Kumar: Scaling Up Newborn Programming in India Agenda Setting, Policy Formulation and Implementation

7/28/2019 Kumar: Scaling Up Newborn Programming in India Agenda Setting, Policy Formulation and Implementation

1/18

Scaling up newborn programming in India: agenda setting, policy

formulation and implementation

Dr. Rakesh Kumar

Joint Secretary

Ministry of Health and Family WelfareGovernment of India

Session 3B

Wednesday 17th April 2013


2/18

Outline of presentation

Trends, rate of decline of mortality

Magnitude, diversity, inequity

Milestones for agenda setting

Strategic approaches

Recent policy decisions


3/18

Trends in Child, Infant and Neonatal Mortality Rates

Steady decline seen in U-5MR (74 to 55 in 6 yrs) and IMR (58 to 44 in 8 yrs)

Decline in neonatal mortality has been disproportionately slow

Little change in the Early Neonatal Mortality Rate

Neonatal Mortality now constitutes 56% of the total U-5 mortality and an estimated 820,000 o1.45 million under-5 deaths annually (SRS 2011)

77% of neonatal deaths take place in first week of life.

74

69

64

5958 58 57

55 53 5047

4

37 37 37 36 35 34 33

2628 28 29 27 27

252

20

30

40

50

60

70

80

2004 2005 2006 2007 2008 2009 2010 20

Deathsper1000livebirths

NMR

IMR

U5MR

NMR, IMR, U-5MR trend, India (SRS data)

ENMR


4/18

-6.1

-2.9

-2.9

-2.7

0

0

0

-7.5

0

-9.1

-6.8

-7.8

-7.2

-10 -8 -6 -4 -2 0

2011

2010

2009

20072006

2005

2004

2003

2002

2001 % annualchanprevious year i

U5MR

% average ann

change over p

year inNMR

STAGNANT

Annual Rate of decline in Under Five & Neonatal Mortality Rates

National Rural Health

2005-06

Major Health Systems S

A 6% decline noted for

during this phase o


5/18

India: Challenges-Magnitude, Diversity, Inequity

4944 44

41 41 41 41 40 39

27 25 24 22 24 23 23 22 21

0

10

20

3040

50

60

70

80

2000 2001 2002 2003 2004 2005 2006 2007 2008 2

Deathsper100

0livebirths

Urban- rural disparity (NMR)

Districts with

minimum NMR

Districts w

maximum NSTATE , RANGE

ASSAM 20Kamrup (30) Dhubri (50)

MADHYA PRADESH 38Bhopal (28) Pa

BIHAR 26Patna (22) Khagaria (4

ODISHA 44Anugul (31)

Intra-state disparities

414040

37

1818

157

0 10 20 30 40 50

Madhya Pr.Odisha

Uttar Pr.Rajasthan

DelhiMaharashtraTamil Nadu

Kerala Neonatal Mortality Rate

Inter-state disparities

Demographic: 1.2 bn people, 26 m birth cohort

Geographical: 35 States/UTs, 640 districts, 6000

blocks, 600,000 villages

Infrastructure: 0.15 m Sub centers, 24000 PHCs,

4400 CHCs, 640 District hospitals

Health Workforce: 0.86 m ASHAs, 0.17 m ANMs

Inequities: Urban-rural, socio-cultural, economic,

religious, castes & tribes, gender, regional

disparities


6/18

53.6

64

7

61

62.6

36.8

45.4

60.1

33.5

72

68.7

26.5

47.3

43.4

0 10 20 30 40 50 60 70

ORT or Increased fluid in Diarrhoea

Vit. A Supplementation (1st Dose )

Children received measles vaccine

Full Immunization

Complementary Feeding (6-9 months)

