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Child Health Division, NRHM, Haryana
in technical collaboration with
Rapid
Assessment
07 Nov, 2013 to 9 Nov, 2013
&
13Nov,2013 to 14 Nov, 2013
District Panchkula
Facility Readiness Assessment for Essential
Newborn Care and Resuscitation
Page 1 of 26
Table of Contents 1. Objectives: ............................................................................................................................... 2
2. Materials and Methods ............................................................................................................ 2
3. General findings of district Panchkula are as follows: ...................................................... 3
3. a. Overall Training Status ..................................................................................................................... 4
3. b. Status of Newborn Corners ............................................................................................................... 4
3 c. Availability of equipment and instruments in NBCCs (n=19) ........................................................... 4
3 d. Status of Designated Newborn Stabilization Units (NBSUs) ............................................................ 5
4. Quantitative Analysis of various facilities (n= 19) .............................................................. 5
5. Facility wise Qualitative Findings ...................................................................................... 19
1. GH Panchkula ............................................................................................................................... 19
2. CHC Kalka .................................................................................................................................... 19
3. CHC Raipur Rani ......................................................................................................................... 20
4. PHC Hangola ................................................................................................................................. 21
5. PHC Kot ......................................................................................................................................... 21
6. PHC Morni .................................................................................................................................... 21
7. PHC Barwala ................................................................................................................................. 22
8. PHC Nanakpur .............................................................................................................................. 22
9. PHC Punjore ................................................................................................................................. 22
10. PHC Surajpur ........................................................................................................................... 22
11. Urban Slum Dispensary, Sector- 19 ........................................................................................ 23
12. SC Jaloli ..................................................................................................................................... 23
13. SC Maranwala ........................................................................................................................... 24
14. SC Karanpur ............................................................................................................................. 24
15. SC Bargodam ............................................................................................................................ 24
16. SC Ramgarh .............................................................................................................................. 25
17. SC Nadda Sahib ........................................................................................................................ 25
18. SC Mauli .................................................................................................................................... 25
19. Saketri ........................................................................................................................................ 25
Page 2 of 26
1. Objectives:
1. Qualitative and quantitative assessment of readiness of our health facilities for
essential newborn care and resuscitation.
2. To assess the quality of essential newborn care provided to each and every
neonate immediately after birth.
3. To understand the existing knowledge, skills, attitudes and practices of the health
service providers.
4. On job trainings to the service providers on novelties in essential newborn care
and resuscitation.
2. Materials and Methods
1. A structured and tested assessment tool has been used to assess the facilities on 8
parameters viz. facility identification and infrastructure, availability of services,
human resource, Equipment and supplies, Register and client case records, protocols
and guidelines, individual case records, knowledge and practices.
2. Knowledge and skill assessment has been done on the newborn simulators
(mannequins).
3. The current and ideal practices in essential newborn care and resuscitation have been
demonstrated to the service providers on the mannequins.
Our teams visited 19 facilities in the district, from 7th November, 2013 to 9st November, 2013
and 13th November 2013 to 14th November 2013, including General Hospital, all CHCs and
PHCs and the delivery huts with monthly delivery load of 3 or more. Following is the list of
facilities visited:
S.No. Name of Facility
1 GH Panchkula
2 CHC Kalka
3 CHC Raipur Rani
4 URCH sector 19
5 PHC Pinjore
6 PHC Kot
7 PHC Morni
Page 3 of 26
8 PHC Nanak pur
9 PHC Surajpur
10 PHC Hangola
11 PHC Barwala
12 SC Saketri
13 SC Nada Sahib
14 SC Karapur
15 SC Baadgodam
16 SC Maadwala
17 SC Mouli
18 SC Jalouly
19 SC Ramgarh
3. General findings of district Panchkula are as follows:
1. Effective hand washing not in practice.
2. Birth preparedness before delivery is still not in practice.
3. Skin to skin contact between mother and baby not in practice.
4. Milking of cord (in some facilities) still in practice.
5. Injection Vitamin K is not administered to every newborn.
6. Improper segregation of bio-medical waste. Yellow bags are not used.
7. Shifting of every baby to Newborn Corner is still in practice.
8. Case sheets are not available in the Sub-Centers.
9. Record keeping in delivery rooms has scope for improvement.
10. Partograph are filled but need quality improvement and proper interpretation.
11. Disinfection protocols are not followed as per guidelines. Non availability of regular
disinfectant in many facilities.
