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Indian Academy of Pediatrics IAP-AAP-LDSC

First Golden Minute Project

(Under academic grant from Johnson & Johnson, India)

Basic Newborn Care and Resuscitation Program

For Private sector

Administrative Manual

Compiled by –

Naveen Thacker

CP Bansal

Vineet Saxena

Vikas Goyal

Sailesh Gupta

Tanmay Amladi

Rhishikesh Thakre

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Introduction

This Project aims towards dealing with the “Birth Asphyxia” which is rightly

considered as one of the leading cause of Neonatal Mortality in our country.

It was proved by many studies that:

1. We are very well equipped with technical knowledge and skills in dealing with

Birth Asphyxia. If we are able to save these new born by very basic skills –

we can certainly make a favorable and palpable dent in high NMR.

2. Certain other basic steps like – Prevention of infection, temperature

maintenance, early initiation of effective Breast Feeding and Kangaroo Mother

Care – can further improve a “neurologically intact” survival of newborn.

Keeping this in mind the IAP has started - The IAP NRP First Golden Minute Project

- today it is one of the biggest Health Projects of its kind in the world, with a

tremendous track record of success story. The program basically has two components

1. Basic New Born Care – which comprises of ;

a. Resuscitation of newborn baby (upto using Bag and Mask – for

providing Positive Pressure Ventilation) – As by doing this basic skill

effectively one can ensure successful resuscitation of 99% of

asphyxiated newborns.

b. Care of baby at birth

c. Prevention of infection

d. Thermal protection (with KMC)

e. Feeding of Normal and LBW babies

f. Transport of Newborn

2. Advanced NRP

Comprising of all nine chapters of Text Book of NRP along with latest

NRP guidelines.

.

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The BNRP program was launched in Govt Sector by Ministry of Health and Family

Welfare as Navajaat Shishu Suraksha karyakram (NSSK) – with IAP as its nodal

agency for technical inputs and arranging resource persons. Members of IAP have

contributed tremendously in implementation of this program and today IAP enjoys

great respect and trust in implementing such programs.

Theme of BNRP There is a need for Basic Newborn Care and Resuscitation Program in every

city/district to impart this training of Basic Skills of Neonatal Resuscitation – we also

have challenging task to bring awareness for this program and change the attitude

towards the immense effectiveness of this Program among medical personnel.

The BNRP intends to train all the health personnel of Private Sector involved in

conducting deliveries in Basic New Born care and Resuscitation.

This can only be done by imparting the basic skills of neonatal resuscitation by

practical training and then testing those skills before leveling them as BNRP trained

birth attendant. Such training courses will be organized by IAP at various levels under

academic grant from J & J India, during next three years.

It is certainly an arduous task but IAP has taken it as a mission and the missionary

zeal shown by the fellow members is certainly commendable.

Structure of Course and course coordination In the next 3 years many Basic Newborn Care and Resuscitation Program in

Private Sector courses will be conducted in India under academic grant from

Johnson and Johnson, India. It is suggested that every Basic Newborn Care and

Resuscitation Program Course should be coordinated by a Course Coordinator. It is

further suggested that Course Coordinator should be preferably President of Local

IAP Branch or a person identified by him in consultation with State Academic

Coordinator.

In these courses the participation of Medical Personnel from Private

sector will be preferred. However if a medical personnel or

pediatricians from Government sector wish to join or attend they can

very well do so.

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This write up provides step-by-step suggestions for planning a course by Course

coordinator, including a sample timeline, a discussion of pre-course administrative

details, selection of a program format, and organization strategies for Basic Newborn

Care and Resuscitation Program course supplies and equipment. Preparation practice

will vary, depending on the course type, format, and number of participants involved.

Wearing the “IAP FGM” Instructor’s Batch is Mandatory.

Types of Courses Basic Newborn Care and Resuscitation Program for Private Sector under FGM

Project offer Provider Courses, and Trainer Courses.

A Provider course is designed for healthcare professionals involved in any aspect of

newborn care and neonatal resuscitation. This usually includes Pediatricians,

Obstetricians, Anesthetists, Medical officers, Staff Nurses and paramedic staff in

private hospitals. This course teaches a stepwise approach to basic neonatal

resuscitation and care of newborn at birth.

The provider course are -

1. One day duration (NSSK part 1) by completing it, the provider will get

certificate for Part 1 only.

2. Two day duration (NSSK part 1 &2); It may be completed on two consecutive

Sundays or on two consecutive days (which ever is convenient to local

organizers and participants. They will be provided certificate of completing

“Full Course”.

