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7/28/2019 Kumar: Scaling Up Newborn Programming in India Agenda Setting, Policy Formulation and Implementation
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Scaling up newborn programming in India: agenda setting, policy
formulation and implementation
Dr. Rakesh Kumar
Joint Secretary
Ministry of Health and Family WelfareGovernment of India
Session 3B
Wednesday 17th April 2013
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Outline of presentation
Trends, rate of decline of mortality
Magnitude, diversity, inequity
Milestones for agenda setting
Strategic approaches
Recent policy decisions
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Trends in Child, Infant and Neonatal Mortality Rates
Steady decline seen in U-5MR (74 to 55 in 6 yrs) and IMR (58 to 44 in 8 yrs)
Decline in neonatal mortality has been disproportionately slow
Little change in the Early Neonatal Mortality Rate
Neonatal Mortality now constitutes 56% of the total U-5 mortality and an estimated 820,000 o1.45 million under-5 deaths annually (SRS 2011)
77% of neonatal deaths take place in first week of life.
74
69
64
5958 58 57
55 53 5047
4
37 37 37 36 35 34 33
2628 28 29 27 27
252
20
30
40
50
60
70
80
2004 2005 2006 2007 2008 2009 2010 20
Deathsper1000livebirths
NMR
IMR
U5MR
NMR, IMR, U-5MR trend, India (SRS data)
ENMR
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-6.1
-2.9
-2.9
-2.7
0
0
0
-7.5
0
-9.1
-6.8
-7.8
-7.2
-10 -8 -6 -4 -2 0
2011
2010
2009
20072006
2005
2004
2003
2002
2001 % annualchanprevious year i
U5MR
% average ann
change over p
year inNMR
STAGNANT
Annual Rate of decline in Under Five & Neonatal Mortality Rates
National Rural Health
2005-06
Major Health Systems S
A 6% decline noted for
during this phase o
7/28/2019 Kumar: Scaling Up Newborn Programming in India Agenda Setting, Policy Formulation and Implementation
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India: Challenges-Magnitude, Diversity, Inequity
4944 44
41 41 41 41 40 39
27 25 24 22 24 23 23 22 21
0
10
20
3040
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2
Deathsper100
0livebirths
Urban- rural disparity (NMR)
Districts with
minimum NMR
Districts w
maximum NSTATE , RANGE
ASSAM 20Kamrup (30) Dhubri (50)
MADHYA PRADESH 38Bhopal (28) Pa
BIHAR 26Patna (22) Khagaria (4
ODISHA 44Anugul (31)
Intra-state disparities
414040
37
1818
157
0 10 20 30 40 50
Madhya Pr.Odisha
Uttar Pr.Rajasthan
DelhiMaharashtraTamil Nadu
Kerala Neonatal Mortality Rate
Inter-state disparities
Demographic: 1.2 bn people, 26 m birth cohort
Geographical: 35 States/UTs, 640 districts, 6000
blocks, 600,000 villages
Infrastructure: 0.15 m Sub centers, 24000 PHCs,
4400 CHCs, 640 District hospitals
Health Workforce: 0.86 m ASHAs, 0.17 m ANMs
Inequities: Urban-rural, socio-cultural, economic,
religious, castes & tribes, gender, regional
disparities
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53.6
64
7
61
62.6
36.8
45.4
60.1
33.5
72
68.7
26.5
47.3
43.4
0 10 20 30 40 50 60 70
ORT or Increased fluid in Diarrhoea
Vit. A Supplementation (1st Dose )
Children received measles vaccine
Full Immunization
Complementary Feeding (6-9 months)
Exclusive breastfeeding
Postnatal 3 checkups for newborns within 10 days
Post Natal visit to mothers within 2 weeks
Early initiation of breast feeding (
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Child Survival Call to Action: A Promise Renewed,
held in Washington (June 2012), co-hosted by Govts. of USA, Ethiopia & India
RMNCH+A CoalitionGovt led multi-stakeholder platform on lines of Global PMNCH
Indias Call to Action: Child Survival and Developmentheld in Mahabalipuram (February 201
Launch of RMNCH+A Strategic Approach
Commitments from all partners, constituencies and stakeholders
Strategic approaches defined
State-specific annual targets for accelerated decline in mortality
Agenda setting: Key milestones
Differential planning and implementation for High Priority Districts
Guidelines developed for intensification of RMNCH+A interventions in these districts
Developmental Partner harmonization
Plan of Action developed
St t i A h 1 RMNCH A d Id tifi ti f P D i
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Inter-linkages between different interventio
various stages of the life cycle
Linking child survival to other interventions
as reproductive health, family planning, m
newborn and child health
Sharper focus on adolescents
Recognizing nurses as pivots for service
Expanding focus on child development and
of life
STRATEGIC
APPROACH TO
RMNCH+A
Strategic Approach 1: RMNCH+ A and Identification of Programme Drivers..
