INDIAN NEWBORN ACTION PLAN

INDIAN NEWBORN ACTION PLAN AND OTHER INITIATIVES TO REDUCE NEONATAL MORTALITY RATE

1. INDIA NEWBORN ACTION PLAN DR MANISH CHOUDHARY PG 1 ST YEAR RESIDENT JLN MEDICL COLLEGE AJMER

2. Introduction The India Newborn Action Plan (INAP) is India’s committed in response to the 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 ENAP sets forth a vision of a world that has eliminated preventable newborn deaths and stillbirths. It is an action plan to end preventable deaths is a roadmap for change . It sets out a vision and proposes a goal and targets to end newborn deaths from preventable causes.

3. India has been at the forefront of the global effort to reduce child mortality and morbidity. Its continuous commitment and ongoing efforts have resulted in a 59% reduction in under-5 (U5) child mortality since 1990 . Programmes and initiatives by GOI lead to a significant reduction in the number of neonatal deaths - from 1.35 million in 1990, to around 0.76 million in 2012.

4. B ut while neonatal deaths reduced by 44%, child deaths (under 5 years) reduced by 59%. 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%.

5. WHEN DO NEWBORNS DIE? About half of child deaths occur in the neonatal period . It is estimated that around 40% of all stillbirths and neonatal deaths take place during labour and the day of birth, i.e. approximately within 48 hours. About three-fourths of the total neonatal deaths occur in the first week of life, with the first 24 hours accounting for more than one-third (37%) of the deaths occurring during the entire neonatal period.

6. DISTRIBUTION OF NEONATAL DEATHS - DAY 1 TO 7 39.3 7.3 10.2 6.2 5.5 2.8 2.8 5 10 35 30 25 20 15 40 45 Da y 1 Da y 2 Da y 3 Da y 4 Da y 5 Da y 6 Da y 7

7. DISTRIBUTION OF NEWBORN DEATHS IN THE FIRST WEEKS 74.1 12.6 10 3.1 10 20 30 40 50 60 70 80 Week 1 Week 2 Week 3 Week 4

8. WHAT DO NEWBORN DIE OF ?

9. Cause of neonatal deaths in I ndia

10. Key Highlights of India Newborn Action Plan (INAP)

11. The two specific goals of INAP are : 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

12. Strategy intervention packages Six pillars of INAP Preconception Antenatal care Care duri n g labor Childbir t h Immediate Newborn care Care o f healthy N e wborn Care of Small & Sick newborn Care beyond Survival

13. Pre-Conception and Antenatal Care

14. Care during Labour and Childbirth

15. Immediate Newborn Care

16. Care of Healthy Newborn

17. Care of Small and Sick Newborn

18. Care beyond Newborn Survival

19. Monitoring and evaluation Framework It is imperative to have a better comprehensive information system for monitoring and assessing progress towards the targets identified under INAP. The Government of India has established a web-based tracking system (Mother and Child Tracking System) to track every pregnant woman and child till the age of 2 years.

20. The success of the India Newborn Action Plan hinges on active participation and commitment by the states to attain the vision of ending preventable deaths of newborns and stillbirths. This would translate into achieving Single Digit NMR and Single Digit SBR by 2030.

21. Milestones in Child Survival Programmes in India 1985 – UIP 1992 – Child Survival and Safe Motherhood Programme (CSSM ) 1995 –NMBS 1997 – RCH I 2004 –IMNCI 2005 – RCH II 2005 – National Rural Health Mission 2013 – RMNCH+ A Strategy 2013 – National Health Mission 2014 – India Newborn Action Plan (INAP)

22. UNIVERSAL IMMUNISATION PROGRAM Universal Immunization Programme is a vaccination program launched by the Government of India in 1985. It was started with vaccine against 6 VPD’s –DPT, TB, MEASLES , POLIO and TETANUS vaccine to women. It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one of the key areas under National Rural Health Mission (NRHM) since 2005. The program now consists of vaccination for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, hepatitis B, diarrhoea , Japanese encephalitis, rubella, pneumonia ( Heamophilus Influenza Type B) and Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis). .

23. CHILD SURVIVAL & SAFE MOTHERHOOD The first public health initiative in India that covered the health of newborns Strategies for improved neonatal survival Antenatal care to all pregnant women Promote safe delivery Assist establishment of breathing at birth Maintain newborn’s warmth Promote early exclusive breastfeeding Prevention of infection Early detection and referral of high risk newborns Promote birth spacing

24. NATIONAL MATERNITY BENEFIT SCHEME National Social Assistance Programme. To ensure all BPL women get cash assistance 8-12 weeks prior to delivery Rs. 500 per birth irrespective of no. of children and age of the women* Focus – Provision of nutrition support during pregnancy

25. REP R OD U CTIV E & C HIL D HEA L T H I Integration of CSSM Family welfare program Adolescent Health Prevention of RTI & STI

26. IMNCI WHO/UNICEF developed a new approach to tackling the major diseases of early childhood called the Integrated Management of Childhood Illnesses IMNCI is an Indian adaptation of the Integrated Management of Childhood Illness approach, a globally accepted model which has been tested in several countries. The IMNCI strategy addresses the major causes of under-five morbidity and mortality which are responsible for more than 90% of the mortality, namely pneumonia, neonatal problems, diarrhoea , malaria, measles and malnutrition.

