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THE INDIA NEWBORN ACTION PLAN
THE INDIA NEWBORN ACTION PLAN
▪ Current Situation
▪ Vision & Goals
▪ Guiding principles
▪ Strategic Intervention Packages
▪ Milestones
▪ Way Forward
CAUSES OF NEONATAL DEATHS : INDIA
Data Source : Liu et all. Lancet 2012 Statistical report
• Prematurity is the major cause (35%)
• Neonatal infections cause 1/3rd
of neonatal deaths (Pneumonia and Diarrhoea - 18%, and Sepsis-15%)
• Intra-partum causes / Birth asphyxia – responsible for 1/5th
of neonatal deaths
TIMING OF NEONATAL DEATHS
5
Contribution of Neonatal to Under Five Mortality (%)
64 63 63 6259 58 58 57 56 56
54 54 54 5349
39
0
10
20
30
40
50
60
70
Data Source – SRS 2012
WHERE ARE THESE DEATHS HAPPENING…..
4 states: UP, Bihar, MP and Rajasthan contribute to 56% of neonatal deaths
in India
14% of global newborn deaths
TRENDS IN MORTALITY RATES IN INDIA (2000-2012)
Source: SRS
6866
6360
58 58 5755
5350
4744
4244
40 4037 37 37 37 36 35 34 33
3129
32
2725 25 26
28 28 2927 27
25 24 23
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Infant Mortality Rate
Neonatal Mortality Rate
Early Neonatal Mortality Rate
MAJOR MILESTONES FOR INDIA'S NEW BORN
1992 – Child Survival & Safe Motherhood Program (CSSM) – RI, ARI, Diarrhoea, Safe delivery kits, FRUs
1997 – RCH I – RTI and STI component added
2005 - RCH II/ NRHM –
Cash transfers for institutional delivery;
Introduction of ASHAs
2011 – JSSK – Free health care made an entitlement for Pregnant women and New Born
2013 – Call to Action Geographical prioritization – 184 HPDs and RMNCH+A
Rapid scale up of Facility based new born care – 548 SNCUs
Largest Community based program for New born in place –Home visits by 900,000 + ASHA workers
Major Policy gaps around high impact interventions addressed
Seven States have achieved MDG 4
THE INDIA NEWBORN ACTION PLAN
India envisions a health system that eliminates preventable deaths of newborns and stillbirths and where:
- every pregnancy is wanted
- where every birth is celebrated, and
- where women, babies, and children survive, thrive, and reach their full potential.
Targets to achieve single digit NMR and SBR by 2030
GOAL 1: ATTAIN SINGLE DIGIT NEONATAL MORTALITY RATE BY 2030
29.0
26.2
22.1
18.6
15.7
25.9
20.5
15.2
9.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2012 2015 2020 2025 2030 2035
NMR (Based on Current AAR) NMR (Accelerated levels to achieve global targets)
GOAL 2: ATTAIN SINGLE DIGIT STILL BIRTH RATE BY 2030
22.0 21.420.5
19.718.8
20.0
16.6
13.2
9.8
0.0
5.0
10.0
15.0
20.0
25.0
2012 2015 2020 2025 2030 2035
SBR (Projected Levels Based on Current AAR) SBR (Accelerated levels to achieve global targets)
JOURNEY OF INAP IN INDIA
2013, April - Johannesburg, Global Newborn Health Conference
Constitution of a National Committee
Constitution of Sub-committees: HBNC, FBNC, Urban Newborn Health, Pvt Sector and RMNCH+A
Bottleneck Analysis: Rajasthan, Odisha and Andhra Pradesh
RECENT POLICY INITIATIVES TO STRENGTHEN NEWBORN INTERVENTIONS
Antenatal Corticosteroids in Pre-term Labour
Gentamicin use by ANMs for sepsis management in young infants
Vitamin K at birth
Scaling up FBNC
Revised guidelines for HBNC
SNCU online monitoring and follow up tracking
system
RECENT POLICY DECISIONS TO STRENGTHEN 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
▪ Breast and Cervical cancer screening
▪ Training of Surgeons for Caesarean section
▪ 3-day hands-on training programme for intrapartum and newborn care
Integration
Partnerships
Equity
Gender
Accountability
Quality of care
ConvergenceI
N
A
P
SIX GUIDING PRINCIPLES
SIX INTERVENTION PACKAGES
Pre-conception & Antenatal
Care
Care during
labour & childbirth
Immediate newborn
care
Care of healthy
newborn
Care of small &
sick newborn
Care beyond survival
I
N
A
P THUMB RULES:
1. All interventions delivered at family &community level are also available at outreach/ Sub Centre level.
2. All interventions delivered at outreach/Sub Centre level are also delivered at health facility level.
WHERE SHOULD WE FOCUS….
High Impact Interventions For Reducing Neonatal Deaths
Interventions around Birth – 41% impact
(Skilled birth attendance, emergency obstetric care, neonatal
resuscitation and immediate care at birth)
Care of Small and Sick newborn – 30% impact
( Kangaroo mother care, SNCU, Full supportive care)
Community Care – 25 to 30% impact (Exclusive Breast
feeding, hand washing, home based care, behaviors & practices)
WHERE SHOULD WE FOCUS….
