THE INDIA NEWBORN ACTION PLAN

THE INDIA NEWBORN ACTION PLAN

THE INDIA NEWBORN ACTION PLAN Current Situation Vision & Goals Guiding principles Strategic Intervention Packages Milestones Way Forward

CAUSES OF NEONATAL DEATHS : INDIA Prematurity is the major cause (35%) Neonatal infections cause 1/3 rd of neonatal deaths (Pneumonia and Diarrhoea - 18%, and Sepsis- 15%) Intra-partum causes / Birth asphyxia responsible for 1/5 th of neonatal deaths Data Source : Liu et all. Lancet 2012 Statistical report

TIMING OF NEONATAL DEATHS 5

Contribution of Neonatal to Under Five Mortality (%) 70 64 63 63 62 60 50 59 58 58 57 56 56 54 54 54 53 49 40 39 30 20 10 0 Data Source SRS 2012

WHERE ARE THESE DEATHS HAPPENING.. 4 states: UP, Bihar, MP and Rajasthan contribute to 56% of neonatal deaths in India 14% of global newborn deaths

TRENDS IN MORTALITY RATES IN INDIA (2000-2012) 68 44 32 66 63 60 58 58 57 55 53 50 47 44 42 40 40 37 37 37 37 36 35 34 33 31 29 27 28 28 29 25 25 26 27 27 25 24 23 Infant Mortality Rate Neonatal Mortality Rate Early Neonatal Mortality Rate 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Source: SRS

MAJOR MILESTONES FOR INDIA'S NEW BORN 1992 Child Survival & Safe Motherhood Program (CSSM) RI, ARI, Diarrhoea, Safe delivery kits, FRUs 1997 RCH I RTI and STI component added 2005 - RCH II/ NRHM Cash transfers for institutional delivery; Introduction of ASHAs 2011 JSSK Free health care made an entitlement for Pregnant women and New Born 2013 Call to Action Geographical prioritization 184 HPDs and RMNCH+A Rapid scale up of Facility based new born care 548 SNCUs Largest Community based program for New born in place Home visits by 900,000 + ASHA workers Major Policy gaps around high impact interventions addressed Seven States have achieved MDG 4

THE INDIA NEWBORN ACTION PLAN India envisions a health system that eliminates preventable deaths of newborns and stillbirths and where: - every pregnancy is wanted - where every birth is celebrated, and - where women, babies, and children survive, thrive, and reach their full potential. Targets to achieve single digit NMR and SBR by 2030

GOAL 1: ATTAIN SINGLE DIGIT NEONATAL MORTALITY RATE BY 2030 35.0 30.0 29.0 26.2 25.0 20.0 15.0 25.9 20.5 22.1 15.2 18.6 15.7 10.0 5.0 9.9 0.0 2012 2015 2020 2025 2030 2035 NMR (Based on Current AAR) NMR (Accelerated levels to achieve global targets)

GOAL 2: ATTAIN SINGLE DIGIT STILL BIRTH RATE BY 2030 25.0 20.0 15.0 22.0 21.4 20.5 19.7 18.8 20.0 16.6 10.0 5.0 13.2 9.8 0.0 2012 2015 2020 2025 2030 2035 SBR (Projected Levels Based on Current AAR) SBR (Accelerated levels to achieve global targets)

JOURNEY OF INAP IN INDIA 2013, April - Johannesburg, Global Newborn Health Conference Constitution of a National Committee Constitution of Sub-committees: HBNC, FBNC, Urban Newborn Health, Pvt Sector and RMNCH+A Bottleneck Analysis: Rajasthan, Odisha and Andhra Pradesh

RECENT POLICY INITIATIVES TO STRENGTHEN NEWBORN INTERVENTIONS Scaling up FBNC Gentamicin use by ANMs for sepsis management in young infants Vitamin K at birth Antenatal Corticosteroids in Pre-term Labour Revised guidelines for HBNC SNCU online monitoring and follow up tracking system

RECENT POLICY DECISIONS TO STRENGTHEN MATERNAL HEALTH Distribution of Misoprostol by ASHAs in home delivery cases Calcium supplementation during pregnancy Screening for Gestational Diabetes Hypothyroidism Congenital Syphilis, and Hepatitis B De-worming during pregnancy Ultrasonography during pregnancy Breast and Cervical cancer screening Training of Surgeons for Caesarean section 3-day hands-on training programme for intrapartum and newborn care

SIX GUIDING PRINCIPLES Partnerships I N A P Convergence Quality of care Integration Equity Gender Accountability

SIX INTERVENTION PACKAGES I N Preconception & Antenatal Care Care during labour & childbirth Immediate newborn care Care of healthy newborn Care of small & sick newborn Care beyond survival A P THUMB RULES: 1. All interventions delivered at family &community level are also available at outreach/ Sub Centre level. 2. All interventions delivered at outreach/sub Centre level are also delivered at health facility level.

