9th September, 2013 to 19th
September, 2013
Rapid
Assessment District Hisar
Facility Readiness Assessment for Essential
Newborn Care and Resuscitation
Child Health Division, NRHM, Haryana
in technical collaboration with
Table of Contents
Sr. No.
1.
2.
3.
4.
5.
6.
6 a.
6 b.
6 c.
6 d.
6 e.
6 f.
6 g.
6 h.
6 i.
6 j.
6 k.
6 l.
6 m.
6 n.
6 o.
6 p.
6 q.
6 r.
6 s.
6 t.
6 u.
6 v.
6 w.
6 x.
6 y.
6 z.
6 aa.
6 ab.
6 ac.
6 ad.
6 ae.
6 af.
6 ag.
6 ah.
6 ai.
6 aj.
6 ak.
6 al.
6 am.
Content
Objectives
Materials and Methods
List of facilities visited
General findings of District
4a. Overall Training Status
4b. Status of Newborn Corners
4c. Availability of equipment and instruments in NBCC
4d. Status of NBSUs
Quantitative findings of facilities
Qualitative findings of facilities
General Hospital, Hisar
General Hospital, Hansi
General Hospital, Adampur
CHC Aryanagar
PHC Balsmand
PHC Chaudhriwas
PHC Gawar
PHC Satrod Kalan
CHC Barwala
PHC Agroha
PHC Dhansu
PHC Landri
CHC Mangali
PHC Kaimri
PHC Ladwa
PHC Nalwa
PHC Talwandi Rukka
CHC Narnaund
PHC Khanda kheri
PHC Mirchpur
PHC Thurana
CHC Siswal
PHC Chuli Bagarian
PHC Dobhi
PHC Kajlan
PHC Neoli Kalan
CHC Sisai
PHC Data
PHC Gurana
PHC Umra
CHC Sorkhi
PHC Baas
PHC Puthi Saimain
PHC Puthi Mangal Khan
CHC Uklana
PHC Daulatpur
PHC Hasangarh
PHC Pabra
URCH Azadnagar
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12-13
13
13-14
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15
15-16
16
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16-17
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17-18
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19-20
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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 39 facilities in the district, from 9th September, 2013 to 19th September,
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.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Name of Facility
General Hospital, Hisar
General Hospital, Hansi
General Hospital, Adampur
CHC Aryanagar
PHC Balsmand
PHC Chaudhriwas
PHC Gawar
PHC Satrod Kalan
CHC Barwala
PHC Agroha
PHC Dhansu
PHC Landhri
CHC Mangali
PHC Kaimri
PHC Ladwa
PHC Nalwa
PHC Talwandi Rukka
CHC Narnaund
PHC Khanda kheri
PHC Mirchpur
PHC Thurana
CHC Siswal
2|Page
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
PHC Neoli Kalan
PHC Kajlan
PHC Dobhi
PHC Chuli Bagarian
CHC Sisai
PHC Data
PHC Gurana
PHC Umra
CHC Sorkhi
PHC Puthi Saimain
PHC Puthi Mangal Khan
PHC Baas
CHC Uklana
PHC Daulatpur
PHC Hasangarh
PHC Pabra
URCH Azadnagar
3. The findings of district Hisar in general are as follows:
• Well established referral linkages at the time of delivery (Higher centers are
catering mainly high risk deliveries).
• Availability of staff (including medical officers) and attendants (Nursing staff) in
most of the facilities.
• New born care corners (NBCC) established in almost all the labour rooms.
• Availability of reasonable number of trained staff in NSSK and IMNCI.
• At birth immunization in many facilities.
• Availability of resuscitation equipment in many facilities.
