TOWARDS SKILLED NEONATAL
RESUSCITATION: THE INDIAN
STORY-YEAR ONE
Naveen Thacker ; Panna Choudhury
William Keenan ; Vineet Saxena
Indian Academy of Pediatrics
Incredible Story of Implementation of Newborn
Resuscitation Program in India…probably largest ever !
Stakeholders
The story is about……
 A collaborative model of national and international
professional societies with governmental and
private support that can provide effective training
on a huge scale within short period of time.
 The ‘Hands on’ learning approach was associated
with a major pre to post improvement in skills
acquisition and application in the training setting.
Story is about…..
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Vision of IAP leadership
Commitment at Political & Bureaucratic level
Support from AAP, LDSC, Johnson & Johnson
Arranging adequate training material
Microplan: Movement of trainers, manikins, kits…
Why Skilled Resuscitation is
important in India ?
Every year in India……
…. 27 million women become pregnant
… 1 million babies are stillborn;
300,000 intra-partum causes
… about 1 million neonates die due to
Infections (36%)
Preterm (25%)
Asphyxia (23%)
NRP can reduce asphyxia related neonatal
mortality upto 2/3rd
Figure 5
Scaling up NRP in Public Sector is Urgent
India’s Janani Suraksha Yojana(JSY),
Conditional cash transfer program
to increase birth in health facilities.
Lancet 2010; 375: 2009-2023
• Large scale shift:
from home to
institutional
deliveries
•Urgent need of
large no. of SBA’s
Engaging IAP Leadership
Newborn Resuscitation Program
taken under
Presidential Action Plan 2009
IAPs Strength
• 18,000 dedicated pediatricians
• 300 branches
Resuscitation Program:
Advance or Basic !
• Requirement of Birth Attendant
trained in resuscitation: 0.25 million
• Advance NRP training for all not feasible
• Basic NRP can address most asphyxia cases
Developed the program based on
Lessons 1-3 of AAP text book of NRP &
Skilled birth attendants manual of LDSC
Program is named as
Newborn Resuscitation Program- First
Golden Minute(NRP-FGM) Program
Aims to have one NRP trained person
attending every delivery
( 27 millions deliveries /year in India )
Administrative Structure for NRP Program
Steering Committee
Core Committee
Administrative
Academic
Who will be trained ?
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36,000 Pediatricians
40,000 Obstetricians
20,000 Anesthetists
Medical officers, Doctors in private
practice who are attending deliveries
• Nurses and Auxiliary Nurse Midwives
Adds to 0.25 million birth attendants
Manikins and Resuscitation Kits
Squeeze bulbs for simulation of crying,
breathing and heart activity
Umbilical cord that can be cut
multiple times
•LDSC provided some kits initially
•Arrangement with Laerdal Co. for Manikins; field
tested first in India
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Industry Support
Johnson and Johnson India committed
unprecedented educational grant and logistical
support for the implementation of the program
to train 200,000 birth attendants
“First Golden Minute: Trainings in 2009”
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Jan 21-22, 2009:
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Feb 28 -Mar 1, 2009 : Meerut
March 21-22, 2009
: Hyderabad
March 28-29, 2009
: Raipur
April 18-19, 2009
: Guwahati
April 24-25, 2009
: Varanasi
April 27-28, 2009
: Gwalior
April 29, 2009
: Agra
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May 02 -03,2009
May 17,
2009
May 22,
2009
June 7,
2009
June 20,
2009
June 27,
2009
July 19,
2009
July 26,
2009
August 9
2009
September 13, 2009
October
2009
November 28 2009
December 16 2009
January 5-6
2010
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Bangalore
: Kolkata
: Trivandrum
: Bareilly
: Mumbai
: Chennai
: Mysore
: Ernakulaum
: Coimbatore
: Trichur
: Trichy
: Belgaum
: Salem
: Calicut
:Hyderabad
ToT’s were carried out for IAP
members at various places
Engaging Ministry of Health
• Data to show birth asphyxia as major problem.
• Basic NRP, a short course program, can reduce
neonatal mortality substantially.
• Successful implementation of the program in
other developing countries.
• Commitment of IAP leadership for trainings in
public sector.
Ministry of Health launched
Navjaat Shishu Suraksha Karyakram (NSSK)
GOI and IAP have signed a MoU for training on 09-12-2009
WHERE ?
Roll out Plan
10 States = ~ 300 Districts
4 Trainers per district
1200 Trainers planned in 4 months
States in India where newborns
are at high risk of dying
Program included Basic Newborn Care and
Resuscitation
Prevention of Infection
Wash Hands
Wear Gloves
Cord Care
Clean
Chain
Prevention of hypothermia
Warm
Chain
Early initiation &
exclusive breastfeeding
Kangaroo Mother care
Expert Committee developed the module
Action Plan
Selection and Motivation of Trainers
• Only trainers who are highly committed and
can give reasonable time are chosen
• Mission mode is emphasized.
• Motivation is praise, SMS at the start of
training highlighting their mission, SMS at the
end of training congratulating their efforts.
Quality of Training
• Quality of training is given high priority.
• Microplan included program details sent in
advance to Organizers, Trainers, Providers.
• Faculty meeting held at previous day evening,
where every one’s role is planned, rehearsed.
• Facility and stations checked in advance.
Emphasis on Skill and Innovation
• Emphasis on ‘hands on skill’
• Role play and video’s
• Pre test and post test both written and skill
based are designed to improve learning
• Based on feedback the process of conducting
the program are improved upon
Evaluation of training- pre-test and post-test of
240 Trainers
Knowledge- by Written Evaluation
89%
83%
+6%
Pre-test
Post-test
Change
Evaluation of training- pre-test and post-test of
240 Trainers
Skills – by Performance Evaluation
88%
+65%
23%
Pre-test
Post-test
Change
Persons trained till June 2010, in Govt Sector
Type of Course
Persons Trained
Instructors in Govt Sector
1530
Providers in Govt Sector
Madhya Pradesh 951
Rajasthan 667
Kerala 167
Orissa 24
Jharkhand 468
Total Providers in Govt Sector
1550
Overall TOTAL in Govt. Sector
3080
Training target in 2010 more than 30,000
What are we going to do?
• A sustainable system of training, retraining and
certification
• Follow up/ Monitoring of training
• Operational Research
• Impact study on mortality reduction
We conclude……
 A collaborative model of national and international
professional societies with governmental and
private support can provide effective training on a
huge scale within short period of time.
 The ‘Hands on’ learning approach was associated
with a major pre to post improvement in skills
acquisition and application in the training setting.
Steering Committee of IAP NRP FGM
President IAP
2009 and
Chairperson
President IAP
2010 and CoChairperson
President IAP
2007 and
National CoOrdinator
Thank you
Hon. General
Secretary, IAP,
2010