NEW BORN AND

CHILD HEALTHCARE
Presented By:
Dr. Kalpit Sharma
Dr. Amit Chhabra
Dr. Aditi Mittal
Anamika Prasad
Apoorvya Kapoor
Akanksha Sharma
 Overview
 Definition
 Areas of concern
 National Health Programmes
• RCH
• IMNCI
• UIP
• NSSK
 State Health Programmes
 Analysis of Health organizations at different levels
 Suggestions/Recommendations
What do we mean by newborn and child
health care

The professional and academic field that

focuses on the determinants , mechanisms
and systems that promote and maintain the
health , safety , well-being and appropriate
development of children in community and
society in order to enhance the future health
and welfare of subsequent generations.
TERMS:
• Neonatal Period-Birth --> 28 days of life

• IMR- the number of infant deaths per 1000

live births

• Neonatal mortality rate-the number of

neonatal deaths per 1000 live births.
State-wise burden of neonatal
deaths

Neonatal Mortality burden in major states

Hr Pb
As
TN
HP
0.4%
UP
Kn Kr
0.5%
WB As
Hr Pb Rest
1.3% 1.5%
1.8%
TN 2.9%
3.8% UP
Kn
26.1%
Gj 4.1%

WB
4.5%

Guj
4.5%

Or Or
4.7%

Mh Mh
5.6%
MP
13.0% MP
AP

AP
6.4%

Bi
Rj Bi
11.8%
7.2%
Rj
UP:Uttar Pradesh;MP:Madhya Pradesh;Bi:Bihar;Rj:Rajasthan;Mh:Maharashtra;Or:Orissa;WB: West Bengal; Kn:Karnataka,TN:Tamil Nadu;As:
Assam;Hr:Haryana;Pb:Punjab;Ke:Kerala;HP:Himachal Pradesh
Estimation based on data from National Human Development Report 20017 & SRS 2001
Estimation based on data from National Human Development Report 2001 & SRS 2000
 About half of child deaths occur in the neonatal
period (ICMR Study 2003)

Day U5 Child
When do neonates die deaths
die? 1st day 20%
Week 1 74.1
D1 39.3
D2 7.3
D3 10.2
By 3rd day 25%
D4 6.2
D5 5.5

D6 2.8 By 7th day 37%

D7 2.8
Week 2 12.6
Week 3 10 By 28th 50%
Week 4 3.1 day
0 10 20 30 40 50 60 70 80
Percent (%)
 National goals & MDG context

1990 Current NRHM MDG

2012 2015

Infant 80 55 <30 <27

Mortality Rate (2007)

Neonatal Mort 53 37 <20 <20

rate (2005)

U5M Rate <36

107 74
(2005) -
Developments related to child health
• 1978 : EPI
• 1984 : UIP
• 1985 : Oral rehydration therapy 1
• 1990 : UIP and ORT universalized , ARI as a
pilot in 26 districts
• 1992 : CSSM
• 1997 : RCH 1
• 2005 : NRHM and RCH 2
 NRHM

•Launched in April 2005.

•To reduce maternal and infant
mortality and
•To provide universal access to public
health services.
 Reproductive Child Health (RCH)
Programme
•To improve the health status of women and children,
especially the poor and under served, Government of India
during 1997-98 launched the RCH Programme for
implementation during the 9th plan period.
•The second phase of RCH program i.e. RCH – II has been
commenced from 1st April, 2005 the five year file 2010. The
main objective of the program is to bring about a change in
mainly three critical health indicators i.e. reducing total
fertility rate, infant mortality rate and maternal mortality rate
 COMPONENTS OF RCH-II:
1.  Population Stabilization
2.  Material Health
3.  Newborn Care
4.  Child Health
5.  Adolescent Health
6.  RTI/STI treatment and control
7.  Urban Health.
 8. Tribal Health
 9.  Other Priority Areas:
 
            a. Targeted of services
            b. Strengthening service delivery
            c.  Infrastructure and maintenance
            d.  Supply of drugs and equipment
            e.  Strengthening of health care providers.
 RCH II
• HBNC
• NRC
• Facility based care – SNCUs
• Micronutrient Supplementation – Vitamin A
and Iron folic acid
• IMNCI
HBNC-Home based newborn and childhood
care

