Facility-Based Newborn Care India, Gujarat - Successes and Challenges

Dr. Narayan Gaonkar & Dr. Nuzhat Rafique Health Specialist, UNICEF Gujarat State Office, India

Background: Causes of Child Death in India

Ref: The Lancet, Vol 379, Issue 9832, 9-15 June 2012, Pages 2151-2161

1.7m (23% of world total) U5 children died in 2010 52% deaths occurred in first month

Background: Situation of Child Health in India (SRS

2011)

80
Deaths per 1000 live births

70 60 50 40 30 20 2004 37 58

IMR
58 57 55

69 64 53

U5M rate
59 55 44 31 25 2010 24 2011

50

47

37

NMR

37 28

36 29

35 27 2008

34 27 2009

33

26

28 2005

Early NMR
2006 2007

Steady 5 point decline in U5MR Steady 3 point decline in IMR each year; Slow decline in NMR

Background: Infant Mortality trends in Gujarat

140 120 100 80 60 40 20
Rural Total Urban

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

48

41 27 Goal 27
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1981

1983

1985

Latest update from SRS -2011 by RGI

2015

Types of Newborn Care Services in India

Type of Facilities Special Newborn Care Units (SNCUs) Definition/services Present in District Hospitals/sub-district hospitals Provide specialized services for sick newborns Present at First Referral Units (FRUs)/CHCs Provide care for sick newborns- initial stabilization Type of Provider Pediatricians/Medical Officers and Staff Nurses Numbers 418

Newborn Stabilization Units (NBSUs)

Medical Officers and Nurses under supervision of Pediatricians Nurse midwives and doctors

1,554

Newborn Care Present in all delivery rooms Corners (NBCCs) for essential newborn care

13,167

Thrust areas for new born survival

IMNCI / HNBC
Continuum of care

ENBC

Community level

At every delivery point

Newborn Stabilization Units & SNCU

FRUs & District Level

Success and ImpactNationwide

Call to Action Summit in February 2013 and launch of RMNCH+ A strategy SPECIAL CARE OF NEWBORNS have averted 179000 newborn deaths SNCUs accreditation through National Neonatology Forum Strengthening public private partnership and accreditation of the private health facilities eg Gujarat Provision for cashless services for newborns under Rashtrya Swasthya Bima Yojana (RSBY) scheme

National Initiative: Janani -Shishu Suraksha Karyakram

GoI Initiative entitles newborns for:

- Free transport from home to facility and to hospitals - Free management and treatment including drugs - Drop back from Institutions to home

SNCUs/NBSUs in Gujarat State (as on March 2013)

NBSU - 153 SNCU - 33

Tapi

Innovation: Chiranjeevi Yojna: An innovative model

of PPP in Gujarat PPP between GoG and Private Gynecologists/Trust hospitals (>600). Service coverage through 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 outsourcing -

Awards received: 1. Asia Innovation Award (Singapore) 2. India Prime Ministers Award for Administrative Excellence in April 2009

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

Innovations: Perinatal Referral Services in Gujarat Launched on :29 August, 2007 A

525 Ambulances with total emergencies attended at 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 and rural areas 30-45 minutes KHILKHILAT Special Ambulances dedicated for Newborn referral has been planned in the year 2013-14

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 ensures regular follow up after discharge at Community & Facility level proved use of technology is feasible & effective even in remote districts.

SNCU data base is a driving factor for improving perinatal care; Use of antenatal steroids being initiated across the State and provision of neonatal nurses done for labor room.

Addressing key challenges

Challenges Working Solutions Human Resources: Paucity of trained HR Policy manpower; only 53% of the units have Multi tasking and multi skills adequate MOs and 40% have adequate Nurses (Capacity building of Medical in India Officers and Staff Nurses) Service Delivery: Follow up of newborns after discharge from SCNUs; Quality of services in Private Sector a challenge Referral: Functional referral linkages between community and different level of newborn care facilities Monitoring: State level monitoring and supportive supervision quality Supply management: procurement and Software for tracking Linkages with IMNCI trained front line functionaries Strengthen accreditation Improving community awareness Inter facility transfers Spatial mapping of levels of NBC facilities Mentoring visits by Medical Colleges and training institutes Capacity building

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

Thank You

For every child Health, Education, Equity, Protection UNICEF HUMANITY ADVANCE