Neonatal units in teaching and non-teaching hospitals both in public and private hospitals have been increasing in number in the country since the sixties. In 1994, a District Newborn Care Programme was introduced as a part of the Child Survival and Safe Motherhood Programme (CSSM) in 26 districts. Inpatient care of small and sick newborns in the public health system got a boost under National Rural Health Mission with the launch of the national programme on facility-based newborn care (FBNC). This has led to a nationwide creation of Newborn Care Corners (NBCC) at every point of child birth, newborn stabilization units (NBSUs) at First Referral Units (FRUs) and special newborn care units (SNCUs) at district hospitals. Guidelines and toolkits for standardized infrastructure, human resources and services at each level have been developed and a system of reporting data on FBNC created. Till March 2015, there were 565 SNCUs, 1904 NBSUs and 14 163 NBCCs operating in the country. There has been considerable progress in operationalizing SNCUs at the district hospitals; however establishing a network of SNCUs, NBSUs and NBCCs as a composite functional unit of newborn care continuum at the district level has lagged behind. NBSUs, the first point of referral for the sick newborn, have not received the desired attention and have remained a weak link in most districts. Other challenges include shortage of physicians, and hospital beds and absence of mechanisms for timely repair of equipment. With admission protocols not being adequately followed and a weak NBSU system, SNCUs are faced with the problem of admission overload and poor quality of care. Applying best practices of care at SNCUs, creating more NBSU linkages and strengthening NBCCs are important steps toward improving quality of FBNC. This can be further improved with regular monitoring and mentoring from experienced pediatricians, and nurses drawn from medical colleges and the private sector. In addition there is a need to further increase such units to address the unmet need of facility-based care.

Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan.   Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices.

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Objective To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India. Design Facility-based assessment of district hospitals. Settings 13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Participants Staff nurses and doctors. Intervention None. Methods An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed. Results Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8–10%. There was a 65 percent shortfall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities. Conclusion The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.