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Facility based newborn care in India: norms and standards

Dr Pavitra Mohan, MD, MPH Health Specialist, UNICEF India Regional Child Health Managers Meeting, November 2011. Facility based newborn care in India: norms and standards. Govt. Facilities 47%. CES, 2009. Institutional births: CES: 72%, DLHS-3: 47%. 2.

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Facility based newborn care in India: norms and standards

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  1. Dr Pavitra Mohan, MD, MPH Health Specialist, UNICEF India Regional Child Health Managers Meeting, November 2011 Facility based newborn care in India: norms and standards

  2. Govt. Facilities 47% CES, 2009 Institutional births: CES: 72%, DLHS-3: 47% 2

  3. Sick Neonate treated (OPD & Indoor) in Referral Hospitals in Orissa, 2004-2006

  4. Facility Based Newborn care in India: A Conceptual framework At Delivery Sick newborn Special newborn care unit (12-20 beds) Newborn corner (1 bed) District Hospital Stabilization units (4 beds) CHC PHC Community

  5. Facility Based Newborn Care • Essential Care to all Newborns • Special Care to Sick Newborns • Normal post-natal care to normal newborns • Follow-up of sick newborns

  6. Status of Special Care Newborn Units in India • More than 00 units “operational”, more than 100 in pipeline • Rapid expansion between 2005-2010 • Partnership between UNICEF/ NNF/ national and state governments • Plans to have at-least one SCNU in each district • Supported by network of Newborn Stabilization Units at first referral units, and newborn care corners in each “delivery-point”

  7. Status of Special Care New Born Units : Madhya Pradesh, India 18 Functional 20 Under Construction B H D M R N Sanctioned for all 50 G L R D T A S O P S V P T K M R W A C T P N M C A K N G U N P AN S T N S D H M D S S J P S A V D S R J G D M H N U M R S D L K T R T M B P L U J N J B P R S N S H E A N P N S P D D R I D R J B A M D L D H R D W S H S B S N I H R D C D W K N D B L G K R G B R W B T L B H P

  8. Assessment of 8 Special Care Newborn units in India • Assess the effectiveness in improving newborn survival • Understand the operational bottlenecks that affect their functioning and limit their effectiveness • Sieve out lessons for scaling up SCNUs in India and other similar settings

  9. What are these districts like? • Infant Mortality Rate: 48-73/1000 live births • Literacy rate among women: 36%-63% • % institutional deliveries: 22%-36% • % children fully immunized: 23%-65%

  10. Results: Profile of newborns admitted in 8 SCNUs • No of admissions/100 births: 19.5 (4-39) • % of intramural admissions among all admissions: 68.5% (54%-90%) • % of boys among all admissions: 63.8% (58-70% ) • % of babies with birth weight: • Between 1500-2499: 35% (22-46%) • <1.5 kg: 6%

  11. Admission Profile: Reasons for admission

  12. Decline in mortality among admitted newborns after one year Current mortality among admitted newborns range from 5-15%

  13. Where did the decline occur?

  14. Adequacy of number of beds

  15. Adequacy of beds: Average length of stay and bed occupancy rate

  16. Adequacy of Human resources

  17. Maintenance of Equipments

  18. Adequacy of asepsis practices

  19. Determinants of outcomes: Human resources

  20. Determinants of outcomes: Asepsis practices

  21. Norms and Standards • TOOL-KIT 2008 (UNICEF, NNF, WHO-CC): • Levels of newborn care • Services at each level • Infrastructure and design • Equipment: list, numbers and specs • Human resources • Training • Cost

  22. Norms and Standards (2011) • Operational Guidelines (Ministry of Health and Family Welfare): 2011 • Part-1: Setting up, costing and operational steps • Part-2: Key clinical & housekeeping protocols • Annexure 1.1: List of Equipment • Annexure 1.2: List of Dash board indicators • Annexure 1.3: Reporting format • Annexure 1.4: Checklist for facility assessment • Annexure 2.1: Working Definitions • Annexure 2.2: New born case record sheet

  23. Norms and standards: how did they help? • Ready reckoner for the states and districts • Quality assurance: design, space, infrastructure • Procurement of equipment • Ensuring human resources • Budgeting in state and district plans • Less dependence on external support • Assessment against norms: policy briefs for advocacy • Consensus (in India?)

  24. Acknowledgements • National Neonatology Forum and all members • Public Health Foundation of India • All the nurses and doctors who are making quality newborn care available in some of the remotest districts of the country, often in difficult circumstances…..

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