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Naveen Thacker ; Panna Choudhury William Keenan ; Vineet Saxena Indian Academy of Pediatrics. TOWARDS SKILLED NEONATAL RESUSCITATION: THE INDIAN STORY-YEAR ONE. Incredible Story of Implementation of Newborn Resuscitation Program in India… probably largest ever !. Stakeholders.

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TOWARDS SKILLED NEONATAL RESUSCITATION: THE INDIAN STORY-YEAR ONE

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Naveen thacker panna choudhury william keenan vineet saxena indian academy of pediatrics

Naveen Thacker ; Panna Choudhury William Keenan ; VineetSaxenaIndian Academy of Pediatrics

TOWARDS SKILLED NEONATAL RESUSCITATION: THE INDIAN STORY-YEAR ONE


Towards skilled neonatal resuscitation the indian story year one

Incredible Story of Implementation of Newborn Resuscitation Program in India…probablylargest ever !

Stakeholders


The story is about

The story is about……

  • Acollaborative 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

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…


Towards skilled neonatal resuscitation the indian story year one

Why Skilled Resuscitation is important in India ?

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%)

  • NRP can reduce asphyxia related neonatal mortality upto 2/3rd

    • .


Towards skilled neonatal resuscitation the indian story year one

Figure 5

Scaling up NRP in Public Sector is Urgent

India’s Janani Suraksha Yojana(JSY),

Conditional cash transfer program to increase birth in health facilities.Lancet 2010; 375: 2009-2023

  • Large scale shift: from home to institutional deliveries

  • Urgent need of large no. of SBA’s


Engaging iap leadership

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

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


Towards skilled neonatal resuscitation the indian story year one

Program is named as

Newborn Resuscitation Program- First Golden Minute(NRP-FGM) Program

Aims to have one NRP trained person attending every delivery

( 27 millions deliveries /year in India )


Administrative structure for nrp program

Administrative Structure for NRP Program

Steering CommitteeCore Committee

Administrative

Academic


Who will be trained

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


Towards skilled neonatal resuscitation the indian story year one

Squeeze bulbs for simulation of crying, breathing and heart activity

Umbilical cord that can be cut multiple times

Manikins and Resuscitation Kits

  • LDSC provided some kits initially

  • Arrangement with Laerdal Co. for Manikins; field tested first in India

19


Industry support

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

“First Golden Minute: Trainings in 2009”

ToT’s were carried out for IAP members at various places

  • 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

  • ............................


Engaging ministry of health

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

Ministry of Health launched

Navjaat Shishu Suraksha Karyakram (NSSK)

GOI and IAP have signed a MoU for training on 09-12-2009


Towards skilled neonatal resuscitation the indian story year one

Roll out Plan

10 States = ~ 300 Districts

4 Trainers per district

1200 Trainers planned in 4 months

WHERE ?

States in India where newborns are at high risk of dying


Towards skilled neonatal resuscitation the indian story year one

Program included Basic Newborn Care and Resuscitation

Prevention of Infection

Wash Hands

Wear Gloves

Cord Care

Clean Chain

Early initiation & exclusive breastfeeding

Prevention of hypothermia

Warm Chain

Kangaroo Mother care


Towards skilled neonatal resuscitation the indian story year one

Expert Committee developed the module

Action Plan


Selection and motivation of trainers

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

  • 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 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


Evaluation of training pre test and post test of 240 trainers

Evaluation of training- pre-test and post-test of 240 Trainers


Evaluation of training pre test and post test of 240 trainers1

Evaluation of training- pre-test and post-test of 240 Trainers


Persons trained till june 2010 in govt sector

Persons trained till June 2010, in Govt Sector


What are we going to do

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

We conclude……

  • Acollaborative 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.


Thank you

Thank you

Steering Committee of IAP NRP FGM

President IAP 2010 and Co- Chairperson

President IAP 2009 and Chairperson

President IAP 2007 and National Co- Ordinator

Hon. General Secretary, IAP, 2010


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