Page 4 of 26
3. a. Overall Training Status
No. of Birth attendants SBA NSSK IMNCI
63 57 50 49
Total Percentage 90 79 77
3. b. Status of Newborn Corners
No. of
Facilities
Visited
Newborn Corners
with Radiant
Warmer
Newborn
Corners with
200 W bulb
Total
NBCCs
Established
NBCCs still not
established
19 9 8 15 4 (SC Bargodam,
Marawala, USD 19 and
Karanpur)
3 c. Availability of equipment and instruments in NBCCs (n=19)
Sr.
No.
Equipment/Instrument Available (No. of
Facilities)
Not available (No. of
Facilities)
1. Self-Inflating Bag 19 0
2. Mask Size ‘1’ 19 0
3. Mask Size ‘0’ 19 0
4. Shoulder Roll 16 3
5. Suction Catheter 13 6
6. Disposable Mucus Extractors 17 2
7. Suction Machine 18 1
8. Oxygen Cylinder 12 7
9. Baby Sheets 18 1
10. Disinfectant 18 1
11. Vitamin K 17 2
12. NBCC at appropriate place 12 7
Page 5 of 26
Score 75% and Above Score 51% to 74% Score 50% and less
3 d. Status of Designated Newborn Stabilization Units (NBSUs)
Sr. No. Name of Institution Status
CHC Kalka Functional
CHC RaipurRani Established but Not Functional
4. Quantitative Analysis of various facilities (n= 19)
NAME OF THE
FACILITIES
INFRASTRUCT
URE
DELIVER
Y AND
NEWBOR
N CARE
SERVICE
S
ESSENTIA
L DRUGS,
EQUIPMEN
T AND
SUPPLIES
PROTOCOL
S AND
GUIDELINE
S
KNOWLEDG
E ABOUT
INFECTION
PREVENTIO
N
PROVIDER
K0WLEDG
E AND
SKILLS
REGISTER
S AND
CLIENT
CASE
RECORDS
FACILITY’
S
OVERALL
AVERAGE
GH
PANCHKULA 90 89 80 70 57 52 56 71
PHC
BARWALA 69 83 72 80 57 62 58 69
PHC
NANAKPUR 76 83 70 60 86 51 56 69
CHC KALKA 92 100 79 40 57 57 44 67
PHC PINJORE 78 89 68 60 43 54 66 65
PHC KOT 76 78 70 60 57 55 55 64
PHC
SURAJPUR 76 83 68 60 43 55 66 64
Page 6 of 26
PHC MORNI 69 78 69 80 43 59 52 64
PHC
HANGOLA 67 78 74 70 57 45 46 62
URCH SEC 19 65 83 64 50 57 58 55 62
District
Average 67 80 65 59 44 51 32 57
SC SAKETRI 59 83 58 60 43 57 6 52
CHC RAIPUR
RANI 71 83 67 70 0 40 29 52
SC
RAMGARH 59 78 51 70 29 49 0 48
SC JALOULY 59 78 59 40 43 47 10 48
SC
MARWALA 59 78 59 40 43 47 10 48
SC NADDA
SAHIB 53 67 53 80 29 54 0 48
SC MOULI 57 67 53 60 43 47 0 47
SC
KARANPUR 57 78 61 40 43 44 0 46
SC BAR 47 67 46 30 14 40 0 35
Page 7 of 26
Figure 1. KNOWLEDGE ABOUT EFFECTIVE ANC
Figure 2. KNOWLEDGE OF DETECTION OF HIGH RISK MOTHERS
0
20
40
60
80
100MINIMUM 4 VISITS
BIRTH PLAN
TT AND IFA
HIGH RISK MOTHERDETECTION
DANGER SIGN
PROMOTE EBF
ROUND 1
020406080
100PREVIOUS CS
5 OR MOREDELIVERIES
LESS THEN 2YEARS BIRTH…
AGE OF PRIMI <18OR >30 YEARS
PREVIOUS STILLBIRTH
PREVIOUSNEONATAL DEATH
PREVIOUSINSTRUMENTAL…
H/O ABORTIONSOR OTHER…
H/ONEONATAL/INFA…
ROUND 1
Page 8 of 26
Figure 3. KNOWLEDGE ABOUT LABOUR PROGRESS
Figure 4. LABOUR PROGRESS MONITORING KNOWLEDGE
0
20
40
60
80
100
REGULARUTRINE
CONTRACTION
DILATION OFCERVIX
