Assessment of Essential Newborn Care Services in Secondary-level Facilities from Two Districts of India|
Malhotra, Sumit; Zodpey, Sanjay P.; Vidyasagaran, Aishwarya L.; Sharma, Kavya; Raj, Sunil S.; Neogi, Sutapa B.; Pathak, Garima & Saraf, Abhay
India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the
high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care
(ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur
district in Madhya Pradesh were included. Six secondary-level facilities from the districts─two district hospitals
(DHs) and four community health centres (CHCs) were evaluated, where maximum institutional
births within districts were taking place. The assessment included record review, facility observation, and
competency assessment of service providers, using structured checklists and sets of questionnaire. The domains
assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother
care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the
CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed.
Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely
unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six
facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction
device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining
ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting
a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed.
While knowledge domain scores were largely satisfactory (>75%) for the majority of providers in domains
of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all
other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (<50%).
The findings underpin the need for improving the existing ENC services by making newborn care corners
functional and enhancing skills of service providers to reduce neonatal mortality rate in India.
Clinical competence; Health facilities; Health personnel; Newborn care; Process assessment; India