Exclusive breastfeeding

Postnatal 3 checkups for newborns within 10 days

Post Natal visit to mothers within 2 weeks

Early initiation of breast feeding (


7/18

Child Survival Call to Action: A Promise Renewed,

held in Washington (June 2012), co-hosted by Govts. of USA, Ethiopia & India

RMNCH+A CoalitionGovt led multi-stakeholder platform on lines of Global PMNCH

Indias Call to Action: Child Survival and Developmentheld in Mahabalipuram (February 201

Launch of RMNCH+A Strategic Approach

Commitments from all partners, constituencies and stakeholders

Strategic approaches defined

State-specific annual targets for accelerated decline in mortality

Agenda setting: Key milestones

Differential planning and implementation for High Priority Districts

Guidelines developed for intensification of RMNCH+A interventions in these districts

Developmental Partner harmonization

Plan of Action developed

St t i A h 1 RMNCH A d Id tifi ti f P D i


8/18

Inter-linkages between different interventio

various stages of the life cycle

Linking child survival to other interventions

as reproductive health, family planning, m

newborn and child health

Sharper focus on adolescents

Recognizing nurses as pivots for service

Expanding focus on child development and

of life

STRATEGIC

APPROACH TO

RMNCH+A

Strategic Approach 1: RMNCH+ A and Identification of Programme Drivers..


9/18

VHND,VHSNC

WIFS IYCFUIPBCC

SBA

MCH

WINGS

COMMUNITY

PROCESSES

SKILLED HUMAN

RESOURCES

PHYSICAL

INFRASTRUC-

TURE

MCTS

INTERVAL

IUCD AT

SUBCENTRE

HBNC

DELIVERY

POINTS

ADOLESCENT

HEALTH

SERVICES

SNCU,

NBSU,

NBCC

ORS+ ZINC

PPIUCD

JSY &

JSSK

IMNCI

DISTRIBUTION

OF

CONTRACEPT-

IVES BY ASHA

St t i A h 2 E i il bilit f N b C t ll l l


10/18

Healthy NewSick Newborns

After Discharge

Sick Newborns

Strategic Approach 2: Ensuring availability of Newborn Care at all levels

Newborn care Corners(NBCC) at all DeliveryPoints

Equipped for

resuscitation with trainedpersonnelEssentialNewborn Care &

resuscitation

ENC to all newborns Accredited Social HeActivist (ASHA)

6 visits in first 42 day(7 visits for home del

Incentives to ASHAs USD per newborn

Home BasedNewborn Care

Sick Newborn Care Unitsat District Hospitals andtertiary health facilities

Newborn StabilisationUnits at FRUs; 4 beddedunits

Facility BasedNewborn Care forsick newborn

Free healthcare at Public

Health facilities (JSSK)

St t i A h 3 H lth S t St th i


11/18

Strategic Approach 3: Health System Strengthening

415 MCH wings adding up 25,000 more beds [660 million USD pla

in 2012-13]

16,800 Deliverypoints 418 Special Newborn Care Units; 1554 Newborn Stabilization

and 13,167 Newborn Care Corners

Assured Referral transport (National Ambulance Service)

Augmentation of HRH

Institutional delivery cash assistance scheme or Janani SuraYojana (JSY) [324 million USD for 2012-13]

Free assured healthcare services and referral transport for pre

women and infant at public health facilities (Janani Shishu Sura

Karyakram) [491 million USD allocated in 2012-13]

St t i A h 5 Fi i l I t t i P bli H lth S t i 2005


12/18

824

1073

1582

1789

2132

2393

276

0

500

1000

1500

2000

2500

3000

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011

Total central funding of 13 billion USD (till 2012-13) to

States under NRHM, that has special focus on MNCH

Strategic Approach 5: Financial Investment in Public Health Systems since 2005

Strategic Approach 4: Reaching areas & populations with highest mortality burd


13/18

Ambitious targets setting for all the states with higher percentage annualrate of decline in NMR, IMR, U5MR, MMR and TFR. MoU signed with thestate Governments for accelerated and sustained improvements in Healthindicators

184 High Priority Districts (HPDs) of 640 districts identified based oncomposite health index

differential planning & implementation, focus on underservedblocks/tribal areas, 30% more allocation of funds

Integrated Action Plan - Additional central assistance scheme for tribaland backward districts, addressing social determinants of health.