DISCHARGE OFBLOOD AND
MUCUS
BREAKING OFWATERS AND
RUPTIORMEMBRANE
ROUND 1
020406080
100FETAL HEARTBEAT
COLOUR OF…
DEGREE OF MOLDING
DILATION OF CERVIX
DESCENT OF HEADUTERINE…
MATERNAL BP
MATERNAL…
MATERNAL PULSE
ROUND 1
Page 9 of 26
Figure 5. RECORDING OF OBSERVATIONS
Figure 6. KNOWLEDGE ABOUT 3 STAGE OF LABOUR MANAGEMENT
0
20
40
60
80
100
ONPARTOGR
APH
ONPATIENTCLINICALRECORDS
ON PIECEOF PAPER
ROUND 1
60
80
100
IMMEDIATE
OXYTOCIN
CCTUTRINE
MASSAGE
ROUND 1
Page 10 of 26
Figure 7. KNOWLEDGE ABOUT IMMEDIATE CARE TO NEWBORN WITHIN 1 Hr
Figure 8. KNOWLEDGE ABOUT SIGN AND SYMPTOMS OF SEPSIS/INFECTION IN
NEWBORN
0
20
40
60
80
100BREATHING OF BABY
DRY THE BABY
OBSERVE FOR COLOR OFBABY
WEIGHT THE BABY
CARE FOR UMBLICALCORD
INITIATE BF WITH IN 30MIN
EXAMIN NEWBORNWITHIN 1 HRS
ADMINISTER VIT K
ROUND 1
0
20
40
60
80
100
LESS MOVEMENT(POOR MUSCLE
TONE)
POOR OR NO BF
HYPO/HYPERTHERMIA
RESTLESSNESS/IRRITABILITY
DIFFICULTY/FASTBREATHING
INFECTION ONEYE/THROAT/SKIN
DEEPJAUNDICE
SEVEREABDOMINALDISTENTION
ROUND 1
Page 11 of 26
Figure 9. KNOWLEDGE OF MANAGEMENT ABOUT INFECTION IN NEWBORN
Figure 10. KNOWLEDGE ABOUT MANAGEMENT OF LBW (<2.5 KG) BABIES
0
20
40
60
80
100
EXPLAIN SITUATIONTO MOTHER
CONTINUE TO BF
KEEP AIRWAYS OPENBEGIN ANTIBIOTICS
REFER
ROUND 1
0
20
40
60
80
100WARMTH OF BABY
PROVIDE EXTRASUPPORT TO MOTHER
FOR BF
MONITOR ABLITY TOBF/SUCKING CAPACITY
OF BABY
MONITOR BABY FORFIRST 24 Hr
ENSURE INFCETIONPREVENTION
REFER
Page 12 of 26
Figure 11. KNOWLEDGE ABOUT SIGN AND SYMPTOMS OF BIRTH ASPHYXIA
Figure 12. KNOWLEDGE ABOUT STEPS OF RESUSCITATION
0
20
40
60
80
100
DEPRESSEDBREATHING
FLOPPINESS
NOT CRIED AT BIRTH
DELAYED CRYING ATBIRTH
HEART RATE BELOW100
CENTRAL CYNANOSIS
ROUND 1
020406080
100CALL FOR HELP
EXPLAIN SITUATION TOMOTHER
PLACE NEWBORN FACEUP
WRAP OR COVER BABYEXCEPT FACE AND…
EXTENDED POSITION OFNECK OF NEWBORN
SUCTION MOUTH THENNOSE
START VENTILATIONUSING BAG AND MASK
ROUND 1
Page 13 of 26
Figure 13. KNOWLEDGE ABOUT RESUSCITATION STEP CONT…
Figure 14. Knowledge about what to do if newborn start breathing after initial resuscitation
0
20
40
60
80
100
PLACE BABY MASKAND FORM SEAL
ENSURE APPROPRIATESEAL
VENTILATE 1 OR 2TIMES FOR CHEST
RISING
VENTILATE 40-60 PERMINUTE
DETERMINESPONTINIOUSBREATHING
ROUND 1
0
20
40
60
80
100KEEP BABY WARM
INITIATE BFMONITORING THE
BABY
ROUND 1
Page 14 of 26
Figure 15. What to do ? If Newborn is not breathing after initial Resuscitation
Figure 16. Over all Readiness of facilities in Infrastructure
0
20
40
60
80
100
CONTINUETO
VENTILATE
ADMINISTER
OXYGEN
ASCESSNEED FORSPECIAL
CARE
INTUBATEBABY
REFERBABY
ROUND 1
92 90
78 76 76 76 71 69 69 67 67 6559 59 59 59 57 57 53
47
0
20
40
60
80
100
Page 15 of 26
