Success-Stories-on-Health-Sector

maDHYa PraDEsH
sCaling uP snCus
ProblEm statEmEnt
The State of Madhya Pradesh (MP) with a population
of 73 million and an annual birth cohort of 1.9
million has the highest infant mortality rate (iMR) in
the country. To address the issue of high and stagnant
neonatal mortality and use the opportunity of increasing
institutional delivery for improving new born survival
rate, the government of MP with technical support of
UNICEF has put a strong focus on strengthening facilitybased
new born care by establishing special newborn
care units (SNCUs) to complement ongoing communitybased
strategies.
ProgrammE DEsCriPtion
SNCUs are primarily meant to provide specialised care
to small and sick new borns who account for 80% of
newborn deaths. The State initiated simultaneous steps to
develop infrastructure, ensure availability of equipment
and attract adequate human resources to facilitate rapid
scale- up of SNCUs from the initial two units in Guna
and Shivpuri in 2007-08 to achieving State-wide scaleup
across all 50 districts by 2013. This made MP the first
State in the country to achieve universal coverage of
SNCUs at district level as per the norms recommended
by government of india (goi), with 270,000 newborns
treated in last six years.
The need of a robust real-time data management system
to monitor the performance and long term outcomes of
newborns discharged from SNCUs was addressed in
2012 by piloting an online data monitoring system which
was developed by UNICEF, and realising the relevance
it was subsequently taken up by goi for national level
scale-up. all these initiatives coupled with increase in
institutional deliveries have contributed to the State
showing 20% decline in the neonatal mortality rate in
the last five years (2007-2012). SRS 2013 revealed the
highest drop of 3 points in neonatal Mortality in Madhya
Pradesh, the national decline in neonatal Mortality
being 1 point.
ProgrammE outComEs
1. MP registered the highest decline in neonatal
mortality rate in the country (SRS 2013). The
achievement is largely due to improved survival
of neonates because of successful treatment of sick
newborn through SNCUs.
2. State-wide scale-up in five years with 53 SNCUs
and 270,000 newborns treated MP has become the
first State in the country to achieve universal scaleup
of SNCUs covering all 50 districts in the State.
The scale-up has been fast and methodical without
compromising on the quality and has benefitted more
than 270,000 newborns in the last six years with an
overall mortality rate of 12.4 % during treatment.
Average Bed Occupancy in the year 2013 for SNCUs
in Madhya Pradesh was 106.4 %.
3. Utilisation of services across all caste categories
including the most vulnerable: The services in the
SNCUs have been kept free for beneficiaries across all
castes, to reduce out-of-pocket expenses and remove
cost barriers in access to care.
4. Standardiation of quality of care and accreditation of
SNCUs: In order to have standardised certification of
quality of care, national neonatology Forum which is
the apex professional body of neonatologists of india
has been assigned the task of accreditation of SNCUs
in india.
5. Ripple effect on care in labour room and at birth:
Analysis of SNCU data showed prematurity, birth
asphyxia and neonatal sepsis as the three major causes
for admission and deaths in SNCUs. MNH wings
have been sanctioned for all 50 districts of the State
and several of them have been made functional.
6. Special care for low birth weight and pre-term
Baby–Kangaroo Mother Care Ward 48 districts
have sanction for Kangaroo Mother Care Wards to
provide special care to Low Birth Weight babies. Till
date, 22 kangaroo Mother Care Wards have been
made functional.
ConClusions/lEssons lEarnt
The strong collaboration between State government
and UNICEF, working closely from pilot to scale-up on
different components like civil work, procurement, HR
recruitment, capacity-building and putting up a robust
monitoring system was critical. The experience also
highlighted the importance of district-level leadership,
secured funding under flagship, sound planning, strong
bureaucratic commitment and high political buy-in
for an intervention addressing the need at the ground
level. it also showed that by removing administrative
bottlenecks in recruitment, improving remuneration
and pay packages and providing suitable working
conditions, it is possible to attract and retain specialised
human resources in SNCUs. Thus, the combination of all
these factors helped in turning the dream of scaling-up
of SNCUs into reality. Future challenges will now focus
around quality of care, improving outcomes, using data
for decision-making and ensuring long-term survival,
growth and development of babies after discharge from
SNCUs by effectively linking facility-based care with
community-based care.
130 | Making a Difference : good, Replicable and innovative Practices