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7/28/2019 Rafique: India
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Facility-Based Newborn Care India, Gujarat- Successes and Challenges
Dr. Narayan Gaonkar & Dr. Nuzhat RafiqueHealth Specialist, UNICEF Gujarat State Office, India
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Background: Causes
of Child Death in India
1.7m (23% of world total) U5 childrendied in 2010
52% deaths occurred in first month
Ref: The Lancet, Vol 379, Issue 9832, 9-15 June 2012, Pages 2151-2161
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Background: Situation of Child Health in India (SRS2011)
69
64
59
55
58 58 5755
53
50
47
44
37 37 37 36 35 34 3331
2628 28 29 27 27
25 24
20
30
40
50
60
70
80
2004 2005 2006 2007 2008 2009 2010 2011
Deat
hsper1000
live
births
NMR
Early NMR
U5M rateIMR
Steady 5 point decline in U5MR
Steady 3 point decline in IMR each year;
Slow decline in NMR
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0
20
40
60
80
100
120
140
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
Rural
Total
Urban
41
48
27
Latest update from SRS -2011 by RGI
Goal 27
60.3 Million Population in the state of Gujarat (2011)> 1.28 million births annually> 52,000 Infant deaths annually> 73% infant deaths occur during neonatal period
Background: Infant Mortality trends in Gujarat
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Types of Newborn Care Services in
India
Type ofFacilities
Defini tion/services Type of Provider Numbers
Special NewbornCare Units(SNCUs)
Present in DistrictHospitals/sub-districthospitalsProvide specialized services
for sick newborns
Pediatricians/MedicalOfficers and StaffNurses
418
NewbornStabilizationUnits (NBSUs)
Present at First Referral Units(FRUs)/CHCsProvide care for sicknewborns- initial stabilization
Medical Officers andNurses undersupervision ofPediatricians
1,554
Newborn CareCorners (NBCCs)
Present in all delivery roomsfor essential newborn care
Nurse midwives anddoctors
13,167
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Newborn
StabilizationUnits &
SNCU
ENBC
FRUs & District Level
IMNCI/ HNBC
Community level At every delivery point
Thrust areas for new born survival
Continuum of care
S d I t
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Success and Impact-
NationwideCall to Action Summit in February 2013
and launch of RMNCH+ A strategy
SPECIAL CARE OF NEWBORNS haveaverted 179000 newborn deaths
SNCUs accreditation through National
Neonatology Forum
Strengthening public private partnershipand accreditation of the private healthfacilities eg Gujarat
Provision for cashless services fornewborns under Rashtrya Swasthya BimaYojana (RSBY) scheme
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National Initiative: Janani -Shishu Suraksha
Karyakram
GoI Initiative entitlesnewborns for:
- Free transport from home to
facility and to hospitals
- Free management andtreatment including drugs
- Drop back from Institutionsto home
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SNCU - 33Tapi
SNCUs/NBSUs in Gujarat State (as on March 2013)
NBSU - 153
I ti Chi j i Y j
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Innovation: Chiranjeevi Yojna: An innovative modeof PPP in Gujarat
PPP between GoG and Private
Gynecologists/Trust hospitals (>600). Service coverage through outsourcing -
normal delivery, assisted delivery &
CS, EmONC
Voucher System (Cash Less)
For Below Poverty Line family and non income tax paying tribal
Linked with 108 emergency transport
Awards received:
1. Asia Innovation Award (Singapore)
2. India Prime Ministers Award for Administrative Excellence in April 2009
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Innovations: Bal Sakha Yojna Innovative PPP model
with Private Pediatricians / Trust Hospitals with NICU to provdie free
care for newborns of poor and tribal families
Bal-Sakha Scheme 1: Chiranjeevi Births and Govt.
Hospital Births
Bal-Sakha Scheme 2 : for poor and all Tribal Infants up to
1 month age who are referred by front line functionaries
Extended Bal-Sakha Yojana: in 43 tribal talukas of
Gujarat State. Caters BPL infants up to 1 year of age
I ti P i t l R f l S i i G j t
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Innovations: Perinatal Referral Services in Gujarat
A Launched on :29 August, 2007
525 Ambulances with total emergencies attendedat 3,300,610
Pregnancy Related Cases :1,107,764
Deliveries in Ambulance & at Scene: 32,543
Calls Answered :99% in First Ring
Response time - urban areas 7-14 minutes andrural areas 30-45 minutes
KHILKHILAT
Special Ambulances dedicated for Newborn referral has been planned in the
year 2013-14
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Lessons learnt
Survival in SNCU only is not enough as 10% mortality by one year
of age, highlighting need for long term follow up.(Source : UNICEF GOMP follow up study in Guna and Shivpuri)
Strong data management and follow up tracking system ensuresregular follow up after discharge at Community & Facility level
proved use of technology is feasible & effective even in remotedistricts.
SNCU data base is a driving factor for improving perinatal care;
Use of antenatal steroids being initiated across the State andprovision of neonatal nurses done for labor room.
Add i k h ll
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Addressing key challenges
Challenges Working Solutions
Human Resources: Paucity of trained
manpower; only 53% of the units haveadequate MOs and 40% have adequate Nursesin India
HR Policy
Multi tasking and multi skills(Capacity building of MedicalOfficers and Staff Nurses)
Service Delivery: Follow up of newborns afterdischarge from SCNUs; Quality of services in
Private Sector a challenge
Software for tracking Linkages with IMNCI trained front
line functionaries Strengthen accreditation
Referral: Functional referral linkages betweencommunity and different level of newborn carefacilities
Improving community awareness Inter facility transfers Spatial mapping of levels of NBC
facilities
Monitoring: State level monitoring andsupportive supervision quality
Mentoring visits by MedicalColleges and training institutes
Supply management: procurement and Capacity building
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Next steps:
Policy/data/research:- Dissemination of RMNCH+A strategy
- Analysis and use of dash board indicators at national and state level
- Operational research on newborn care
Service Delivery:- Strengthening focus on perinatal care including essential newborn care
- Strengthening follow up mechanisms for SNCUs discharged newborns
Community based approaches:- Home based maternal and newborn care strengthening
- Strengthening referral mechanisms for sick newborns
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UNICEF
For every chi ld
Health, Education, Equity, Protection
ADVANCE HUMANITY
Thank You