A Trainer course is designed primarily to train pediatricians who can carry forward

Basic Newborn Care and Resuscitation Program.

The trainer courses could be-

1. Regional training of Trainers course – organized once a year and the participation

is by invitation based on the recommendations of State Academic and Zonal

coordinators and approved by steering committee.

2. District training of Trainers courses – Organized in a major city with 4 potential

personnel from surrounding 8/9 districts, the invitees are based on

recommendations of state IAP President and State academic coordinators.

For, Trainer and Provider courses the potential candidates in either category must be

carefully chosen considering their experience of working in maternity and neonatal

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facilities, and must successfully complete training requirement given elsewhere. Their

willingness and commitment to work for this mission must be carefully judged.

ROAD MAP IAP NRP FGM Basic Newborn Care and Resuscitation Program

(Private Sector)

Calculating the training load and the basic structure

1. First we should find out the number of Districts in a State in which we wish to start program.

2. We propose to make 4 District Trainers in each District. Hence, to calculate the number of District Trainers in a state we have to multiply the No of Districts with 4, it will give us the number of Districts Trainers needed in that state.

3. To calculate the Training of Trainers (ToT) workshop number we have to divide the Number of District Trainers in a particular state by 40. As in one Training of Trainers - 40 District Trainers will be trained. (These will be labeled as District Instructor’s Training of Trainers Workshop).

4. Now these District Trainers will be responsible to conduct Provider Courses in their respective Districts and they will be training all the Private Sector Pediatricians, Obstetricians and Gynecologists and Nursing Home doctors – these will be labeled as District Provider Courses.

Two Paramedical staff from each private maternity service provider center will also be trained; hence their number should also be calculated.

5. The District Trainers should preferably be Pediatricians and IAP members but if O&G members are willing to become trainer, they can also be trained as District Trainers.

These courses are based on lessons 1 to 6 of NSSK Training Manual

of Basic Newborn care and Resuscitation Program (MOHFW, GOI,

2009). Please note it is meant for poor resource settings where skilled

manpower and / or instruments are not available. The manual will be

available in regional languages as soon as it is essential for training

of Nurses, ANMs and paramedic workers of private medical facilities.

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Example in Madhya Pradesh

1. Total number of ditricts in MP : 50 2. Total number of trainers needed 4 @ District: 200 3. Total number of Training of Trainers = 40 @ Training of Trainers: 5

(Gwalior, Bhopal, Indore, Jabalpur and Rewa)

Big cities may have more number of District ToTs – depending upon the population

Selection of Participants 1. Participants for Training of Trainers – i.e. Potential District Trainers should be

selected by State academic coordinator in consultation with the Local IAP President and Secretary – they should preferably be Pediatricians and IAP members.

2. The selection should be made only after considering the merits of candidates (teaching skills, academic understanding and willingness to propagate the skills of Basic New born Care)

3. The final list has to be sent for approval to steering committee of IAP NRP FGM.

6. The Participants will have to give an undertaking that they will promote and propagate the mission of NRP FGM.

Release of Finances for the Courses 1. The finances for these courses will be released through Central IAP 2. Finances for the Training of Trainers (ToT) workshop will be rendered by

Central IAP to the organizing branch as per recommendations of State Academic and Zonal Coordinators

3. For provider courses the organizing branch shall submit the THREE MONTH program with dates to the State Academic and Zonal Coordinators. Then they will be entitled for the release of advance payment (about 75%) the final payment will be made ONLY after submission of actual bills and the dully filled course roaster.

Course Schedule 1. The Training of Trainers (ToT) courses will be two consecutive days – and the

course will run nonstop as mentioned in the guidelines of courses. 2. The Provider course is also of two days and should “preferably” be on two

consecutive days – but if the participants or the local IAP organizers feel they can spread the course in two consecutive sundays, it would be acceptable (as the trainers of such courses will be local only).

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3. The participants of Provider course may also opt for just Part 1 Provider course which will comprise of lesson 1 and 2 of NSSK Manual.

Guidelines for Training of Trainers (TOT) Program

1. It should be a two day program of 18 hours duration. 2. Many District trainers were trained in Basic New born Resuscitation in last

two years. Similarly regional trainers were trained at Bangalore Training of Trainers during Pedicon 2009. New program includes other components of newborn care and there are many changes in resuscitation component also including algorithm which is adopted from NSSK Training manual. To be eligible for becoming Trainers in FGM Basic New born Care and Resuscitation Program, all these trainers have to undergo a reorientation Program of 15 hrs duration over two days or they can attend Training of Trainers of 18 hrs over two days. This is essential so that they may become well versed with the present status of and style of conducting workshop using NSSK manual. If the number of DI is less in some state than such reorientation course can be done jointly for 2-3 states.

