Navjaat Shishu Suraksha Karyakram

The Navjaat Shishu Suraksha Karyakram (NSSK) is a key national initiative launched by the Ministry of Health and Family Welfare, Government of India, with the objective of reducing neonatal morbidity and mortality through the provision of essential newborn care and basic resuscitation at every birth. The programme focuses on building the capacity of healthcare providers to ensure that each newborn receives skilled and safe care during and immediately after delivery.

Background and Need

India accounts for one of the highest numbers of neonatal deaths globally, with a significant proportion of these deaths occurring within the first 24 hours of life. The leading causes of neonatal mortality are:

• Birth asphyxia (failure to breathe at birth),
• Prematurity and low birth weight, and
• Infections such as sepsis and pneumonia.

Prior to the introduction of structured neonatal care training, many deliveries—especially in rural and resource-poor settings—were attended by birth attendants without adequate resuscitation or newborn management skills.
To address this critical gap, the Navjaat Shishu Suraksha Karyakram was launched in 2009 under the National Rural Health Mission (NRHM) (now part of the National Health Mission – NHM). It was developed in collaboration with the Indian Academy of Paediatrics (IAP) and the World Health Organization (WHO) to strengthen the capacity of doctors, nurses, and midwives in newborn care.

Objectives of NSSK

The key objectives of the programme are to:

1. Reduce neonatal mortality and morbidity by improving the quality of care at birth.
2. Train healthcare providers in essential newborn care and neonatal resuscitation techniques.
3. Standardise delivery room practices to ensure that every newborn is handled safely.
4. Prevent common neonatal complications such as asphyxia, hypothermia, and infection.
5. Promote early initiation of breastfeeding and proper postnatal care.

Core Components

NSSK training is based on five key principles of newborn care that form the foundation of the programme:

1. Prevention of Hypothermia – Immediate drying, wrapping, and ensuring skin-to-skin contact to maintain body temperature.
2. Prevention of Infection – Following strict hand hygiene, aseptic delivery practices, and proper cord care.
3. Establishment of Breathing – Immediate assessment and resuscitation of babies who do not cry or breathe after birth.
4. Early Initiation of Breastfeeding – Promoting exclusive breastfeeding within the first hour of life.
5. Recognition of Danger Signs – Identifying sick newborns early and referring them to higher-level facilities.

Training Structure and Methodology

The NSSK programme is designed as a two-day skill-based training course focusing on hands-on learning and practical demonstrations.
Key features of the training include:

• Use of simulation-based teaching using neonatal manikins to practice resuscitation.
• Stepwise demonstration of Essential Newborn Care (ENC) and Newborn Resuscitation (NR).
• Focused sessions on infection prevention, thermal protection, and breastfeeding support.

Target trainees:

• Medical officers, paediatricians, and staff nurses.
• Auxiliary Nurse Midwives (ANMs), Lady Health Visitors (LHVs), and Skilled Birth Attendants (SBAs).
• Paramedical staff and nursing students involved in delivery care.

Training centres: The programme is implemented through State Institutes of Health and Family Welfare (SIHFWs), District Training Centres, Medical Colleges, and District Hospitals.

Implementation and Integration

The Navjaat Shishu Suraksha Karyakram operates as part of the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy, integrating newborn care into maternal and child health services.
It complements other government initiatives such as:

• Janani Suraksha Yojana (JSY): Encouraging institutional deliveries.
• Janani Shishu Suraksha Karyakram (JSSK): Providing free healthcare services to pregnant women and newborns.
• Facility-Based Newborn Care (FBNC): Establishing Newborn Care Corners (NBCCs), Newborn Stabilisation Units (NBSUs), and Special Newborn Care Units (SNCUs).
• LaQshya Programme: Improving the quality of care in labour rooms and maternity wards.

Through such integration, NSSK strengthens the continuum of care from birth to postnatal life.

Outcomes and Achievements

Since its inception, NSSK has led to significant improvements in newborn care practices across India:

• Over hundreds of thousands of healthcare providers have been trained nationwide in essential newborn care and resuscitation.
• Delivery room practices have improved, resulting in better management of asphyxia and prevention of hypothermia.
• Enhanced institutional deliveries and skilled birth attendance have contributed to declining neonatal mortality rates.
• The programme has raised awareness about the importance of immediate care and breastfeeding within the golden hour after birth.

As per national data, India’s Neonatal Mortality Rate (NMR) has declined steadily from 39 per 1,000 live births (2005) to around 24 per 1,000 live births by 2023, partly due to initiatives like NSSK.

Challenges

Despite its success, several challenges persist:

• Shortage of trained personnel in rural and remote regions.
• Inconsistent follow-up and refresher training, leading to skill attrition.
• Equipment shortages and maintenance issues in delivery points.
• Limited supervision and monitoring of skill performance post-training.
• High caseloads and inadequate staffing at primary healthcare facilities.

Future Directions

To strengthen the NSSK and sustain progress towards reducing neonatal mortality, future efforts must focus on:

1. Universal training coverage to ensure all birth attendants are skilled in newborn care.
2. Digital learning and e-training platforms for continuous capacity-building.
3. Periodic skill assessments and refresher courses to maintain proficiency.
4. Improved supply chains for resuscitation and newborn care equipment.
5. Enhanced data monitoring and real-time feedback systems.
6. Community-level interventions through Accredited Social Health Activists (ASHAs) for postnatal follow-up.