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National Health Mission

Ministry of Health and Family Welfare, Government of India

Schemes

 
 
Facility Based Newborn and Child Care :
 

Neonatal mortality is one of the major contributors (2/3) to the Infant Mortality. To address the issues of higher neonatal and early neonatal mortality, facility based newborn care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust area under NHM.

Special Newborn Care Units (SNCU)

  • States have been asked to set up at least one SNCU in each district. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services.

Newborn Stabilization units (NBSUs)

  • NBSUs are established at community health centres /FRUs. These are 4 bedded units with trained doctors and nurses for stabilization of sick newborns.

New Born Care Corners (NBCCs)

  • These are 1 bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.

A comprehensive “Facility Based Newborn Care Operational Guide- 2011, a guideline for planning and Implementation” have been published and disseminated in 2011 by Child Health Division, MoHFW, GOI to act as reference tool for the states to take necessary steps in implementation of same.

TitleDownload
Two Year Progress of  SNCUs -A Brief Report (2011-12 & 2012-13)  PDF file that opens in new window. To know how to open PDF file refer Help section located at bottom of the site. (10.5 MB)
SNCUs Technical Report PDF file that opens in new window. To know how to open PDF file refer Help section located at bottom of the site. (2.03 MB)
2nd Quaterly SNCUs Technical Report PDF file that opens in new window. To know how to open PDF file refer Help section located at bottom of the site. (2.79 MB)
 
Mother Newborn Care Units:
 

SNCU complex are enumerated as under:
  • Waiting Area in front of SNCU with simple amenities like comfortable sitting space, safe drinking water, AV system, Tea/Coffee vending machine and a wash room for the parent or attendants.
  • Entry area – space for Gowning, hand washing, Shoe rack
  • Follow UP area with AV facilities and adequate space for daily counselling, during discharge and imparting FPC training
  • Reception area for receiving the cases and assess under triage area
  • Newborn care area (SNCU area for cases admitted as per Admission criteria for SNCU) -to accommodate at least 20 Radiant warmers with additional clear, designated area as isolation ward for the infectious cases like Varicella, diarrhea etc. and area for procedures (desirable). Separate out-born and inborn units may not be required if strict asepsis protocols like that of an OT are followed. Additional hand washing facility within the SNCU, Mother’s area, feeding room (Human Milk Storage Room) will help in ensuring hand-washing before handling of newborn.
  • Doctor’s and sister’s duty room with wash rooms, storage rooms and Janitors/sluice room
  • A separate Step down/ KMC unit which is existing in many units as per the existing guidelines can now be upgraded and named as mother newborn care unit (MNCU) which will be an ideal available space to keep the mother- baby dyad together to fulfill the following objectives:
  • Decongesting SNCU of newborns who do not require intensive care but need observational care for their medical conditions.
  • Making provisions (Bed, diet and treatment) for the mothers of SNCU admissions.
  • The admission criteria of SNCU as per FBNC Operational Guidelineswill continue to be followed.
  • NO newborn deserving admission in SNCU will be shifted tothe MNCU
  • Stepdown/ KMC unit may be amalgamated as MNCU to have provisions for both mother and baby.

As described above the existing stepdown/KMC area as per the existing guidelines can now be upgraded as MNCU. Each state will have to customize it facility-wise, based on local needs and make it contextual requiring renovation, extension or create additional space. The states in the forthcoming PIPs can include the budget proposals for gap filling of SNCUs having high case load/overcrowding/ units in the process of developing KMC or step down area. Once successful they can extend it later to all units in phased manner. The state should make an effort to have a room close to SNCU and big enough to have adult beds, a separate eating and washing area for the mothers. MNCU will be jointly owned by both Department/Unit of Pediatrics and Obstetrics and Gynecology for management of common conditions of both the mother and baby and the designated doctors and nurses will monitor them daily. (For detail refer MNCU guidance note)

 
Janani Shishu Suraksha Karyakram (JSSK)
 

Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011and has provision for both pregnant women and sick new born till 1 year after birth are (1) Free and zero expense treatment, (2) Free drugs and consumables, (3) Free diagnostics & Diet, (4) Free provision of blood, (5) Free transport from home to health institutions, (6) Free transport between facilities in case of referral, (7) Drop back from institutions to home, (8) Exemption from all kinds of user charges.

The initiative would further promote institutional delivery, eliminate out of pocket expenses which act as a barrier to seeking institutional care for mothers and sick new borns and facilitate prompt referral through free transport.