• PHCs with availability of generators and 24*7 backup supply.
• Availability of running water and toilets in the facilities.
• Registers and records maintained in most of the facilities (Case sheets with
uniformly printed formats).
• Availability of Gynecologists in SDHs and CHCs.
• Many birth attendants not trained in SBA.
• Hand washing stations not appropriate for effective hand washing. Effective hand
washing before delivery not followed.
• Simplified Partographs not available in many facilities.
• Partographs maintained in many facilities but method is not correct and in most
cases these are filled after delivery for record completion.
• Autoclave available but not used in some facilities.
• Home deliveries in some areas of the district due to unavailability of 24*7
services in some PHCs.
• Birth preparedness before delivery not done in some facilities.
• Labour room protocols for infection prevention not followed in routine.
3|Page
•
•
•
•
•
•
•
•
•
•
•
•
•
Case sheets do not have records of essential newborn care.
Suction of every new born in practice despite good cry.
Immediate cord cutting in practice.
Infection prevention and hygiene protocols for labour room and NBCC are not
followed in majority of the facilities.
Bag and Mask used for resuscitation. Chronology of resuscitation is not clear
(PSSR not followed). Steps are not in chronological order (Resuscitation
equipment are not available)
Use of Bag and Mask not appropriate.
Regular refresher trainings needed for resuscitation.
AMTSL practices are not followed in some facilities.
Skin to skin contact not in practice.
Use of Radiant Warmer and separation of every newborn from mother is in
practice.
Skills of essential newborn care lacking.
Immediate drying not followed in many facilities
Management of low birth weight babies not done as per protocols
4 a. Overall Training Status
Sr. No.
No. of Birth attendants
1.
204
SBA
NSSK
113
167
IMNCI
135
4 b. Status of Newborn Corners
Newborn Corners
with Radiant
Warmer
Newborn
Corners with
200 W bulb
Total NBCCs
Established
NBCCs still not
established
36 (39) (No labour
room in Mirchpur)
19
37 (18 with both
Bulb and warmer)
One (Recently shifted to
new building URCH
Azadnagar)
4 c. Availability of equipment and instruments in NBCCs (n=39)
Sr. No.
1.
2.
Equipment/Instrument
Self-Inflating Bag
Mask Size ‘1’
Available (No. of
Facilities)
39
38
Not available (No.
of Facilities)
0
1(Gawar)
4|Page
3.
Mask Size ‘0’
35
(4) Choudhriwas
GH Hisar (LR)
Talwandi rukka
Daulatpur
4.
5.
6.
Shoulder Roll
Suction Catheter
Disposable Mucus Extractors
38
37
37
1
2 (Pabra and Sisai)
2 (Puthi Samain,
Suryanagar)
7.
8.
Suction Machine
Oxygen Cyinder
39
37
0
2 (URCH Azadnagar
and Suryanagar)
9.
10.
Baby Sheets
NBCC at appropriate place
38
33
1 (Balsamand)
6 (changes suggested
on site)
4 d. Status of Designated Newborn Stabilization Units (NBSUs)
Sr. No.
Name of
Institution
Status
Functionality
No. of Radiant
Warmers
1.
SDH Hansi
Established
Not Functional
1
No. of
Phototherapy
Units
1
2.
CHC Barwala
NA
Only in NBCC
0
3.
CHC Mangali
Not
Established
