Naveen Thacker ; Panna Choudhury William Keenan ; Vineet Saxena

Indian Academy of Pediatrics

TOWARDS SKILLED NEONATAL TOWARDS SKILLED NEONATAL RESUSCITATION: THE INDIAN STORY-YEAR RESUSCITATION: THE INDIAN STORY-YEAR ONEONE

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…..

• 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…

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%)

Why Skilled Resuscitation is important in India ?

Figure 5

Scaling up NRP in Public Sector is Urgent

• Large scale shift: from home to institutional deliveries•Urgent need of large no. of SBA’s

India’s Janani Suraksha Yojana(JSY),

Conditional cash transfer program to increase birth in health facilities. Lancet 2010; 375: 2009-2023

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

Aims to have one NRP trained person attending every delivery

( 27 millions deliveries /year in India )

Program is named as Newborn Resuscitation Program- First Golden Minute(NRP-FGM) Program

Administrative Structure for NRP Program

Steering Committee Core Committee

Administrative

Academic

Who will be trained ?

• 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

19

Umbilical cord that can be cut multiple times

Squeeze bulbs for simulation of crying, breathing and heart activity

•LDSC provided some kits initially •Arrangement with Laerdal Co. for Manikins; field tested first in India

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”• Jan 21-22, 2009: Bangalore• 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• May 02 -03,2009 : Kolkata• May 17, 2009 : Trivandrum• May 22, 2009 : Bareilly• June 7, 2009 : Mumbai• June 20, 2009 : Chennai• June 27, 2009 : Mysore• July 19, 2009 : Ernakulaum• July 26, 2009 : Coimbatore• August 9 2009 : Trichur• September 13, 2009 : Trichy• October 2009 : Belgaum• November 28 2009 : Salem• December 16 2009 : Calicut• January 5-6 2010 :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 ?

States in India where newborns are at high risk of dying

Roll out Plan 10 States = ~ 300 Districts 4 Trainers per district 1200 Trainers planned in 4 months

Wash Hands

Program included Basic Newborn Care and Resuscitation

Wear Gloves

Prevention of hypothermiaEarly initiation & exclusive breastfeeding

Prevention of Infection

Kangaroo Mother care

Clean Chain

Warm Chain

Cord 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

Evaluation of training- pre-test and post-test of 240 Trainers

Persons trained till June 2010, in Govt Sector

Type of Course Persons Trained

Instructors in Govt Sector 1530Providers 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.

Thank you

Steering Committee of IAP NRP FGM

President IAP 2009 and Chairperson

President IAP 2010 and Co- Chairperson

President IAP 2007 and National Co- Ordinator

Hon. General Secretary, IAP, 2010