• Care of Sick
• New born at Home
• Based on Gadchiroli Model.
• Pilot in UP, Bihar, Orissa, Rajasthan and MP
 Iron and folic acid supplementation
Objectives
• Screening of children for anaemia wherever required and
appropriate treatment of those found anaemic
• Reducing prevalence of anaemia by 25% and moderate and
severe anemia by 50% in children
Strategy
Infants: Exclusive breast feeding for six months, and
introduction of green leafy vegetables in the seventh
month
Preschool children : advocacy with regard to dietary
diversification
 Vitamin A supplementation strategy
Objectives
• Decrease prevalence of Vitamin A deficiency form
the current 0.7% to 0.3%
Strategy
• Infancy: to encourage colostrums feeding
• 1,00,000 IU dose of Vitamin A is being given at
nine months
• Childhood:
• Vitamin A dose of 2,00,000I.U at 18,24,30 and 36
months of age
Integrated Management of Neonatal and
Childhood illness (IMNCI)
• The Indian version of IMCI funded by WHO-
UNICEF.
• Component of newborn and child health strategy
in RCH Phase II.
• IMNCI for children
 Management of Acute Respiratory Illnesses
 Management of Diarrhoea and Dehydration
 Management of malnutrition and growth
monitoring of under fives
IMNCI country adaptation and
implementation so far
Training for IMNCI
 IMNCI status
India Rajasthan

Number of districts where 156 33

IMNCI is implemented

Total number of people 124636 16672

trained on IMNCI
(30,nov,2009)
 Immunization

• Delivering effective and safe vaccines

• Aim is to reduce mortality and morbidity due
to VDPs.
• India has one of the lowest routine
immunization (RI) rates in the world.
 5% had Annual under 5
only 43.5% birth
of children received year
no cohort of mortality
age 12-23 24
vaccinati rate of
million
months ons at all surviving
74/1000
were fully infants
vaccinated

over 12.5 million under-

immunized children each
year
 ●
●was launched in India in 1978 to control other VPDs.

EPI ●diphtheria, pertussis, tetanus, poliomyelitis, typhoid

●

and childhood tuberculosis

●
● It gained momentum in 1985

UPI ●
● Measles vaccine was included in the programme
and typhoid vaccine was discontinued

●
UIP was merged in child survival and
CSSM safe motherhood program (CSSM) in
1992-93
• The Cold-chain system was strengthened
• Training programmes were launched
extensively throughout the country.
• Intensified polio eradication activities were
started in 1995-96
• Since 1997 immunization activities are an
important component of Reproductive and
Child Health (RCH) program.
• From April 2005, immunization is an important
component of RCH II under the National Rural
Health Mission (NRHM).
IMMUNIZATION PROGRAM IN RAJASTHAN
• Deptt. Of Medical & Health services is organizing MCHN days
on Monday and Thursday.
• On this day, the ANM, Aanganwadi workers, trained Midwife
are taking parts.
• Microplans of all districts are prepared after training of
workers/ officers jointly to organize the MCHN days.
• Alternate vaccine delivery system is implemented so that
vaccines reaches each Aanganwadi/sub centre as per
microplan.
• To monitor MCHN days effectively
- a core group is framed at Distt. Level, Panchyat
samiti level, PHC level etc.
- special monitoring drive is being organized with
the help of Deptt.of Women and child Welfare
RECOMMENDED IMMUNIZATION SCHEDULE FOLLOWED IN INDIA
SINo Age Disease Vaccination Remarks
1 AT BIRTH HEPATITIS B HEP B VACCINE -I  