Not
Established
NA
Only in NBCC
1
4.
CHC Uklana
Not
Established
NA
Only in NBCC
1
5.
CHC Aryanagar
Not
Established
NA
Only in NBCC
1
5|Page
4. Quantitative Analysis of various facilities (n= 37)
Score 75% and Above
Name Of
Facility
Infrastructure
Score 50% and less
Score 51% to 74%
Registers
Knowledge
Delivery And Essential Drugs,
Provider
And
Facility’s
Protocols And About
Newborn Care Equipment And
Knowledge Client
Overall
Guidelines
Infection
Services
Supplies
And Skills Case
Average
Prevention
Records
CHC Barwala
85
78
87
80
57
66
75
75
PHC Chuli
Bagrian
69
89
79
70
57
70
75
73
PHC Landri
79
83
72
70
71
72
61
73
PHC Nalwa
98
89
77
50
71
46
69
71
PHC Putty
Mangal Khan
75
89
82
70
71
39
67
71
CHC Mangali
67
72
72
70
57
65
73
68
PHC Khanda
Kheri
88
78
80
60
57
54
58
68
GH Hisar
63
89
84
70
57
59
50
67
GH Hansi
67
89
80
70
57
52
56
67
CHC
Narnaud
71
72
74
60
57
66
66
67
SDH
Adampur
87
83
74
80
29
61
50
66
PHC Ladwa
75
83
79
80
29
55
59
66
CHC Sorkhi
79
89
71
70
43
49
56
65
PHC
Neolikalan
81
83
74
60
43
46
62
64
PHC Sisai
81
89
60
60
43
61
49
63
PHC Agroha
65
78
76
80
29
57
55
63
PHC Gurana
77
83
72
90
14
53
47
62
PHC Kaimri
81
78
66
70
43
46
52
62
6|Page
CHC Arya
Nagar
81
89
79
60
14
48
61
62
PHC Bass
63
89
81
60
29
39
66
61
PHC Dobi
42
83
74
80
43
45
57
61
DISTRICT
AVERAGE
72
82
73
64
36
51
49
61
PHC Datta
65
83
70
90
14
50
47
60
PHC Satrod
Kalan
52
78
79
60
43
55
50
60
PHC Dhansu
69
83
68
60
29
48
56
59
PHC Kajlan
48
83
80
50
29
57
57
58
PHC Pabra
73
83
60
40
43
50
52
57
PHC
Hassangarh
88
78
64
50
29
37
41
55
PHC
Puthisamain
75
83
73
60
29
31
36
55
PHC Umra
67
72
73
60
29
46
28
54
CHC Uklana
71
94
70
50
0
44
46
54
PHC
Daulatpur
69
83
60
50
14
46
48
53
PHC
Talwandi
77
83
60
40
14
43
51
53
PHC
Balsamand
62
72
61
60
29
45
36
52
PHC Gawar
75
72
65
60
14
50
6
49
PHC
Chaudhariwas
71
67
66
60
29
50
0
49
PHC Thurana
79
78
72
60
0
33
7
47
URCH Azad
Nagar
58
78
73
60
0
40
0
44
7|Page
Graph 1. Status of Infrastructure (n=37)
100
98
88 88 87
80
85
81 81 81 81 79 79 79
77 77 75 75 75 75
73 72 71 71 71
69 69 69 67 67 67
65 65 63 63
62
60
58
52
48
42
40
20
0
Graph 2. Scores of infection prevention knowledge in providers (n=37)
Knowledge of Infection Prevention
100
80 71 71 71
60
57 57 57 57 57 57 57
43 43 43 43 43 43 43
40
20
36
29 29 29 29 29 29 29 29 29 29 29
14 14 14 14 14 14
0 0 0
0
8|Page
Graph 3. Status of Registers and Client Case record maintenance (n=37)
Registers and Client Case records
100
80 75 75 73
60
69 67
66 66
62 61 61
59 58
57 57 56 56 56 55
52 52 51 50 50 50 49 49
48 47 47
40
46
41
36 36
28
20
7 6
0 0
0
Graph 4. Availability of Essential Drugs, Equipment and Supplies (n=37)
Essential Drugs, Equipment And Supplies
100
87
80
60
84 82
81 80 80 80 79 79 79 79
77 76
74 74 74 74 73 73 73 73 72 72 72 72
71 70 70
68 66 66
65 64
61 60 60 60 60
40
20
0
9|Page
Graph 5. Status of skills in essential newborn care and resuscitation (n=37)
100
80
72
70
66 66 65
61 61
60
59 57 57
55 55 54
53 52
51 50 50 50 50 49
48 48
40
46 46 46 46 46 45 45
44 43
40 39 39
37
33
20
0
5. Facility wise Qualitative Findings
a. GH Hisar









