IndianNewborn Action Plan [Recovered].pptx

Indian Newborn Action plan

1. Indian Newborn Action Plan Dr Medha Sharma MBBS ,MD Community medicine 23-09-2023 1

2. 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 India Newborn Action Plan (INAP) is India’s committed response to the Global Every Newborn Action Plan (ENAP). Launched in September 2014 23-09-2023 2

3. Milestones in Child Survival Programmes in India 23-09-2023 3

4. INAP lays out a vision and a plan for India 23-09-2023 4

5. INAP supported by 23-09-2023 5

6. Goal 23-09-2023 6

7. Goal 1: Ending Preventable Newborn Deaths to achieve “Single Digit NMR ” by 2030, with all the states to individually achieve this target by 2035 23-09-2023 7

8. Goal 2: Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the states to individually achieve this target by 2035 23-09-2023 8

9. INPA Builds on existing commitments under the national health mission and 'call to action' for child Survival and development. Identifies major guiding principles under the overarching principle of integration : Equity Gender Quality of care Convergence Accountability Partnerships Defines six pillars of interventions Serves as a framework for states/districts to develop their own action plan 23-09-2023 9

10. Principles Identifies major guiding principles under the overarching principle of integration : Equity Gender Quality of care Convergence Accountability Partnerships 23-09-2023 10

11. Principles 23-09-2023 11

12. ` 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. Over that period, from 1990-2012 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. 23-09-2023 12

13. INAP & Its Emergent need 2014 23-09-2023 13

14. Situational analysis 2014 23-09-2023 14

15. Causes of neonatal Deaths in India 23-09-2023 15

16. Timing of Deaths 23-09-2023 16

17. 23-09-2023 17

18. Action Plan Strategic approach 23-09-2023 18

19. Strategic Intervention Packages 23-09-2023 19

20. Priority action 1. Pre conceptional and antenatal care D elaying age at 1st pregnancy Train service providers and availability of commodities of FP P rovide PPIUCD 4. Train an adequate numbers of ANMs (including ANC component) 5. Scale up nutritional interventions (Folic acid ,Ca & IFA) 6. Strengthen convergence for nutrition counselling 7. Screening of high-risk pregnancies 8. Malaria interventions for pregnant women in endemic area 9. Promote counselling and birth preparedness 23-09-2023 20

21. Priority action 2.Care during labour & child birth S trengthen public health facilities MCH wings in high case load facilities 3. Trained health workers at all delivery points. 5. Establish Quality Assurance mechanism at each level 6. Institutionalize referral mechanism 7. Improving management of preterm labor 8. S upportive supervision 9. Generate awareness on JSSK entitlements, promote community participation 10. Sound surveillance system for tracking stillbirths 23-09-2023 21

22. Priority action 3.Immediate newborn care Establish fully functional NBCCs at all delivery points NSSK-trained staff Standardized protocols for essential newborn care Develop Quality Assurance mechanisms Regular quality audits Availability of Vit k injection Strengthen counselling for breastfeeding, postnatal care, and community and home care practices 23-09-2023 22

23. Priority action 4.Care of healthy new born 1. Rational deployment of ASHAs 2. Capacity-building of ASHAs 3. Ensure uninterrupted supply of ASHA HBNC kits 4. Ensure timely payments of HBNC incentives for ASHAs 5. M onitoring of HBNC visits, with regards to quality and coverage 6. Implementation of standardized norms 7 . Ensure availability of vaccines and logistic support for immunization at all delivery points. 23-09-2023 23

24. Priority action 5.Care of Small and Sick Newborn Standardized clinical guidelines at all levels Fully functional NBSU& SNCU Upgrade NICU (ventilation & surgeries) Operationalize SNCU monitoring software's Institutionalise network of regional / state FBNC collaborating centres & Medical colleges Ensure timely availability of logistics & drugs Quality training Develop quality assurance mechanism 23-09-2023 24

25. Priority action 6.Care beyond newborn survival 1. Screening of birth defects and developmental delays. 2. Deploy mobile health teams 3. Establish fully functional District Early Intervention Centers (DEICs) 4. Institutionalize a robust referral mechanisms 5. Establish center of excellence at tertiary care hospitals for management of birth defects 6 . Follow up of all sick/high-risk newborns discharged from the SNCU for a period of one year by ASHAs 23-09-2023 25

26. Bottle neck analysis India used a systematic and standard approach , to analyze the challenges and implementation issues for newborn health packages. The BNA tool analyzed nine interventions . Each intervention was reflected in a “ tracer interventions” used as “proxy indicator” The BNA has helped to get a clear understanding of the gaps and challenges with regards to two specific aspects viz. human resources for health, and quality of care. 23-09-2023 26