Figure 17. Availability of Protocols Guideline at Facilities
Figure 18. Knowledge of Infection Prevention
80 80 8070 70 70 70
60 60 60 60 60 60 5950
40 40 40 4030
0
20
40
60
80
100
80 80 8070 70 70 70
60 60 60 60 60 60 5950
40 40 40 4030
0
20
40
60
80
100
Page 16 of 26
Figure 19. Registers and Client Case records
Figure 20. ESSENTIAL DRUGS, EQUIPMENT AND SUPPLIES
66 6658 56 56 55 55 52
46 44
32 29
10 10 60 0 0 0 0
0
20
40
60
80
100
PH
C P
INJO
RE
PH
C S
UR
AJP
UR
PH
C B
AR
WA
LA
PH
C N
AN
AK
PU
R
GH
PA
NC
HK
ULA
PH
C K
OT
UR
CH
SEC
19
PH
C M
OR
NI
PH
C H
AN
GO
LA
CH
C K
ALK
A
Dis
tric
t A
vera
ge
CH
C R
AIP
UR
RA
NI
SC J
ALO
ULY
SC M
AR
WA
LA
SC S
AK
ETR
I
SC N
AD
DA
SA
HIB
SC R
AM
GA
RH
SC M
OU
LI
SC K
AR
AN
PU
R
SC B
AR
80 7974 72 70 70 69 68 68 67 65 64 61 59 59 58
53 53 5146
0
20
40
60
80
100
GH
PA
NC
HK
ULA
CH
C K
ALK
A
PH
C H
AN
GO
LA
PH
C B
AR
WA
LA
PH
C N
AN
AK
PU
R
PH
C K
OT
PH
C M
OR
NI
PH
C P
INJO
RE
PH
C S
UR
AJP
UR
CH
C R
AIP
UR
RA
NI
Dis
tric
t A
vera
ge
UR
CH
SEC
19
SC K
AR
AN
PU
R
SC J
ALO
ULY
SC M
AR
WA
LA
SC S
AK
ETR
I
SC N
AD
DA
SA
HIB
SC M
OU
LI
SC R
AM
GA
RH
SC B
AR
Page 17 of 26
Figure 21. Over All Status of facilities for ENBC/R Skills
Figure 22. Over All Status of facilities for ENBC/R
62 59 58 57 57 55 55 54 54 52 51 51 49 47 47 47 45 4440 40
0
20
40
60
80
100
71 69 69 67 65 64 64 64 62 62 57 52 52 48 48 48 48 47 4635
0
20
40
60
80
100
Page 18 of 26
Figure 23. FACILITIES CLASSIFICATION FOR ENBC/R FACILITY READINESS
Figure 24. Essential Newborn Care District Average
0
68
32
GOOD (75 AND ABOVE) AVERAGE (51 TO 74 ) POOR (BELOW 50)
6159
5756
545252
51494949
4747
4543
4139
0 10 20 30 40 50 60 70
HSR
PKL
KKR
JND
YNR
GUR
FTB
SNP
NNL
ROUND 1
Page 19 of 26
5. Facility wise Qualitative Findings
1. GH Panchkula
a) Labour room running along with PNC ward/construction going on for new labour
room
b) RW available at labour room : Unhygenic sheets on RW, Bag of Ambu meconium
stained, 0 size mask not available, Shoulder role not as standard protocol,
Thermometer not available at NBCC
2. CHC Kalka
a) Shoulder role not as per guideline
b) Two Bag and mask available at labour room but one payer of 0 and 1 size mask not
available
c) Tube lights and bulb in labour room out of order
d) No lightning in toilet and hand washing area
e) Thermometer dipped in solution need to kept in dry bottle
f) Chittel dipped in solution need to kept in dry bottle
g) Feeding tubes used for suction
h) Bio medical waste disposal contractor visit facility twice a week need to rationalize as
per contract
i) Room thermometer not available in labour room
j) Only yellow and red bag available in labour room for Bio medical waste segregation
need to put black and bag bucket too.
