Facility based newborn care in
India: norms and standards
Dr Pavitra Mohan, MD, MPH
Health Specialist, UNICEF India
Regional Child Health Managers Meeting,
November 2011
Govt. Facilities
47%
CES, 2009
Institutional births: CES: 72%, DLHS-3: 47%
UNICEF
2
Sick Neonate treated (OPD & Indoor) in
Referral Hospitals in Orissa, 2004-2006
3500
3000
2500
2004
2005
2006
2000
1500
1000
500
0
Baripada DHH
UNICEF
Udala SDH
Karanjia SDH
Rairangpur SDH
IMNCI /JSY
referrals
SCNU
Newborn
Stabilization
units
UNICEF
Newborn
Corners
Training inputs
Referrals
Facility Based Newborn care in India: A Conceptual framework
At Delivery
Sick newborn
District Hospital
Newborn
corner
CHC
(1 bed)
PHC
Community
UNICEF
Special newborn care
unit
(12-20 beds)
Stabilization units
(4 beds)
Facility Based Newborn Care
Essential Care to all Newborns
Special Care to Sick Newborns
Normal post-natal care to normal newborns
Follow-up of sick newborns
UNICEF
Status of Special Care
Newborn Units in India
More than 00 units “operational”, more
than 100 in pipeline
Rapid expansion between 2005-2010
Partnership between UNICEF/ NNF/
national and state governments
Plans to have at-least one SCNU in
each district
Supported by network of Newborn
Stabilization Units at first referral units,
and newborn care corners in each
“delivery-point”
UNICEF
Status of Special Care New Born Units :
Madhya Pradesh, India
18 Functional
MRN
BHD
20 Under Construction
Sanctioned for all 50
GLR
DTA
SOP
SVP
TKM
NMC
GUN
AKN
RWA
CTP
PAN
STN
SDH
MDS
SJP
RTM
DHR
IDR
DMH
BPL
UJN
DWS
NSP
BRW
UNICEF
KND
MDL
SNI
BHP
CDW
BTL
UMR
DDR
HSB
HRD
KRG
KTN
SDL
JBP
RSN
SHE
JBA
SA
VDS
RJG
BLG
ANP
UNICEF
Assessment of 8 Special Care
Newborn units in India
Assess the effectiveness in improving newborn
survival
Understand the operational bottlenecks that affect their
functioning and limit their effectiveness
Sieve out lessons for scaling up SCNUs in India and
other similar settings
UNICEF
What are these districts
like?
Infant Mortality Rate: 48-73/1000 live births
Literacy rate among women: 36%-63%
% institutional deliveries: 22%-36%
% children fully immunized: 23%-65%
UNICEF
Results: Profile of newborns
admitted in 8 SCNUs
No of admissions/100 births: 19.5 (4-39)
% of intramural admissions among all admissions:
68.5% (54%-90%)
% of boys among all admissions: 63.8% (58-70% )
% of babies with birth weight:
Between 1500-2499: 35% (22-46%)
<1.5 kg: 6%
UNICEF
Admission Profile: Reasons for
admission
UNICEF
Decline in mortality among
admitted newborns after one
year
District
Decline in neonatal mortality after 1year
Tonk
4.5%
Dibrugarh
11.8%
Mayurbhanj
28.4%
Purulia
48.1%
Lalitpur
-8.6%
Vaishali
43.0%
Guna
13.6%
Port Blair
16.2%
UNICEF
Current mortality among admitted newborns range from 5-15%
Where did the decline
occur?
UNICEF
Adequacy of number of
beds
Tonk
Dibrugarh
Mayurbhanj
Purulia
Lalitpur
Vaishali
Guna
Port Blair
UNICEF
Existing number of beds
Required Number of Beds
12
20
17
23
12
25
14
32
12
25
13
32
20
32
14
10
Adequacy of beds: Average length
of stay and bed occupancy rate
Name of the unit
UNICEF
Average length of
stay (in days)
Bed occupancy rate
Tonk
5.1
106%
Dibrugarh
4.4
137%
Mayurbhanj
4
155.3%
Purulia
15
100%
Lalitpur
3.4
52%
Vaishali
2.2
28.1%
Guna
5.5
130%
Port Blair
5.6
96%
Adequacy of Human resources
Name of the unit
UNICEF
Total number of beds Nurse: bed ratio
Doctor : bed ratio
Tonk
12
1: 1.5
1: 4.0
Dibrugarh
17
1: 0.8
1: 5.7
Mayurbhanj
12
1: 1.2
1: 4.0
Purulia
14
1: 0.7
1: 4.7
Lalitpur
12
1: 2
1: 6.0
Vaishali
13
1: 1
1: 2.6
Guna
20
1: 2
1: 6.7
Port Blair
14
1: 1.8
1: 7.0
Maintenance of Equipments
Name of the unit
UNICEF
Reported time for repair of essential equipment
(warners, phototherapy units)
Tonk
6 months
Dibrugarh
1.5 months
Mayurbhanj
6 months
Purulia
1.5 months
Lalitpur
3 months
Vaishali
1.5 months
Guna
0.5 month
Port Blair
6 months
Adequacy of asepsis
practices
Name of the unit
UNICEF
Asepsis score
Tonk
5
Dibrugarh
8
Mayurbhanj
3
Purulia
9
Lalitpur
5
Vaishali
5
Guna
7
Port Blair
9
Determinants of outcomes:
Human resources
UNICEF
Determinants of outcomes:
Asepsis practices
UNICEF
Norms and Standards
TOOL-KIT 2008 (UNICEF, NNF, WHO-CC):
• Levels of newborn care
• Services at each level
• Infrastructure and design
• Equipment: list, numbers and specs
• Human resources
• Training
• Cost
UNICEF
Norms and Standards (2011)
Operational Guidelines (Ministry of Health and Family
Welfare): 2011
Part-1: Setting up, costing and operational steps
Part-2: Key clinical & housekeeping protocols
Annexure 1.1: List of Equipment
Annexure 1.2: List of Dash board indicators
Annexure 1.3: Reporting format
Annexure 1.4: Checklist for facility assessment
Annexure 2.1: Working Definitions
Annexure
2.2: New born case record sheet
UNICEF
Norms and standards: how did
they help?
Ready reckoner for the states and districts
Quality assurance: design, space, infrastructure
Procurement of equipment
Ensuring human resources
Budgeting in state and district plans
Less dependence on external support
Assessment against norms: policy briefs for advocacy
Consensus (in India?)
UNICEF
Acknowledgements
National Neonatology Forum
and all members
Public Health Foundation of
India
All the nurses and doctors who
are making quality newborn
care available in some of the
remotest districts of the
country, often in difficult
circumstances…..
UNICEF