anantapur newborn action plan

ANAPSingle Digit IMR & SMR-2030DISTRICT NEW BORN ACTION PLAN

ANANTAPURAMU

ANANTAPURAMU NEOBORN ACTION PLAN 2015

The Newborn Action Plan: an action plan to end preventable deaths is a roadmap for change . It sets out a vision and proposes a goal and targets to end newborn deaths from preventable causes.

SIX GUIDING PRINCIPLES AND SIX STRATEGIC OBJECTIVES ARE AT THE CORE OF THE PLAN.

ANAP_Anantapuramu Newborn Action Plan

The vast majority of newborn deaths are preventable.

I don’t mean theoretically preventable under ideal but

unrealistic circumstances. I mean preventable with

relatively simple and relatively inexpensive

interventions. Preventable with systems and

technology available we have now in almost every

country.”

Melinda Gates

World Health Assembly May 2014


We need to focus more on the most vulnerable children: the newborns.

Many conditions that result in

a newborn dying can easily be prevented or treated.

We need a combined approach to the mother

and her baby during her pregnancy, to have someone

with knowledge and skills with her during

childbirth, and effective care for both after birth.—Gro Harlem Brundtland, Director-General,

World Health Organization


Vision

• A healthy start for every newborn born in Anantapuramu of Andhra Pradesh


MissionTo strengthen the health system to cultivate an enabling environment where skilled providers of newborn care value and practice Essential Early Newborn Care (EENC) at every birth


Objective:

To reduce NMR to below 10 by 2030

To reduce Still Birth Rate below 10 by 2030


RationaleÔ Investing in newborn health and survival helps achieve Health and Developmental goals

Ô Honoring New borns’ human rightsThe Convention [on the Rights of the Child]…works—and

its utility can be seen in the everyday use to which [it is]

being put by country after country, in policy, in practice,

and in law.

—Carol Bellamy, Executive Director, UNICEF


15%

14%

7%

5%

13%

14%

4%

8%

9%

1%10%Preterm birth complications

Birth Asphyxia

Noenatal infections

Congenital abnormalities

Other conditions

Pnoumonia

Diarhoea

Injuries

NCDs

Measles

Other conditions

NeonatalDeaths54%

Newborn deaths account for more than 50% of U5 deaths

Source: WHO Global Health observatory 2010

RATIONALE


IMR = 45NMR = 30PNMR = 20ENMR = 13LNMR = 17


30 26.2

22.1

18.6

15.7

30

25.9

20.5

15.29.9

0

5

10

15

20

25

30

35

2012 2015 2020 2025 2030 2035

PROJECTED LEVELS OF NEONATAL MORTALITY RATES : 2012-2030

NMR (BASED ON CURRENT AAR)

NMR (ACCELERATED LEVELS TO ACHIEVE GLOBAL TARGETS)

Anantapuramu


Causes of Neonatal Mortality-India

Source: Liu et al, Lancet 2012 Statistical Report

35%

20%

15%

16%

9%

3% 2%

Preterm birth complications

Birth Asphyxia

Sepsis

Pneumonia

Malformations

Other conditions

Diarhoea


Causes of Infant deaths _ Anantapur

Sepsis12%

Asphyxia25%

LBW25%

Pneumonia12%

Diarrhoea13%

Fever related13%

Measles0%

Andhra Pradesh- Anantapur - Known Causes of Infant & Child Deaths against total reported known causes of infant & child deaths -Apr'13 to Mar'14

Source: NRHM _H MIS 2013-14


Distribution of neonatal deaths by time since birth _ India

72.9

13.5 13.5

0

10

20

30

40

50

60

70

80

Week 1 Week 2 Week 3-4

PERCENTAGE


Proportion on Infants dying in first week of life _ India

36.9

7.4 10.1 6.6 5.1 3.4 3.50

5

10

15

20

25

30

35

40

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

PERCENTAGE


Distribution of deaths based on time of death _ Anantapur

Infant Deaths within 24 hrs of birth

0.0%Infant Deaths between 24hrs & under 1 week

21.6%Infant Deaths between

1 week & under 1 month2.7%

Child Deaths between 1 month & under 1

year16.2%

Child Deaths between 1yr& under 5years

59.5%

Infant & Child Deaths against reported Infant & Child deaths - Andhra Pradesh- Anantapur-Apr'13 to Mar'14