2 AT BIRTH POLIO ORAL PV 0 DOSE  

3 BIRTH TO 6 WK TUBERCULOSIS BCG  

4 4 -6 WEEKS HEPATITIS B HEP B VACCINE -II  

DIPHTHERIA
PERTUSIS DPT-I
5 6 WEEKS  
TETANUS OPV -I
POLIO

DIPHTHERIA
PERTUSIS DPT-II *DELHI GOVT
6 10 WK TETANUS OPV-II RECOMMENDA
POLIO HEP B VACCINE III* TION
HEPATITIS B
 DIPHTHERIA
DPT-III
PERTUSIS *DELHI GOVT
7 14 WEEKS OPV- III
TETANUS RECOMMENDATION
HEP B VACCINE IV*
POLIO
*IAP
8 24 WEEKS HEPATITIS B HEP B VACCINE III*
RECOMMENDATION
POLIO OPV-IV
9 9 -12MTHS  
MEASLES MEASLES
MUMPS
10 15-18 MTHS MEASELES MMR*  
RUBELLA
DIPHTHERIA
*RECOMMENDED
PERTUSIS DPT –BOOSTER I
11 18 MTHS BY DELHI GOVT &
TETANUS OPV –V
IAP ONLY
POLIO

*IAP
12 24 MTHS TYPHOID TYPHOID*
RECOMMENDATION
DIPHTHERIA
PERTUSIS DPT BOOSTER – II
13 4-5 YR  
TETANUS OPV -VI
POLIO
 Navjat shishu suraksha karyakram
(NSSK)
Launched on 15th september,2009
Focuses on:
• Prevention of hypothermia
• Prevention of infection
• Early initiation of breast feeding
• Basic newborn resuscitation
 Objectives of NSSK
• One trained person at institutional facility,
where deliveries take place

• NSSK will train healthcare providers at the

district hospitals, CHCs and PHCs
 RAJASTHAN GOVT.
Concerned Deptt:
“Deptt. Of Women & Child Development”
Draft XIth Five-Year Plan document prepared by the Govt. of Rajasthan
Basic theme and focus: women and children.

The main thrust ofthe XI plan

• To ensure survival, protection and development of Children
• IMR
• MMR
• Malnutrition among children in the 0-3 years age group
• Sex ratio
• Countering Anemia (among women in the 15-49 years age group)
• Minimizing drop out rate in elementary education.
• Reduction in IMR to at
least 32/1000 by2012 end

• At least 90 % of children
to receive complete
Immunization

• Quality essential new born care

Appr. care & treatment of infants and children suffering from common
illness
 STATE CHILD POLICY 2008
Child policy so as to enable systematic implementation and effective monitoring of programmes
and policies aimed at children up to the age of 18 years.

• Ensuring food and nutrition security at all levels specially keeping in mind the specific
needs of children and adolescent girls.
• Providing quality education for all children of all categories up to secondary level.
• Securing for all children legal and social protection from all kinds of abuse, exploitation
and neglect with a special focus on girls.
• Provide essential healthcare to all children from birth to adulthood,
as a right, to reduce mortality and morbidity due to preventable
causes.
• Strengthen maternal healthcare with special focus on child delivery
and feeding practices.
• Take care of children affected by HIV and AIDS.
• Ensuring facilities of sanitation and safe drinking water.
• Ensure effective teamwork of public and private partners and ensure child participation in
matters relating to and decisions affecting their lives.
 CHILD HEALTH: APPROACH
• Strengthening the convergence between the Deptt. ofMedical &
Health and Deptt. Of Women & Child Development.
• “Monitoring and Evaluation Cell” in the DOHFW for MCH
services(in association with DOWCD)
• Management Information System (MIS) about children
• Combining the role of “Sahyogini”(additional worker at
Anganwari ) with ASHA
• “Yashoda”:Facility based new-born aides
• Training of people in IMNCI (16,672) (30,nov,2009)
• Well baby clinics at Distt. Hospitals
(eg.Dausa DH Thurs3-5Pm)
• ORS Therapy promotion
• Acute Respiratory Infections (ARI) awareness.
• Promoting institutional deliveries for minimizing
MaternalMortality (MMR)
• A system for Maternal Mortality auditing being
developed.
• Strengthen and re-energize school health
programme
• Community based monitoring.
ICDS(INTEGRATED CHILD DEVELOPMENT SCHEME)
•Aanganwadi Centers
Exclusive breast-feeding promotion upto 6months.
Promoting Infant and Young Child Feeding(IYCF) practices
by encouraging colostrums feeding
Complementary feeding promotion of infants aged 6-9 month.
Provision of Nutritional supplements for < 6 years of age children