27. REP R OD U CTIV E & C HIL D HEA L T H II  To reduce maternal and child morbidity and mortality with emphasis on rural health care  Integrated with NRHM  Major strategies  Essential Obstetric Care  Emergency obstetric care  Strengthening referral system

28. National Rural Health Mission The National Rural Health Mission (NRHM) was launched on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter- sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality. NRHM focuses on Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Services. The emphasis here is on strategies for improving maternal and child health through a continuum of care and the life cycle approach.

29. RMNCH+A The RMNCH+A strategy is built upon the continuum of care concept and is holistic in design, encompassing all interventions aimed at reproductive, maternal, newborn, child, and adolescent health under a broad umbrella, and focusing on the strategic lifecycle approach. The RMNCH+A strategy promotes links between various interventions across thematic areas to enhance coverage throughout the lifecycle to improve child survival in India.

30. The “plus” within the strategy focuses on: Inclusion of adolescence as a distinct life stage within the overall strategy. Linking maternal and child health to reproductive health and other components like family planning, adolescent health, HIV, gender, and preconception and prenatal diagnostic techniques. Linking home and community-based services to facility-based services. Ensuring linkages, referrals, and counter-referrals between and among various levels of health care system to create a continuous care pathway, and to bring an additive /synergistic effect in terms of overall outcomes and impact.

31. What is Continuum of Care? Continuum of care guides and directs patients over time through a comprehensive array of health services spanning all levels and intensity of care. In other words, that care might begin when someone is born and end with supportive services to the family when he dies.

32. Other Interventions under National Health Mission focusing on newborns

33. JANANI SURAKSHA YOJNA  Launched on 12 th April 2005  Modification of National Maternity Benefit scheme  Objective  Reducing IMR & MMR through increased delivery at health institutions

34. NAVAJAT SISHU SURAKSHA KARYKRAM Navjat Shishu Suraksha Karykram (NSSK) Launched on September 15, 2009 Focuses on: Prevention of Hypothermia Prevention of Infection Early initiation of Breast feeding Basic Newborn Resuscitation Objectives: To train healthcare providers at DH, CHCs and PHCs

35. JANANI SISHU SURAKSHA KARYKRAM JSSK supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana and is aimed at mitigating the burden of out of pocket expenses incurred for pregnant women and sick newborns. Aims to offer completely free and cashless services, including normal or caesarian delivery in all the government hospitals. The scheme also envisages free treatment for a sick new born (up to 30 days after birth) in any government health institution in rural or urban areas & transportation facilities

36. F - IMNCI From November 2009 IMNCI has been re - baptized as F-IMNCI , (F -Facility) with added component of: Asphyxia Management and Care of Sick new born at facility level, besides all other components included under IMNCI .

37. Facility Based Newborn Care (FBNC) (2011) - Newborn care facilities at various levels of public health services that includes Newborn Care Corners (NBCCs) at all points of childbirth to provide immediate care; Newborn Stabilization Units (NBSUs) at CHC/FRUs for management of selected conditions and to stabilize sick newborns before referral to higher centres ; and Special Newborn Care Units (SNCUs) at district/sub-district hospitals to care for sick newborns (all types of care except assisted ventilation and major surgeries)

38. HOME BASED NEWBORN CARE (HBNC)

39. KEY ACTIVITIES IN HBNC Care for every newborn through a series of home visits in the first 6 weeks of life. Information and skill to the mother Examination of every newborn for prematurity Extra home visits for preterm and LBW babies Early identification of illness Follow up of sick newborns after they are discharged from facilities Counseling the mother on postpartum care Counseling on family planning

40. HBNC Home visits Home deliveries: 1 st , 3 rd ,7 th , 21 st , 28 th and 42 nd day Institutional deliveries: 3 rd , 7 th , 14 th , 21 st , 28 th and 42 nd Services offered: Essential care of the newborn Examination of the newborn Early recognition of danger sign Stabilization % Referral Counseling of mother for Breastfeeding Warmth Care of the baby Immunisation Postpartum care & Use of family planning methods

41. Rashtriya Bal Swasthya Karyakram (RBSK)(2013 ) Screening of children with birth defects, diseases, deficiencies, and developmental delays (including disabilities ) All children, ages 0 to 18 years targeted

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