7th October, 2013 to 15th October, 2013 RAPID Assessment District Rewari Facility Readiness Assessment for Essential Newborn Care and Resuscitation Child Health Division, NRHM, Haryana in technical collaboration with Table of Contents Sr. No. Content Page No. 1. Objectives 2 2. Materials and Methods 2 3. List of facilities visited 2-3 4. General findings of District 3 4a. Overall Training Status 4 4b. Status of Newborn Corners 4 4c. Availability of equipment and instruments in NBCC 4 4d. Status of NBSUs 5 5. Quantitative findings of facilities 5-9 6. Qualitative findings of facilities 6 a. General Hospital, Rewari 10 6 b. SDH Kosli 10 6 c. CHC Bawal 10 6 d. PHC Kosla 11 6 e. PHC Sangwari 11-12 6 f. PHC Tankri 12 6 g. CHC Gurawara 12 6 h. PHC Dahina 13 6 i. PHC Fathpuri 13 6 j. PHC Jatusana 13 6 k. CHC Khol 13-14 6 l. PHC Bassduda 14 6 m. PHC Siha 14-15 6 n. CHC Meerpur 15 6 o. PHC Baharawas 15 6 p. PHC Dharuheda 16 6 q. PHC Masani 16 6 r. CHC Nahar 17 6 s. PHC Bawwa 17-18 6 t. PHC Guryani 18 6 u. SC Chillar 18-19 6 v. SC Jadra 19 6 w. SC Kapriwas 19 6 x. SC Nangal Sehbazpur 19 1 | P a g e 1. Objectives: 1. Qualitative and quantitative assessment of readiness of our health facilities 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 the job trainings to the service providers on novelties in essential newborn care and resuscitation. 2. 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, 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. Our teams visited 24 facilities in the district, from 7th October, 2013 to 15th October, 2013, including General Hospitals, 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. General Hospital, Rewari 2. SDH Kosli 3. CHC Bawal 4. PHC Kosla 5. PHC Sangwari 6. PHC Tankri 7. CHC Gurawara 8. PHC Dahina 9. PHC Fathpuri 10. PHC Jatusana 11. CHC Khol 12. PHC Bassduda 13. PHC Siha 14. CHC Meerpur 15. PHC Baharawas 16. PHC Dharuheda 17. PHC Masani 18. CHC Nahar 19. PHC Bawwa 20. PHC Guryani 21. SC Chillar 22. SC Jadra 2 | P a g e 23. SC Kapriwas 24. SC Nangal Sehbazpur 4. The findings of district Rewari in general are as follows: • Good infrastructure. • Availability of equipment. • Availability of doctors and staff nurses. • Established Newborn Care Corners. • At birth immunization done in most of the facilities. • Many birth attendants not trained in SBA, NSSK and F-IMNCI. • Designated NBSUs not functional. • Hand washing stations not appropriate for effective hand washing. • Partographs maintained in many facilities but method is not accurate and filled after delivery for record completion. Simplified Partographs not available in many facilities • Autoclave available but not used in some facilities • Reuse of disposable mucus extractors is in practice. • Birth preparedness before delivery not done in some facilities. • Labour room protocols for infection prevention not followed in routine. • Effective hand washing before delivery not followed. • Case sheets do not have records of essential newborn care. • Suction of every new born in practice despite good cry. • Augmentation of labour by oxytocin is rampant. • Baby drying and wrapping sheets are not available. • Cradles are still available in post natal wards (not recommended). • Skin to skin contact between mother and baby is not in practice. • Immediate cord cutting in practice. • Milking of cord still in practice. • Infection prevention and hygiene protocols for labour room and NBCC are not followed in majority of the facilities. • Regular refresher trainings needed for resuscitation. Steps are not in chronological order (Resuscitation equipment are not available) • AMTSL practices are not followed in some facilities. • Use of Radiant Warmer and separation of newborn from mother for every newborn is in practice. • Skills of essential newborn care lacking. • Immediate drying of newborn not followed in many facilities • Management of low birth weight babies not done as per protocols 3 | P a g e 4 a. Overall Training Status Sr. No. No. of Birth attendants SBA NSSK IMNCI 1. 