The number of deaths of children less than one year of age per 1,000 live births is referred to as Infant mortality rate (IMR). In Haryana, the Infant Mortality Rate (IMR) in Haryana is 42 per 1,000 live births which are similar to the national average of 42 per 1,000 live births as per Sample Registration System (SRS) 2012. These figures need to be studied in the backdrop of the fact that India carries the single largest share (around 25-30%) of neo-natal deaths in the world and that about 45% of the neonatal deaths occur within the first two days of life!
The Sample Registration System 2012 statistics show that the neonatal mortality rate was 28 per 1,000 live births accounting for 66 per cent of the total IMR in Haryana. In the same way, case fatality rate is very high in premature babies in the state.
According to National Rural Health Mission (NRHM) data, "home delivery by unskilled people, lack of essential newborn care, poor child care practices, lack of early detection of sick newborns and inadequate infrastructure for specialised care of sick newborns" are the factors responsible for IMR. An NRHM survey has identified the five districts- Hisar, Jind, Panipat, Palwal, Mewat with high incidence of IMR. The state government concedes IMR is high also in Bhiwani and Mahendergarh districts. Substantial interventions are required to be done to reduce neo-natal mortality in Haryana. The present arrangements are inadequate to arrest these deaths.
Government officials point out the scarcity of resources at many hospitals, while others were not using them properly. Besides, the state also require many more Sick Newborn Care Units than just the 22 at present. Such units need to be set up in every block. There is an urgent requirement of widespread availability of essential equipment such as Open Care Radiant Warmers, Phototherapy Units, Resuscitator, Oxygen concentrator, etc., at the block and village dispensaries to ensure against infant mortality.
The Central government's Janani Shishu Suraksha Karyakram too has been found wanting in the state. A National Health Systems Resource Centre (NHSRC) survey of one such facility at Kaithal in 2012 noted: Diagnostics not available at PHC (Public Health Centre); No USG (Ultrasonography )at GH (Government Hospital)- Absence of Sonologist; RT available, drop back not adequate, poor IEC . The situation is not different even now.
It is argued that facility-based newborn care can reduce neo-natal mortality by 23-50% in different settings. Such facility-based newborn care, thus, has a significant potential for improving the survival of new-borns. These are required immediately. Yet, the need of the hour is also to optimise the available resources. The state government concedes that staff nurses and Auxiliary Nurse Midwives in the state lacked the capability to tackle two major causes of neo-natal death--birth asphyxia and respiratory distress.
A recent survey by USAID has also suggested that applying the Regular Appraisal of Program Implementation in Districts (RAPID) strategy and conducting multiple rounds of programme assessments is required to empower facility heads and district and state health officials with information and data to guide corrective actions. There is a need to provide supporting supervision by the administration too, so as to improve the knowledge and skills of health providers towards saving lives of newborn babies.