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VHND,VHSNC
WIFS IYCFUIPBCC
SBA
MCH
WINGS
COMMUNITY
PROCESSES
SKILLED HUMAN
RESOURCES
PHYSICAL
INFRASTRUC-
TURE
MCTS
INTERVAL
IUCD AT
SUBCENTRE
HBNC
DELIVERY
POINTS
ADOLESCENT
HEALTH
SERVICES
SNCU,
NBSU,
NBCC
ORS+ ZINC
PPIUCD
JSY &
JSSK
IMNCI
DISTRIBUTION
OF
CONTRACEPT-
IVES BY ASHA
St t i A h 2 E i il bilit f N b C t ll l l
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Healthy NewSick Newborns
After Discharge
Sick Newborns
Strategic Approach 2: Ensuring availability of Newborn Care at all levels
Newborn care Corners(NBCC) at all DeliveryPoints
Equipped for
resuscitation with trainedpersonnelEssentialNewborn Care &
resuscitation
ENC to all newborns Accredited Social HeActivist (ASHA)
6 visits in first 42 day(7 visits for home del
Incentives to ASHAs USD per newborn
Home BasedNewborn Care
Sick Newborn Care Unitsat District Hospitals andtertiary health facilities
Newborn StabilisationUnits at FRUs; 4 beddedunits
Facility BasedNewborn Care forsick newborn
Free healthcare at Public
Health facilities (JSSK)
St t i A h 3 H lth S t St th i
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Strategic Approach 3: Health System Strengthening
415 MCH wings adding up 25,000 more beds [660 million USD pla
in 2012-13]
16,800 Deliverypoints 418 Special Newborn Care Units; 1554 Newborn Stabilization
and 13,167 Newborn Care Corners
Assured Referral transport (National Ambulance Service)
Augmentation of HRH
Institutional delivery cash assistance scheme or Janani SuraYojana (JSY) [324 million USD for 2012-13]
Free assured healthcare services and referral transport for pre
women and infant at public health facilities (Janani Shishu Sura
Karyakram) [491 million USD allocated in 2012-13]
St t i A h 5 Fi i l I t t i P bli H lth S t i 2005
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824
1073
1582
1789
2132
2393
276
0
500
1000
1500
2000
2500
3000
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011
Total central funding of 13 billion USD (till 2012-13) to
States under NRHM, that has special focus on MNCH
Strategic Approach 5: Financial Investment in Public Health Systems since 2005
Strategic Approach 4: Reaching areas & populations with highest mortality burd
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Ambitious targets setting for all the states with higher percentage annualrate of decline in NMR, IMR, U5MR, MMR and TFR. MoU signed with thestate Governments for accelerated and sustained improvements in Healthindicators
184 High Priority Districts (HPDs) of 640 districts identified based oncomposite health index
differential planning & implementation, focus on underservedblocks/tribal areas, 30% more allocation of funds
Integrated Action Plan - Additional central assistance scheme for tribaland backward districts, addressing social determinants of health.
Harmonisation of techno-managerial support for integrated
RMNCH+A planning, implementation & monitoring throughDevelopment Partners (includes UN agencies, foundations,bilaterals, CSOs) across HPDs
Strategic Approach 4: Reaching areas & populations with highest mortality burd
Strategic Approach 6: Robust Health Information Systems
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Monitoring
Web-based Mother and Child Tracking System
Web-based Health Management Information System
Survey based Score cards and HMIS based Dashboard
Online monitoring software for Special Newborn Care Units
MCTS
HMIS
Scorecard
SNCUOnline
Strategic Approach 6: Robust Health Information Systems
Recent Policy Decisions
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Newborn screening atpublic health facilities
Mobile Teams
Screening by ASHAs asHBNC
Screening
Early Intervention Centre atDistrict hospital for furtherassessment and act as areferral linkage toappropriate health facility
Referral
Free of cost servincluding surgicainterventions at pidentified tertiaryinstitutions
Manage
1. Child Screening & Early Intervention Services (Rashtriya Bal Swasthya Karyakram
Systemic approach for early identification of 4Ds: Defects at birth, Deficiency, Diseases and
Disability in children 0-18 years (270 million, when scheme fully implemented) of which 26 milliowill be newborns
Recent Policy Decisions
Recent Policy Decisions
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Recent Policy Decisions..
2. JSSK : Free entitlements for treatment of all infants in public health facilitie
3. National Iron + initiative and WIFScovering 130 adolescents in India
4.Financial incentives to ASHAs for promoting delay in first pregnancy and
spacing and terminal methods and promotion of PPIUCD spacing methods
5. Technical Group agreed for administration of pre-referral injectable antibiot
neonatal sepsis and Pneumonia management by ANMs
A glimpse of new born care facilities and infrastructure in Public Health Syste
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A glimpse of new born care facilities and infrastructure in Public Health Syste
Newborn transport Basic Ambulance for PWEmergency transport vehi
Newborn Stabilization Unit SNCU at district level
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