k) Towel available at hand washing area of labour room need to discourage towel uses
should promote air dry
l) NBSU established need to available Syringe Hub cutter, weight machine,
Laryngoscope set neonate, digital thermometer, room heater, room thermometer,
concealed lights, Stethoscope with neonatal chest piece, shoe rack
Page 20 of 26
3. CHC Raipur Rani
a) Training of staff nurses not completed.
b) Mucus extractors expired in May-13.
c) Distilled water level in O₂ humidifier not maintained.
d) Good practice of keeping vaccines in labour room to ensure administration of birth
doses. OPV and Hep. B vaccines should have date of opening mentioned on it.
e) Disinfection of Radiant warmer, AMBU bag, suction apparatus not done regularly.
f) DHIS 2 reporting of labour room needs improvements. Records in delivery register
and reported data do not match.
g) Knowledge of staff nurses is average for,
i. ANC
ii. Identification of high risk pregnancies
iii. Identification of true labour pains
iv. Monitoring of labour progress
v. AMTSL
vi. Immediate care for new-born
vii. Special care for low birth weight new-borns
h) Knowledge of staff nurses is not adequate for,
i. Neonatal Resuscitation
ii. Identification of infection/sepsis in new-born
i) Shoulder roll is not available.
j) Wall clock with seconds hand not available at NBCC.
k) Case records need improvements,
i. Details of at birth immunisation
ii. Care provided to new-born
iii. Details of resuscitation if done
iv. Vital signs of new-born
Page 21 of 26
4. PHC Hangola
a) One staff nurse not trained in SBA and NSSK
b) GPLAD, term preterm and maternal complications not mentioned in the maternal
case sheets
c) Cord cutting with blade, breastfeeding initiation timings not mentioned in the baby
case sheets
d) New Born Care Corner was not located appropriately. NBCC relocated in the labour
room
e) Breast feeding not initiated within half an hour after birth, hand washing not in
practice, Skin to skin contact not initiated
f) Resuscitation chronology not practiced (Position suction stimulation and
repositioning not followed as per protocols)
g) Milking of cord is in practice
h) Every baby is shifted to new born care corner
i) Disinfectants not available
j) Yellow colour coded bag not used for placenta segregation
k) Filling of partograph need improvement
5. PHC Kot
a) Some essential drugs are out of stock
b) Colour coded buckets and bags not available
c) Skills for high risk detection not as per protocols
d) Baby not dried after delivery
e) Spot lamp not functional
f) Case sheets need improvements in term of baby notes on essential new born care
and resuscitation.
6. PHC Morni
a) NBCC well established with radiant warmer, shoulder roll, mucous extractor,
oxygen cylinder, concentrator, bag and mask of both sizes
b) Double gloving in practice
c) Skin to skin contact in practice
d) Practice of re-clamping the cord
e) Immediate cord cutting in practice
f) Inj vitamin K not available and not in practice
Page 22 of 26
7. PHC Barwala
a) NBCC well established with bag and mask, radiant warmer, shoulder roll, oxygen
cylinder, suction apparatus
b) Practice of skin to skin contact
c) Double gloving in practice
d) Immunization of newborn with BCG, OPV and Hep B in practice
e) Vitamin K in practice
f) Facility having delivery load of about 35-40 deliveries a month. Single delivery
table available and 3 inpatient beds are available
g) Space constraint in facility
h) Case sheets are being prepared for delivery cases. Delivery notes and baby notes
are being recorded
i) Record keeping very good.
8. PHC Nanakpur
a) Well maintained Labour room with well-established NBCC with 200 W bulb as
heat source.
b) Record keeping is good.
c) Knowledge of staff nurse about essential newborn care and resuscitation is good.
d) Skills of staff nurse about essential newborn care and resuscitation is average.