3. Training of Trainers for District Trainers for Pvt Sector will be two day course as per the set roster of NSSK manual. The city will be decided by the State Academic coordinators of NRP FGM in consultation with State IAP President and Secretary; local IAP will coordinate it as per the mentioned guidelines under central IAP.

4. Participants will be invited from nearby Districts of the city where Training of Trainers is being organized. After getting the approved list from Steering Committee.

5. Five National/Regional Trainers will conduct each of such Training of Trainers; this Training of Trainers will be coordinated by state academic coordinators. They will plan the course and seek permission from Zonal coordinator.

6. The lead trainer (appointed by Zonal coordinator) will decide the faculty in consultation with zonal coordinator and will be responsible for smooth conduction of all stations and time management for each lesson and skill.

7. The Local IAP office bearers will be responsible for arranging all logistics. They should ensure that all the participants receive the manual at least a fortnight before the scheduled date of course – and they MUST read it before the course.

8. The training kits should remain with the IAP office bearers, and they should ONLY be used for training purposes.

9. From bigger cities more numbers can be selected but the Total number of DIs of the state should remain constant (i.e. four per District).

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10. One set of resuscitation kit will be given to each participant (who will be designated as District Instructor), but they should keep them with local IAP office and should use them only for training.

11. District Trainers will conduct District Provider courses of Basic Newborn care and resuscitation in respective Districts.

12. In cities or districts where there is no IAP Branch there we should identify a Paediatrician {an active iapian to work as IAPNRP FGM Coordinator (with consultation of state academic coordinators)}.

Guidelines for District Provider Courses Aim: to train all the Pediatricians, Gynecologists and 2 paramedical from each Nursing Home. Calculating the load Total No of Pediatricians + Total No of Gynecologists + 2 Paramedic from each maternity service provider setup = Total number of participants in a particular District. Total Number of Participants divided by 40 will give the Total number of provider courses needed. For Example in MP

-­‐ Pediatricians – 1500 -­‐ Gynaecologists – 2500 -­‐ Nursing Homes + Private Hospitals – 500 -­‐ Total Number of courses - 141

o Total No. of Doctors - 4000 @ 32/course = 125 o Total no paramedics 1000 @32/course = 32

1. The Designated District Trainers - shall be responsible for conducting District Provider courses

2. These courses shall be of two days – strictly restricting to the roster of present NSSK teaching. However as mentioned earlier if the participants or local organizers feel it can be stretched to consecutive Sundays.

3. Ratio of trainer to participant shall be maximum 1:8. 4. The budget for these courses will be as mentioned, and will be released as per

the set frame – explained earlier. 5. State academic coordinators shall supervise these course and if a city has a

National trainer than he/she must be involved as an expert and must be given due acknowledgement. The sanctity must be maintained in every District Provider course and all components MUST be accomplished sincerely.

6. District Provider Courses will be organized at District places and shall be programmed as per local traditions – Total of 18 hours should be devoted for one course (can be stretched to two consecutive Sundays).

7. All the stationary (filled pre & post-test, written and performance evaluation) forms with final marks tally with course roster MUST be sent to State

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academic coordinator of state with a copy marked to Central Office of IAP and National Coordinator.

Feedback Form

Every course will have feedback form to be seriously filled by Participants. It will be

a feedback about trainers and also about the arrangements of the course

Common Questions about Pre-course Planning

How do I justify the need for a Basic Newborn Care and Resuscitation Program

course and identify potential beneficiaries?

The Basic Newborn Care and Resuscitation Program under NRP FGM is designed

primarily for those who participate in neonatal resuscitation in the delivery room and

care for newborns in facilities. To identify potential beneficiaries of the course, a list

of maternity and general facilities (where-in maternity facilities are offered) in a city /

district can be prepared. This can be done with the help of the local government and

municipality. Birth records can be obtained on request from the medical officers of

local municipal bodies to garner names of facilities (public, private, and corporate)

where the babies were born. Many births are reported as home deliveries which are

mostly attended by non-qualified attendants including Dais (TBAs). A database can be

created from the information gathered, which should include names of health

professionals, their medical qualifications, their operational facility, contact details,

workload (number of deliveries conducted in a month) etc. Officials can be requested

to fill out an 'experience survey' form and analyze the results. Based on the result

candidates may be chosen for training.

