Rafique: India

7/28/2019 Rafique: India

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

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


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Background: Causes

of Child Death in India

1.7m (23% of world total) U5 childrendied in 2010

52% deaths occurred in first month

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


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Background: Situation of Child Health in India (SRS2011)

69

64

59

55

58 58 5755

53

50

47

44

37 37 37 36 35 34 3331

2628 28 29 27 27

25 24

20

30

40

50

60

70

80

2004 2005 2006 2007 2008 2009 2010 2011

Deat

hsper1000

live

births

NMR

Early NMR

U5M rateIMR

Steady 5 point decline in U5MR

Steady 3 point decline in IMR each year;

Slow decline in NMR


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0

20

40

60

80

100

120

140

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

Rural

Total

Urban

41

48

27

Latest update from SRS -2011 by RGI

Goal 27

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

Background: Infant Mortality trends in Gujarat


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Types of Newborn Care Services in

India

Type ofFacilities

Defini tion/services Type of Provider Numbers

Special NewbornCare Units(SNCUs)

Present in DistrictHospitals/sub-districthospitalsProvide specialized services

for sick newborns

Pediatricians/MedicalOfficers and StaffNurses

418

NewbornStabilizationUnits (NBSUs)

Present at First Referral Units(FRUs)/CHCsProvide care for sicknewborns- initial stabilization

Medical Officers andNurses undersupervision ofPediatricians

1,554

Newborn CareCorners (NBCCs)

Present in all delivery roomsfor essential newborn care

Nurse midwives anddoctors

13,167


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Newborn

StabilizationUnits &

SNCU

ENBC

FRUs & District Level

IMNCI/ HNBC

Community level At every delivery point

Thrust areas for new born survival

Continuum of care

S d I t


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Success and Impact-

NationwideCall to Action Summit in February 2013

and launch of RMNCH+ A strategy

SPECIAL CARE OF NEWBORNS haveaverted 179000 newborn deaths

SNCUs accreditation through National

Neonatology Forum

Strengthening public private partnershipand accreditation of the private healthfacilities eg Gujarat

Provision for cashless services fornewborns under Rashtrya Swasthya BimaYojana (RSBY) scheme


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National Initiative: Janani -Shishu Suraksha

Karyakram

GoI Initiative entitlesnewborns for:

- Free transport from home to

facility and to hospitals

- Free management andtreatment including drugs

- Drop back from Institutionsto home


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SNCU - 33Tapi

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

NBSU - 153

I ti Chi j i Y j


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Innovation: Chiranjeevi Yojna: An innovative modeof PPP in Gujarat

PPP between GoG and Private

Gynecologists/Trust hospitals (>600). Service coverage through outsourcing -

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

Awards received:

1. Asia Innovation Award (Singapore)

2. India Prime Ministers Award for Administrative Excellence in April 2009


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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

I ti P i t l R f l S i i G j t


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Innovations: Perinatal Referral Services in Gujarat

A Launched on :29 August, 2007

525 Ambulances with total emergencies attendedat 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 andrural areas 30-45 minutes

KHILKHILAT

Special Ambulances dedicated for Newborn referral has been planned in the

year 2013-14


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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 ensuresregular follow up after discharge at Community & Facility level

proved use of technology is feasible & effective even in remotedistricts.

SNCU data base is a driving factor for improving perinatal care;

Use of antenatal steroids being initiated across the State andprovision of neonatal nurses done for labor room.

Add i k h ll


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Addressing key challenges

Challenges Working Solutions

Human Resources: Paucity of trained

manpower; only 53% of the units haveadequate MOs and 40% have adequate Nursesin India

HR Policy

Multi tasking and multi skills(Capacity building of MedicalOfficers and Staff Nurses)

Service Delivery: Follow up of newborns afterdischarge from SCNUs; Quality of services in

Private Sector a challenge

Software for tracking Linkages with IMNCI trained front

line functionaries Strengthen accreditation

Referral: Functional referral linkages betweencommunity and different level of newborn carefacilities

Improving community awareness Inter facility transfers Spatial mapping of levels of NBC

facilities

Monitoring: State level monitoring andsupportive supervision quality

Mentoring visits by MedicalColleges and training institutes

Supply management: procurement and Capacity building


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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


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UNICEF

For every chi ld

Health, Education, Equity, Protection

ADVANCE HUMANITY

Thank You

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Rafique: India