1. Naveen Thacker ; Panna Choudhury William Keenan ; Vineet Saxena Indian Academy of Pediatrics TOWARDS SKILLED NEONATAL RESUSCITATION: THE INDIAN STORY-YEAR ONE

2. Incredible Story of Implementation of Newborn Resuscitation Program in India…probably largest ever ! Stakeholders

3. The story is about……  A collaborative 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.

4. 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…

5. 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. Why Skilled Resuscitation is important in India ?

6. Figure 5 Scaling up NRP in Public Sector is Urgent Large scale shift: from home to institutional deliveries Urgent need of large no. of SBA’s India’s Janani Suraksha Yojana(JSY), Conditional cash transfer program to increase birth in health facilities. Lancet 2010; 375: 2009-2023

7. Engaging IAP Leadership Newborn Resuscitation Program taken under Presidential Action Plan 2009 IAPs Strength 18,000 dedicated pediatricians 300 branches

8. 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

9. Aims to have one NRP trained person attending every delivery ( 27 millions deliveries /year in India ) Program is named as Newborn Resuscitation Program- First Golden Minute(NRP-FGM) Program

10. Administrative Structure for NRP Program Steering Committee Core Committee Administrative Academic

11. 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

12. Manikins and Resuscitation Kits 19 Umbilical cord that can be cut multiple times Squeeze bulbs for simulation of crying, breathing and heart activity LDSC provided some kits initially Arrangement with Laerdal Co. for Manikins; field tested first in India

13. 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

14. “ First Golden Minute: Trainings in 2009” 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............................ ToT’s were carried out for IAP members at various places

15. 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.

16. Ministry of Health launched Navjaat Shishu Suraksha Karyakram (NSSK) GOI and IAP have signed a MoU for training on 09-12-2009

17. WHERE ? States in India where newborns are at high risk of dying Roll out Plan 10 States = ~ 300 Districts 4 Trainers per district 1200 Trainers planned in 4 months

18. Wash Hands Program included Basic Newborn Care and Resuscitation Wear Gloves Prevention of hypothermia Early initiation & exclusive breastfeeding Prevention of Infection Kangaroo Mother care Clean Chain Warm Chain Cord Care

19. Expert Committee developed the module Action Plan

20. 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.

21. 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.

22. 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

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

26. Persons trained till June 2010, in Govt Sector Type of CoursePersons Trained Instructors in Govt Sector1530 Providers in Govt Sector Madhya Pradesh951 Rajasthan667 Kerala167 Orissa24 Jharkhand468 Total Providers in Govt Sector1550 Overall TOTAL in Govt. Sector3080 Training target in 2010 more than 30,000

27. 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

28. We conclude……  A collaborative 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.

30. Thank you Steering Committee of IAP NRP FGM President IAP 2009 and Chairperson President IAP 2010 and Co- Chairperson President IAP 2007 and National Co- Ordinator Hon. General Secretary, IAP, 2010