Description of India newborn action Plan -2014 in brief

1. INDIA NEWBORN
ACTION PLAN
Dr Rambadan P. Chauhan
Professor-Community Medicine
BKLWRMC-Sawarde, District-Ratnagiri

2. Goals INAP
As per ‘Community Medicine’ with recent advance’ by AH Suryakantha, 4th Ed
Goal 1:Ending preventable newborn deaths to achieve single digit
NMR.
NMR=Total deaths up to 28 days from birth x 1000/total live births igga
dasp (in a give geographic area =igga, during a specified
period=dasp)
NMR 2012=28 , 2015=26.2
Average annual reduction rate=3.4 %
With this rate NMR BY 2030=15.7
Goal 2:Ending preventable still births to achieve single digit SBR.
SBR=Total still births x 1000/total live births+Total still births igga dasp
SBR 2012=22 , 2015=21.4
Average annual reduction rate=4.4 %
With this rate SBR BY 2030=19

3. INDIA NEWBORN ACTION PLAN
At the end of the lecture you {student (s)} should be able to understand,
1.Rationale, goal, strategic intervention
categories & levels of care.
2. Six components of INAP
3.Three levels of care of each component.
4.Dashboard indicators of INAP

4. 1.INDIA NEWBORN ACTION PLAN
• Launched: In 2014, in response to global Every
Newborn Action Plan.
• Goals: 1.Single digit neonatal mortality rate (NNR) by
2030 2. Single digit still birth rate (SBR) by 2030
• Strategic Intervention categories: 3 categories,
1.Essential (E) 2.Situational (S) 3.Advanced (A)
• Levels: 3 1.Family and community (FAC)
2.Outreach:sub-centre (OSC) 3.Health facility (HeFa)
• Global conference in April 2013, Johannesberg,SA:
Global Every newborn action plan: single digit NMR &
SBR by 2035.

5. 6 Components: PreCa-ImCa-CaCa
1. Pre-conception and antenatal care:
2. Care during labour and childbirth: SCIPEM
3. Immediate newborn care (I-DVA)
DEHI/ViNe/ANR
4. Care of healthy newborn HIA/HEC/BODH
5. COSASN=Care of small and sick newborn:
TIKFI
6. Care beyond newborn survival:
ScreeFo/ScreeFo/ ScreeMaFo

6. 1. Pre-conception and antenatal care
Family And Community (FAC): ReNuCoPre
1.Reproductive health and family planning (E) comprising 3
(ADB) a. Adolescent reproductive health b. Delayed ages of
marriage and first pregnancy c. Birth spacing
2.Nutrition related intervention (E) comprising 5
(BalPeriMaMiNu)
a. Balanced energy protein supplementation (BEPS)
b. Peri-conceptional folic acid
c. Maternal calcium supplementation
d. Micronutrient supply (iron, folic acid and iodine)
e. Nutrition counselling
3.Counselling and birth preparedness (E)
4.Prevention against malaria

7. 1. Pre-conception and antenatal care
Contents OSC:outreach/
Sub Centre
HeFa:Health facility
Antenatal
screening &
management
E:PE, Eclampsia,
Tetanus (PET)
S:Malaria
E: Gestational DM, Anemia-
severe, PIH, Eclampsia,
Syphilis, Hep. B, HIV , HDN
(GAPES-H3)
S: Malaria, Hypothyroidism,
(MH4)
Adolescent
friendly health
services/clinics
Nutrition &
reproductive health
counselling
RKSK, RBSK
Family Planning Interval IUCD Post-partum IUCD
E=Essential S=Situational A=Advanced

8. 2. Care during labour and childbirth:
SCIPEM
Family And
Community
(FAC):
Outreach/
Sub Centre (OSC)
Health facility
(HeFa)
1.Skilled birth
attendance (E )
1.Identify complications &
Referrals (E )
1.Emergency obstetric services
(E ) : Basic & comprehensive
2.Clean birth
practices ( E )
2.Pre-referral dose by
HWF(E),
a. Antenatal corticosteroids
in preterm labour ex inj
Dexa 3ml (12 mg) im/iv
b.Antibiotics for premature
rupture of membranes ex
inj Monocef 2gm iv stat
2.Management of preterm
labour: (E ),
a. Antenatal corticosteroids in
preterm labour
b.Antibiotics for premature
rupture of membranes

9. 3. Immediate newborn care (I-DVA)
DEHI/ViNe/ANR
FAC: DIHE OSC
:ViNe
HeFa: ANR
1.Delayed cord clamping (E )
2.EBF (E )
3.Hypothermia Prevention (E)
ImHeSkiD
a. Immediate drying
b. Head covering
c. Skin-to-skin care
d. Delayed bathing
4.Infection Prevention
1.Vitamin K
at birth ( E )
2.Neonatal
resuscitation
(E )
1.Advanced
neonatal
resuscitation

