P a g e | 1 RAPID ASSESSMENT Facility Readiness for Essential Newborn Care & Resuscitation (ENC/R) 13th to 18th May, 2013 District Jind Child Health Division, NRHM Haryana in technical collaboration with Objectives: 1. Qualitative and quantitative assessment of readiness of health facilities in district Jind for essential newborn care and resuscitation. 2. To assess the quality of essential newborn care provided to each and every neonate immediately after birth. 3. To understand the existing knowledge, skills, attitudes and practices of the health service providers. 4. On job trainings to the service providers on novelties in essential newborn care and resuscitation. Materials and Methods 1. A structured and tested assessment tool has been used to assess the facilities on 8 parameters viz. facility identification and infrastructure, availability of services, human resource, Equipment and supplies, Register and client case records, protocols and guidelines, individual case records, and knowledge and practices. 2. Knowledge and skill assessment has been done on the newborn simulators (mannequins). 3. The current and ideal practices in essential newborn care and resuscitation have been demonstrated to the service providers on the mannequins. A team of Consultants and Interns visited 36 facilities in the district, from 13th May, 2013 to 18th May, 2013, including General Hospital, Sub-District Hospital, all CHCs and PHCs and the delivery huts with monthly delivery load of 3 or more. Following is the list of facilities visited: Sr. No. Name of Facility 1. GH Jind 2. SDH Narwana 3. CHC Julana 4. CHC Kalwa 5. CHC Kandela 6. CHC Kharak Ramji 7. CHC Safidon 8. CHC Uchana 9. CHC Ujhana 10. PHC Alewa 11. PHC Amargarh 12. PHC Chatter 13. PHC Dahola 14. PHC Daryawala 15. PHC Dhamtan Sahib 16. PHC Dhanoda Kalan 17. PHC Dhanouri 2 18. PHC Dhatrath 19. PHC Dumer Khan 20. PHC Durjanpur 21. PHC Hatt 22. PHC Jai Jaiwanti 23. PHC Muvana 24. PHC Nidhana 25. PHC Rajana Kalan 26. PHC Ramrai 27. PHC Sinser 28. PHC Siwanamaal 29. PHC Shamlon Kalan 30. SC Chuharpur 31. SC Gatauli 32. SC Jhanj Kalan 33. SC Kabar Cha 34. SC Kila Jafargarh 35. SC Malvi 36. SC Singhana Common findings of District Jind are given below: 1. Absence of NBCC at most of the delivery points. Examination table was being used as NBCC with no provision for warmth like 200 W bulb. 2. Baby cradle is still in use, which should be discarded as it acts as a barrier between maternal thermal care and newborn. 3. Baby cloth (dry sheets) not available. 4. Hand washing before delivery not in practice. If practiced, then proper technique not being followed. 5. Suction machines and oxygen cylinders at most of the facilities are non functional. Staff does not know how to use it. 6. Room thermometers to know the temperature of the delivery room are not available in most of the facilities. Low reading clinical thermometer (alcohol based thermometers) to check the temperature of newborns is not available. 7. Birth dose Hepatitis-B vaccine and Inj. Vitamin K not given to newborn at the time of birth. 8. Inadequate supply of emergency medicines like magnesium sulphate, adrenaline, etc across the district. 3 9. Infection prevention protocols are not being followed; used instruments are being washed with detergent powder for re-use. 10. Effective hand washing (washing hands following six golden steps) before delivery is not in practice. 11. Non availability of newborn case sheets and records. 12. Record of services provided to the newborn immediately after birth is not kept at any of the facilities. Baby notes on essential newborn care are not maintained. At sub- centre level case sheets are not available. 13. Use of double gloves during delivery and newborn care process is not in practice. 14. Use of Oxytocin for induction/augmentation of labour is still in practice which has to be discouraged. 15. The skills required for essential newborn care and resuscitation have been found below average in general. The chronology of these skills is of paramount importance and needs repeated refresher trainings. 16. In most of the facilities the baby is delivered in a tray and taken away from the mother after immediate cord cutting. 17. Skin-to-skin contact on the mother’s chest or abdomen and “Baby Crawl” encouragement is not in practice. 18. Segregation of Bio-medical waste not being done properly. 19. Infection prevention protocols are not being followed; used instruments are being washed with water and detergent powder for re-use. Rusted delivery kit instruments are being used at many facilities. 