Rapid Assessment of Newborn Stabilization Units (NBSUs) and

Newborn Care Corners (NBCCs)

Instruction Sheet

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.

Purpose of the exercise

Facility based newborn care in a given district is provided by a network of Newborn Stabilization
Units (NBSUs) at sub-district health facility (CHC, FRU or SDH) and a Special Newborn Care Unit
(SNCU) at the District Hospital. In addition, essential newborn care is provided at Newborn Care
Corners (NBCCs) situated within the labour rooms and operation theatres of all health facilities.

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. Infrastructure: area, bed strength, availability of water and electricity

2. Human resource: availability and adequacy of doctors, staff nurses & paramedical staff, their
training status
3. Service utilization: Criteria for admissions, their demographic and morbidity profile,
management and outcome
4. Logistics: Availability and adequacy/functionality of drugs, equipments and consumables
5. Reporting and record keeping
6. Supervisory and referral mechanism
7. Aseptic practices by directly observing these
8. Clinical case management practices through retrospective review of case sheets of admitted
babies
The specific outputs are to

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;

While interviewing and observations

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

5. Provide factual information as needed.

6. Recognize verbal and non-verbal problems and address problems as they are identified.

7. No prompting unless really needed

8. Report observations in an objective manner.

During data collection

9. Determine the appropriate source(s) for the information required; do not overlook important
sources.

10. Recognize internal inconsistencies and resolve them when possible.

11. Accurately record information in the format.

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)

2. Administrative profile (RHS 2010)

No. of Blocks
No. of villages
No. of Gram Panchayat

3 Health profile (Census 2011)

CBR (AHS 2011)
Infant Mortality Rate (AHS 2011)
Neonatal Mortality Rate (AHS 2011)
Still births per 1000 live births

4. Facility status (2010-11 HMIS / as per district record)

SN Public Sector Total No Designated as FRUs (in no.)
1 District Hospitals
2 Sub Divisional Hospitals
3 Other Hospitals (please specify category/
type of facility e.g. Referral Hospital,
Women and Child Hospital etc. make
separate row for each category)
4 CHC
5 Block PHCs
6 PHC (break up to be included if Mini
PHCs APHC,UGPHC)
7 Total Sub centers
8 No. of licensed blood banks
9 No. of licensed blood storage units/centers
5. Accreditation of Private Health Facilities:
S Private Sector Accredited for Accredited for sick new born care
N Deliveries services
(Normal &
LSCS)
1 No of Private Hospitals Accredited
under JSY
2 No of Private Hospitals Accredited
under any other scheme (specify)

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

7. Was there a district orientation on FBNC operational guidelines? YES  NO 

When___/_____/____
8. How many trainers have been trained in the district for
a) NSSK: ___________
b) F-IMNCI: ___________
c) FBNC: ___________
9. Child Health:
2011-12 (HMIS)
Indicators 2010-11 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
(HMIS)
New born breastfed within
one hr of birth
Number of new born
weighed less than 2.5 kgs
No of functional SNCU
No of functional NBSU
No of functional NBCC

10. Brief information regarding functionality of SCNU in the district

Number of beds available

Number of Medical officer/Specialist posted
Number of Nurses posted
Cumulative number of admission in the last quarter (Apr-
Jun)
Cumulative number of deaths in the last quarter (Apr-Jun)
 SECTION B: NBSU Assessment Form
I. GENERAL INFORMATION
Name of the State: ___________________ Name of the District: _____________________

Name of the block: ___________________ Name of the facility: _____________________

Address of facility

Type of designated facility DH  SDH  FRU  CHC  24X7 PHC 

Number of beds in the facility

Is there 24-hour coverage for delivery and YES  NO 
newborn? (If yes, ask to see a duty roster
for night staffing)

24-hour duty roster present YES  NO 

If yes, is staff present onsite YES  NO 

Type of services provided (Designated by Cemoc  Bemoc 
the state)
High Risk pregnancies are detected YES  NO 

If above is yes then are they referred to YES  NO 

higher centre for delivery

Normal deliveries YES  NO 

Assisted (Forceps delivery/Vacuum) YES  NO 

Manual removal of placenta YES  NO 

Administration of parenteral oxytocin / YES  NO 

antibiotics / inj. Mg SO4

Management of PPH /other complications YES  NO 

Caesarean section YES  NO 

Availability of laboratory services YES  NO 

If yes
 24X7 YES  NO 
 Blood sugar  In house  Outsourced  Private
 In house  Outsourced  Private
 Serum bilirubin
 Hemogram  In house  Outsourced  Private

