NEONATAL SURVIVAL STRATEGY AND CHALLANGES PRESENTATION DONE IN IAPSM UP,UK,STATE CONFERENCE IN GORAKHPUR , INDIA

1. Dr. Harivansh Chopra
Dr. Harivansh Chopra,
DCH, MD
Professor,&Head
Department of Community Medicine,
LLRM Medical College, Meerut.
NEONATAL SURVIVAL
STRATEGY &CHALLANGES
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2. Dr. Harivansh Chopra
Conclusions
80% of the newborns can be managed at home either by
mother or with the assistance of skilled and trained workers.
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.
7 feb. 2003

3. Dr. Harivansh Chopra
Whether this NEWBORN will survive
? ?
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0
20
40
60
80
100
120
1980 1990 2000 2010 2012 2013
114
80
68
47
42
40
69
53
44
33
29 28
PER1000LIVEBIRTHS
YEAR
COMPARISON OF INFANT AND NEONATAL MORTALITY
Infant Mortality
Neonatal Mortality
66%
65%
4
60%
70% 69% 70%
HBNC GUIDELINES BY MOHFW…

5. Dr. Harivansh Chopra
0
10
20
30
40
50
60
70
80
week 1 week 2 week 3 week 4
74.1
12.6 10
3.1
PERCENTAGE%
week 1 week 2 week 3 week 4
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DISTRIBUTION OF NEONATAL DEATH WEEKS 1 TO 4
HBNC GUIDELINES BY MOHFW

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DISTRIBUTION OF NEONATAL DEATHS DAY 1 TO 7
0
5
10
15
20
25
30
35
40
D 1 D 2 D 3 D 4 D 5 D 6 D 7
39.3
7.3 10.2
6.2 5.5
2.8 2.8
PERCENTAGE%
DAYS
Distribution of Neonatal Deaths Day 1-7
HBNC GUIDELINES BY MOHFW6

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RURAL URBAN TRENDS…
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INAP DOCUMENT BY MOHFW

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GEOGRAPHICAL
DIFFERENCES…
NMR > 30/1000
NMR 7/1000
8INAP GUIDELINES BY MOHFW

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CAUSES FOR NEONATAL DEATHS IN INDIA
BIRTH
ASPHYXIA
20%
PRE TERM
35%
SEPSIS
15%
PNEUMONIA
16%
DIARRHOEA
2%
MALFORMATIONS
9%
OTHER
3%
BIRTH ASPHYXIA
PRE TERM
SEPSIS
PNEUMONIA
DIARRHOEA
MALFORMATIONS
OTHER
Lancet 2012
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11. Dr. Harivansh Chopra
STRATEGY
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HYPOTHERMIA PREVENTION
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Asphyxia prevention
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Provisions of antenatal, natal, post natal
and neonatal care
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Prevention of infection
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Promotion of referral
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Prevention of prematurity & Low Birth
Weight
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Prevention of congenital malformation
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Yes to exclusive Breast feeding
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• HYPOTHERMIA PREVENTIONH
• PROVISIONS OF ANTENATAL, NATAL,
POSTNATAL & NEONATAL CARE
• PROMOTION OF REFERRALP
• PREVENTION OF PREMATURITY &
LOW BIRTH WEIGHT
• PROMOTION OF SMALL FAMILY
• PREVENTION OF CONGENITAL
MALFORMATIONS
P
• YES TO EXCLUSIVE
BREAST FEEDINGY
• ASPHYXIA PREVENTION
A
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MILESTONES IN CHILD SURVIVAL AND SAFE MOTHERHOOD
PROGRAMME
2014 – INDIA NEWBORN ACTION PLAN
2013 – NATIONAL HEALTH MISSION
2013 – RMNCH + A STRATEGY
2005 – NATIONAL RURAL HEALTH MISSION
2005 – RCH II
1997 – RCH I
1992 – CHILD SURVIVAL AND SAFE MOTHERHOOD
PROGRAMME
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JANANI SURAKSHA YOJNA
INTEGRATED MANAGEMENT OF NEONATALAND
CHILDHOOD ILLNESS
NAVJAT SHISHU SURAKSHA KARYAKARAM
JANANI SHISHU SURAKSHA KARYAKARAM
FACILITY BASED NEWBORN CARE
HOME BASED NEWBORN CARE
RASHTRIYA BAL SWASTHA KARYAKARAM
INDIA NEWBORN ACTION PLAN
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1. Janani Suraksha Yojna
• Launched in 2005
• Objective : Safe motherhood intervention to increase
institutional delivery through demand-side financing
and conditional cash transfer
• Status: implemented in all States/UT’s
Special Focus on Low performing States
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28. Dr. Harivansh Chopra
2. Integrated Management Of Neonatal and
Childhood illness (IMNCI)
• Launched in 2007
• Objective: Standard case management of major causes of neonatal and
childhood morbidity and mortality
• Status: operationalized in more than 500 districts
5.9 lakh health and other functionaries, including physicians, nurses,
AWWs, ASHAs trained under IMNCI.
26,800 medical officers and specialists placed at CHCs / FRUs trained
under F-IMNCI
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29. Dr. Harivansh Chopra
3. Navjat Shishu Suraksha Karyakaram
(NSSK)
• Launched in 2009
• Objective: Basic newborn care and
resuscitation training programme
• Status: 1.3 lakh health providers trained to
date
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30. Dr. Harivansh Chopra
4.Janani Shishu Suraksha Karyakaram
(JSSK)
• Launched in 2011
• Objective: Zero out of pocket expenditure for
maternal and infant health services through
free health care and referral transport
entitlements.
• Status: implemented in all States / UT’s
Assured service package benefits extended to
sick children upto age one.
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31. Dr. Harivansh Chopra
5. Facility Based Newborn
(FBNC)
• Launched in 2011
• Objective: Newborn Care facilities at various levels of Public Health
Services that includes NBCCs, NBSUs, and SNCUs.
• Status: NBCCs
NBSUs
SNCUs
more than 6300 persons provided FBNC training.
online reporting system reported and scaled up in 7 states.
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6. Home Based Newborn Care (HBNC)
• Launched in 2011
• Objective: provision of essential newborn care to all newborns,
special care of preterm and LBW newborns by ASHA workers.
• Status: implemented in all States and UT’s
• Most of ASHA’s trained in newborn care
• ASHA’s visited more than 12 lakh newborn in 2013.
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33. Dr. Harivansh Chopra
7. Rashtriya Bal Swasthya Karyakaram
(RBSK)
• Launched in 2013
• Objective: Screening of children with birth defects, diseases,
deficiencies, and developmental delays.
• Status: All children 0 to 18 targeted
More than 8 crore children screened and more than 10 lakh
children identified for tertiary care in 2013.
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34. Dr. Harivansh Chopra
8. INDIA NEWBORN ACTION PLAN
• Launched in September 2014
• Objective:
To reduce NMR to below 10 by 2030
To reduce Still Birth Rate below 10 by 2030
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CHALLENGES
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3Qs
Quantity
QualityQuestionable
Policy
Challenge is how to implement H.A.P.P.Y ? 36