9. PHC Punjore
a) Well maintained PHC
b) Skills and practices for ENCR need regular follow up
c) Promotion of Infection prevention protocols is strictly required
d) Documentation need few improvements regarding baby notes
10. PHC Surajpur
a) PHC running in another SC building
b) No Staff nurse
c) No Hand washing station inside labour room
d) Promotion of Infection prevention protocols is strictly required Skills and
practices for ENCR need regular follow up
e) Documentation need few improvements regarding baby notes
Page 23 of 26
11. Urban Slum Dispensary, Sector- 19
a) Bleaching powder for disinfection is not available.
b) Baby sheets are not available.
c) NBCC not established.
d) Baby mask of size ‘0’ is not available.
e) Colour coded bags for biomedical waste segregation and disposal are not
available.
f) Disposable surgical blades for cord cutting are not available.
g) Case records are well maintained but notes on essential newborn care are
incomplete.
h) There are issues related to procurement of articles and items required for delivery
and newborn care. Cord clamps, baby sheets, mucus extractors, surgical blades,
disinfectants (bleaching powder) etc. are not available and these items are difficult
to procure in small quantities, moreover, there are no vendors for such items in
local market. Also, medicines are in very limited supply and need to be purchased
locally.
i) Milking of cord is still in practice.
j) Knowledge of one staff nurse about essential newborn care and resuscitation is
good but for other two it is average.
k) Skills of staff nurses for essential newborn care and resuscitation are average
Recommendations
a) Resolve procurement issues related to medicines and other items with Civil
Surgeon’s office. Ensure regular supply of required items and medicines to the
dispensary.
b) Write complete notes on essential newborn care as described during the visit.
c) Promote peer learning to improve knowledge and skills of service providers.
12. SC Jaloli
a) Sub centre running in damaged building
b) Toilet available but not usable
c) Promotion of Infection prevention protocols is strictly required
d) Skills and practices for ENCR need regular follow up
e) Documentation need few improvements regarding baby notes
Page 24 of 26
13. SC Maranwala
a) Well maintained Sub Centre
b) Inappropriate Hand washing station
c) Promotion of Infection prevention protocols is strictly required
d) Skills and practices for ENCR need regular follow up
e) Documentation need few improvements regarding baby notes
14. SC Karanpur
a) Case sheets and partographs not available
b) Delivery register with only address/ male female/ weight and time of birth
mentioned
c) Active management of third stage of labour not done (Inj oxytocin after delivery
not administered)
d) Two hundred watt bulb not available
e) Invertors not functional
f) Oral pills and condom contraceptive not available
15. SC Bargodam
a) NBCC not established at facility
b) Shoulder roll to be prepared as directed
c) Baby sheets are not available
d) Toilet non-functional since 2007
e) Facility having delivery load of about 4-5 deliveries a month
f) Case sheets are not being prepared
g) Partographs are not available and are not being filled
h) Kelly’s pad not available on delivery table
i) Yellow bags not available
j) Biomedical waste segregation not being done
k) Spot lamp non-functional since 3 months
l) Practice of separating newborn and mother despite good cry
m) Practice of re-clamping the cord
n) Immediate cord cutting in practice
o) Inj vitamin K not available
Page 25 of 26
16. SC Ramgarh
a) Shoulder roll to be prepared as directed
b) Case sheets are not being prepared
c) Partographs are not available and are not being filled
d) Kelly’s pad not available on delivery table
e) Practice of separating newborn and mother despite good cry
f) Practice of re-clamping the cord
g) Immediate cord cutting in practice
h) Mask of size 0 not available
i) Inj vitamin K not available
17. SC Nadda Sahib
a) NBCC not established. It was established as onsite correction with 200 W bulb,
bag and mask of both sizes
b) Shoulder roll to be prepared as directed
c) Case sheets are not being prepared
d) Practice of separating newborn and mother despite good cry
e) Practice of re-clamping the cord
f) Immediate cord cutting in practice
g) IEC material not displayed at appropriate places
h) Hand washing station not appropriate
18. SC Mauli
a) Well maintained labour room, but no NBCC.
b) Immediate cord cutting and milking of cord still in practice.
c) Case sheets for delivery cases are not available.
d) Knowledge of ANM about essential newborn care and resuscitation is average.
e) Skills of staff nurse about essential newborn care and resuscitation are average.
19. Saketri
a) Well maintained labour room with NBCC in a small room adjoining it. NBCC has
all the articles and equipment necessary for newborn resuscitation.
b) Knowledge of ANMs about essential newborn care and resuscitation is good.
c) Skills of ANMs about essential newborn care and resuscitation are average.