93 58 67 60 4 b. Status of Newborn Corners Newborn Corners with Newborn Total NBCCs NBCCs still not Radiant Warmer Corners with Established established 200 W bulb 20 4 24 0 4 c. Availability of equipment and instruments in NBCCs (n=24) Sr. No. Equipment/Instrument Available (No. of Not available (No. Facilities) of Facilities) 1. Self-Inflating Bag 24 0 2. Mask Size ‘1’ 24 0 3. Mask Size ‘0’ 21 3 (PHC Bharawas, SC Chillar, SC Nangal Sahbajpur) 4. Shoulder Roll 22 2 (PHC Siha, Jatusana) 5. Suction Catheter 24 0 6. Disposable Mucus Extractors 19 5 (CHC Nahar, Bawal, PHC Dahina, Siha, SC Jadra) 7. Suction Machine 24 0 8. Oxygen Cylinder 21 3 9. Baby Sheets 20 4 (PHC Bawwa, Kosla, Dharuhera, Masani) 10. NBCC at appropriate place 22 2 4 | P a g e 4 d. Status of Designated Newborn Stabilization Units (NBSUs) Sr. No. Name of Status Functionality No. of Radiant No. of Institution Warmers Phototherapy Units 1. CHC Bawal Established Not Functional 1 1 2. CHC Khol Not NA Only in NBCC 0 Established 5. Quantitative Results and Scores (>75 Good, 50-75 Average, <50 Poor) Essential Register Delivery And Protocols Knowledge Provider Drugs, s And Facility’s Name of Infrastructu Newborn And About Knowledg Equipment Client Overall Facility re Care Guideline Infection e And And Case Average Services s Prevention Skills Supplies Records PHC 100 94 73 80 100 71 65 83 DAHINA PHC 80 89 71 70 57 59 51 68 BARAWAS PHC 72 89 75 70 57 66 47 68 FATEHPURI PHC DHARUHER 66 89 74 70 43 61 59 66 A PHC 72 89 73 70 43 62 50 65 KOSALA PHC SIHA 82 83 65 80 43 45 45 63 SC NANGAL 78 89 79 70 29 48 45 63 SEHBAJPUR CHC NAHAR 76 83 83 50 43 40 55 62 CHC KHOL 72 83 69 60 43 45 56 61 DH REWARI 76 89 71 70 0 38 75 60 DISTRICT 72 84 68 62 36 48 44 59 AVERAGE 5 | P a g e SC JADRA 74 83 74 60 43 36 41 59 PHC 100 94 73 80 100 71 65 83 DAHINA PHC 80 89 71 70 57 59 51 68 BARAWAS PHC 72 89 75 70 57 66 47 68 FATEHPURI PHC DHARUHER 66 89 74 70 43 61 59 66 A PHC 72 89 73 70 43 62 50 65 KOSALA PHC SIHA 82 83 65 80 43 45 45 63 SC NANGAL 78 89 79 70 29 48 45 63 SEHBAJPUR CHC NAHAR 76 83 83 50 43 40 55 62 CHC KHOL 72 83 69 60 43 45 56 61 DH REWARI 76 89 71 70 0 38 75 60 SC JADRA 74 83 74 60 43 36 41 59 6 | P a g e Graph I. Status of Infrastructure (n=24) 100 100 82 80 78 76 76 76 80 74 74 74 74 72 72 72 72 70 68 66 66 66 66 64 60 58 60 54 40 20 0 Graph II. Overall Scores of facilities in Facility Readiness (n=24) 100 83 80 68 68 66 65 63 63 62 61 60 59 59 58 58 58 57 56 56 56 55 60 53 53 50 47 44 40 20 0 7 | P a g e Graph III. Scores of infection prevention knowledge in providers (n=24) 100 100 80 60 57 57 43 43 43 43 43 43 43 43 43 40 36 29 29 29 29 29 29 29 29 20 14 14 0 0 0 Graph IV. Provider’s knowledge and skills for Essential Newborn Care and Resuscitation (%) (n=24) 100 80 71 66 62 61 60 59 60 56 49 49 48 48 48 47 45 45 45 45 43 40 39 38 37 40 36 34 26 20 0 8 | P a g e Graph V. Status of Registers and Client Case record maintenance (n=24) 100 80 75 65 63 59 60 56 56 56 55 51 50 48 47 47 45 45 45 44 44 41 41 40 37 34 20 4 0 0 0 Graph VI. Availability of Essential Drugs, Equipment and Supplies (n=24) 100 83 79 76 80 75 75 74 74 73 73 71 71 69 69 68 68 67 67 65 63 61 60 59 58 60 53 53 40 20 0 9 | P a g e 6. Facility wise Qualitative Findings a. General Hospital, Rewari Report not available b. SDH Kosli • The facility is under serving than its designation and available staff. It is operating from an old building, soon will be shifted to new building. • Most of the staff nurses are not trained for SBA, NSSK and IMNCI.