India Newborn Action Plan

India Newborn Action Plan (INAP) was launched in September 2014, for accelerating the reduction of preventable newborn deaths and stillbirths in the country - with the goal of attaining ‘Single Digit Neo-natal Mortality Rate (NMR) by 2030’ and ‘Single Digit Still Birth Rate (SBR) by 2030’. Currently, there are estimated 7.47 lakh neonatal deaths annually.The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the goal is achieved.

The India Newborn Action Plan (INAP) is India’s committed response to the Global Every Newborn Action Plan (ENAP), launched in June 2014 at the 67th World Health Assembly, to advance the Global Strategy for Women’s and Children’s Health.

Goals

Ending Preventable Newborn Deaths to achieve “Single Digit NMR” by 2030, with all the states to individually achieve this target by 2035.
Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the states to individually achieve this target by 2035

Snapshot of India Newborn Action Plan (INAP)

Builds on existing commitments under the National Health Mission and 'Call to Action' for Child Survival and Development
Aligns with the Global Every Newborn Action Plan (ENAP); defines commitments based on specific contextual needs of the country
Aims at attaining Single Digit Neonatal Mortality Rate by 2030, five years ahead of the global plan
Emphasizes strengthened surveillance mechanism for tracking stillbirths
Focuses on ending preventable newborn deaths, improving quality of care and care beyond survival
Prioritizes those babies that are born too soon, too small, or sick—as they account for majority of all newborn deaths
Aspires towards ensuring equitable progress for girls and boys, rural and urban, rich and poor, and between districts and states
Identifies major guiding principles under the overarching principle of Integration: Equity, Gender, Quality of Care, Convergence, Accountability, and Partnerships
Defines six pillars of interventions: Pre-conception and antenatal care; Care during labour and child birth; Immediate newborn care; Care of healthy newborn; Care of small and sick newborn; and Care beyond newborn survival
Serves as a framework for states/districts to develop their own action plan with measurable indicators

INAP – National Targets

Targets	Current	2017	2020	2025	2030
Impact targets
NMR (per 1000 live births)	29	24	21	15
SBR (per 1000 live births)	22	19	17	13
Coverage Targets
Safe delivery (institutional + home delivery by SBA (%)	76	90	95	95	95
Initiation of breastfeeding within one hour of birth (%)	-	75	90	90	90
Women with preterm labour receiving at least one dose of antenatal corticosteroids (%)	-	75	90	95	95
Babies born in health facilities with birth asphyxia received resuscitation (%)	-	75	90	95	95
Babies received complete schedule of home visits under HBNC by ASHA (%)	-	50	75	95	95
Newborn with sepsis in the community received Gentamicin by ANM (%)	-	50	75	75	75
Newborn discharged from SNCU followed until age one (%)	-	35	50	75	75
Newborn with low birth weight / Prematurity managed with KMC at facility (%)	-	35	50	75	90

Strategic Intervention Packages

Intervention packages in descending order of impact on neonatal mortality

Package 1: Care during Labour and Child birth
Package 2: Care of Small and Sick Newborn
Package 3: Care of Healthy Newborn
Package 4: Immediate Newborn Care
Package 5: Pre-Conception and Antenatal Care

Intervention packages in descending order of impact on still -births

Package 1: Care during Labour and Child birth
Package 2: Pre-Conception and Antenatal Care

Details of strategic interventions

Package 1: Pre-Conception and Antenatal Care

Pre-Conception and Antenatal Care Interventions Package
Family and Community	Outreach/Sub Centre	Health Facility
Reproductive Health & Family 1. Planning [E] • Adolescent reproductive health • Delaying age of marriage and first pregnancy • Birth spacing 2. Nutrition related interventions [E] • Balanced energy protein supplementation • Peri-conceptional folic acid • Maternal calcium supplementation • Multiple micronutrient supplementation (Iron, Folic Acid & • Iodine) • Nutrition Counselling 3. Counselling & birth preparedness [E] 4. Prevention against Malaria [S]

5. Antenatal screening for Anemia and Hypertensive disorders of pregnancy (PIH, Preeclampsia, Eclampsia) [E]

6. Antenatal screening for Malaria [S]

7. Prevention and management of mild to moderate anemia [E]

8. Maternal tetanus immunization [E]

9. Adolescent friendly health services (nutrition and reproductive health counselling) [E]

12. Antenatal screening & management of Hypothyroidism, Hepatitis B, HIV, Malaria [S]

13. Adolescent friendly health clinics (as per RKSK guidelines) [E]

14. Post-partum family planning services including PPIUCD insertion [E]

Package 2: Care during Labour and Child birth

Care During Labour and Childbirth
Family and Community	Outreach/Sub Centre	Health Facility
1. Skilled birth attendance [E] 2. Clean birth practices [E]	3. Identification of complications and timely referral [E] 4. Pre-referral dose by ANM [E] • Antenatal corticosteroids in preterm labour • antibiotics for premature rupture of membranes	5.Emergency obstetric care [E] • Basic and Comprehensive 6. Management of preterm labour [E] • Antenatal corticosteroids in preterm labour • Antibiotics for premature rupture of membranes

Package 3: Immediate Newborn Care

Immediate Newborn Care
Family and Community	Outreach/Sub Centre	Health Facility
1. Delayed cord clamping [E] 2. Interventions to prevent hypothermia [E] • Immediate drying • Head covering • Skin-to-skin care • Delayed bathing 3. Early initiation and exclusive breastfeeding [E] 4. Hygiene to prevent infection [E]	5. Vitamin K at birth [E] 6. Neonatal Resuscitation [E]	7. Advanced neonatal resuscitation [E]

Package 4: Care of Healthy Newborn

Care of Healthy Newborn
Family and Community	Outreach/Sub Centre	Health Facility
1. Home visits till six weeks by trained ASHA [E] • Counselling • Prevention of hypothermia, cord care • Early identification of danger signs • Prompt and appropriate referral 2. Exclusive breastfeeding [E] 3. Clean postnatal practices [E]	4. Immunization [E] • BCG • OPV • Hepatitis B	All the interventions (except home visits)

Package 5: Care of Small and Sick Newborn

Care of Small and Sick Newborn
Family and Community	Outreach/Sub Centre	Health Facility
1. Thermal care and feeding support (for home deliveries) [E]	2. Integrated management using IMNCI and use of oral antibiotics [E] 3. Injectable Gentamicin by ANMs for sepsis [E] • Pre referral • Completion of antibiotic course in case referral is refused / not possible “OR” as advised by treating physician	4. Kangaroo mother care at facility [E] 5. Full supportive care at block and district level [E] • NBSU at block level • SNCU at district level 6. Intensive care services (NICU) at regional level [A] for • Assisted ventilation • Surfactant use • Surg

Package 6: Care beyond Newborn Survival

Care beyond Newborn Survival
Family and Community	Outreach/Sub Centre	Health Facility
1. Screening for birth defects, failure to thrive and developmental delays [E] 2. Follow up visits of [E] • SNCU discharged babies till 1 year of age • small and low birth weight babies till 2 years of age	3. As before	4. Newborn screening [A] 5. Management of birth defects [E] -Diagnosis -Treatment, including surgery 6. Follow-up of high-risk infants (discharged from SNCUs, and small newborns) for -Developmental delay -Appropriate management

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Last Modified : 9/21/2020