All staff nurses not trained in SBA, IMNCI and F-IMNCI.
Injection Dexamethasone not available
Glucose 5% and Ringer’s lactate not available
Injection Vitamin K not available and not administered.
Toilet not available in the labour room.
Partograph not filled regularly.
Baby weight not mentioned on new born case sheets.
Record of birth asphyxia and essential new born care not available
All new born having signs of birth asphyxia are directly referred to SNCU for further
management, So no further record of such new born is not available in the labour
room.
Recommendations




Arrange for trainings of staff nurses.
Make all the essential and life-saving drugs available.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
10 | P a g e
31
b. GH Hansi
 Very well maintained labour room with established newborn corner.
 NBCC is also established in OT with 200 W bulb.
 Infection prevention protocols are not followed as per guidelines.
 All the oxygen cylinders are without humidifiers and flow-meters.
 Newborn Stabilization Unit (NBSU) is not established.
 Knowledge of staff nurses about essential newborn care and resuscitation is average.
 Skills of all the staff nurses about essential newborn care and resuscitation are below
average and needs great improvement.
Recommendations



Follow infection prevention protocols as per guidelines.
Get humidifiers and flow-meters attached to oxygen cylinders in labour room and OT.
Establish and functionalize NBSU in the hospital. Train at least two nurses for
Facility Based Newborn Care (FBNC) for smooth functioning of NBSU.
c. SDH Adampur
 Separate septic and aseptic labour room available.
 1 phototherapy machine available but not in use.
 2 radiant warmers available.
 Infrastructure is underutilized
 11 staff nurses available, only 4 of which are SBA trained
 Rusted delivery instruments in labour room
 Shoulder roll not available
 Practice of immediate cord cutting
 Resuscitation skills lacks chronology
 Vitamin K not in practice
 Documentation of essential newborn care is not being done
 Partographs are not being filled
 Infection prevention protocols not being followed.
Recommendations





Arrange for trainings of staff nurses.
Establish and functionalize NBSU.
Train at least two nurses for Facility Based Newborn Care (FBNC) for smooth
functioning of NBSU.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
11 | P a g e
d. CHC Arya Nagar
 Hand washing station is not appropriate.
 Infection prevention in labour room needs improvement.
 Notes regarding baby need to be mentioned in case sheets.
 Skin to skin contact should be made during delivery for temperature maintenance
naturally.
 Cord should be cut with new blade every time.
 Immediate Breast feeding should be done.
 Vitamin K should be administered at birth.
Recommendations



Make hand washing station appropriate as suggested during visit.
Follow infection prevention protocols as per guidelines.
Maintain record of essential newborn care and birth asphyxia in the case sheets.
e. PHC Balsamand



















Home deliveries are prevalent in the area. Most of the deliveries are being conducted
at home by a trained birth attendant (Dai). There are many reported cases of still birth.
Private RMP Doctors are also prevalent in the area
No separate PNC ward is available.
Out of three staff nurses posted none is trained in SBA. All staff nurses not trained in
F-IMNCI.
Vitamin K not administered to the new born before discharge
At birth immunization not done before discharge (Only zero polio is given).
Baby cloth not available
Inj Vitamin K not administered to the new born
Normal saline inj. Epinephrine not available
Tab Folic acid not available.
Baby botes not available in records.
GPLAD not mentioned in case sheets.
Injection oxytocin is given to every new born after delivery.
Low birth weight new born (<1800gm) are not referred to GH/SNCU.
Infection prevention protocols not followed.
Autoclave not available and not used
Knowledge regarding immediate care to new born within one hour after delivery need
improvement.
Partographs are filled but just for record completion and most of them are filled after
delivery.
Sign and symptoms of infections in newborn, low birth weight baby’s management
knowledge need up-gradation.
Knowledge regarding the signs of birth asphyxia and management thereafter need
hand holding support from the Medical officer in-charge.
12 | P a g e
Recommendations

Improve institutional facilities and services to curtail home deliveries. Motivate
people for institutional deliveries and benefits associated.
 Arrange for trainings of staff nurses.
 Start administering BCG-birth dose, Hepatitis B birth dose and OPV-0 and injection
vitamin k to every newborn.
 Make all the essential and life-saving drugs available.
 Follow infection prevention protocols as per guidelines.
 Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
f. PHC Chaudhariwas
 Very well equipped labour room but only one delivery in past six months.
 Newborn corner not established in labour room. Radiant warmer or 200 W bulb as a
source of heat, baby face mask of size ‘0’ and shoulder roll not available.
 Hand washing area is not appropriate. Though there are elbow taps but are placed
very low which hinders effective hand washing.
 Knowledge of staff nurse about essential newborn care and resuscitation is below
average and holds scope for improvement.
 Skills of staff staff nurse about essential newborn care and resuscitation are below
average.
Recommendations




