INDIA NEWBORN ACTION PLAN

BY
DR. KRITI SINGH
JR-II11
GSVM MEDICAL COLLEGE, KANPUR
1
9/30/2019

 Introduction
 Every Newborn Action Plan & Global Targets
 Milestones in Child Survival Programmes
 India Newborn Action Plan
 Current Mortality Trends - India
 Goals & INAP – National Targets
 Facility based Newborn Care Database
 Guiding Priniciples
 The Strategic package Interventions & Priority Actions
 Milestones for INAP Monitoring
 Levels and Indicators
Total no of Slides 47
29/30/2019

 The India Newborn Action Plan (INAP) is India’s committed response to the Global Every
Newborn Action Plan (ENAP), launched in June 2014 at the 67th World Health Assembly
advancing the Global Strategy for Women’s and Children’s Health.
 The ENAP sets forth a vision of eliminating preventable newborn deaths and stillbirths in
world.
 INAP lays out a vision for India to end preventable newborn deaths, accelerate progress, and
scale up high-impact yet cost effective interventions.
 Built on existing commitments under the National Health Mission and 'Call to Action' for
Child Survival and Development
 Guided by the principles of Integration, Equity, Gender, Quality of Care, Convergence,
Accountability, and Partnerships.
 Six pillars of intervention packages across various stages with specific actions to impact
stillbirths and newborn health. .
 To reduce preventable newborn deaths and preventable stillbirths to single digits, i.e., fewer
than 10 per 1,000 live births by 2030.
 The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the
goal is achieve. 39/30/2019

At the 2014 World Health Assembly all 194 Member States endorsed Every Newborn action plan.
Implementing ENAP is fundamental to the achievement of UNICEF’s Every child alive campaign and
the “triple billion” targets of WHO’s 13th General Programme of Work.
 ENAP is aligned with the sustainable development goal (SDG) target 3.2 and the Every Woman, Every
Child Global Strategy for Women’s, Children’s and Adolescents’ Health 2016−2030.
 Newborn deaths account for 47% of all under-5 mortality, or 7000 deaths per day.These events are by
far the largest cause of early mortality (0−49 years) as estimated by the Global Burden of Disease
2017.
 Goal 1.Ending preventable newborn deaths.
 A neonatal mortality rate (NMR) of 15 per 1000 live births was set as the interim target for 2020. At
the current rate of progress, 32% of the 90 countries reporting to the Every Newborn Tracking tool in
2018, will not meet this 2020 target.
 Goal 2. Ending preventable stillbirths.
 A stillbirth rate (SBR) of 14 per 1000 total births was set as the interim target by 2020. It is
estimated that 59% of the 90 reporting countries will not meet this target by 2020. Only 32% of
countries have defined a stillbirth reduction target.
49/30/2019

 Within the 90 reporting countries completing the Every Newborn tracking tool, 10
with the highest newborn mortality reductions have been termed “fast
progressors”; Afghanistan, Bangladesh, Ethiopia, Ghana, Guinea-Bissau, India,
Nepal, Pakistan, Sierra Leone and Zimbabwe had a reduction of between 3.7 and
4.8 newborn deaths per 1000 live births in the past 5 years (2013-2018).
59/30/2019

 1992 – Child Survival and Safe Motherhood Programme (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)
89/30/2019

 Newborn health has now come to the attention of policymakers and UNICEF.
 The Indian government has introduced two landmark programmes the National Rural Health Mission
(NRHM) and the Reproductive, Maternal, Newborn, Child and Adolescent Strategy (RMNCH+A Strategy).
 India Newborn Action Plan (INAP) aims to significantly reduce preventable newborn deaths and
stillbirths and to bring down the Neonatal Mortality Rate and Still Born Rate to “single digits” by
2030.
 Emphasizes strengthened surveillance mechanism for tracking stillbirths.
 Prioritizes those babies that are born too soon, too small, or sick—as they account for majority of all
newborn deaths.
 Focuses on ending preventable newborn deaths, improving quality of care and care beyond survival.
 Aspires towards ensuring equitable progress for girls and boys, rural and urban, rich and poor, and
between districts and states.
 Identifies major guiding principles under the overarching principle of Integration: Equity, Gender,
Quality of Care, Convergence, Accountability, and Partnerships.
 Defines six pillars of interventions: Pre-conception and antenatal care; Care during labour and
childbirth; Immediate newborn care; Care of healthy newborn; Care of small and sick newborn; and
Care beyond newborn survival.
109/30/2019

