India Newborn Action Plan (INAP) 2030

Introduction and Vision

• Launch: Instituted by the Ministry of Health and Family Welfare (MoHFW), Government of India, in September 2014.
• Genesis: It is India’s concerted strategic response to the global Every Newborn Action Plan (ENAP), aligned with the 67th World Health Assembly resolution.
• Core Vision: A comprehensive framework envisioning a future with
  • zero preventable deaths of newborns and stillbirths, w
  • here every pregnancy is wanted,
  • every birth celebrated, and
  • women and neonates survive, thrive, and reach their full neurodevelopmental potential.

Goals and Targets (By 2030)

INAP sets highly ambitious, accelerated goals, aiming to achieve its targets five years ahead of the global ENAP and Sustainable Development Goals (SDG) timelines.

• Neonatal Mortality Rate (NMR): Target is a “Single Digit NMR” (Less than 10 per 1000 live births by 2030).
• Stillbirth Rate (SBR): Target is a “Single Digit SBR” (Less than 10 per 1000 total births by 2030).

Guiding Framework and Principles

1. Integration: Seamlessly aligning newborn health with maternal, child, and adolescent health programs (RMNCH+A) along the continuum of care.
2. Equity: Prioritizing the most marginalized, remote, and vulnerable populations to eliminate geographical and socio-economic disparities.
3. Gender: Ensuring strict gender parity in care-seeking behavior and newborn survival interventions.
4. Quality of Care: Mandating evidence-based, timely, safe, and respectful care at all health facility levels.
5. Convergence: Emphasizing multi-sectoral coordination (e.g., sanitation, nutrition, women and child development).
6. Accountability: Tracking programmatic progress through robust data metrics and Maternal Perinatal Death Surveillance and Response (MPDSR).
7. Partnerships: Engaging the private sector, NGOs, and professional bodies (e.g., Indian Academy of Pediatrics, National Neonatology Forum).

The Six Strategic Intervention Packages (Pillars)

The INAP operational framework spans the continuum of care from pre-pregnancy to early childhood through six distinct pillars.

1. Preconception and Antenatal Care

• Objective: Optimize maternal health to prevent prematurity, low birth weight, and congenital anomalies.
• Key Interventions:
  • Iron and Folic Acid (IFA) supplementation to mitigate maternal anemia and prevent neural tube defects.
  • Tetanus toxoid (TT) immunization.
  • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Assured comprehensive and quality ANC by a medical officer/specialist on the 9th of every month.
  • Early identification and high-risk pregnancy management (e.g., PIH, gestational diabetes, infections).

2. Care During Labour and Childbirth

• Objective: Prevent intrapartum complications (birth asphyxia) and fresh stillbirths.
• Key Interventions:
  • Promotion of institutional deliveries via Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), and Surakshit Matritva Aashwasan (SUMAN).
  • LaQshya Initiative: Upgrading labor rooms and maternity operation theatres to adhere to strict quality and intrapartum protocols.
  • Utilizing partographs for labor monitoring and administration of antenatal corticosteroids for anticipated preterm labor.

3. Immediate Newborn Care

• Objective: Ensure intact survival in the “golden minute” and the immediate postnatal hours.
• Key Interventions:
  • Provision of essential newborn care at dedicated Newborn Care Corners (NBCCs) located within delivery rooms.
  • Standardized neonatal resuscitation capabilities via the Navjaat Shishu Suraksha Karyakram (NSSK) training.
  • Strict adherence to delayed cord clamping, maintaining the warm chain, and immediate skin-to-skin contact.
  • Early initiation of breastfeeding (within one hour).

4. Care of the Healthy Newborn

• Objective: Promote somatic growth, neurological development, and prevent community-acquired neonatal infections.
• Key Interventions:
  • Exclusive breastfeeding promotion under the MAA (Mothers’ Absolute Affection) program.
  • Completion of birth-dose routine immunization (Hepatitis B, OPV, BCG) prior to institutional discharge.
  • Home Based Newborn Care (HBNC): Scheduled domiciliary visits by ASHA workers to monitor weight, temperature, umbilical cord stump health, and feeding adequacy.

5. Care of the Small and Sick Newborn

• Objective: Deliver specialized, high-acuity management for prematurity, neonatal sepsis, and hypoxic-ischemic encephalopathy.
• Key Interventions:
  • Tiered expansion of Facility Based Newborn Care (FBNC).
  • Establishment of Special Newborn Care Units (SNCUs) at district hospitals and Newborn Stabilization Units (NBSUs) at First Referral Units.
  • Institutionalization of Kangaroo Mother Care (KMC) units for low birth weight infants.
  • Provision of non-invasive ventilation (CPAP) and safe oxygen delivery systems in SNCUs.

6. Care Beyond Newborn Survival

• Objective: Optimize long-term neurodevelopmental outcomes and manage congenital anomalies.
• Key Interventions:
  • Rashtriya Bal Swasthya Karyakram (RBSK): Early pediatric screening for the “4 Ds”: Defects at birth, Diseases, Deficiencies, and Developmental delays.
  • Establishment of District Early Intervention Centers (DEICs) for longitudinal follow-up, early stimulation, and rehabilitation of high-risk SNCU graduates.

Health System Strengthening and Monitoring

• Bottleneck Assessment (BNA): INAP relies on systematic BNA tools across states to dynamically identify and rectify gaps in health workforce, supply chain, and financing.
• Data Tracking: Outcomes are monitored via the Health Management Information System (HMIS), Sample Registration System (SRS), and National Family Health Survey (NFHS).
• Death Audits: Implementation of Perinatal and Neonatal Death Reviews to identify modifiable health-system delays and assign accountability.