Upload
marianna-mitchell
View
218
Download
0
Tags:
Embed Size (px)
Citation preview
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
UNICEF
Institutional births: CES: 72%, DLHS-3: 47%
Govt. Facilities 47%
2
CES, 2009
UNICEF
Sick Neonate treated (OPD & Indoor) in Referral Hospitals in Orissa, 2004-2006
0
500
1000
1500
2000
2500
3000
3500
Baripada DHH Udala SDH Karanjia SDH Rairangpur SDH
2004
2005
2006
UNICEF
Newborn Stabilization
units
Newborn Corners
IMNCI /JSYreferrals
SCNU
ReferralsTraining inputs
UNICEF
Facility Based Newborn care in India: A Conceptual framework
Community
PHC
CHC
District Hospital
Newborn corner
(1 bed)
At Delivery Sick newborn
Stabilization units
(4 beds)
Special newborn care unit
(12-20 beds)
UNICEF
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
UNICEF
Status of Special Care Newborn Units in IndiaMore than 00 units “operational”, more than 100 in pipeline
Rapid expansion between 2005-2010Partnership between UNICEF/ NNF/ national and state governments
Plans to have at-least one SCNU in each districtSupported by network of Newborn Stabilization Units at first referral units, and newborn care corners in each “delivery-point”
UNICEF
BTL
SVP
SNI
SDH
SA
CDWBLG
CTP
KRG
RSN
MDL
STN
VDS
DHRJBA
PAN
SJP
KND
DMH
SHE
SOP
UJN
RJGSDL
DWS
JBP
HSB
GUNRWATKM
NSP
MDS
KTN
DDR
AKN
BHD
IDR
GLR
MRN
RTM
ANP
BRW
UMR
NMC
HRD
BHP
BPL
DTA
18 Functional
20 Under Construction
Status of Special Care New Born Units : Madhya Pradesh, India
Sanctioned for all 50
UNICEF
UNICEF
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
UNICEF
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%
UNICEF
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%
UNICEF
Admission Profile: Reasons for admission
UNICEF
Decline in mortality among admitted newborns after one year
District Decline in neonatal mortality after 1year
Tonk 4.5%
Dibrugarh 11.8%
Mayurbhanj 28.4%
Purulia 48.1%
Lalitpur -8.6%
Vaishali 43.0%
Guna 13.6%
Port Blair 16.2%
Current mortality among admitted newborns range from 5-15%
UNICEF
Where did the decline occur?
UNICEF
Adequacy of number of beds
Existing number of beds Required Number of Beds
Tonk 12 20
Dibrugarh 17 23
Mayurbhanj 12 25
Purulia 14 32
Lalitpur 12 25
Vaishali 13 32
Guna 20 32
Port Blair 14 10
UNICEF
Adequacy of beds: Average length of stay and bed occupancy rate
Name of the unit Average length of stay (in days)
Bed occupancy rate
Tonk 5.1 106%
Dibrugarh 4.4 137%
Mayurbhanj 4 155.3%
Purulia 15 100%
Lalitpur 3.4 52%
Vaishali 2.2 28.1%
Guna 5.5 130%
Port Blair 5.6 96%
UNICEF
Adequacy of Human resources
Name of the unit Total number of beds Nurse: bed ratio Doctor : bed ratio
Tonk 12 1: 1.5 1: 4.0
Dibrugarh 17 1: 0.8 1: 5.7
Mayurbhanj 12 1: 1.2 1: 4.0
Purulia 14 1: 0.7 1: 4.7
Lalitpur 12 1: 2 1: 6.0
Vaishali 13 1: 1 1: 2.6
Guna 20 1: 2 1: 6.7
Port Blair 14 1: 1.8 1: 7.0
UNICEF
Maintenance of Equipments
Name of the unit Reported time for repair of essential equipment (warners, phototherapy units)
Tonk 6 months
Dibrugarh 1.5 months
Mayurbhanj 6 months
Purulia 1.5 months
Lalitpur 3 months
Vaishali 1.5 months
Guna 0.5 month
Port Blair 6 months
UNICEF
Adequacy of asepsis practices
Name of the unit Asepsis score
Tonk 5
Dibrugarh 8
Mayurbhanj 3
Purulia 9
Lalitpur 5
Vaishali 5
Guna 7
Port Blair 9
UNICEF
Determinants of outcomes: Human resources
UNICEF
Determinants of outcomes: Asepsis practices
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
UNICEF
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
UNICEF
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?)
UNICEF
UNICEF
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…..