There is a need for a continuous Basic Newborn Care and Resuscitation Program in

every city / district. c Convincing health professionals about the need for Basic

Newborn Care and Resuscitation Program may prove to be a challenge.

What is the recommended course length?

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The length of Basic Newborn Care and Resuscitation Program Provider course is

about 18 hours spread over two days – for “full course” comprising of Lesson No 1 -

6, while for Part 1 i.e. Lesson 1 & 2 is of one day duration (about 9 Hrs.)

What information I can get from Internet about the course?

The website of IAP NRP FGM is www.iapnrpfgm.org you can have every

information related to the present course and the future courses, we have Pre-Test

which will be online and all the participants will have to appear in this Online Pre-

Test (part 1 and part 2 as is applicable) Both the tests are mandatory for the Trainer

course, while participants of provider course may appear in both for “full-course” or

in part 1.

Preparations before a Course What do I need to know about choosing a location for Basic Newborn Care and

Resuscitation Program course?

While deciding location one should keep the following facts in mind -

• There should be one Class Room for lectures, with facility for audiovisual

equipment (DVD Player is must; Laptop, and LCD Projector are preferable

but not essential.). Alternatively a TV set with DVD player is sufficient to

show videos

• There should be enough rooms to run five Skill Stations simultaneously – the

stations should not cause disturbance between groups..

It is advisable to keep these courses in Hospitals where an ideal venue can be created.

However, in some instances, an ideal venue may not exist for the Basic Newborn Care

and Resuscitation Program course. As a Trainer of Basic Newborn Care and

Resuscitation Program, one may need to be flexible and creative under challenging

conditions.

What should I know about choosing faculty for my Basic Newborn Care and

Resuscitation Program course?

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There must be enough Trainers to support your learners. The recommended ratio is

One Trainer for every 6-8 learners.

How do I procure course manual, other NRP training material and ensure

availability of Manikins for training?

• Each learner is required to have access to a copy of course Training

manual.

• Please get in touch with your state academic coordinator/Zonal coordinator

for supplies and availability of manuals, manikins for training.

How should I manage the administrative aspects of the course?

Elicit administrative support:

• Prepare an excel sheet with the registrant’s name, address, phone number, and

professional discipline. This is important for completing the Basic Newborn

Care and Resuscitation Program FGM Course Roster. You also will use the

information for sending each registrant a confirmation letter, creating an

attendance sign-in sheet Through a letter of confirmation the registrant should

be reminded of the course date, time and location

What are the typical course handouts?

• Plan of the day

• Performance Checklist

• Performance Evaluation Test Part I & II (Pre & Post course)

• Written Evaluation Part I & II (Pre and Post course)

• Posters

• Evaluation forms (Feedback Forms) to be filled by participants

The day of the Course

• Check audiovisual arrangements half hour before the course begins

• Mark attendance of all course attendees

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• Give hand outs

• Administer pre test evaluation

Course Documentation

NRP FGM

Basic Newborn Care and Resuscitation Program The NRP FGM project aims to develop an efficient, cost effective and sustainable

system for ongoing training and monitoring of Basic Newborn Care and Resuscitation

Program in India. It is important that the program fulfils the need for large scale

training and periodic re-training and continuous evaluation with emphasis on quality

control. The program will create a sustainable network through dedicated Regional

trainers and District Trainers. IAP will issue Certificate/Cards valid for two years to

various levels of Trainers and providers, and arrange for revalidation every two years.

More than 2 lac health professionals will be trained in Basic Newborn Care and

Resuscitation Program under NRP FGM Project in the next 3 years.

Documentation and data management of courses conducted and records of the validity

of various Trainers and Providers cards are very important for the success of this

program and for research, which will help in fine tuning program strategy in the

coming years.

This chapter gives a step by step approach for documentation requirements and

procedures for NRP FGM Basic Newborn Care and Resuscitation Program.

A NRP FGM Basic Newborn Care and Resuscitation Program course is organized by

a designated Course-Coordinator (IAP Branch President or his nominee, identified by

the Regional Trainer/ State Academic Coordinator). The Course coordinator may not

necessarily be a trained FGM Instructor.

The course will be conducted by a Lead Trainer and Assisting Trainers identified by

the Regional Trainer/ State Academic Coordinator. Trainer level qualifications for

various courses are detailed elsewhere in this document.