 
Facility Based Integrated Management of Neonatal and Childhood Illness (F- IMNCI)
 

F-IMNCI is the integration of the Facility based Care package with the IMNCI package, to empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as at the facility. Facility based IMNCI focuses on providing appropriate skills for inpatient management of major causes of Neonatal and Childhood mortality such as asphyxia, sepsis, low birth weight and pneumonia, diarrhea, malaria, meningitis, severe malnutrition in children. This training is being imparted to Medical officers, Staff nurses and ANMs at CHC/FRUs and 24x7 PHCs where deliveries are taking place. The training is for 11 days.

 
Integrated Management of Neonatal & Childhood Illnesses (IMNCI)
 

which includes Pre-service and In-service training of providers, improving health systems (e.g. facility up-gradation, availability of logistics, referral systems), Community and Family level care.

 
Home Based New Born Care (HBNC):
 

A new scheme has been launched to incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration, amounting to a total of Rs. 250 for five visits. This would be paid at one time after 45 days of delivery, subject to the following :

  • recording of weight of the newborn in MCP card
  • ensuring BCG , 1st dose of OPV and DPT vaccination
  • both the mother and the newborn are safe till 42 days of the delivery, and
  • registration of birth has been done

A comprehensive “Home Based Newborn Care Operational Guideline- 2011” has been developed, published and disseminated in 2011 by Child Health Division, MoHFW, GOI to provide framework and guidance to enable a coherent home based new born care strategy and act a reference tool for the states to plan necessary interventions.

 
Home based care for young child (HBYC):
 

India witnessed a higher decline in maternal and child mortality compared to global average since the inception of National Health Mission (NHM). With the National Health Policy, 2017 in place, there is an unprecedented opportunity to build upon the gains made in the last ten years and achieve Sustainable Development Goals.

Malnutrition continues to be the underlying cause of death for 35% of Under 5 Mortality reported in India. The interaction between under nutrition and infection can create a vicious cycle of worsening illness and deteriorating nutritional status. Interventions promoting infant and young child feeding are known to improve child survival, growth and intellectual development. Numerous gaps and barriers are observed in the delivery and practice of IYCF recommendations. Research points to the benefits of integrated delivery platforms, notably combining nutrition interventions with support for parents in promoting play-based learning.

Under National Health Mission, Child Health division, MoHFW, GOI has rolled out Home-Based Care for Young Child (HBYC) Programme as an extension of the Home Based New Born Care (HBNC) programme to promote evidence based interventions delivered in four key domains namely nutrition, health, childhood development and WASH (Water, Sanitation and Hygiene). An operational guideline for Home Based Care for Young Child (HBYC) programme was released by Hon’ble Prime minister of India on 14th April, 2018 in Chhattisgarh.

Under Home Based Care of Young Child (HBYC) programme, the additional five home visits will be carried out by ASHA with support from Anganwadi workers. ASHA will provide home visits on 3rd, 6th, 9th, 12th and 15th months to promote early initiation of breast feeding, exclusive breast feeding till 6 months and continued breast feeding till 2nd year of life along with adequate complementary feeding, prevention of childhood Pneumonia and Diarrhoea and to ensure age appropriate immunization and early childhood development . The quarterly home visits schedule for low birth weight babies, SNCU & NRC discharges will now be harmonized with the new HBYC schedule.

ASHAs will be provided incentive of Rs. 250 for completion of 5 home visits under HBYC for each young child (Rs. 50 per visit) as per the recommended schedule and additional commodities namely ORS packet and Iron Folic Acid syrup will be provided in the kit National Deworming Day, Newborn Care, IYCF& IDCF material: Material reports, IEC material to be shifted from old website to new website under Child Health section. Important letters and DO’s of Child health need to be updated on new website

 
Strengthening Facility based Paediatric Care:
 

Facility based care is complementary to community level interventions in bringing down childhoodmorbidity and mortality. Newborns and children referred from communities and primary healthcarefacilities are often seriously ill and at high risk of dying. Those reaching health facilities need tobe managed appropriately and without delay in instituting care. This objective can be achieved byestablishing a well-organised unit, adequate human resources, drugs, equipment and other logisticsthat provides functional quality of care consistent with clinical standards.