Source: NRHM _H MIS 2013-14


Status of Health Care Delivery System-Facilities

Type of facility

Number desired

Number functioning

Gap % of deficiency

SCs 587 586 01 0.17

24x7 PHCs 80 42 38 47.50

CHCs 25 15 10 40%

AH 9 2 7 72%

DH 01 01 00 0

Teaching Hospital

01 01 00 0


Status of Infrastructure for Newborn Health Care Services

STATISTIC Number Established

Number Required

Gap Gap %

NBCC 63(83 in 63 Delivery points)

99 38 38.3%

NBSU 11 18 07 38.8%

SNCU 01 02 01 50%

NRC 01 02 01 50%


Status of HRCadre Numbe

r in position

Vacant

Vacant%

Trained in NSSK

Trained in SBA

% Trained in NSSK

% Trained in SBASCBC

SN 481 122 25.36 400 302 83.16 62.7820%

LT 82 44 53.65 - - - -

ANM 919 253 27.52 179 93 19.47 10.11


Status of HR

Cadre Number in position

Vacant Vacant% Trained in NSSK

% of Trained in NSSK

% of Trained in EmNOCSCBC

MO 206 83 40.29 131 63.59 33%17%

Pediatricians 32 0 0 8 25 0

GynObs 32 0 0 8 25 0

Anesthetists 27 0 0 0 0 0


1 Tadipatri

2 Gooty

3 Uravakonda

4 Kalyanadurg

5 CK Palli

6 Penugonda

7 Kadiri

8 Madakasira

CEmNOCs


Functional - 6

Functional - 6

Blood banks

Blood Storage Centres


Existing = 11

NBCC = 73

NBSUs


●

Existing

●● ●

●

●●

●●

●

USGMachines


Data to ponderStatistic Number Statistic Number

ELA live births 78926

Number of Expected LBWs 24% 18942 Sick new born expected=10%

7892

LBWs requiring FBNC 25% of LBW 4736 Requiring FBNC = 100% 7892

Presently working SNCUs 01

Number of beds in SNCU 20

Number of days stay per bed (assumed) 7

Number of babies per year per bed 52

Total babies who can be given bed(52x20) 1020 1020

Number of babies requiring beds 4736 7892

Gap in requirement of beds 3716 6872

Percentage of provision of beds 21.5% 12.9%

% Devoid bed care 88.5% 87.1%


Data to ponderSTATISTIC Number

Number of Live births 78926

Number of Malnourished children expected = 27%

21310

Number of beds in NRC 20

Total babies who can be given beds 1020

Number of babies requiring beds = 30% 6393

Gap 5373

% of provision of beds 15.95%

% devoid of FBNC 84.05%


SWOT AnalysisIt helps to focus on our strengths, overcome our weaknesses, minimize threats, and take the greatest possible advantage of opportunities available to our organization.


STRENGTHS• 1 Fully functional SNCU in public sector

• Fully functional SNCUs{2} with RDT(NGO)