20. Disposable D Lee Mucus Extractors are cheap and best devised for suction when electric or foot operated suction machines are either not available or cannot be used, but in most of the facilities Disposable D Lee Mucus Extractors are not available. 4 Table 1.Quantitative Results and Scores (>75 Good, 50-75 Average, <50 Poor) Delivery Essential Protocols/ and Drugs Guidelines Provider Facility Name of Infrastructure Newborn Equipment and Infection Knowledge Overall Facility Care and Prevention and Skills Average Services Supplies Knowledge SDH Narwana 92 100 75 19 72 71 GH Jind 100 91 85 16 57 70 PHC Muvana 83 82 72 25 75 68 CHC Safidon 92 91 69 16 63 66 PHC Chatter 75 73 60 41 80 66 CHC Kaharak 83 82 56 19 51 Ramji 58 CHC Kalwa 92 64 64 41 29 58 PHC Alewa 92 73 60 28 33 57 PHC Dhanouri 75 82 62 25 42 57 PHC Rajana 75 82 59 22 46 Kalan 57 CHC Ujhana 75 73 60 31 43 56 CHC Uchana 75 73 60 28 42 55 PHC Dhanoda 83 82 53 3 55 Kalan 55 PHC Daryawala 50 82 57 22 63 55 PHC Jai 75 82 57 16 36 Jaiwanti 53 CHC Kandela 92 73 60 13 24 52 PHC Dhatrath 75 73 64 19 29 52 DISTRICT AVERAGE 73 71 55 18 43 52 PHC Ramrai 67 73 56 9 49 51 SC Gatauli 92 73 40 9 39 51 PHC 75 64 59 13 39 Durjanpur 50 PHC 75 73 54 9 36 Amargarh 50 PHC Dhamtan Sahib 75 82 43 3 44 49 PHC Sinser 50 55 56 28 54 49 SC Kila 75 64 41 25 38 Jafargarh 49 SC Singhana 58 64 43 25 52 48 5 PHC Uchana 75 73 43 19 30 48 PHC 83 64 46 16 29 Siwanamaal 48 SC Chuharpur 75 73 29 13 48 47 PHC Shamlon 58 64 56 13 44 Kalan 47 PHC Dumer 58 64 60 13 39 Khan 47 SC Jhanj Kalan 75 55 25 28 38 44 PHC Nidhana 58 64 47 19 29 43 PHC Dahola 75 45 52 6 33 42 SC Malvi 75 55 46 13 19 41 CHC Julana 42 64 53 6 31 39 PHC Hatt 50 55 51 9 20 37 SC Kabar Cha 42 36 47 13 28 33 6 Graph I. Overall Scores of health facilities in Facility Readiness 100 80 71 70 68 66 66 58 58 57 57 60 57 57 56 55 55 55 53 52 52 52 51 51 50 50 49 49 49 48 48 48 47 47 47 44 43 42 41 39 40 37 33 20 0 GH JIND GH SC Malvi PHC Hatt PHC SC Gatauli SC CHC Kalwa CHC PHC Sinser PHC PHC Alewa PHC PHC Dahola PHC PHC Ramrai PHC CHC Ujhana CHC SC Singhana PHC Chatter PHC CHC Safidon CHC PHC Uchana PHC CHC JULANA CHC CHC Kandela CHC PHC Muvana PHC PHC Shamlon… PHC PHC dhanoda… PHC CHC UCHANA CHC PHC Dhatrath PHC SC Chuharpur SDH Narwana SDH PHC Dhamtan…PHC PHC Dhanouri PHC SC Jhanj Kalan SC Jhanj PHC NIDHANA PHC PHC Amargarh PHC SC KABAR CHA SC KABAR PHC Jaijaiwanti PHC PHC Daryawala PHC SC Kila Jafargarh SC Kila PHC siwanamaal PHC PHC DURJANPUR PHC PHC Rajana kalan Rajana PHC kalan Rajana PHC CHC kaharak ramji kaharak CHC PHC DUMER KHAN DUMER PHC DISTRICT AVERAGE DISTRICT 7 Graph II. Grading of GH, SDH, and CHC for Facility Readiness (%) 100 80 71 70 66 58 58 60 56 55 52 52 39 40 20 0 8 Graph III. Grading of PHCs for Facility Readiness (%) 100 80 68 66 57 57 60 57 57 55 55 53 52 52 51 50 50 49 49 48 48 47 47 43 42 40 37 20 0 PHC Hatt PHC PHC Sinser PHC PHC Alewa PHC PHC Dahola PHC PHC Ramrai PHC PHC Chatter PHC PHC Uchana PHC PHC Muvana PHC PHC Dhatrath PHC PHC Dhanouri PHC PHC NIDHANA PHC PHC Amargarh PHC PHC Jaijaiwanti PHC PHC Daryawala PHC PHC siwanamaal PHC PHC DURJANPUR PHC PHC Rajana kalan Rajana PHC PHC Rajana kalan Rajana PHC PHC DUMER KHAN DUMER PHC DISTRICT AVERAGE DISTRICT PHC Shamlon Kalan Shamlon PHC PHC dhanoda Kalan dhanoda PHC PHC Dhamtan Sahib Dhamtan PHC 9 Graph IV. Grading of Sub-Centres for Facility Readiness (%) 100 80 60 52 51 49 48 47 44 41 40 33 20 0 DISTRICT SC Gatauli SC Kila SC SC SC Jhanj SC Malvi SC KABAR AVERAGE Jafargarh Singhana Chuharpur Kalan CHA 10 Graph V. Grading of health facilities for Infrastructure (%) 100 100 92 92 92 92 92 92 83 83 83 83 80 75 75 75 75 75 75 75 75 75 75 75 75 75 75 75 75 75 73 67 58 58 58 58 60 50 50 50 42 42 40 20 0 GH JIND GH SC Malvi PHC Hatt PHC SC Gatauli CHC Kalwa CHC PHC Sinser PHC PHC Alewa PHC PHC Dahola PHC PHC Ramrai PHC CHCUjhana SC Singhana PHC Chatter PHC CHC Safidon CHC PHC Uchana PHC CHC JULANA CHC CHC Kandela CHC PHC Muvana PHC PHC dhanoda… PHC CHC UCHANA CHC PHC Dhatrath PHC SC Chuharpur SDH Narwana SDH PHC Dhamtan… PHC PHC Dhanouri PHC SC Jhanj Kalan SC Jhanj PHC NIDHANA PHC PHC Amargarh PHC SC KABAR CHA SC KABAR PHC Jaijaiwanti PHC PHC Daryawala PHC SC Kila Jafargarh SC Kila PHC siwanamaal PHC PHC DURJANPUR PHC PHC Rajana kalan Rajana PHC kalan Rajana PHC CHC kaharak ramji kaharak CHC PHC DUMER KHAN DUMER PHC DISTRICT AVERAGE PHC Shamlon Kalan Shamlon PHC 11 Graph VI.