anantapur newborn action plan

ANAP
Single Digit IMR & SMR-2030
DISTRICT 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

Mission
To 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

Rationale
Ô Investing in newborn health and survival helps
achieve Health and Developmental goals
Ô Honoring New borns’ human rights
The 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
Neonatal
Deaths
54%
Newborn deaths account for more than 50% of U5 deaths
Source: WHO Global Health observatory 2010
RATIONALE

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

30 26.2
22.1
18.6
15.7
30
25.9
20.5
15.2
9.9
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
Sepsis
12%
Asphyxia
25%
LBW
25%
Pneumonia
12%
Diarrhoea
13%
Fever related
13%
Measles
0%
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
P
E
R
C
E
N
T
A
G
E

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
P
E
R
C
E
N
T
A
G
E

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
month
2.7%
Child Deaths between
1 month & under 1
year
16.2%
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 HR
Cadre Numbe
r in
positio
n
Vacan
t
Vaca
nt%
Trained
in NSSK
Trained
in SBA
%
Trained
in NSSK
%
Trained
in SBA
SCBC
SN 481 122 25.36 400 302 83.16 62.78
20%
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
EmNOC
SCBC
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
●
● ●
●
●
●
●
●
●
USG
Machines

Data to ponder
Statistic 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 ponder
STATISTIC 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 Analysis
It 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

OPPORTUNITIES
o NHM funding
o Building capacities
o Strengthening of HBNC
o International NGO support

THREATS
o 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 - Anantapuramu
Target % Current 2017 2020 2025 2030
Safe delivery
95 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- Anantapuramu
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- Anantapuramu
Newborn
discharged
from SNCU
receiving
follow up
NA 35 50 75 80
Newborn
with
LBW/Prematu
rity managed
with KMC at
facility
NA 35 50 75 90

Coverage Target - Anantapuramu
% 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 - Anantapuramu
Target Current 2017 2020 2025 2030
Inj.
Vitamin
K at
birth
20% 40 65 85 95
Peri-
concepti
onal
folic acid
NA 35 50 75 95

Guiding Principles
EQUITY
GENDER
QUALITY OF CARE
CONVERGENCE
PARTNERSHIPS
ACCOUNTABILITY
INTEGRATION INNOVATION LEADERSHIP TEAMWORK

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
Proportionalmortality
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

Family/communityOutreach/out
patient
Clinical
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 nutrition
Education 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 packages
Six 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, 2013

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 inequities
Health 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 activities
Household 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 activities
Champions: 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 and
Antenatal Care

Priority actions
1. 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 actions
4. 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 actions
7. 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 Actions
1. 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 Actions
4.. 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 Actions
7. 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 Actions
1. 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 Actions
5. 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 Actions
1.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 Actions
5.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 Actions
9. 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 Actions
1.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 survival
Priority Actions

Priority Actions
1.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 Actions
4. 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 Actions
7. 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 framework
ᇹ 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

Conclusion
80% 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-conceptional
and Pregnancy Period

Than Q

Than Q once again

anantapur newborn action plan

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