transforming care for every small and sick newborn · 2020. 7. 1. · target : sncu staff, program...
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#EveryChildAlive#EveryNewborn#EveryNewborn #EveryChildAlive
Transforming care for every
small and sick newborn
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The SNCU Online Story of India
Using Data for Action
Dr. Gagan Gupta, UNICEF- HQ
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Data Source – UNIGME Estimates, 2019 and SRS 2018
India – Story of 25 Million Babies Born Each Year
0
100000
200000
300000
400000
500000
600000
700000
800000
India Nigeria Pakistan China DR Congo
Annual Neonatal Deaths Top Five Countries
Nigeria
Pakistan
Ethiopia
DR Congo
Remaining Top Four CountriesIndia
▪ 549,000 die in first 28 days
▪ 22% of global burden
▪ 64% of Under 5 deaths
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India – Story Shifting from Home to Hospitals
▪ 2005 – Every second women delivering at home
▪ 2015- Eight out of Ten women delivering in health facility
▪ Urgency for Investing in care of small and sick newborns
o 850+ Special Newborn Care Units (SNCUs)
o 1 million newborn treated annually
▪ Challenge – No system to monitor outcomes
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Piloted in 2 SNCUs in 2012 – UNICEF, National Health Mission
Target : SNCU staff, program managers, policy makers
Focus of online monitoring –
o Real time analysis on 250 + parameters
o Using data to monitor performance
Scaled up by National Health Mission across India
o 800+ SNCUs online with 5 million admissions, 495,000 deaths
o One of the largest real time online data for small and sick newborn
Solution – Moving from SNCUs to SNCU online
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Monitoring Solution for SNCUs
Uniform Data RecordingSimultaneous Online Entry
Dedicated data operator
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Dr. Gagan Gupta, Health Specialist
Using Evidence for Advocacy and Action
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Gaps in Care Seeking for Girl Child
194,000 Fewer Female SNCU Admissions in 2019, in spite of free care
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Birth Asphyxia61%
Other Causes39%
• Skilled Birth Attendance
• Emergency Obstetric care
• Neonatal Resuscitation
Access and Quality of care around birth is the key
Preventable Asphyxia Deaths in SNCUs – Care in Delivery room ?
Data Source, SNCU online data system
SNCU mortality in > 2.5 kg weight : 117,500 deaths
January 2013 till December 2019
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Quality of Care – Antibiotic Use in SNCUs
Antibiotics Usage in SNCUs (India) – 51%
Snippet from SNCU fact sheet 2017-18
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Many are Still Susceptible on Discharge
Need for continued care at home and in community
26% are below 2000 gm on discharge
o Hypothermia prevention
o Feeding support
o Hygiene
o Optimal Development
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Convergence at Community
Level
Community
Care with
Facility
Linkages (25 to 30%)
Extending Continuum of Care…
Back to Community
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Regular Follow up at Home and in SNCUs - ECD
Counselling and Screening on Discharge
Home Visits by ASHA – Referral Linkages
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Improvement in Key Quality Indicators
14
9
0
2
4
6
8
10
12
14
16
Mortality in SNCU %
2016 2019
Maharashtra Uttar Pradesh
72
46
0
10
20
30
40
50
60
70
80
Antibiotics Usage %
Valu
es in
%
2016 2019
Rajasthan
14
0
5
10
15
20
25
30
35
Scheduled Follow-up
2016 2019
Data Source: SNCU online data
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▪ Intervention addressed the need on the ground
▪ Seeing is Believing – Creating pilots with government
▪ Government Leadership and ownership by states
▪ Ensuring dedicated HR and funding under NHM
▪ Continued support during scale up
▪ Regular review and feedback to districts
▪ Evolving and adapting as per emerging need
▪ Exchange across countries and partners
What Helped