The Ministry of Health and Family Welfare (MoHFW) has operationalized Facility Based Newborn Care (FBNC) to counter the grave challenge of neonatal mortality. FBNC comprises thousands of Newborn Care Corners (NBCCs) at delivery points as well as Newborn Stabilizing Units (NBSUs) and SNCUs. Quality of care at birth through NBCC and NBSU is critical to the survival of newborns as prevention of fatal conditions such as birth asphyxia is a more cost effective option than treatment of complications in SNCU.
An assessment done by MoHFW in 2011-12 recognized the need for strengthening quality of care at sub-district level facilities. The large number of human resources at these facilities need supportive supervision to develop and maintain critical skills for newborn resuscitation and essential care at birth. It is estimated that on an average 50-75 service providers need supportive supervision and mentoring support in each district. However, there is no provision for this support currently and the estimated load far exceeds the available capacity of the few state/regional centres.
To improve the quality of immediate newborn care in sub-district facilities, at least one SNCU at divisional level has been identified to function as a Divisional Resource Centre in each state. This SNCU, designated as a Regional/SNCU Treatment & Training Centre, is assigned a dual role by providing clinical care and hands-on training and supportive supervision to providers from NBCCs and NBSUs in the district. Selection criteria for SNCU Treatment & Training Centre include availability of space, manpower and willingness besides being able to maintain their own quality of care.
Establishment and gap support provision
- The NIPI Project established and supports 5 SNCUs as district resource centers for newborn care– Raisen and Hoshangabad in Madhya Pradesh; Nalanda in Bihar; Alwar in Rajasthan; and Sambalpur in Odisha.
Development of composite index for monitoring the SNCU performance on quality parameters
- An online SNCU platform has been developed which generates data from all SNCUs across the states. Reporting of data focuses on admissions, deaths and causes of admissions.
- A composite index for quality of care in SNCU has been developed, which provides a performance overview of all SNCUs at a glance on a single sheet and also allows for identifying domains where corrective actions need to be taken. This index has been successfully tested in Odisha and is being used by State Health Missions.
Logistics and travel support
- The project provided human resource, gap support in infrastructure & maintenance, and travel support for mentoring and supportive supervision to NBSU and NBCC by doctors and staff nurses. Hands-on trainings of NBSU and NBCC staff was conducted.
Preparation of tools
- Score based checklists were developed to enable quality check of various aspects of care at NBCC during mentoring visit.
- State Resource Centres have also been established in three states – J.K. Lone hospital in Rajasthan, Nalanda Medical College Hospital in Bihar, and Shishu Bhawan in Odisha. These resource centres provide FBNC training and two-week SNCU observership in Rajasthan.
- In 2015, Divisional Resource Centres provided 160 Mentoring Visits to 98 NBCCs and 36 NBSUs. State Resource Centres conducted mentoring visits to 23 SNCUs in 2015. Score based checklists have been developed to enable quality check of various aspects of care at NBCC during mentoring visits.