Increase delivery load to justify infrastructure and equipment.
Establish NBCC as discussed during the visit.
Improve hand washing stations as discussed during visit to ensure effective hand
washing.
Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
g. PHC Gawar
 Equipped labour room but only 5 deliveries in past 6 months.
 Newborn corner established with all necessary equipment.
 Baby face mask of size ‘1’ is not available.
 Knowledge of staff nurse about essential newborn care and resuscitation is below
average and holds scope for improvement.
 Skills of staff staff nurse about essential newborn care and resuscitation are below
average.
Recommendations



Increase delivery load to justify infrastructure and equipment.
Improve hand washing stations as discussed during visit to ensure effective hand
washing.
Provide baby face mask of size ‘1’ in NBCC.
13 | P a g e

Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
h. PHC Satrod Kalan:
 All newborns were being shifted to NBCC.
 Milking of cord was in practice.
 Cord cutting was being done just after delivery of newborn.
 Bed head tickets were partially filled.
 AMBU bag Autoclave is not in practice.
Recommendations:

There is no need to shift all newborns to NBCC. Only those who require special care
i.e. basic resuscitation or resuscitation with AMBU bag are required to be shifted.
 Cord should be cut with sterile blade, milking of cord is not recommended and cord
cutting should be done with a gap of 1 to 3 minutes after birth.
i. CHC Barwala
 Facility designated for NBSU during visit space identified and communicated to SMO
need to establish NBSU as soon as possible
 NBCC established at labour room need to keep a shoulder roll (0.5 to 1 inch
diameter), baby sheets are to be arranged as per delivery load (for 30 delivery per
month 6 to 10 sheets required )
 Essential Newborn Care and Resuscitation knowledge inadequate at facility during
visit we took session on this SMO should ensure same knowledge should be in
practice.
 Hygiene should be maintain in labour room area during visit we took session about
infection prevention and hygiene facility in charge should ensure
implementation/practice
 Delivery and Newborn registers provided to facility should fill all delivery and its
events in it.
 Every newborn should room in with mother.
j. PHC Agroha:
 Unclean machintosh available on delivery table.
 Inappropriate size of shoulder roll was available at radiant warmer.
 PNC ward was not clean which provides uncongenial environment for mother and
newborn.
 Autoclaving of AMBU Bag and masks is not in practice.
 Delivery table cushion (bed) plastic cover is torn. Provide new cushion for delivery
table.
Recommendations:




The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
AMBU bag should be autoclaved on regular basis.
Elbow tap should be made available for labor room so that proper hand washing
techniques should be followed.
Machintosh once used should be cleaned after every delivery and if torn or cut, should
be discarded off.
14 | P a g e
k. PHC Dhansu
 Congested labour room and NBCC.
 All essential equipment available and functional at NBCC.
 Good record keeping. Case files complete in most senses except notes of immediate
newborn care.
 Infection prevention seems highly compromised and not practiced as per guidelines.
 Knowledge of staff nurses about essential newborn care and resuscitation is average.
 Skills of all the staff nurses about essential newborn care and resuscitation are below
average and needs great improvement.
Recommendations



Start writing notes on essential newborn care as discussed during the visit.
Improve infection prevention by following guidelines.
Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
l. PHC Landri
 Well maintained delivery room with appropriately placed NBCC.
 Skills of staff nurses are good about –
o Essential new born care.
o Identification of Birth Asphyxia.
o Process of Resuscitation.
 Well maintained case sheets available with appropriate case notes.
 Infection prevention and hygiene protocols are not followed for NBCC.
Recommendations
 Maintain sterile environment at NBCC.
 Sterilize Bag and Mask regularly.
 Suction machine bottles should contain 3% phenol or 5% Lysol.
m. CHC Mangali
 CHC having space constraint so no properly designated PNC and ANC room.

No designated area for boiling and autoclaving, duty room for nurses and utility
rooms for linen.

