1. 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

2. UNICEF Institutional births: CES: 72%, DLHS-3: 47% Govt. Facilities 47% 2 CES, 2009

3. UNICEF Sick Neonate treated (OPD & Indoor) in Referral Hospitals in Orissa, 2004-2006

4. UNICEF ReferralsTraining inputs

5. UNICEF Facility Based Newborn care in India: A Conceptual framework Community PHC CHC District Hospital Newborn corner (1 bed) At DeliverySick newborn Stabilization units (4 beds) Special newborn care unit (12-20 beds)

6. UNICEF 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

7. 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”

8. UNICEF BTL SVP SNI SDH SA CDW BLG CTP KRG RSN MDL STN VDS DHR JBA PAN SJP KND DMH SHE SOP UJN RJG SDL DWS JBP HSB GUN RWA TKM NSP MDS KT N DDR AKN BHD IDR GLR MRN RTM ANP BRW UMR NMC HRD BHP BPL DTA 18 Functional 20 Under Construction Status of Special Care New Born Units : Madhya Pradesh, India Sanctioned for all 50

9. UNICEF

10. 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

11. 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%

12. 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%

13. UNICEF Admission Profile: Reasons for admission

14. UNICEF Decline in mortality among admitted newborns after one year Current mortality among admitted newborns range from 5-15%

15. UNICEF Where did the decline occur?

16. UNICEF Adequacy of number of beds

17. UNICEF Adequacy of beds: Average length of stay and bed occupancy rate

18. UNICEF Adequacy of Human resources

19. UNICEF Maintenance of Equipments

20. UNICEF Adequacy of asepsis practices

21. UNICEF Determinants of outcomes: Human resources

22. UNICEF Determinants of outcomes: Asepsis practices

23. 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

24. 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

25. 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

26. 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…..