Harmonisation of techno-managerial support for integrated

RMNCH+A planning, implementation & monitoring throughDevelopment Partners (includes UN agencies, foundations,bilaterals, CSOs) across HPDs

Strategic Approach 4: Reaching areas & populations with highest mortality burd

Strategic Approach 6: Robust Health Information Systems


14/18

Monitoring

Web-based Mother and Child Tracking System

Web-based Health Management Information System

Survey based Score cards and HMIS based Dashboard

Online monitoring software for Special Newborn Care Units

MCTS

HMIS

Scorecard

SNCUOnline

Strategic Approach 6: Robust Health Information Systems

Recent Policy Decisions


15/18

Newborn screening atpublic health facilities

Mobile Teams

Screening by ASHAs asHBNC

Screening

Early Intervention Centre atDistrict hospital for furtherassessment and act as areferral linkage toappropriate health facility

Referral

Free of cost servincluding surgicainterventions at pidentified tertiaryinstitutions

Manage

1. Child Screening & Early Intervention Services (Rashtriya Bal Swasthya Karyakram

Systemic approach for early identification of 4Ds: Defects at birth, Deficiency, Diseases and

Disability in children 0-18 years (270 million, when scheme fully implemented) of which 26 milliowill be newborns




16/18

Recent Policy Decisions..

2. JSSK : Free entitlements for treatment of all infants in public health facilitie

3. National Iron + initiative and WIFScovering 130 adolescents in India

4.Financial incentives to ASHAs for promoting delay in first pregnancy and

spacing and terminal methods and promotion of PPIUCD spacing methods

5. Technical Group agreed for administration of pre-referral injectable antibiot

neonatal sepsis and Pneumonia management by ANMs

A glimpse of new born care facilities and infrastructure in Public Health Syste


17/18

A glimpse of new born care facilities and infrastructure in Public Health Syste

Newborn transport Basic Ambulance for PWEmergency transport vehi

Newborn Stabilization Unit SNCU at district level
http://www.google.co.in/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=FwWA9INeoRy0sM&tbnid=4pb6UMKM6ckygM:&ved=&url=http://www.nrhmtn.gov.in/emri.html&ei=nMdnUYvLDYnjrAe0mIGQBg&bvm=bv.45175338,d.bmk&psig=AFQjCNHaZ_6DD4m-QCY_EagCzdOXkZGEiQ&ust=1365842204808293http://www.google.co.in/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=FwWA9INeoRy0sM&tbnid=vk4Hqt4dbD0KxM:&ved=&url=http://www.nrhmtn.gov.in/emri.html&ei=nMdnUYvLDYnjrAe0mIGQBg&bvm=bv.45175338,d.bmk&psig=AFQjCNHaZ_6DD4m-QCY_EagCzdOXkZGEiQ&ust=1365842204808293http://www.google.co.in/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=FwWA9INeoRy0sM&tbnid=vk4Hqt4dbD0KxM:&ved=&url=http://www.nrhmtn.gov.in/emri.html&ei=nMdnUYvLDYnjrAe0mIGQBg&bvm=bv.45175338,d.bmk&psig=AFQjCNHaZ_6DD4m-QCY_EagCzdOXkZGEiQ&ust=1365842204808293http://www.google.co.in/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=FwWA9INeoRy0sM&tbnid=4pb6UMKM6ckygM:&ved=&url=http://www.nrhmtn.gov.in/emri.html&ei=nMdnUYvLDYnjrAe0mIGQBg&bvm=bv.45175338,d.bmk&psig=AFQjCNHaZ_6DD4m-QCY_EagCzdOXkZGEiQ&ust=1365842204808293


18/18

Documents

Kumar: Scaling Up Newborn Programming in India Agenda Setting, Policy Formulation and Implementation