The vision for paediatric care at District Hospital is to set up a comprehensive unit comprisingof the following sub-units:

  1. Paediatric Outpatient Facility (including immunisation and counselling services)
  2. Emergency Triage Assessment and Treatment (ETAT) Facility
  3. Paediatric Inpatient Facility
  4. a) High Dependency Unit
  5. b) Paediatric Ward
  6. c) Diarrhoea Treatment Unit
  7. d) Isolation Room
  8. Ancillary (eg;laboratory, imaging, pharmacy) & Auxiliary Facilities (eg; play area,

hospital kitchen)

The general paediatric care facility will function in close coordination with specialised unitsthat already have approved guidelines for operationalization and include the following:

  • Newborn care facilities (Newborn Care Corners, Newborn Stabilisation Unit, Special

Newborn Care Unit)

  • Nutrition Rehabilitation Centre
  • District Early Intervention Centre
 
Family Participatory Care:
 

Realizing that parents if trained during their stay in the hospital to provide essential care to their sick and small newborns and explained what to do at the time of crises will not only help in improving survival of the babies after discharge from newborn care units but also help in the overall growth and development of the baby. In this regard Child Health division MoHFW, released Operational Guidelines on Family Participatory Care (FPC) at a recently concluded 4th Summit on Best Practices held at Indore. Family-participatory care (FPC) for newborn essentially provides a setting in which family is empowered, encouraged and supported as the constant care-provider, in addition to available nursing staff, to complement care of their sick newborn in nursery, from admission until discharge and continue in home settings too. However, the primary responsibility of care continues to rest with the conventional health care provider namely the nurse and doctor. Under FPC capacities of parents-attendants is built in essential newborn care through a structured training programme (Audio -Visual module and a training guide). The staff at newborn care unit provides continuous supervision and support. Provisions for infrastructure and logistics strengthening required for implementing FPC are ensured in the annual state PIP.States like Madhya Pradesh, Odisha, Rajasthan and Bihar have already implemented in SNCU across the state (with technical support from NIPI-Newborn Project). Parents-attendants are involved in a limited way for maintaining hygiene, cleaning the soiled baby, positioning of babies, and alerting the staff if they notice anything unusual with the baby.

 
Navjat Shishu Suraksha Karyakram(NSSK)
 

NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have a trained health personal in Basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.

 
Infant and Young Child Feeding :
 

Infant and Young Child Feeding is the single most preventive intervention for child survival. It advocates the following:-

  • Early initiation (within one hour of birth) and exclusive breast feeding till 6 months.
  • Timely complementary feeding after 6 months with continued breast feeding till the age of 2 yrs.
 
Nutritional Rehabilitation Centres (NRC)
 

(treat severe acute malnutrition amongst children)

Severe Acute Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhoea and pneumonia. Deaths amongst SAM children are preventable, provided timely and appropriate actions are taken.

Nutritional Rehabilitation Centres (NRCs) are being set up in the health facilities for inpatient management of severely malnourished children, with counselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow up.

An “Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition-2011” has been published and disseminated in 2011 by Child Health Division, MoHFW,

 
Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases :
 

Promotion of zinc and ORS supplies is ensured.

Childhood Diarrhoea

In order to control Diarrrhoeal diseases Government of India has adopted the WHO guidelines on Diarrhoea management.

  • India introduced the low osmolarity Oral Rehydration Solution (ORS), as recommended by WHO for the management of diarrhea.
  • Zinc has been approved as an adjunct to ORS for the management of diarrhea.Addition of Zinc would result in reduction of the number and severity of episodes and the duration of diarrhoea.
  • New guidelines on management of diarrhoea have been modified based on the latest available scientific evidence.

 

Acute Respiratory Infections

 

  • Acute Respiratory Infections forms 19 % of all under five mortalities in India (WHO 2007 report) and along with Diarrhoea are two major killers of under five children.
  • India leads the world in the number of pneumonia cases with nearly 44, 00, 000 cases yearly. Early diagnosis and appropriate case management by rational use of antibiotics remains one of the most effective interventions to prevent deaths due to pneumonia. The ARI guidelines are being revised with the inclusion of the latest available global evidence.
 
Supplementation with micronutrients :
 

  • The policy has been revised with the objective of decreasing the prevalence of Vitamin A deficiency to levels below 0.5%, the strategy being implemented is:
    • 1,00,000 IU dose of Vitamin A is being given at nine months
    • Vitamin A dose of 2,00,000 IU (after 9 months) at six monthly intervals up to five years of age
    • All cases of severe malnutrition to be given one additional dose of Vitamin A.
Coverage with Vitamin ACES (2009)DLHS-3 (2007-08)NFHS-3 (2005-06)
Children 9 months and above who have received at least one dose of Vitamin A 65.4 % 55.0% 24.8%

Iron and Folic Acid supplementation

  • To manage the widespread prevalence of anaemia in the country, the policy has been revised.
  • Infants from the age of 6 months onwards up to the age of five years shall receive iron supplements in liquid formulation in doses of 20mg elemental iron and 100mcg folic acid per day per child for 100 days in a year.
  • Children 6-10 years of age shall receive iron in the dosage of 30 mg elemental iron and 250mcg folic acid for 100 days in a year.
  • Children above this age group would receive iron supplements in the adult dose