How Uttar Pradesh Saved Thousands Of Its Ailing Newborn Babies Through Simple Fixes  

If one looks beyond the shrill rhetoric of the Gorakhpur medical hospital case, it seems the last one year has been good for newborn babies in Uttar Pradesh. Data available with the health department show remarkable improvement in the performance of neonatal units in 2017-18 compared to the previous years.

The special care newborn units (SCNUs) usually operate as part of a district level hospital. They are meant to save sick babies upto 28 days, either born within the hospital, nursing homes or at homes. They are crucial because studies have found that the daily risk of mortality in the first month of life is 30 times higher than the second month. In fact, two-thirds of all baby deaths happen during the first four weeks.

Here's what the numbers look like: In 2015-16, a total of 42,474 newborns were admitted to SCNUs, while 31,390 were successfully discharged. In 2016-17, the number of admissions rose to 55,288 but the percentage of babies discharged came down, with the figure closing at 37,832.

In 2017-18, however, the rise in the number of newborns admitted to SCNUs was steep at 85,259 while the percentage of them discharged was stable at about 65 per cent (a total of 55,759 were discharged).

From 2016-17 to 2017-18, deaths came down from 11.4 per cent to 10.6 per cent, referral cases increased from 5,024 to 10,429 (9.44 percent to 12.6 percent), cases of left-against-medical-advice went up from 8.16 percent to 9.2 percent. Commonly called LAMA, these are cases when a patient leaves a hospital against the advice of their doctor, and thus are not counted in the discharged list.

Overall, close to 25,000 more babies with medical complications went home healthy last year than two years ago.

Dr Anil Verma, who is posted in Lucknow as general manager, child health, for Central government's National Health Mission (NHM), looked satisfied as he shared the figures. "A significant improvement," he said.

This is certainly encouraging for a state where the burden of neonatal deaths is notoriously high.

India contributes a quarter of an estimated 3.1 million neonatal deaths globally, that is, babies dying within four weeks of birth. Uttar Pradesh, along with Madhya Pradesh, Rajasthan and Bihar, contributes to more than half of these 0.75 million newborn deaths in India.

The abysmal situation can be gauged from the fact that while the best-performing state in this area, Kerala, reported a neonatal mortality rate (NMR) of 6 per 1000 live births, UP reported it as high as 35 (figures are from 2013). Similarly, UP also fares badly in infant mortality rate (children up to 1 year of age dying per 1000 live births) at about 43.

Loosely speaking, more than 750 newborns die in UP daily. About 45 per cent of them don’t survive more than two days. About 70 per cent of these daily deaths are preventable.

As the numbers reveal, a major gain last year can be seen in a surge of parents seeking professional care for their sick babies. Verma says this has been made possible by filling vacant posts and hiring necessary staff.

“We were struggling with manpower. This year, we filled some 300 vacant posts, mostly nurses, that turned the SCNUs around.”

The state currently has 78 such units, out of which 10 are located in tertiary medical institutes - like Gorakhpur’s BRD medical hospital - while the rest are spread across 63 districts. UP has 75 districts; experts say that two-three functional units in a district is a good number.

Six more units are coming up while as many are currently being upgraded, said Verma.

The biggest challenge, he says, was the availability of specialists. “But we didn’t wait for them, and instead appointed regular pediatricians.” The department also advertised actively in medical colleges.

Taking cue from other states, the department went for the bidding model to fill up posts in remote areas. Under this model, the doctors are free to quote a pay package, often higher than the salaries their counterparts get in more urban, comfortable locations.

“We have paid as high as Rs 2.5 lakh a month for remote locations. But this had to be done.”

Dr Verma informed that about 60 per cent of the financial burden for the neonatal programme is borne by the centre while the rest by the state government. The execution, however, is almost entirely the state’s efforts.

The history of neonatal units in India goes back to 2003 when United Nations Children’s Fund (Unicef) helped set up one in West Bengal’s Purulia district. The unit brought down the NMR by 14 per cent in the first year and by 21 per cent in the second year. The success prompted the central government to make neonatal clinics central to its child health strategy when it launched National Rural Health Mission (NRHM) in 2005.

At that time, the Purulia SNCU unit cost around Rs 3 lakh to set up. Today, such a unit needs an investment of Rs 10-12 lakh, said Dr Verma.

In UP, most efforts to save babies have been marred by poor-functioning of ill-equipped units and lack of awareness among new parents.

Dr Neelamber Srivastava, senior consultant at Lucknow’s Veerangana Jhalkari Bai Women and Child Hospital, said there has been a marked improvement in “institutional deliveries” in a year. He is referring to deliveries assisted by child attendants or in hospitals. “Child complications come down when institutional deliveries go up,” he stated.

At his hospital, which houses one of Lucknow’s oldest SCNUs, the number of newborn admissions rose from 744 in 2016-17 to 914 in 2017-18. The number includes deliveries in the hospital as well as done outside.

“The increase has come about thanks to grassroots ASHA workers. More than a lakh-and-a-half of them received training last year so they bring patients to medical centres,” said Srivastava.

The most common reasons why babies die is because they are severely underweight (at times less than a kilogramme), asphyxiated or suffering from life-threatening infections, he said.

For a unit to operate efficiently, it needs to be equipped with sophisticated machines and life-saving instruments. These include incubators, oxygenators, multi-parameter monitoring systems, electronic weighing scales, intravenous drip systems and body warmers that play a crucial role in the baby’s battle for survival.

“I have got whatever I asked for. I can say I have all the equipment I needed,” he said.

A senior doctor in Rampur district, on the condition of anonymity, told Swarajya that the government’s move to directly send equipment to the SCNUs rather than cash has helped things.

Data for the entire state also shows that the rate of death on the first day has come down from 37 per cent in 2015-16 to 24.5 per cent in 2017-18.

The numbers look heartening. A senior official with state’s health ministry, who did not wish to be named, said that if the trend continues, Uttar Pradesh can hope to drop the dubious tag of being one of the poorest performers in this area in the coming years.