The Lead Trainer is responsible for reporting the course by sending Course-Roster to

central IAP office.

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When should the Course Roster Form be submitted?

The Lead Trainer must submit completed NRP FGM Basic Newborn Care and

Resuscitation Program Course-Rosters preferably by entering on website at the

earliest after completion of the program. The remaining amount will only be

reimbursed from central IAP Office – when all the original bills are accompanied by

the dully filled course-roster. However, the course completion certificates shall be

awarded after the course completion and they will be signed received from NRP FGM

Office.

Each form should include the names of only those candidates who were taught at the

same course level (Provider, Trainer District or Regional Trainer). If more than 1

course level is taught on the same day, separate NRP FGM Course-Rosters must be

submitted.

Common Questions about Course Documentation Why it is important to submit the Course-Roster Form?

If the lead Trainer does not submit the Course Roster, the NRP FGM staff cannot

verify participation by trainers or participants. If a course participant calls the IAP

office to verify his or her provider status, no such record will exist.

Why do I need to write participant’s address and email address?

It is important to maintain data and also to send NRP Updates periodically throughout

the year and additional mailings with information about NRP FGM.

When does the participant get course completion certificates?

Immediately after the course the certificate of successful completion should be

awarded to those who scores 84% and above – those do not score should undergo

remediation and failing which they should be asked to repeat the course at next

opportunity.

What is the responsibility of a Lead Instructor/Course Coordinator for record

keeping and how long after course completion?

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Lead trainer need to maintain the following record for at least 3 years after the date of

course:

• A completed Course Roster

• A copy of the NRP FGM Master Recording Sheet. This sheet lists the name of

each course participants along with scores from performance and written

evaluations and Mega code.

The course coordinator needs to maintain the following record for at least 1 year

(Preferably 3 years) after the date of course:

• A signed attendance sheet listing all participants

• Individual Answer/Recording Sheet of each participant of written evaluation

and Mega code. This will help if there are any questions in future.

How will the IAP NRP FGM staff maintain records?

• Each Course Roster submitted will be kept in an electronic file with a copy to

core committee for at least 3 years from the last course completion date on the

form.

• A Trainer FGM ID will be assigned to all who have completed Trainer

courses.

Annexures

1. Course Roster Form

2. Mark sheet

3. Feedback form

Allotted Budget IAP has launched NRP First Golden Minute Project in 2009. First Golden Minute Project has two components: Basic Newborn Care and Resuscitation Program and Advanced NRP. This document contains guidelines for roll out of Basic Newborn Care and Resuscitation Program in private sector. Johnson and Johnson has provided academic grant to train 2,00,000 health care providers in private sector in coming 3 yrs. Government of India has launched Basic Newborn Care and Resuscitation Program under NSSK to reduce neonatal mortality. IAP is nodal agency for implementation of NSSK in Government sector. IAP has adopted NSSK Training manual for use in private sector with permission of Government of India, MOHFW.

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Below we have explained for planning of roll out of this program in private sector: . MAXIMUM APPROVED BUDGET FOR TRAINING OF TRAINERS COURSE FOR DISTRIC TRAINERS

State level training of district trainers of two days duration total cost in INR

Detail unit cost no. no. of days

TA for National faculty 10000 2 1 20000

Per Diem for National faculty 2000 2 2 8000

Stay for national faculty 2500 2 2 10,000

TA for regional faculty 2500 3 1 7,500

Per Diem for Regional faculty 1500 3 2 9,000

Stay for regional faculty 2500 3 1 7,500

TA for out station participants 1200 40 1 48,000

Stay for outstation participants ( Twin sharing) 1000 40 1 40,000

food expenses 500 50 2 50,000

audio visual charges 2,500 1 2 5,000

Stationery 1000 1 1 1,000

Contingency 2,000 1 1 2,000

208,000

cost of one training no. of trainings grand total

208,000 40 8320000

Please note that the per diem for National faculty for one day (if more than half day is wasted in travel) – as Rs 1000/- has to be approved MAXIMUM APPROVED BUDGET FOR DISTRICT PROVIDER COURSE

District level training of Doctors, Nurses of one days duration total cost in INR

Detail unit cost no. no. of days

Per Diem for District facilitator 750 4 2 6,000

food expenses 200 32 2 12,400

audio visual charges 1,000 1 2 2,000

stationery 500 1 1 500

contingency 5,000 1 1 5000

25,900

Grand total for one District training for two days

cost of one training

25,900

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