• Easy accessibility of delivery points

• Effective referral transportation

• Utilization of JSSK for free USG

• Dedicated ANC day on every Friday with SOP


WEAKNESSES• Sub optimal utilization of NBCCs

• Non functional NBSUs

• Availability of Specialists

• Accessibility of Newborn care facilities

• No follow up of trainings

• Inadequate awareness on Sick infant component free entitlements under JSSK

• Unsatisfactory SBA/ NSSK skills & Knowledge implementation


OPPORTUNITIESo NHM funding

o Building capacities

o Strengthening of HBNC

o International NGO support


THREATSo Low female literacy

o Socio-economic-cultural milieu

o Beliefs and norms

o Quacks


Impact targets- Anantapuramu

Targets Current 2017 2020 2025 2030

NMR 30 24 21 15 <10

SBR 22 19 17 13 <10

Targets{Per 1000 live births}


Coverage Targets - AnantapuramuTarget % Current 2017 2020 2025 2030

Safe delivery95 98 98 100 100

Initiation of breastfeeding within 1 hour

55 75 90 95 98

Women with preterm labor receiving at least one dose of Corticosteroids

NA 75 90 95 98


Coverage targets- AnantapuramuTargets Current 2017 2020 2025 2030

Babies born with asphyxia received resuscitation

NA 75 90 95 98

Babies receiving complete schedule of visits as per HBNC

NA 50 75 90 95

Newborn with Sepsis Gentamycin by ANM

NA 50 75 80 85


Coverage Targets- AnantapuramuTargets Current 2017 2020 2025 2030

Newborn discharged from SNCU receiving follow up

NA 35 50 75 80

Newborn with LBW/Prematurity managed with KMC at facility

NA 35 50 75 90


Coverage Target - AnantapuramuTargets Current 2017 2020 2025 2030

% of Malnourished Children admitted in NRC

20% 40 50 75 90

% of Children followed up till adequate weight gain

NA 35 50 75 80

% of birth registrations 15% 50 75 90 95


Coverage Targets - AnantapuramuTarget Current 2017 2020 2025 2030

Inj. Vitamin K at birth

20% 40 65 85 95

Peri-conceptionalfolic acid

NA 35 50 75 95


Guiding Principles

EQUITY

GENDER

QUALITY OF CARE

CONVERGENCE

PARTNERSHIPS

ACCOUNTABILITY

INTEGRATION INNOVATION LEADERSHIP TEAMWORKANANTAPURAMU NEOBORN ACTION PLAN 2015

INTEGRATION

Integrated Service delivery, Continuum of care, Programme Coordination

INNOVATION

Interventions, Delivery approaches, Technology

EQUITY

Universal Coverage

Closing equity gap

GENDER

Improved decision making, Power, Resource access

ACCOUNTABILITY

Transperancy, Over sight

CONVERGENCE

Addressing Socio-cultural, Community, Individual, Structural

attributes

LEADERSHIP

TEAMWORK

QOC

Regulation,Standards.Protocols,

Organizational capacity

PARTNERSHIPS

Instituionalization of partenerships with acedmic,

professional bodies


We must get it right from (24 hours around birth) the start: Age at death for Neonates (0-28 days)

0

5

10

15

20

25

30

35

0 1 2 3 4 5 6 7 8 9 1011 1213 14 1516 1718 19 2021 22 2324 2526 27 28

Days of life

Prop

ortio

nal m

orta

lity

What we do then affects the rest of the newborn's life

2 out of 3 newborn deaths occur in the 3 days of life

WHO, 2012


Reproductive

AgeAntenatal

period

Adolescent

School

age

Preschool

Continuum of the Life Cycle

Intra-partum

Delivery

Immediate Newborn•First Embrace

•Care for LBW/Preterm

•Care for Sick Newborn

Post

neonatal

Late

neonatal

Enhancing overall efforts on maternal and child health by focusing on a weak link


Fam

ily/c

om

mu

nit

yO

utr

eac

h/o

ut

pat

ien

t

Clin

ical

antenatal care postnatal care

early postnatal home visits for mother and

newborn

cleaner, safer birth

adolescent health at home and

school

child health care

obstetric and childbirth care including essential newborn care

emergency newborn care

reproductive health care

reproductive health care

intersectoral Improved living and working conditions including housing, water and sanitation, and nutritionEducation and empowerment

emergency child care

ongoing care for the child at home

pregnancy home visits

What to focus on?Packages within RMNCH continuum of care

ChildhoodNewborn/postnatalBirthPregnancyPre-pregnancy BirthANANTAPURAMU NEOBORN ACTION PLAN 2015

What to focus on?Prevention & care for main causes of neonatal deaths (3 by 2)

Preterm birth• Preterm labor management including antenatal corticosteroids*

• Care including Kangaroo mother care, essential newborn care

Birth complications (and intrapartum stillbirths)

• Prevention with obstetric care *

• Essential newborn care, and resuscitation*

Neonatal infections

• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*

• Case management of neonatal sepsis *

1

2

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

Over two-thirds of newborn deaths preventable – actionable now without intensive care

3


Health Sector Strategic & Investment Plan

Integrated National RMNCH Plan

Increasing access and use of Family Planning

Ending preventable newborn deaths

Ending preventable deaths from pneumonia and diarrhoea (GAPPD)

Ending preventable maternal deaths

Sharpen focus within existing national RMNCH and health strategies and plans; not a new stand alone plan


Strategy intervention packagesSix pillars of INAP

Preconception

Antenatal care

Care during labor

Childbirth

Immediate

Newborn care

Care of healthy

Newborn

Care of Small &

Sick newborn

Care beyond Survival


Priority interventions of EENC

WHO, 2013ANANTAPURAMU NEOBORN ACTION PLAN 2015

1. Care during Labor & Child birth{20% cause of preventable mortality}• Improved Deliveries & QOC at Public Health Institutions

