Aug 2014 – Jul 2018

India Safe Care, Saving Lives

India

Country

India – South Asia

‘Safe Care, Saving Lives’ aims to improve quality of care and save lives. It will also provide guidance on how this model could be replicated in other government-sponsored health insurance schemes across India.

$3,848,732 Multi-Year Grant Value

‘Safe Care, Saving Lives’ is dedicated to saving the lives of mothers and babies. The programme is the first of its kind in India, working with the government and publicly funded insurance schemes in the southern states of Andhra Pradesh (the Aarogyasri HealthCare Trust) and Telangana (the Dr. NTR Vaidya Seva Scheme). It will set standards of care in labour wards and newborn care units, and support facilities in achieving these.   

 Newborns in these states are particularly vulnerable. In Telangana, 15,350 newborns die every year (a neonatal mortality rate of twenty five per thousand live births) and in Andhra Pradesh, 22,400 newborns die per year (a neonatal mortality rate of twenty six per thousand live births). Both states have high neonatal mortality rates in comparison to other southern states, such as Karnataka at twenty per thousand live births and Kerala at six per thousand live births.

'Safe Care, Saving Lives’ supports health workers to identify the major causes of perinatal death in their health facility, and to develop and implement their own solutions to close the gaps in quality of care that contribute to these preventable deaths.  

Impact

In some cases, a small change can make the difference between life and death. The two case studies below highlight some simple shifts in behaviour with potentially powerful results. 

Sixty Seconds to Survival at Nalgonda District Hospital, Telangana

About 760,000 newborns die every year in India, the highest number of newborn deaths in the world.  Birth asphyxia – the failure to initiate and sustain breathing at birth - is one of the three most common causes of neonatal deaths in India.

Straightforward measures like clearing the airways, tactile stimulation to the baby, and, if required, resuscitation using a bag and mask can help save a newborn’s life and prevent long term disability. This must happen within the first minute of birth or ‘golden minute’. Otherwise, the baby is at risk of seizures, long term disabilities such as cerebral palsy, neuro-developmental delays, and even death.

Nalgonda District Hospital is a public sector hospital in Telangana, serving a population of 3.4 million. At the start of the Safe Care, Saving Lives project, hospital staff found that 31% of newborns were admitted to Special Newborn Care Units (SNCUs) due to perinatal asphyxia.

To understand why this figure was so high Dr Yadaia, Dr Shobha and their team analysed cases of newborn asphyxia coming from the labour room to the SNCU. They identified a number of issues. Despite having hospital staff trained in neonatal resuscitation, very few high risk deliveries were being identified and attended by the appropriate staff. Since the delivery room and SNCU were at opposite ends of the 250-bed hospital, rapid response was difficult. Furthermore, if a high risk birth was identified in time, and labour room staff wanted to call the team trained in neonatal resuscitation, they had to contend with poor network connectivity.

To overcome these barriers, staff devised a number of solutions. One low-tech innovation was to fix a bell between the SNCU and the labour room, allowing the message to go out regardless of phone signal. Staff cut down their data entry workload and increased quality of care by establishing a system of quickly stamping the record to indicate a high-risk delivery.

After just nine months, the hospital’s compliance levels – in identifying high risk deliveries and ensuring that trained resuscitation staff attended births – rose to an impressive 100%. Staff also managed to reduce cases of birth asphyxia. Between January 2014 to December 2015, the number of SNCU admissions due to birth asphyxia dropped by twenty five percent, down from one hundred and ninety-five to just one hundred and forty-six admissions in 2015. 

As Dr Sujata Rao puts it, ‘the hospitals working under the Safe Care Saving Lives program are showing how empowered facilities can devise novel yet simple ways of addressing this “know - do” gap [the gap between knowing what to do, and actually doing it] in their facilities’.

Breastfeeding success at Niloufer Hospital, Hyderabad

Niloufer hospital in Hyderabad is a large and busy referral hospital. During early implementation of ‘Safe Care, Saving Lives’, 100% of staff knew that breastfeeding during the first hour of life improves a baby’s chance of survival. Yet there were no programmes in place to ensure that it happened, and a tiny 10% of babies breastfed within that window.

Kangaroo Care UnitStaff at the hospital tested out a range of solutions. They trialled having birth companions to support the baby on their mother’s chest, adding a stamp to the patient record stating when breastfeeding began, and implementing regular monitoring and feedback.

Five months later, over 80% of mothers were breastfeeding within the first hour of birth. Hospital staff created a video so that other hospitals could replicate their practices. The chart below illustrates the percentage of mothers breastfeeding within the first hour, during different phases of the project. In May, staff recorded an increase in the numbers of mothers breastfeeding from 26% to 64% of mothers breastfeeding, a rise likely attributable to interventions such as staff being sensitised to the benefits of breastfeeding.