NBSU and NBCC Assmt Tool
NBSU and NBCC Assmt Tool
NBSU and NBCC Assmt Tool
The instruction sheet should be read by all involved in this exercise. The basic information and set of
guidelines for filling up the questionnaire is detailed below. The exercise is learning and sharing
exercise with the purpose of a rapid cross-sectional assessment and objective to support the
district/state authorities in planning, implementing and standardizing the quality.
NBSUs expand the outreach of special newborn care within a district, beyond the district hospital.
When well networked and supported by SNCU at the district hospital, these units can manage large
numbers of new-borns requiring special care at the sub-district level, and thereby:
Reduce delay in initiation of appropriate care (delay in reaching SNCU from a distant area)
for sick newborns and improve outcomes
Help in stabilizing sick newborns before referral to higher centre
Prevent overloading of SNCUs at the district hospital
Reduce the cost of care
However currently there is a concern that the network of SNCUs, NBSUs and NBCCs is not
functioning optimally. Though the operational status and service utilization of SNCUs is being
monitored regularly, there is no such mechanism for the NBSUs & NBCCs. This assessment aims to
generate understanding and insights on the current functioning of NBSUs & NBCCs in the country,
and identify future directions to ensure optimal utilization and effective functioning of these units in a
district.
The assessment has been designed to review the operational status of NBSUs and NBCCs by
comparing the following parameters with the recommended norms (as given in the FBNC
guideline):
1. Provide a facility based strength and gap analysis with supportive supervision recommendations
2. Share the findings of the field visit, district interactions and suggested recommendations with the
MD (NRHM) / concerned state officials
3. Review the current guidelines as against the field findings for guiding the operationalization.
Methodology
The designated teams are identified by CH division (MOHFW) and are experts visiting the districts
under the guidance of GOI.
The team has been allotted selected district in the state to conduct the rapid assessment. This is a
supportive exercise to understand the strengths and gaps in the implementation of facility based
newborn care at the district/ sub-district level. The teams have been oriented at the national level and
will be carrying relevant background information and formats to be filled up during the visit.
The overall plan is to simultaneously conduct this in 6 states with at least 2 districts each. The process
involves the state and district officials in the assessments.
The concerned teams are instructed to follow the following steps during the visit to the district.
1. The team will first meet the concerned RCHO/child health nodal officer/concerned district
officials.
2. The form 1 detailing the district profile should be completed and made available to the visiting
team. It will help to have a quick overview of the district profile.
3. The team will work with the district officer to select the facilities for review. District should
nominate district officers to accompany the team during their field visits.
4. Information of the visit to the selected facility should be provided to MOIC of facility by the
RCHO prior the team’s assessment.
5. Districts teams will be visiting 2 NBSUs in each district (districts are encouraged to select and
route chart the plan). However, if the experts wish to visit another facility, support should be
extended to the team.
6. Along with assessment of the NBSU, the NBCCs (OT and LR) and postnatal ward in the selected
facility will also be assessed. 2 other NBCCs besides facility will also be assessed.
7. The team should ensure compliance as per the instructions. Teams are requested to follow the
following guiding principles;
1. Read ALL the instructions in the given format before starting the assessment.
2. Demonstrate professionalism.
3. Listen effectively.
4. Capture data and responses and record them according to the standards outlined in the tool
6. Recognize verbal and non-verbal problems and address problems as they are identified.
9. Determine the appropriate source(s) for the information required; do not overlook important
sources.
12. All formats should be legible and filled completely for further review.
8. The de-briefing meeting at the district level and state should be conducted by the team. Findings
of the field visit and district interactions with suggested recommendations to be shared with MD
(NRHM) /concerned state officials.
9. The filled up formats along with a detailed report should be submitted / mailed to Dr. P.K
Prabhakar DC(CH) at [email protected] and copied to Dr. Renu Srivastava at
[email protected] within 1 week of completing the assessment.
10. Overall compilation of the data and the report will be completed at NCHRC, NIHFW and will be
submitted to GOI. A copy of same will be shared with the state HQ.
11. Recommendations to be reviewed and follow up actions by GOI to be taken after the assessments
SECTION A: District Profile
(This section is to completed by the District officials – RCHO, District Child Health
Coordinator, District program Manager, along with the local map depicting the public and
private health facilities)
Name of the district………… State…………………….
1. Demographic profile (Census 2011)
Population (in lakhs)
% of Rural
% of Urban
% of SC
% of ST
% of others
% of BPL population
Literacy rate
Population density (per Sq km)
Sex Ratio at birth
Sex Ratio ( 0-6)
6. How much budget has been allocated for the FBNC program (establishment and recurring
costs) in the district PIPs? How much was utilized?