 Countries around the world aim to reduce preventable deaths of infants and neonatal mortality to
at least as low as 12 per 1000 live births (SDG 3.2).
 The latest UNICEF report placed India’s NMR at 25.4 per 1000 live births, ranging between 10 in
Kerala & Goa, and 44 in Bihar & Uttarakhand.(Uttar Pradesh-
 In India; As per the estimations made by Lancet (2011) the current stillbirth rate is 22 per 1000 total
births, there are wide interstate variations.
 As per the national HMIS 3,03,857 stillbirths were reported for year 2015-16.
 Amongst the total stillbirths deaths are (45%) intra-partum and (56%) antepartum.
 The states of Uttar Pradesh, Madhya Pradesh, Rajasthan and Bihar contribute to more than half of
newborn and under-five deaths in India.
 India has witnessed a significant reduction in the number of neonatal deaths from 1.35 million in
1990, to around 0.76 million in 2012.
 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%.
119/30/2019

CHILD HEALTH INDICATOR CURRENT STATUS NHP TARGET
IMR(Infant Mortality Rate) 33 28 by 2019
Neonatal Mortality Rate 23 16 by 2025
Under 5 Mortality Rate 37 23 by 2025
SRS 2017
129/30/2019

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
189/30/2019

 Integration:
 The RMNCH+A approach recognizes that newborn health and survival is inextricably linked to
women’s health across all life stages.
 It inter-links each of the five life stages, with newborn health as a distinct life stage, and it
connects community outreach and facility-based services.
 The six key principles that guide INAP are:
1. Equity would be strengthened by community strategies to improve demand for services, birth
preparedness, and essential newborn care practices, including home visits by community health
workers and participatory women’s groups, especially in the urban slums.
2. Gender based differences in decision-making, power, and resource-access have consequences for
the quality of life of the populations, including its health.
3. Quality of Care formulation of comprehensive HRH policy in concurrence with NHM,
strengthening capacities for task-shifting and multi-skilling, ensuring quality for trainings and
supportive supervision. 259/30/2019

4. Convergence
 Socio-cultural and community attributes—e.g., status of women, gender and equity influenced
by caste, class, geography, residence, income, etc.—affect newborn outcomes.
Individual attributes—sex of a child, birth order, previous birth intervals, mother’s age at
marriage, conception and size at birth—are also important.
Structural attributes, malaria is an important cause of maternal and child morbidity and
mortality, while HIV/AIDS also contributes towards increasing newborn morbidity.
 Intradepartmental convergence with National Vector Borne Disease Control Programme
(NVBDCP) and National AIDS Control Programme (NACP) is vital to reduce disease-specific
burden.
 In order to address newborn health, the Ministry of Health & Family Welfare needs to work in
synergy with eight different departments in India:
The Department of Women and Child Development, Panchayati Raj, Social Justice &
Empowerment, Water and Sanitation, Rural Development, Urban Development, Food and
Civil Supplies & Public Distribution, and Education.
269/30/2019

5. Partnerships
 Partnership with academic institutions and professional bodies (National Neonatology
Forum, Indian Academy of Pediatrics, etc.) can play a key role in advancing knowledge
through the study and practice of evidence-based newborn interventions.
 Partnerships with Panchayati Raj Institutions (PRIs) and Self-Help Groups (SHGs) have a
critical role in implementing National Health Mission at the cutting edge both in rural and
urban areas.
6. Accountability
 In line with commitments under Commission on Information and Accountability for Every
Woman Every Child strategy (COIA), Civil Registration and Vital Statistics (birth and death
registration with cause of death assignment) would be progressively strengthened for
counting every newborn.
279/30/2019

Pre-conception
&
Antenatal care
Care during labor
&
childbirth
Immediate
newborn care
Care of healthy
newborn
Care of small
&
sick newborn
Care beyond new
born
&
survival
299/30/2019

The states are urged to develop their action plan based on the Six
Packages described below.
 Essential [E], to be implemented universally.
Situational [S], implementation dependent on epidemiological
context
Advanced [A], implementation based on health-system capacity of
the state/district
309/30/2019