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Status of Health Services in U.P
Required In Position
Sub-centres 31037 20521
Primary Health
Centers
5172 3692
Community Health
Centers
1293 515
(Source: RHS Bulletin, March 2012, M/O Health & F.W., GOI)
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38. Dr. Harivansh Chopra
Seats for Pediatrics in UP…
DEGREE/DIPLOMA GOVERNMENT
INSTITUTION
PRIVATE
INSTITUTION
TOTAL
MD PEDIATRICS 53 21 74
DCH 41 04 45
TOTAL 94 25 119 38

39. Dr. Harivansh Chopra
STATISTIC INDIA UP UP %
POPULATION (in crores) 121.06 19.96 16.4%
No. of SNCUs Established 418 15 3.6%
No. of NBSUs Established 1554 92 5.9%
No. of NBCCs Established 13167 1430 10.9%
State Of India’s Newborn, 2014 by PHFI
STATUS OF INFRASTUCTURE IN INDIAAND UP
SOURCE: STATE OF INDIA’S NEWBORN, 2014 BY PHFI 39

40. Dr. Harivansh Chopra
Some useful data…
Presently working SNCUs in UP: 15
LBW babies requiring Facility Based Care is 15% of all LBW : 228480
No. of LBW babies in UP/year: 1523200
Prevalence of low birth weight : 28%
Total newborn born every year: 5440000
Crude birth rate : 27.2/1000 mid year population
Total population of UP : 19.6 crores
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41. Dr. Harivansh Chopra
Requirement is for 22.8 lakh children and we are able to provide to
only 7800 i.e. 3.4% only.
So total babies who can be given bed :
150 x 52 = 7800
Total no. of beds : 15 x 10 = 150
Then 52 babies per year can be given per bed
No. of Days Stay per bed assume to be 7
Beds per SNCUs approx 10
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42. Dr. Harivansh Chopra
• So we are able to provide Facility Based Care to only 3.4% children.
• So if we wish to reduce our IMR by reducing NMR we have to provide
services to those 96.6% children who are devoid of necessary Facility
Based Care.
• In order to combat such difficulty there is an Essential Need for
• HOME BASED NEWBORN CARE
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29
26.2
22.1
18.6
15.7
29
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
IN INDIA: 2012-2030
NMR (BASED ON CURRENT AAR)
NMR (ACCELERATED LEVELS TO ACHIEVE
GLOBAL TARGETS) 43

44. Dr. Harivansh Chopra
Impact targets
Targets Current 2017 2020 2025 2030
NMR (per
1000 live
births)
29 24 21 15 <10
SBR (per
1000 live
births)
22 19 17 13 <10
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45. Dr. Harivansh Chopra
Coverage targets
Targets Current 2017 2020 2025 2030
Safe delivery
(institutional + home
delivery by SBA (%)
76 90 95 95 95
Initiation of
breastfeeding within
one hour of birth
(%)
- 75 90 90 90
Women with
preterm labour
receiving at least one
dose of
antenatal
corticosteroids (%)
- 75 90 95 95
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46. Dr. Harivansh Chopra
Coverage targets
Targets Current 2017 2020 2025 2030
Babies born in health
facilities with birth
asphyxia
received resuscitation (%)
- 75 90 95 95
Babies received complete
schedule of home visits
under
HBNC by ASHA (%)
- 50 75 95 95
Newborn with sepsis in the
community received
Gentamicin by ANM (%)
- 50 75 75 75
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47. Dr. Harivansh Chopra
Coverage Targets
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Target Current 2017 2020 2025 2030
Newborn
discharged from
SNCU followed
until
age one (%)
- 35 50 75 75
Newborn with low
birth weight /
Prematurity
managed
with KMC at
facility (%)
- 35 50 75 90

48. Dr. Harivansh Chopra
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
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