Availability of blood storage unit YES  NO 

Availability of blood bank YES  NO 
Any other facility specify YES  NO 

Details of the funds available related to the

newborn care (JSSK, RKS, any other)
Whether the available fund is relevant for
 NBSU YES  NO 

YES  NO 

 NBCC

JSY entitlements displayed YES  NO 

JSSK entitlements displayed YES  NO 

Under JSSK scheme – Entitlements for

Mother & Newborn
 Drugs YES  NO 
 Blood YES  NO 
 Diet YES  NO 
 Treatment YES  NO 
 Transport YES  NO 
 Is Infant Death Review conducted? YES  NO 

If yes, then provide details

Mention/Enquire about nearby public or

private facility having neonatal services,
and provide details if applicable

*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

A. NBS unit functional/operational since: ………./………./………. (DD/MM/YY)

B. Total floor area of NBSU (in sq. feet)
C. Number of beds in NBSU

D. Availability of Newborn Care Corner

 Within labour Room: YES  NO 
 Within operation theatre: YES  NO 
E. Is the labour room in close
proximity to NBSU: YES  NO 
If no, give remarks____________________________________________________________

F. Where does the mother stay while the newborn is admitted to NBSU ____________________

G. Is a room thermometer available in NBSU? YES  NO 

H. Is the temperature maintained in NBSU? YES  NO 

I. Is the unit walled with washable tiles up to 7 feet YES  NO 

J. Is continuous water supply available to the NBSU? YES  NO 

If YES check
K. If NO, no. of hours of water supply to NBSU ……………………… hrs.
 Is there a dedicated overhead tank for water? YES  NO 
 Is a dedicated hand washing area available? YES  NO 
 Is a wash-basin with elbow operated tap available YES  NO 
 L. Is there 24*7 electrical Supply:
YES  NO 
If yes check
M. Is the day-light visible in the NBSU? YES  NO 
N. Is the NBSU well lit?
YES  NO 
O. Is there a power supply
YES  NO 
P. Provision of stabilized power back-up
If available If not functional
Provision of Equipment Available Number Capacity Functional Since when
Power back-up Reason
Generator Y  N  Y  N 
Inverter Y  N  Y  N 
Provision of Centralized
safety of servo
electrical stabilizer Y  N  Y  N 
devices and Voltage
equipments stabilizer Y  N  Y  N 
Remark on
safety of
power supply

Overall rating:

Criteria Score

0 1 2

Total floor area (in sq. ft) < 200 ≥ 200

24*7 water supply Not available Available at facility Available in unit

but not in Unit

24*7 electrical supply Not available Available at facility Available in unit

but not in Unit

Number of beds <4 ≥4

Remarks:

III. HUMAN RESOURCE

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

time for NBSU

Full time/part
Qualification
Degree /Dip.
Duration

since when
At facility
Name
Time

FIMNCI FBNC Done Place

Duration

8 am - 2 pm
2 pm - 8 pm
8 pm - 8 am

E. Paediatricians / Medical Officers engaged with NBSU

SN Name Qualification Designated At Medical Training Training Observership Remarks
MO Degree for NBSU facility officer dates
/Dip. since On call / FIMNCI FBNC /Duration Done Place
when residing /Duration
in the
campus
1
2
3

F. Other supporting staff

S. N. Category of staff Regular/Contract At health facility Full time/Part time for
since NBSU
1 Laboratory
2 Ward aide*
3 Cleaning
4 Security
5 Other (Specify)

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

Number of dedicated None <4 ≥4

nurses posted at NBSU

Availability of MO & Not available Available but not F- F-IMNCI/FBNC

training status IMNCI/FBNC trained trained MO or
Paediatrician

Training of Nurses Not trained At least 50% trained All (100%) trained

Remarks:

IV. SERVICE UTILIZATION AND REPORT KEEPING

(Based on the delivery / newborn register or case sheets)

A. Case record register/Case sheets available: YES  NO 

B. Report being sent YES  NO 
C. If yes, how frequently Monthly  Quarterly 
Remark ______________________________________________________________________

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

Average no. of monthly <5 5-10 > 10

admissions

% of LBW (<2.5 kgs) Nil < 80% 80% or more

admitted in NBSU
during the last quarter

% of LBW (<2.5 kgs) Nil < 80% 80% or more

babies with hospital stay
> 24 hrs out of total
LBW admissions (avg.
of 3 months)
 % of Newborn babies <50 50-90 >90
discharged out of total
admissions

% of admissions nil <25% >25%

managed under
phototherapy

Remarks:

V. DRUGS & EQUIPMENT

A. Drugs

Name of Drug Availability at Adequacy of Any stock out in last 6 Remarks

time of visit stock months
(Yes / No) (Yes / No) (Yes / No)
Drugs
Inj. Adrenaline
Inj. Ampicillin
Inj. Gentamycin
Other antibiotics
Inj. Calcium gluconate
Normal saline
10% dextrose
Isolyte-P
Inj. Phenobarbitone
Inj. Vitamin K

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

S. N. Equipment Available Functional If not Use of equipment in

Number YES/NO (Check functional last 1 month
functionality) since when (Determined by used
for number of babies
and no. Of days)
1 Radiant warmer
2 Phototherapy
CFL/Conventional
3 Neonatal Bag & Mask
(0 & 1 size)
4 Laryngoscope
5 Weighing machine
6 Foot operated/
Mechanical suction
machine
7 Thermometer
8 Mobile examination
light
9 Hub cutter
Stethoscope with
neonatal chest piece
11 Oxygen cylinder
12 Oxygen concentrator

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

Expert to check and

than one equipment
working > 7days in

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

Antibiotics (Ampicillin Not available Any one available Both available

and Gentamycin)

Disinfectants (Soap and Not available Any one available Both available
surface disinfectant)

Consumables (I/V Not available Any one available Both available

cannula no. 24 and
feeding tubes)

Radiant warmer Not available Available but not Available &

functional functional

Phototherapy unit Not available Available but not Available &

functional functional
Remarks:

VI. SUPERVISION AND REFERRAL

A. Is there a mechanism of a regular supervision to the unit? YES  NO 

B. No. of supervisory visits conducted to the NBSU over past one year? Mention who conducted the
visits (Attach any reports of the visits, if available)
____________________________________________________
C. Is there a system available to seek support from a collaborative centres/ medical college
hospital/SNCU? YES  NO 
D. If yes how?
_____________________________________________________________________________
 E. Details of support in last 6 months? __________________________
F. Is there a functional system of referral for baby’s to higher centre YES  NO 
G. Is there a functional system of referral from Community/Lower facilities/Frontline worker to the
NBSU? YES  NO 
H. If yes, please describe in brief the referral system (Advance communication , 2 way referral
feedback and feedback to the units, Type of transport use)
________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Overall rating

Criteria Score

0 1 2

Supportive supervision No mechanism Mechanism available Mechanism available

but not operational at and operational at
facility level facility level

Support taken from Never Infrequent Frequent

higher centres (SNCU
/Medical college/others)

Referral system No system System available but System available

no mechanism for with mechanism of
 Two way
two way referral and two way referral and
 Advance information advance information advance information
to higher centre

Transport for referral Not available Available and Available, functional

 Functional motor functional but and operated
vehicle operated by private through Govt scheme
 Operated by private agency (Paid (Free services)
or Govt. services)
Remarks:

VII. ASSESSMENT OF PRACTICES

ASK & OBSERVE

Hand washing before handling baby Always  Sometime 

Before entering SNCU  Not done 
Cleanliness of general equipment Once a day  Alternate days 
Once a week  During Fumigation 
Not done 
Disinfection of baby care equipment After each use  Daily 
When visibly soiled  Not done 
Cleaning and disinfection of floor & walls Once per shift  Once a day 
Once a week  Not done regularly 
Cleaning of linen Autoclaved  Washed & ironed 
Only Washed 
Waste segregation and disposal Appropriate  Not appropriate 

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)

Questions Coding Categories

No. Individual case record (Check for presence of the 1 MONTH AGO 2 MONTHS AGO
following)
1 2 3 4 5 6 1 2 3 4 5 6
1 Criteria for admission according to norms
2 Daily notes
3 Initial treatment order*(usage of antibiotics and IV fluids)
4 Provisional diagnosis
5 Enteral feeds
6 Discharge advice
3 MONTH AGO 4 MONTH AGO
Individual case record (Check for presence of the following)
1 2 3 4 5 6 1 2 3 4 5 6
1 Criteria for admission according to norms
2 Daily notes
3 Initial treatment order*(usage of antibiotics and IV fluids)
4 Provisional diagnosis
5 Enteral feeds
6 Discharge advice

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

Admissions according to Not done Sometime Regular

recommended criteria

Daily notes Not done Sometime Regular

Hand washing Not done Sometime Regular

Waste segregation Not practicing Sometime Practicing

Admission & Discharge Not available Sometime Available

policy
 Remarks:

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.