 1. Prioritize actions for delaying age at 1st pregnancy, with special focus on teenage
pregnancy
 2. Train an adequate number of service providers for Family Planning Services as per
FP 2020
 Saturate high caseload facilities to provide PPIUCD
 Train an adequate numbers of ANMs in SBA (including ANC component)
 Scale up nutritional interventions of peri-conceptional folic acid, maternal calcium
supplementation, and iron folic acid supplementation (NIPI/WIFS). Strengthen
nutrition counselling
 Screening of high-risk pregnancies and their management as per protocols
 Accelerate preventive measures against malaria for pregnant women in endemic area
 Promote counselling and birth preparedness
329/30/2019

 Prioritize and strengthen public health facilities for conducting safe delivery,provision of emergency obstetric care.
 Provision of dedicated MCH wings in facilities with high caseload, including functionalWASH facilities
 All delivery point with trained health workers:
 Ensure trainedand skilled staff at all designated delivery points:
 L1 delivery point should have SBA trainedANMs/SNs, L2 delivery point to have at least one BEmOC trained MO,
and
 L3 delivery point must have at least four obstetrician & gynaecologist /CEmOC trained MOs and four
Anaesthetist/LSAS trained MOs.
 Expand the availability of SBA-trained birth attendants. In addition to ANM, SBA training to be rolled out for AYUSH
doctors.
 Accelerate scale-up of new policy decisions on management of preterm labour through use of antenatal
corticosteroids and antibiotics for premature rupture of membranes
 Develop a mechanism of supportive supervision through existing systems or through partnerships at theregional and
state level.
 Generate awareness on JSSK entitlements, promote community participation, and demandfor safe institutional
delivery
 Establish a sound surveillance system for tracking stillbirths. Institutionalize referral mechanism to ensure to-and-
fro referral.
349/30/2019

 Establish fully functional NBCCs at all facilities conducting deliveries
 Saturate all facilities conducting deliveries with NSSK-trained staff
 Implement standardized clinical protocols for essential newborn care, including
resuscitation
 4. Develop Quality Assurance mechanisms/cells to monitor training quality and
adherence to standardprotocols.Regular quality audits of facilities, including death
audits
 Ensure availability of Injection Vitamin K at all delivery points and its inclusion in
the state’s Essential Drugs List
 Strengthen counselling for breastfeeding, postnatal care, and community and
home care practices
369/30/2019

 Capacity-building of ASHAs to provide newborn care at the community level
 Ensure uninterrupted supply of ASHA HBNC kits and replenishment thereof, from
PHC inventory
 Ensure timely payments of HBNC incentives for ASHAs
 Set up mechanisms for monitoring of HBNC visits, with regards to quality and
coverage
 Ensure availability of vaccines and logistic support for immunization at all delivery
points
389/30/2019

 Establish fully functional NBSUs, SNCUs with priority to High Priority Districts
(HPDs) and scale up KMC unit/wards on the existing FBNC system
 Saturate all districts in the state with fully functional SNCUs followed by all
facilities with >3000 deliveries/year
 Upgrade NICUs at the medical colleges/tertiary care facilities to provide referral
services for advanced newborn care support (ventilation, surgery) at regional level,
and to strengthen linkages with SNCUs andNBSUs5. Operationalize SNCU monitoring
software across all SNCUs / NICUs.
 Scale up new operational guidelines, allowing ANMs to administer injectable
antibiotics for neonatal sepsis
409/30/2019

 Train all levels of service providers engaged in screening of birth defects and
developmental delays. Deploy trained mobile health teams for screening
 Establish fully functional District Early Intervention Centres (DEICs)
 Institutionalize a robust referral mechanisms between screening points and District
Early Intervention Centres (DEICs)
 Establish centres of excellence at tertiary care hospitals for management of
conditions, especially the birth defects requiring surgical correction
 Screen birth defects by the service providers at the facility and in community by
ASHAsduring home visits
 Facility-based follow-up of small and sick babies for developmental delay and
appropriate management
 Follow up of all sick/high-risk newborns discharged from the SNCU for a period of one
year by ASHAs
429/30/2019

INDIA NEWBORN ACTION PLAN

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