Injection Adrenaline not available.

Infection prevention protocols not followed regularly.

One staff nurse not trained in SBA, NSSK and two are not trained in IMNCI.

Skills for resuscitation need improvement.
Recommendations

Follow infection prevention protocols as per guidelines.
15 | P a g e

Arrange for trainings of staff nurses for SBA, NSSK and F-MNCI.
n. PHC Kaimri
 Well maintained labour room with appropriate NBCC with all necessary equipment.
 Apparently there is no birth preparedness before delivery.
 Knowledge of staff nurses about essential newborn care and resuscitation is average.
 Skills of staff nurses about essential newborn care and resuscitation are below
average.
 Record keeping in registers and case sheets is good but baby notes need improvement
and notes on essential newborn care are to be incorporated in the registers.
Recommendations



Birth preparedness is integrated part of delivery process. Improve birth preparedness
to avoid eleventh hour hassles.
Start writing notes of essential newborn care on case sheets as discussed during the
visit.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
o. PHC Ladwa
 NBCC established but not on proper place during visit we identified place need to
install NBCC on identified place
 Suction of every newborn in spite of well cry and breath need to discourage
 Every newborn kept at NBCC need to discourage for normal newborn and mother
 Shoulder role need to replace / prepare as directed during visit
 Unhygienic blood stained labour table and mechantose need to take immediate action
 Bed heads sheets records were inadequate required to capture delivery and newborn
care events in detail
p. PHC Nalwa
Report not received yet.
q. PHC Talwandi
 One staff nurse is not trained in NSSK.
 Infection prevention and hygiene protocols not followed.
 Immediate cord cutting is in practice.
 Skin to skin contact is not maintained.
 Every new born is shifted to radiant warmer.
Recommendations



Ensure cord cutting between 1-3 minutes after delivery.
Ensure skin to skin contact is maintained immediately after every normal delivery to
prevent hypothermia.
Ensure immediate breastfeeding after every normal delivery.
16 | P a g e
 Ensure infection prevention and hygiene.
r. CHC Narnaud
 Mechanical baby weighing scale not working properly.
 Flow meter and pressure valve of oxygen cylinder in labour room is not working.
 Normal saline not available
 Case records need improvement
 Partographs are not filled regularly and need improvement.
 Skills for resuscitation and essential new born care need improvement.
 Injection Vitamin K not administered.
 At birth immunization not done.
Recommendations

Start administering BCG, Hepatitis-B birth doses, OPV-0 dose and injection vitamin
K to every newborn.
 Maintain case records and patograph of each delivery properly as discussed during
visit. Also, write detailed notes on essential newborn care and resuscitation.
s. PHC Khanda Kheri
 Suction of every newborn in spite of good cry and breathing.
 Practice of keeping every newborn at NBCC.
 Shoulder roll needs replacement. Prepare as suggested during visit.
 Administration of antibiotic to mother before every delivery need to discourage for
normal mother
 Immediate cord cutting is usual practice at facility. There is need to discourage this
practice and to promote delayed cord cutting (between 1 to 3 min after birth).
Recommendations

Discourage suction of every newborn. Suction is required in cases where signs of
asphyxia are apparent.
 Only those babies are to be taken to NBCC who require resuscitation. Practice skin to
skin contact between mother and baby in all cases where vitals of both are WNL.
t. PHC Mirchpur
There is no labour room in this PHC.
u. PHC Thurana
Report not received yet.
v. CHC Siswal
Report not received yet.
w. PHC Chuli Bagrain
 NBCC well established with well displayed IEC and equipment uses guidelines
 Expired drug mechanism well followed.
17 | P a g e





Office order displayed for routine immunization in labour room
Well maintained delivery and newborn records
Well maintained referral register
Shoulder roll needs replacement. Prepare as suggested during visit.
Milking of cord is usual practice at facility. Milking of cord is not recommended these
days, so, please discourage this practice.
x. PHC Dobi:
 Vitamin K, Hep B, and BCG at birth doses were not being given.
 Shoulder roll was present, but was not of appropriate size.
 AMBU Bag autoclave was not in practice.
 Bed head tickets does not contain all vital events, at places it was partially filled.
Recommendations:



Birth doses of Vit K, Hep B, OPV, and BCG should be given to all newborns with a
mention in bed head tickets and discharge slip as well.
The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
AMBU bag should be autoclaved on regular basis.
y. PHC Kajlan
 Suction of every newborn in spite of good cry and breathing.
 Practice of keeping every newborn at NBCC.
 Shoulder roll needs replacement. Prepare as suggested during visit.
 Administration of antibiotic to mother before every delivery need to discourage for
normal mother
 Immediate cord cutting is usual practice at facility. There is need to discourage this
practice and to promote delayed cord cutting (between 1 to 3 min after birth).
Recommendations

Discourage suction of every newborn. Suction is required in cases where signs of
asphyxia are apparent.
 Only those babies are to be taken to NBCC who require resuscitation. Practice skin to
skin contact between mother and baby in all cases where vitals of both are WNL.
z. PHC Neolikalan:
 Vit K at birth dose is not given.
 Shoulder roll was not of proper size.
 All staff nurses were NSSK trained, but unable to show required skills for
resuscitation.
Recommendations:



At birth dose of Vitamin K should be given to all newborns.
The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
Regular monitoring and peer learning is recommended to improve the skills.
18 | P a g e
aa. CHC Sisai:
 Very good knowledge of staff nurses regarding ANC checkup, Detection of danger
sign in newborn, management of 3rd stage of labor, newborn routine care for normal
delivery.
 Birth preparedness for delivery and newborn care found to be adequate.
 Average hospital stay of delivery women is approximately 12 hours.
 Well maintained NBCC.
 Timely disinfection of instruments and disposal of waste as per guidelines are
followed.
Recommendations:


Housekeeping protocols are required to be followed.
Pressure of suction machine at NBCC should be maintained between 80 to 100
mmHg for neonatal suction.
ab. PHC Datta









Separate breast feeding room available with a chair and breast feeding kit. This is a
very good initiative
Record maintenance poor. Partographs are filled incompletely and inaccurately
Documentation of essential newborn care is lacking
Documentation of baby resuscitated with bag and mask not available
Disinfection of bag and mask is not in practice
Practice of immediate cord cutting
Resuscitation skills lack chronology.
Double gloving not in practice.
NBCC well established.
Recommendations



Improve record keeping. Maintain partograph properly. Start writing notes on
essential newborn care in case sheets.
Follow infection prevention protocols as per guidelines.
Practice delayed cord cutting (between 1 to 3 minutes of birth).
ac. PHC Gurana







Immunization of newborn in practice
Double gloving not in practice
Practice of separating every newborn from mother despite good cry.
Practice of milking of cord
Practice of immediate cord cutting
Resuscitation skills lacks chronology
Record keeping poor. Partographs incompletely and inaccurately filled
19 | P a g e



Documentation of essential newborn care not being done
Bag and mask not being disinfected regularly
Staff nurse does not know the dose of Vitamin K.
Recommendations




Improve record keeping. Maintain partograph properly. Start writing notes on
essential newborn care in case sheets.
Follow infection prevention protocols as per guidelines.
Practice delayed cord cutting (between 1 to 3 minutes of birth).
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
ad. PHC Umra










Tap in the hand washing area is not elbow operated.
One staff nurse not trained in SBA and IMNCI.
Injection hydrocortisone not available
Need improvement in knowledge regarding care of low birth weight and premature
baby
Knowledge regarding sign of infection prevention and management need
improvements.
Knowledge regarding sign and symptoms of birth asphyxia and management
thereafter need regular refreshers.
Newly recruited staff nurses are not trained in SBA, NSSK and IMNCI.
Partographs are not filled regularly.
Infection prevention protocols are not followed
Injection Vitamin K not administered
Recommendations





Arrange for trainings of staff nurses.
Make all the essential and life-saving drugs available.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
20 | P a g e
ae. CHC Sorkhi