• Assurance of resuscitation corner at every delivery points

• Timely referral by all health workers

Our Commitment

Train & monitor all health providers in NSSK by 2016

Ensure utilization of established NBCCs

Ensure SBA protocols implementation


2. Immediate new born Care• Health Education

Our Commitment

Propagate danger signs

Train all ANMs & ASHAs in identification of danger signs and at risk newborns and on referral protocols


3. Care of healthy Newborn• Count every Newborn through measurement, programme tracking, accountability

Our Commitment

Propagation of danger signs & at risk newborns

Referral protocols


4.Care of Small and Sick Newborn{68% cause of preventable mortality}• Institutional care of Sick newborn

• KMC Units establishment

Our Commitment

Propagate SNCU/NRCs /JSSK

Enhance optimum utilization of NRC

Ensure follow up services of discharged newborns


5. Care beyond Newborn Survival• Establishment of fully functional DEIC

• Effective implementation of RBSK/RKSK

Our commitment

Developmental clinic once weekly

Neonatal follow up clinics


6. Preconception and Antenatal care by Social mobilization• To harness power of parents, family and community

• To reach every woman and newborn to reduce inequitiesHealth education by campaign mode by Specific packaged IEC/BCC activities

Parenting workshops to target populations

Target population 1.Newly wed couples up to birth of second child

2. Late adolescents

Training college girls as trainer for target populations


Preconception & AN care• Quality ANC services with focused fixed day ANC day(Every FRIDAY) with provision of comprehensive package of services(Lab services, Free medicines, MO examination, Health education, Counseling)

• High Risk Antenatal clinics on every Tuesday, with Escort activity

• High Risk admission protocols implementation


Inter sectoral coordination• ICDS

• Women and Child Welfare

• SHGs

• DRDA

• MEPMA

• Panchayat Raj

• NGOs

• Education department

• Civil Societies


Specific Promotional activitiesHousehold Level Essential Newborn Care: Drying, wrapping, delayed bathing, clean cord care including CHX, immediate/exclusive breastfeeding.

Demand and Care Seeking: Preventive care around birth, sustained demand for services and timely care seeking for mothers and newborns

Community leadership and accountability: Solve practical problems, hold health providers accountable to providing quality services, strengthen links between community and facilities, promote incentives for community health workers.


Specific Promotional activitiesChampions: Develop local champions, including parliamentarians, parent groups, professionals, community health volunteers and community leaders; engage and link champions for RMNCH+A

Adolescents: Give special attention to adolescent girls; help prevent early and unwanted pregnancies

Quality and accountability: Be a voice for change. Demand quality, affordable, accessible services. Report poor services. Change social norms regarding preventable maternal and newborn death.


Preconceptional andAntenatal Care


Priority actions1. Prioritize actions for delaying age at 1st pregnancy in convergence with stakeholders and other departments with special focus on teenage pregnancy

2. Train an adequate number of service providers for Family Planning Services and ensure availability of commodities, as per FP 2020

3. Saturate high caseload facilities to provide PPIUCD


Priority actions4. Train an adequate numbers of ANMs in SBA (including ANC component)

5. Scale up nutritional interventions of peri-conceptional folic acid, maternal calcium supplementation, and iron folic acid supplementation (NIPI/WIFS)

6. Strengthen convergence with ICDS, NGOs for nutrition counselling


Priority actions7. Screening of high-risk pregnancies and their management as per protocols and admission protocols implementation

8. Accelerate implementation of Escort activity for pregnant women

9. Promote counselling and birth preparedness


Care during Labour and Childbirth


Priority Actions1. Prioritize and strengthen public health facilities at all levels (L1, L2, L3) for conducting safe delivery, including provision of emergency obstetric care as per the norms of MNH Toolkit

2. Provision of dedicated MCH staff in facilities with high caseload, including functional WASH facilities

3. All delivery points to be saturated with adequately trained health workers


Priority Actions4.. Establish Quality Assurance mechanism at each level, like- use of safe birth checklist and regular quality audits including perinatal death audits

5. Institutionalize referral mechanism to ensure to-and-fro referral, including inter-facility referral, as and where required