Year Allocation Expenditure
2010-2011
2011-2012
Address of facility
YES NO
NBCC
*Essential Criteria to designate as FRU: 24*&7 MCH care, Facility of LSCS, Care of Sick
Newborn and Availability of Blood bank,
Remarks:
II. INFRASTRUCTURE
F. Where does the mother stay while the newborn is admitted to NBSU ____________________
Overall rating:
Criteria Score
0 1 2
Remarks:
A. How many posts of staff nurses have been sanctioned for the NBSU? …….………………..
B. How many staff nurses are deployed at the NBSU? ...…………………
Regular staff nurses ………..………
Contractual staff nurses ……………
C. The average number of staff nurses deployed at NBSU during the last one month or how
frequently they are rotated within the facility?
D. Check the duty roster for number of staff nurses available and note their names as below:
Training Training dates/ Observership
since when
At facility
Name
Time
8 am - 2 pm
2 pm - 8 pm
8 pm - 8 am
Overall rating:
Criteria Score
0 1 2
24*7 availability of No system Nurses and MO 24*7 availability of
manpower available during day nurses with MO on
time only call
Training of Nurses Not trained At least 50% trained All (100%) trained
Remarks:
Last 3 months
Data 1st Month 2nd Month 3rd Month Total
Inborn Outborn Inborn Outborn Inborn Outborn
Total number of deliveries in facility
Total number of Caesarean sections
Total number of live births
< 1000 gm
1000 – 1499 gm
1500 – 2499 gm
≥ 2500 gm
Total number of LBW newborns
Number of still births
Total no. of admissions in NBSU
Male
Female
Total No. of cases admitted to NBSU
Birth weight ≥ 2500 gm
1500 – 2499 gm
1000 – 1499 gm
< 1000 gm
Morbidity Profile
(Primary diagnosis)
Neonatal sepsis
Birth asphyxia
Pre-maturity/LBW
Hypothermia
Jaundice
Any other - specify
Management
(no. of babies who received )
Oxygen
Antibiotics
Gavage feeding
IV fluid
Phototherapy
Enteral feed
Outcome
Discharge
Referral
Left against medical advice
(LAMA)
Died
Duration of stay
< 6 hrs.
6-12 hrs.
12-24 hrs.
24-72hrs.
> 72hrs.
Cause of death
Neonatal sepsis
Birth asphyxia
Pre-maturity/LBW
Hypothermia
Jaundice
Any other - specify
Overall rating
Criteria Score
0 1 2
Remarks:
A. Drugs
Disinfectants
Soap
Handrub (Alcohol-based)
Spirit
10% Betadine
Gluteraldehyde
Surface disinfectant
(Bacillocid 2%) (Lysol 5%)
Floordisinfectant
Slippers
Consumables / Disposables
Gloves
Different colour polythene
bagscannulas
I/V for waste(24)
disposal
Needles
Syringes
Feeding tubes
Endotracheal tube
Nasal prongs
O2 Hood
Pedia set
Suction catheter
Glucostix
B. Equipments
C. Maintenance/Repair of equipments
has broken down, list
equipment functional
Time taken to get the
last 1 month (if more
Any breakdown. Not
Date of procurement
functionality of out
of order equipment
CMC /AMC Yes /
Make & Company
Date of Expiry of
procurement
(check stock
ensure non-
Equipment
Source of
warranty
register)
S. No.
all)
No
1 Radiant Warmer
2 Suction machine
3 Oxygen
concentrator
4 Phototherapy
unit
For radiant warmers
report on voltage
fluctuation and
availability of stabilizer
For Phototherapy units
report on condition of
tubes (no. of tubes
fused/with black
ends/Flickering) and
frequency of change
Overall rating:
Criteria Score
0 1 2
Inventory of drugs and Not available Available but not Available and update
equipments updated
Disinfectants (Soap and Not available Any one available Both available
surface disinfectant)
Overall rating
Criteria Score
0 1 2
Clinical Case Management: Investigator should review 1st six case sheets of the last 4 months. The
investigator should if possible have on the spot case observation and remark on overall judgement regarding
appropriateness and adequacy of treatment protocol. Only note “” if info available,” ” if not available,
if not applicable the cell may be left blank(Get photocopies of the observed case sheets)
Overall rating: Kindly note that a minimum of 12 case sheets need to be observed before
going for scoring
Criteria Score
Out of 24 cases
0 1 2
VIII. FEEDBACK
Investigators should interact with the medical officer- in-charge and staff nurses and any other
available staff. Best practices and challenges should be discussed.
A. Mention the best practices in your unit?
a. ____________________________________________________________________________
b._____________________________________________________________________________
c.____________________________________________________________________________
B. Mention three major bottlenecks/ challenges in functioning of the NBSU
a. ____________________________________________________________________________
b._____________________________________________________________________________
c._____________________________________________________________________________
C. Give three suggestions for improving the services provided through NBSU
a. ____________________________________________________________________________
b._____________________________________________________________________________
c._____________________________________________________________________________
Place _____________________
Date ____ / ____ / __________ Signature _________________________
Name _________________________
Designation ________________________
The team members should acknowledge and document their appreciation of the unit’s
functioning.
Thank the visited unit’s staff and provide your contact details. Also ensure the entered
observations are shared with the concerned medical officer in-charge / staff nurses before
leaving the facility.