Strengthening Pediatric Care services in District Hospitals

Facility-based emergency and inpatient care play a significant role in reducing child mortality, which entails a high level of preparedness at referral health facilities. District Hospitals, positioned in the continuum of care as referral health facilities, are key units at the district level with regard to provision of specialist care under NHM.

In 2014, an evaluation was conducted by the Ministry of Health and Family Welfare (MoHFW), supported by NIPI Newborn Project, in 13 District Hospitals across the states of Bihar, Madhya Pradesh, Odisha and Rajasthan to assess quality of care for children. The study revealed that none of the 13 District Hospitals included in the study have a system for triage and emergency care for sick children. Precious time is lost during transfer of children to paediatric wards for initiation of treatment. The study also revealed the lack of specific guidelines or standards for setting up and operationalization of paediatric care facilities.

To address this gap, the NIPI Newborn Project facilitated the development of Operational Guidelines for strengthening paediatric care at District Hospitals. The Project also identified select District Hospitals as Demonstration Centres for NHM in NIPI support states to implement pilots for Emergency Triage and Treatment (ETAT) of children. Emergency paediatric care for children is now a priority area for intervention within the framework of MoHFW paediatric care guidelines.

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Strategy

Assessment of quality of care for children in district hospitals
  • Study was conducted in 2014 and report finalised & published in January 2015.
National ETAT Resource Centre
  • Identified at Lady Harding Medical College, KSCH in New Delhi
Operational Guideline for strengthening facility based Pediatric Care at District Hospitals
  • Developed & released in September 2015 for facilitating planning, operationalization and monitoring of services for children at District Hospitals
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‘Demonstration Centres’ for Emergency Triage and Treatment (ETAT)
  • Five District Hospitals identified for establishing pilots for ETAT for children under NIPI Newborn Project
Infrastructure & equipment
  • Infrastructure was strengthened and paediatric equipment mobilised in these five demonstration centres
Training package
  • ETAT Training Package for nurses and doctors finalised by NIPI Newborn Project team and faculty from Lady Harding Medical College
Capacity building
  • Nurses and doctors trained at KSCH

Implementation results

  • Of the 3000 infants attended in ETAT, 24% identified as priority cases for emergency care, which otherwise would have been missed
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