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


Well established labour room. Newborn corner established with all necessary
equipment.
Hand washing station is not appropriate and taps are low in height.
As per the knowledge and skill test of the staff nurses it is apparent that there is
practically no birth preparedness before delivery.
Knowledge of two staff nurses about essential newborn care and resuscitation is
average and of one staff nurse is below average.
Skills of all the staff nurses present for essential newborn care and resuscitation are
below average.
Record keeping in registers and case sheets is generally good but case sheets lack
record of essential newborn care.
Recommendations



Birth preparedness is integrated part of delivery process. Practice meticulous birth
preparedness to avoid eleventh hour hassles.
Maintain record of essential newborn care and birth asphyxia in the case sheets.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
af. PHC Bass
Report not received yet.
ag. PHC Puthisamain:





Sufficient numbers of baby sheets were not available, and were not autoclaved.
Machintosh sheet was blood stained and with lots of cracks on it.
Disposable mucus sucker was not available.
Shoulder roll was not as per required height.
Partograph was being filled in wrong manner.
Recommendations:





Baby sheets should be available in sufficient quantity, which should be autoclaved
before use.
Machintosh sheet should be changed on regular basis as it gets any permanent stain or
any crack. It should be wiped out and washed after every use or delivery.
Disposable mucus sucker is desired for suction and should be made available.
Shoulder roll was made by team member, but should be cleaned on regular basis and
needs to be made as per direction after washing / autoclave.
Partograph should be filled in correct manner.
ah. PHC Puthi Mangal Khan
Report not received yet.
21 | P a g e
ai. CHC Uklana





Immediate cord cutting is in practice.
Skin to skin contact is not maintained.
Every new born is shifted to radiant warmer.
Staff nurses have average skills for neonatal resuscitation.
Infection prevention and hygiene protocols are not followed.
Recommendations




Ensure cord cutting between 1-3 minutes after delivery.
Ensure skin to skin contact is maintained immediately after every normal delivery to
prevent hypothermia.
Ensure immediate breastfeeding after every normal delivery.
Ensure infection prevention and hygiene.
aj. PHC Daulatpur






One staff nurse is not trained in NSSK.
Zero size mask not available.
Staff nurses have average knowledge about essential new born care.
Immediate cord cutting in practice.
Shoulder roll not available.
Staff nurses have poor skills for neonatal resuscitation.
Recommendations


Ensure availability of all equipment for NBCC. Unavailability of the same may cause
neonatal death.
Skills of staff nurses need to be improved through regular monitoring and
handholding.
ak. PHC Hassangarh

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




Hand washing station not available.
Oxytocin being used for augmentation of labour.
Rusted delivery instruments.
Staff nurse given additional charges of Death/birth, cold chain. Only 2 staff nurses
available.
Staff nurse available at night is not SBA, NSSK trained.
Double gloving not in practice.
Practice of separating every newborn from mother despite good cry.
Practice of milking of cord.
Practice of immediate cord cutting.
Resuscitation skills lack chronology.
22 | P a g e



Record keeping poor. Partographs are not being filled.
Documentation of essential newborn care not being done.
Infection prevention practices are not being followed.
Recommendations





Make appropriate hand washing station.
Arrange for trainings of staff nurses.
Discourage milking and immediate cutting of cord. Cut cord between 1 to 3 minutes
of birth.
Follow infection prevention protocols as per guidelines.
Keep appropriate record of essential newborn care as discussed during the visit.
al. PHC Pabra
Report not received yet.
am. URCH 14 Azadnagar







Suction of every newborn in spite of good cry and breathing. There is need to
discourage this practice.
After delivery every newborn is taken to NBCC. There is need to discourage this
practice. Practice skin to skin contact between mother and baby if vitals of both are
WNL.
Shoulder roll needs replacement. Prepare shoulder roll as suggested during the visit.
Milking of cord is usual practice at facility. Discourage milking of cord.
Immediate cord cutting is usual practice for every newborn need to cut cord within 1
to 3 minute in case of good cry and breathing in newborn.
Augmentation of labour by oxytocin is usual practice at facility. Discourage this
practice.
Need to promote Skin to skin contact for normal newborn and stable mother.
23 | P a g e