27. Bottle neck analysis 23-09-2023 27

28. Indicators Impact Level Indicators Birth registration Stillbirth rate Early neonatal mortality rate Pre-Conception & Antenatal Care Births to women aged 15 -19 years out of total births (Teenage pregnancy) % of pregnant women who received full ANC Care during Labour and Child Birth % of safe deliveries % of preterm births C- section rate Immediate Newborn Care % of newborns BF within one hour of birth, Receiving vitamin K at birth Weighed at birth % of LBW babies Care of Healthy Newborn Percentage of newborns received schedule of home visits Monitoring & Evaluation Framework - 23-09-2023 28

29. 23-09-2023 29

30. Coverage Targets 2017 2017 target 2020 2020 target 2025 target 2030 target Safe delivery (institutional + home delivery by SBA) 81 90 88 95 95 95 Initiation of breastfeed with in one hour 45 75 41 90 90 90 Women with preterm labour receiving atleast one dose of antenatal corticosteroids 75 90 95 95 Babies born in health facilities with birth asphyxia received resuscitation (%) 75 90 95 95 Babies received complete schedule of home visits under HBNC by ASHA (%) 50 75 95 95 Newborn with sepsis in the community received Gentamicin by ANM (%) 50 75 75 75 Newborn discharged from SNCU followed until age one (%) 35 50 75 75 Newborn with low birth weight/ Prematurity managed with KMC at facility (%) 35 50 75 90 23-09-2023 30

31. Interventions under NHM focusing on newborns 23-09-2023 31

32. Interventions under National Health Mission focusing on newborns Programme (Year) Objectives Status Janani Suraksha Yojana (JSY) (2005) Safe motherhood intervention to increase institutional delivery through demand-side financing and conditional cash transfer Expenditure on scheme has increased from Rs 38 crores to FY 2005 -06 to Rs 1725 crores in FY 2021-22 Integrated Management of Neonatal and Childhood Illnesses (IMNCI) at the community level and F-IMNCI at health facilities (2007) Standard case management of major causes of neonatal and childhood morbidity and mortality Operationalized in >500 districts • 26,800 M.O. and specialists trained under F-IMNCI 23-09-2023 32

33. Programme (Year) Objectives Status Navjat Shishu Suraksha Karyakram (NSSK) (2009) Basic newborn care and resuscitation training programme 1.3 lakh health providers trained to date Janani Shishu Suraksha Karyakram (JSSK) (2011) Zero out-of-pocket expenditure for maternal and infant health services through free healthcare and referral transport entitlements FY 2020-21 >1.29 crore availed benefits 23-09-2023 33

34. Programme (Year) Objectives Status Facility Based Newborn Care (FBNC) (2011) Newborn care facilities at various levels Newborn Care Corners (NBCCs) at all delivery points Newborn Stabilization Units (NBSUs) at CHC/FRUs Special Newborn Care Units (SNCUs) at district/sub-district hospitals 23-09-2023 34

35. Programme (Year) Objectives Status Home Based Newborn Care (HBNC) (2011) Provision of essential newborn care Special care of preterm and LBW Early detection of illness followed by referral and support by ASHA worker FY 2020-21 >1.33 crore newborn Home visited by ASHA Rashtriya Bal Swasthya Karyakram (RBSK) (2013) Screening of children with birth Defects Diseases Deficiencies Developmental delays • All children, ages 0 to 18 years targeted • More than 8 crore children screened and more than 10 lakhs children identified for tertiary care in 2013 23-09-2023 35

36. Initiatives for Strengthening newborn Care (Guidelines) 23-09-2023 36

37. Policy decision to strengthen the 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 Training of Surgeons for C- section 3-day hands-on training programme for intrapartum and newborn care 23-09-2023 37

38. Each of the above nine interventions in turn were evaluated across the following seven health system building blocks (six WHO health system blocks plus community ownership and leadership). 1. Leadership and governance (enabling environment) 2. Health financing (enabling environment) 3. Health work force (supply) 4. Essential medical products and technologies (supply) 5. Health services (supply, quality) 6. Health information systems (quality) 7. Community ownership and partnership (demand) 23-09-2023 38

39. GOAL & Current status 23-09-2023 39

40. Goal 1: Ending Preventable Newborn Deaths to achieve “Single Digit NMR ” by 2030, with all the states to individually achieve this target by 2035 23-09-2023 40

41. Goal 2: Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the states to individually achieve this target by 2035 23-09-2023 41

42. Way Forward 23-09-2023 42