Saving Newborn Lives in Uttar Pradesh (CS-28) India, Year 3 Annual Report

Although the districts had low NMR in comparison with UP, the government wanted to know the reason for this increase and asked that Save the Children support and improve newborn care, especially neonatal care. As a result, project activities were expanded to the Raebareli District. A situational analysis was conducted by INCLEN, which provided a snapshot of the level of facility readiness, service provision at health facilities (HFs), and the knowledge and skill set of care providers in the district. Key findings include: Manpower: Almost all facilities were short-staffed based on the approved staffing plans. While all facilities had doctors available, the involvement of doctors in delivery and newborn care was minimal. Knowledge and skill level of service providers: Many nurses/auxiliary nurse-midwives (ANMs) trained within the past year found it challenging to demonstrate the steps and processes for resuscitation of a non-breathing newborn using positive pressure ventilation and assessment of effective ventilation. The skill status of doctors was also poor, and many of them were either not interested or did not participate in the process. Most doctors and nurses/ANMs also had inadequate knowledge of all components of essential newborn care (ENC) and care of a non-breathing newborn. Facility readiness for delivery and newborn care: A cumulative facility readiness score was compiled, which included eight components. Only the District Women's Hospital scored 75% or higher for the benchmarks set for facility readiness. Secondary data review for pregnancy and newborn care: Review of DLHS, AHS (2012-13), and HMIS (2014-15) data indicated a discrepancy between the survey and HMIS figures for service coverage indicators. The HMIS reported overall institutional delivery in the district at 95%, but the home delivery proportion was high in four blocks, two blocks in the range of 23%-25%, and two blocks in the range of 12%-19%. An overall stillbirth rate of 4% was recorded at public HFs, while the rate at district hospitals ranged from 0% to 13%. The practice of weighing newborns at birth was reported up to 78% of the time in the district, with several facilities reporting lower rates. Although the overall proportion of low birth weight (LBW) newborns was 16%, it varied widely across facilities, from 1% to 60%. All but three facilities reported a high breastfeeding initiation rate within the first hour. The project expanded in Raebareli District for improvement in knowledge and skills of Skilled Birth Attendants (SBAs) in Essential Newborn Care and Resuscitation (ENCR). Training of trainers was conducted on ENCR, and NSSK refresher training was provided for capacity building of SBAs in ENCR. A pool of 15 Medical Officers (MOs) and 1 Staff Nurse (SN) was trained as district-level master trainers. A total of 505 SBAs were trained in NSSK refresher training, and 6 training sessions were monitored by NNF experts and training quality was measured on a checklist. Four new Skill Labs and 8 Functional ENCR demo sites were established, and equipment was purchased. A schedule for practice sessions and supportive supervision was also developed. The project also conducted nested Operations Research on 'Upright Resuscitator'. OR protocols were developed by Save the Children, PATH, and JNMC, and were approved from PATH and AMU, Aligarh IRBs. Permission from GOI and UP was obtained, and frequent and infrequent users of Gonda and Aligarh Districts were identified, nominated based on initial consent, and participation was requested. Testing was conducted at JNMC. The project has strengthened the capacity of SBAs on ENCR, increased confidence levels of SBAs, and improved the quality of training materials. A pool of 15 MOs and 1 SN was trained as district-level master trainers, and 505 SBAs were trained in NSSK refresher training. Four new Skill Labs and 8 Functional ENCR demo sites were established, and equipment was purchased. The project has also conducted nested Operations Research on 'Upright Resuscitator'.