India Newborn Action Plan
India Newborn Action Plan
India Newborn Action Plan (INAP) was launched in September 2014, for accelerating the reduction of preventable newborn deaths and stillbirths in the country - with the goal of attaining ‘Single Digit Neo-natal Mortality Rate (NMR) by 2030’ and ‘Single Digit Still Birth Rate (SBR) by 2030’. Currently, there are estimated 7.47 lakh neonatal deaths annually.The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the goal is achieved.
The India Newborn Action Plan (INAP) is India’s committed response to the Global Every Newborn Action Plan (ENAP), launched in June 2014 at the 67th World Health Assembly, to advance the Global Strategy for Women’s and Children’s Health.
Goals
- Ending Preventable Newborn Deaths to achieve “Single Digit NMR” by 2030, with all the states to individually achieve this target by 2035.
- Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the states to individually achieve this target by 2035
Snapshot of India Newborn Action Plan (INAP)
- Builds on existing commitments under the National Health Mission and 'Call to Action' for Child Survival and Development
- Aligns with the Global Every Newborn Action Plan (ENAP); defines commitments based on specific contextual needs of the country
- Aims at attaining Single Digit Neonatal Mortality Rate by 2030, five years ahead of the global plan
- Emphasizes strengthened surveillance mechanism for tracking stillbirths
- Focuses on ending preventable newborn deaths, improving quality of care and care beyond survival
- Prioritizes those babies that are born too soon, too small, or sick—as they account for majority of all newborn deaths
- Aspires towards ensuring equitable progress for girls and boys, rural and urban, rich and poor, and between districts and states
- Identifies major guiding principles under the overarching principle of Integration: Equity, Gender, Quality of Care, Convergence, Accountability, and Partnerships
- Defines six pillars of interventions: Pre-conception and antenatal care; Care during labour and child birth; Immediate newborn care; Care of healthy newborn; Care of small and sick newborn; and Care beyond newborn survival
- Serves as a framework for states/districts to develop their own action plan with measurable indicators
INAP – National Targets
| Targets | Current | 2017 | 2020 | 2025 | 2030 |
| Impact targets | |||||
| NMR (per 1000 live births) | 29 | 24 | 21 | 15 | <10 |
| SBR (per 1000 live births) | 22 | 19 | 17 | 13 | <10 |
| Coverage Targets | |||||
| Safe delivery (institutional + home delivery by SBA (%) | 76 | 90 | 95 | 95 | 95 |
| Initiation of breastfeeding within one hour of birth (%) | - |
75 | 90 | 90 | 90 |
| Women with preterm labour receiving at least one dose of antenatal corticosteroids (%) | - |
75 | 90 | 95 | 95 |
| Babies born in health facilities with birth asphyxia received resuscitation (%) |
- |
75 | 90 | 95 | 95 |
| Babies received complete schedule of home visits under HBNC by ASHA (%) | - |
50 | 75 | 95 | 95 |
| Newborn with sepsis in the community received Gentamicin by ANM (%) |
- |
50 | 75 | 75 | 75 |
| Newborn discharged from SNCU followed until age one (%) |
- |
35 | 50 | 75 | 75 |
| Newborn with low birth weight / Prematurity managed with KMC at facility (%) | - |
35 | 50 | 75 | 90 |
Strategic Intervention Packages
Intervention packages in descending order of impact on neonatal mortality
- Package 1: Care during Labour and Child birth
- Package 2: Care of Small and Sick Newborn
- Package 3: Care of Healthy Newborn
- Package 4: Immediate Newborn Care
- Package 5: Pre-Conception and Antenatal Care
Intervention packages in descending order of impact on still -births
- Package 1: Care during Labour and Child birth
- Package 2: Pre-Conception and Antenatal Care
Details of strategic interventions
Package 1: Pre-Conception and Antenatal Care