Priority Actions7. Accelerate scale-up of new policy decisions on management of preterm labour through use of antenatal corticosteroids and antibiotics for premature rupture of membranes

8. Develop a mechanism of supportive supervision through existing systems or through partnerships (with professional organizations, medical colleges, and private hospitals)

9. Generate awareness on JSK/JSSK entitlements, promote community participation, and demand for safe institutional delivery

10. Establish a sound surveillance system for tracking stillbirths


Immediate Newborn Care


Priority Actions1. Establish fully functional NBCCs at all facilities conducting deliveries, according to the norms prescribed in the MNH toolkit

2. Saturate all facilities conducting deliveries with NSSK-trained staff

3. Implement standardized clinical protocols for essential newborn care, including resuscitation

4. Develop Quality Assurance mechanisms/cells to monitor training quality and adherence to standard protocols


Prority Actions5. Regular quality audits of facilities, including CDR

6. Ensure availability of Injection Vitamin K at all delivery points

7. Develop a mechanism of ongoing supportive supervision at the facility level

8. Strengthen counselling for breastfeeding, postnatal care, and community and home care practices

9. Focus on community strategies to promote demand for essential newborn care


Healthy Newborn


Priority Actions1.Recruitment and rational deployment of ASHAs as per the population norm

2. Capacity-building of ASHAs to provide newborn care at the community level

3. Ensure uninterrupted supply of ASHA HBNC kits and replenishment thereof, from PHC inventory

4. Ensure timely payments of HBNC incentives for ASHAs


Priority Actions5.Set up mechanisms for monitoring of HBNC visits, with regards to quality and coverage

6. Ensure implementation of HBNC and monitoring mechanism (formats, checklist) for quality of home visits

7. Strengthen and revitalize the role of ANM as supervisor cum mentor to ASHA

8. Institutionalize a framework for supportive supervision and mentoring of ASHAs (Supervisor/Facilitator)


Priority Actions9. Build responsive referral system – easy access and availability of referral transport and medical care at the health facilities for all sick / high-risk newborns referred by ASHAs

10. Strengthen counselling for breastfeeding, postnatal care, entitlements, and home care practices using counsellors and audiovisuals

11. Ensure availability of vaccines and logistic support for immunization at all delivery points.


Small and Sick newborn care


Priority Actions1.Ensure dissemination of guidelines at all levels of facilities with priority to high caseload facilities

2. Ensure fully functional NBSUs, SNCUs with the requisite HR

3. Establish KMC unit/wards on the existing FBNC system

4. Ensaure effective utilization of SNCUs


Care beyond newborn survivalPriority Actions


Priority Actions1.Train all levels of service providers engaged in screening of birth defects and developmental delays.

2. Effective implementation of RBSK

3. Establish fully functional District Early Intervention Centres (DEICs)


Priority Actions4. Institutionalize a robust referral mechanisms between screening points and District Early Intervention Centres (DEICs)

6. Screen birth defects by the service providers at the facility and in community by ASHAs during home visits


Priority Actions7. Facility-based follow-up of small and sick babies for developmental delay and appropriate management

8. Follow up of all sick/high-risk newborns discharged from the SNCU for a period of one year by ASHAs

9. Develop resource network, including private practitioners, to provide specialized care for identified cases


Monitoring frameworkᇹ Establish M& E cell

ᇹSupportive supervision for QoC by using checklists

ᇹ RCH Portal

ᇹ NHM_HMIS

ᇹ SNCU software

ᇹ Utilize analysis reports for mid course corrections


Conclusion

Neonatal Mortality is the major obstacle in reducing Infant

Mortality Rate as well as Under 5 Mortality Rate

To reduce Neonatal mortality we have to reduce incidence of

Low Birth Weight

To reduce Low Birth Weight we have to have Robust

Mechanism of provision of quality Antenatal care as well as

Intranatal care


Conclusion80% of the newborns can be managed at home either by mother or with the assistance of skilled and trained workers by provision of HBNC

Reduction in infant mortality can only be achieved by reducing Neonatal mortality

Neonatal mortality can only be decreased by reducing the Incidence of low birth weight children.

Empowerment of the mothers as well as provision of essential Antenatal care are the key to success.

Nutritional supplementation during Per-conceptionaland Pregnancy Period


Than Q


Than Q once again


anantapur newborn action plan

Health & Medicine