10. 4. Care of healthy newborn
HIA/HEC/BODH
Family And Community: HEC Sub Centre
Imm:BODH
Health Facility:
ATI
1.Home visits till 6 weeks by trained
ASHA (E ) CoHy CER
a. Counselling
b.Hypothermia Prevention
c. Cord-care
d.Early detection of danger signs
e.Referral of high risk cases
2. EBF (E)
3.Clean post-natal practices(E)
Immunization: (E)
-BCG
-OPV
-DPT
-Hepatitis B
ATI=All the
interventions(
except home visits)

11. 5. COSASN=Care of sick and sick
newborn: TIKFI
FAC :T OSC: I, I HeFa: KFI
1.Thermal care and
feeding support (E )
1.IMNCI & oral
antibiotics ( E )
2.Injectable Gentamycin
by HWF/ANM ( E )
a.Pre-referral
b. Completion of
antibiotics in case
referral is refused/not
possible/as advised by
treating physician
1.Kangaroo mother care
( E )
2.Full supportive care at
block (NBSU) and district
(SNCU) (E)
3. Intensive care services
(NICU) at regional level
(A)
a. Assisted Ventilation
b. Surfactant use
c.Surgery

12. 6. Care beyond newborn survival:
ScreeFo/ScreeFo/ ScreeMaFo
FAC : ScreeFo OSC: ScreeFo HeFa: ScreeMaFo
1.Screening for BDF
(birth defects-
Development delays-
failure to thrive) ( E )
2.Follow up visits of ( E )
a.SNCU discharged
babies till 1 year of age
b.Small and low birth
weight babies till 2 years
of age
1.Screening for BDF
(birth defects-
Development delays-
failure to thrive) ( E )
2.Follow up visits of ( E )
a.SNCU discharged
babies till 1 year of age
b.Small and low birth
weight babies till 2 years
of age
1.Screening for BDF
(birth defects-
Development delays-
failure to thrive) ( A )
2.Management of birth-
defects ( E )
3. Follow up visits of ( E )
a.SNCU discharged
babies till 1 year of age
b.Small and low birth
weight babies till 2 years
of age

13. Monitoring and Evaluation /
dashboard indicators for INAP
IPIC3= BT SINDS
Impact indicators BSC SENP
Pre-conception & ANC TASP
Care during labour & Childbirth SPACI
Immediate newborn (NB)care IBN WeLo
Care of healthy NB NewSEMB
Care beyond survival ScreWiDisDistrict

14. Monitoring and Evaluation / dashboard indicators for INAP
Impact indicators (%) BSC SEN N
Birth Registration
Stillbirth rate
Cause specific NMR
Survival rate of NB discharged from sncu/nicu at 1 year
ENMR
NMR
Neonatal deaths to U5 deaths ratio
Pre-conception & ANC (%) TASP
Teenage pregnancy rate
All ANC visits
Severe anemia
PIH
Care during labour & Childbirth (%) SPACI
Safe deliveries
Preterm berths
Antenatal corticosteroids in preterm labour
Caesarean section rate
Intra-partum SBR

15. Monitoring and Evaluation / dashboard indicators for INAP
Immediate newborn (NB)care (%) IBN WeLo
Inj Vitamin K (1mg=0.1ml IM)
Breast fed within 1 hour of birth
NSSK training to labour staff
Weight at birth recorded
Low Birth Weight
Care of healthy NB (%) ASEMB
All home visits done
Sick NB identified by ASHA
EBF rate
Mothers (PNC) stayed for 48 hours in Health Facility
Birth dose of BCG,OPV, Hep B (BOB)

16. Monitoring and Evaluation / dashboard indicators for INAP
Care of small & sick NB(%) DisFuFeMorDeSep
Districts with functional SNCU
Functional SNCU with functional KMC
Female admissions in SNCU
Mortality in NB with birth weight < 1800 gms
Deaths due to birth asphyxia
Sepsis NB cases receiving pre-referral gentamycin
Care beyond survival(%) ScreDeDisDistrict
Screened for birth defects NBs
Defect at birth NBs
Discharged at SNCU followed up for 1 year
Districts with functional DEIC

17. Assignments
LAQ
Describe 6 components of INAP.(6 marks).
Enumerate dashboard indicators of INAP.(2
marks)
SAQs
1.Components of INAP ( Each category 0.5 mark)
2.Dashboard indicators of INAP
3.Describe goals, Intervention categories &
levels of care of INAP (1+1+1) marks