Day of Birth is Most Dangerous for Mother & Newborn
46% of Maternal Deaths
40% of Neonatal Deaths
40% of Still Births
Interventions Targeting Day of Birth – Triple Returns on Investment
19
43,500 45,500
4,56,000
52,000 54,500
1,87000
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
PreconceptionNutrition
Antenatal Care Care during labourand birth including
complications
ImmediateNewborn Care
Care of the healthynewborn
Care Of The Small& Sick Newborn
Dea
ths
aver
ted
Stillbirths averted
Maternal lives saved
Newborn lives saved
India specific analyses based on EN Lancet Paper 3, 2014 by AIIMS, V.K Paul
Number of Deaths Averted by Stage of Intervention
PRECONCEPTION AND ANTENATAL CARE INTERVENTIONS PACKAGE
Family and Community
• Reproductive Health & Family Planning
• Nutrition related interventions
• Counselling & Birth Preparedness
• Prevention against Malaria
Outreach/Sub Centre
• Screening for Anemia and Hypertension
• Malaria screening
• Prevention and management of mild to moderate anemia
• Maternal tetanus immunization
• Adolescent friendly health services
• Interval IUCD insertion
Health Facility
• Antenatal screening & management of Severe anemia, Hypertension in pregnancy, Gestational Diabetes, Syphilis
• Screening & management of Hep B, Hypothyroidism, HIV, Malaria
• Adolescent friendly health clinics
• Post-partum family planning services including PPIUCD insertion
• Prevention of Rh incompatibility
CARE DURING LABOUR AND CHILDBIRTH
Family and Community
• SBA
• Clean birth practices
Outreach / Sub Centre
• Identification of complications and timely referral
• Pre-referral dose by ANM (Antenatal corticosteroids in preterm labour; antibiotics for PROM)
Health Facility
• EmOC
• Management of pre-term labour
IMMEDIATE NEWBORN CARE
Family and Community
• Delayed Cord clamping
• Interventions to prevent hypothermia
• Early initiation and exclusive breastfeeding
• Hygiene to prevent infection
Outreach/ Sub Centre
• Vit. K at birth
• Neonatal resuscitation
Health Facility
• Advanced neonatal resuscitation
CARE OF THE HEALTHY NEWBORN
Family and Community
• Home visits till six weeks by trained ASHA
• Exclusive breastfeeding
• Clean postnatal practices
Outreach / Sub Centre
• Immunisation
Health Facility
• All interventions (except home visits)
CARE OF SMALL & SICK NEWBORNS
Family and Community
• Thermal care and feeding support (for home deliveries)
Outreach/ Sub Centre
• Integrated management using IMNCI and use of oral antibiotics
• Injectable Gentamicin by ANMs for sepsis
Health Facility
• KMC
• Full supportive care at block and district level (NBSU, SNCU)
• NICU at regional level
CARE BEYOND NEWBORN SURVIVAL
Family and Community
• Screening for birth defects, failure to thrive and developmental delays
• Follow up visits of SNCU discharged infants (till 1 year of age), small and low birth weight babies (till 2 years of age).
Outreach/Sub Centre
• As before
Health Facility
• Newborn screening
• Management of birth defects for conditions enlisted under RBSK
• Follow-up of high-risk infants (discharged from SNCUs, and small newborns)
24
43,500 45,500
4,56,000
52,000 54,500
1,87000
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
PreconceptionNutrition
Antenatal Care Care during labourand birth including
complications
ImmediateNewborn Care
Care of the healthynewborn
Care Of The Small& Sick Newborn
Dea
ths
aver
ted
Stillbirths averted
Maternal lives saved
Newborn lives saved
India specific analyses based on EN Lancet Paper 3, 2014 by AIIMS, V.K Paul
Number of Deaths Averted by Stage of Intervention
MONITORING & EVALUATION FRAMEWORK FOR INAP
M&E Framework
MCTS
HMISOn-line SNCU
Monitoring
Milestones
Year National Milestones2014 National launch – India Newborn Action Plan
2015 - 2016 State Newborn Action Plans developed
Reporting by states on Dashboard Indicators
Quality assurance mechanisms strengthened at national and state level
Institutional mechanism established for research and knowledge
management
Gender disaggregated data available and monitored for various
interventions
2017 Mid-course review
2018 - 2019 Stillbirth tracking mechanism strengthened
Accountability framework developed and operationalized at all levels of
health care
Equity disaggregated data available and monitored for all interventions
2020 Review and update action plan
WAY FORWARD
▪ State level action plans to be developed
▪ Forging partnerships as envisaged with various professional bodies
▪ Scale up newer initiatives along with quality trainings
▪ Up gradation of SNCUs and establishment of Kangaroo Mother Care Units
▪ Affirmative actions to address stillbirths
▪ Research priorities to gather evidence to be addressed
A healthy start is central to the human life course….
Every newborn must be able to survive and thrive!