistency
• Newer Initiative
• Like SNCU online
Scaling up
• To address the problem of unidentified causes, scientists, expert
bodies, like ICMR need to work
• eg Gorakhpur scientist identified AES prevalence to JE Virus
Research
• Private Sector sincere engagement and complementing role to the state
can ease down the burden of the government.
Private Sector
Participation:
• Availability of funds as well as its judicious use by state is vital in
effective implementation n framed policies
Political will
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41. References
• IAPSM's textbook of community medicine 2nd edition
• K. Park's textbook of preventive and social medicine 26th Edition
• India Newborn Action Plan (INAP) :National Health Mission 2014
• Rapid Survey On Children (RSOC) 2013
• UNICEF DATA - Child Statistics 2022
• Sample Registration System (SRS) Statistical Report 2019,2018,2017,2022
• National Family Health Survey (NFHS-5,4,3,2) - rchiips.org
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42. Thank
you!!!
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