| Pre-Conception and Antenatal Care Interventions Package | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| Reproductive Health & Family 1. Planning [E] • Adolescent reproductive health • Delaying age of marriage and first pregnancy • Birth spacing 2. Nutrition related interventions [E] • Balanced energy protein supplementation • Peri-conceptional folic acid • Maternal calcium supplementation • Multiple micronutrient supplementation (Iron, Folic Acid & • Iodine) • Nutrition Counselling 3. Counselling & birth preparedness [E] 4. Prevention against Malaria [S] |
5. Antenatal screening for Anemia and Hypertensive disorders of pregnancy (PIH, Preeclampsia, Eclampsia) [E] 6. Antenatal screening for Malaria [S] 7. Prevention and management of mild to moderate anemia [E] 8. Maternal tetanus immunization [E] 9. Adolescent friendly health services (nutrition and reproductive health counselling) [E] 10. Interval IUCD insertion [E] |
11. Antenatal screening & management of Severe anemia, Hypertensive disorders of pregnancy (PIH, Preeclampsia, Eclampsia), Gestational Diabetes, Syphilis [E] 12. Antenatal screening & management of Hypothyroidism, Hepatitis B, HIV, Malaria [S] 13. Adolescent friendly health clinics (as per RKSK guidelines) [E] 14. Post-partum family planning services including PPIUCD insertion [E] 15. Prevention of Rh disease using anti D immunoglobulin [S] |
Package 2: Care during Labour and Child birth
| Care During Labour and Childbirth | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| 1. Skilled birth attendance [E] 2. Clean birth practices [E] |
3. Identification of complications and timely referral [E] 4. Pre-referral dose by ANM [E] • Antenatal corticosteroids in preterm labour • antibiotics for premature rupture of membranes |
5.Emergency obstetric care [E] • Basic and Comprehensive 6. Management of preterm labour [E] • Antenatal corticosteroids in preterm labour • Antibiotics for premature rupture of membranes |
Package 3: Immediate Newborn Care
| Immediate Newborn Care | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| 1. Delayed cord clamping [E] 2. Interventions to prevent hypothermia [E] • Immediate drying • Head covering • Skin-to-skin care • Delayed bathing 3. Early initiation and exclusive breastfeeding [E] 4. Hygiene to prevent infection [E] |
5. Vitamin K at birth [E] 6. Neonatal Resuscitation [E] |
7. Advanced neonatal resuscitation [E] |
Package 4: Care of Healthy Newborn
| Care of Healthy Newborn | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| 1. Home visits till six weeks by trained ASHA [E] • Counselling • Prevention of hypothermia, cord care • Early identification of danger signs • Prompt and appropriate referral 2. Exclusive breastfeeding [E] 3. Clean postnatal practices [E] |
4. Immunization [E] • BCG • OPV • Hepatitis B |
All the interventions (except home visits) |
Package 5: Care of Small and Sick Newborn
| Care of Small and Sick Newborn | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| 1. Thermal care and feeding support (for home deliveries) [E] | 2. Integrated management using IMNCI and use of oral antibiotics [E] 3. Injectable Gentamicin by ANMs for sepsis [E] • Pre referral • Completion of antibiotic course in case referral is refused / not possible “OR” as advised by treating physician |
4. Kangaroo mother care at facility [E] 5. Full supportive care at block and district level [E] • NBSU at block level • SNCU at district level 6. Intensive care services (NICU) at regional level [A] for • Assisted ventilation • Surfactant use • Surg |
Package 6: Care beyond Newborn Survival
| Care beyond Newborn Survival | ||
| Family and Community | Outreach/Sub Centre | Health Facility |
| 1. Screening for birth defects, failure to thrive and developmental delays [E] 2. Follow up visits of [E] • SNCU discharged babies till 1 year of age • small and low birth weight babies till 2 years of age |
3. As before | 4. Newborn screening [A] 5. Management of birth defects [E] -Diagnosis -Treatment, including surgery 6. Follow-up of high-risk infants (discharged from SNCUs, and small newborns) for -Developmental delay -Appropriate management |
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Source: National Health Mission
ਆਖਰੀ ਵਾਰ ਸੰਸ਼ੋਧਿਤ : 9/21/2020
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