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
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
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
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.