WHERE SHOULD WE FOCUS. High Impact Interventions For Reducing Neonatal Deaths Interventions around Birth 41% impact (Skilled birth attendance, emergency obstetric care, neonatal resuscitation and immediate care at birth) Care of Small and Sick newborn 30% impact ( Kangaroo mother care, SNCU, Full supportive care) Community Care 25 to 30% impact (Exclusive Breast feeding, hand washing, home based care, behaviors & practices)

WHERE SHOULD WE FOCUS. Day of Birth is Most Dangerous for Mother & Newborn 46% of Maternal Deaths 40% of Neonatal Deaths 40% of Still Births Interventions Targeting Day of Birth Triple Returns on Investment

Deaths averted Number of Deaths Averted by Stage of Intervention 500,000 450,000 4,56,000 400,000 350,000 Stillbirths averted Maternal lives saved Newborn lives saved 300,000 250,000 200,000 1,87000 150,000 100,000 50,000 43,500 45,500 52,000 54,500 0 Preconception Nutrition Antenatal Care Care during labour and birth including complications Immediate Newborn Care Care of the healthy newborn Care Of The Small & Sick Newborn 19 India specific analyses based on EN Lancet Paper 3, 2014 by AIIMS, V.K Paul

PRECONCEPTION AND ANTENATAL CARE INTERVENTIONS PACKAGE Family and Community Reproductive Health & Family Planning Nutrition related interventions Counselling & Birth Preparedness Prevention against Malaria Outreach/Sub Centre Screening for Anemia and Hypertension Malaria screening Prevention and management of mild to moderate anemia Maternal tetanus immunization Adolescent friendly health services Interval IUCD insertion Health Facility Antenatal screening & management of Severe anemia, Hypertension in pregnancy, Gestational Diabetes, Syphilis Screening & management of Hep B, Hypothyroidism, HIV, Malaria Adolescent friendly health clinics Post-partum family planning services including PPIUCD insertion Prevention of Rh incompatibility

CARE DURING LABOUR AND CHILDBIRTH IMMEDIATE NEWBORN CARE Family and Community SBA Clean birth practices Outreach / Sub Centre Identification of complications and timely referral Pre-referral dose by ANM (Antenatal corticosteroids in preterm labour; antibiotics for PROM) Health Facility EmOC Management of pre-term labour Family and Community Delayed Cord clamping Interventions to prevent hypothermia Early initiation and exclusive breastfeeding Hygiene to prevent infection Outreach/ Sub Centre Vit. K at birth Neonatal resuscitation Health Facility Advanced neonatal resuscitation

CARE OF THE HEALTHY NEWBORN CARE OF SMALL & SICK NEWBORNS Family and Community Home visits till six weeks by trained ASHA Exclusive breastfeeding Clean postnatal practices Outreach / Sub Centre Immunisation Health Facility All interventions (except home visits) Family and Community Thermal care and feeding support (for home deliveries) Outreach/ Sub Centre Integrated management using IMNCI and use of oral antibiotics Injectable Gentamicin by ANMs for sepsis Health Facility KMC Full supportive care at block and district level (NBSU, SNCU) NICU at regional level

CARE BEYOND NEWBORN SURVIVAL Family and Community Screening for birth defects, failure to thrive and developmental delays Follow up visits of SNCU discharged infants (till 1 year of age), small and low birth weight babies (till 2 years of age). Outreach/Sub Centre As before Health Facility Newborn screening Management of birth defects for conditions enlisted under RBSK Follow-up of high-risk infants (discharged from SNCUs, and small newborns)

Deaths averted Number of Deaths Averted by Stage of Intervention 500,000 450,000 4,56,000 400,000 350,000 Stillbirths averted Maternal lives saved Newborn lives saved 300,000 250,000 200,000 1,87000 150,000 100,000 50,000 43,500 45,500 52,000 54,500 0 Preconception Nutrition Antenatal Care Care during labour and birth including complications Immediate Newborn Care Care of the healthy newborn Care Of The Small & Sick Newborn 24 India specific analyses based on EN Lancet Paper 3, 2014 by AIIMS, V.K Paul

MONITORING & EVALUATION FRAMEWORK FOR INAP HMIS On-line SNCU Monitoring MCTS M&E Framework Milestones

Year National Milestones 2014 National launch India Newborn Action Plan 2015-2016 State Newborn Action Plans developed Reporting by states on Dashboard Indicators Quality assurance mechanisms strengthened at national and state level Institutional mechanism established for research and knowledge management Gender disaggregated data available and monitored for various interventions 2017 Mid-course review 2018-2019 Stillbirth tracking mechanism strengthened Accountability framework developed and operationalized at all levels of health care Equity disaggregated data available and monitored for all interventions 2020 Review and update action plan

WAY FORWARD State level action plans to be developed Forging partnerships as envisaged with various professional bodies Scale up newer initiatives along with quality trainings Up gradation of SNCUs and establishment of Kangaroo Mother Care Units Affirmative actions to address stillbirths Research priorities to gather evidence to be addressed

A healthy start is central to the human life course. Every newborn must be able to survive and thrive!