•Micro-Nutrient deficiency (Vitamin A, iron, folic acid, iodine, zinc)

supplementation and fortification.
•Strengthening the “Kishore Shakti Yojana” for adolescent girls.
•State level Nutrition Mission under DWCD to coordinating with NRHM-ICDS.
•Nutrition management and surveillance system.
•Monthly Maternal Child Health and Nutrition Day (MCHN) organized.
•Partnership with community and “PRIs”.
•Malnutrition Treatment Centres (MTCs) in district hospitals/ at all levels.
 CHILDREN WITH SPECIAL NEEDS
• Strengthening services and care of such children
(in all concerned deptts inclu. Medical & Health and Education)
• Special schools at district level with residential facilities.
• Close monitoring of interventions (under the Sarva Shiksha Abhiyan).
• Training of social workers, health workers and families for early
detection of disability.
• Provide for counseling of children and their families.
• Including requirements of such children in all existing schemes for
children and frame appropriate schemes for their growth and
development.
• Dissemination of information programs and schemes related to such
children
CHILDREN AFFECTED/INFECTED BY HIV/AIDS
• state-wide assessment of children infected and
affected
• Strengthening Prevention of Parent to Child
Transmission (PPTCT) services at the district
level.
• Anti Retroviral Treatment (ART) and
OI(Opportunistic Infection)treatment services at
district hospitals
• Capacity Building in Health Care workers.
 District Hospital
Norms for newborn and child care:
 Specialist care:
• Paediatrician
• Neonatologist
• Paediatric surgeon
 Treatment of acute childhood infections
 Fully equipped laboratory and diagnostic services
 Fully equipped blood bank
 Pharmacy
 Paediatric wards
 Neonatal ICU
 Nursery
 Emergency care of newborn and children
 Immunization sessions
 Postnatal care
 Fully equipped operation theatre
 Incubator/ Warmer
 Phototherapy Unit
 Functional ambulance
Ground reality:

 Specialist are present but not in adequate number

 Infrastructure is adequate
 Manpower is inadequate
 No post for neonatologist and paediatric surgeon
 Laboratories were fully equipped and there were full dignostic
facilities including X-ray , USG , etc
 No. of beds in paediatric ward were inadequate as per the
patient inflow( 8 beds)
 Well baby clinic: On every thursday
• Free consultation by the paediatrician
• Free gifts and toys given to children
 No Neonatal ICU
 No incubator/warmer
 No phototherapy unit
 No nursery
 No instruments for emergency care of the newborn
 Operation theatre is also not fully equipped
 No facilities for neonatal and child surgeries
 Provisions for BPL patients were adequate
 Senior paediatrician post was vacant since 13th May 2010
 Community Health Center
Norms for newborn and child care :
 Specialist care-
• Paediatrician
 Emergency care of sick children
 Post natal clinics
 Immunization sessions
 National health programs
 Essential laboratories and diagnostic services
 Referral services
 Internal monitoring
 External monitoring
 Standard operating procedures
 Standard treatment protocols
 RMRS
Ground reality:
 Specialist are present
 Manpower is adequate
 X-ray and hematology lab services are available
 No nursery
 Incubator/warmer is not operational due to lack of expertise
 Suction machine is not working
 Hepatitis B vaccination is not been given
 No aseptic conditions
 Due to lack of anaesthetist OT is not operational
 No provision for admissions of newborn and children
 No pediatric sphygmomanometer is available
 No phototherapy unit is available
 Primary Health Center
Norms for newborn and child care:
 Treatment of children with
• Anaemia
• Diarrhoea
• Dehydration
 Postnatal care
 Newborn care
 Immunization programmes
 Management of low birth weight babies
 Fixed immunization day
 BCG and Measles vaccine should be given regularly
 Nutrition services
 School health programmes
 Collection and reporting of vital statistics
 Education about health
 National child health programmes
 Promotion of safe water supply and basic sanitation
 Referral services
 Internal monitoring
 External monitoring
Ground reality:
 Medical officer was present
 There is fixed immunization day and immunization schedule is
followed as per government guidelines
 Physicians visit the schools once in a year
 Suction machine was not working
 No equipments in the operation theatre
 No AYUSH facility
 No technical expertise and facilities for the management of
low birth weight babies
 No facilities for HIV testing
 No facility for proper disposal of hospital waste
 No ambulance services
 Sub Center
Norms for newborn and child care:
 Postnatal care:
• Sterlization
• Immunization
 Adolescents health
 School health education programmes
 Immunization services should be as per government schedule
 ORS for prevention of diarrhoea and dehydration
 Treatment of minor illness like:
• Fever
• Cough
• Cold
• Worm
 Facility for taking peripheral blood smear
 Field visit and home care
 National child health programmes
 Proper maintenance of records and register
 Transport facility
Ground reality:
 Medicines and vaccines were available and used appropriately
 MPWs and ANM visit the school twice a month and swasthya
parikshan program once a year
 Doctor visits the sub centre twice a month
 Immunization services as per government guidelines
 ORS is given for the prevention of diarrhoea and dehydration
 Treatment of minor illness is given
 Field visit and home care is conducted
 Health education to adolescents is given by health worker
 SUGGESTIONS/RECOMMENDATIONS
 At Government level:
• It should focus on the operational modalities in their action
plans.
• It should fund for addressing inter-state and intradistrict
disparities in terms of health infrastructure and indicators.
• It should increase contribution to Public Health Budget,
increased devolution to Panchayati Raj Institutions and
performance benchmarks for release of funds.
• It should fund interventions like ASHA,Programme
Management Unit (PMU), and upgradation of SC/PHC/CHC .
• It should provide adequate manpower in terms of doctors,
paramedics and other administrative staff.
• It should provide adequate and the required equipments to
the District hospital , CHC,PHC and sub centre.
• It should provide adequate salaries and perks to the doctors
and can even provide some extra money if the doctor is
working more than the required time frame.
• It should develop Health MIS upto CHC level.
• It should prepare annual district reports on people’s health.
• State and national reports on people’s health to be tabled in
assemblies , parliament.
• There should be specific protocols on the reporting of sub
centres , PHC, CHC, and Disrict hospital.
• There should be specific protocol to monitor citizens charter.
• It should conduct mid course reviews and take appropriate
corrective actions
• It should mainstream AYUSH in public health system.
• It should change its approach from centralization to
decentralization at the district level.
• It should define time bound goals and report publicly on their
progress.
• Promotion of public private partnerships.
• Regulation of private sector to ensure availability of quality
services to citizens at reasonable cost.
• Specific protocols should be made to ensure quality.
• It should appoint MBAs for the improved programme
management.
 At Panchayati Raj Institutions level:
• A program should be created which can guide and manage all
public health institutions in the districts , sub centres , CHCs
and PHCs.
• Regular auditing should be done at the CHC , PHC level
• A village health plan should be prepared.
• All health related database should be provided to the
panchayats.
• Funds should be provided at the sub centre and PHC level.
• Specific protocols for the training of health workers should be
developed.
• Health awareness programmes should be organized regularly.
 At NGO level:
• External evaluation and social audit should be conducted.
• Provision of funds.
• Provision of training and technical support to ASHA and
various other organizations.
• It should conduct school health programmes and various
other health awareness programmes.
• It should help CHC and PHC in conducting programmes which
can educate people about basic hygine.
• It should educate people about institutional deliveries.
 At Institutional level:
• The medical officer incharge/ Medical Suprintendent should
set some protocols for the internal monitoring which incudes:
 Social audit
 Medical audit
 Technical audit
 Economic audit
 Disaster preparedness audit
• The incharge should set protocols for Standard Operating
Procedures.
• The incharge should monitor citizens charter
• The incharge should set specific protocols for procuring
equipments.
SOME DOs and DONTs
Thank you