The Government of India has launched various initiatives envisaging a high priority action with regard to neonatal health. Under National Rural Health Mission (NRHM), Accredited Social Health Activists (ASHAs) are being deployed and assigned the responsibility to create awareness in the community regarding maternal and child health issues [14
]. They are further expected to mobilize the community and help them in accessing healthcare services. A safe motherhood intervention named “Janani Suraksha Yojana (JSY)” has been implemented under the NRHM to increase the institutional delivery rates and provide skilled care at birth for the newborn [15
]. Under the Reproductive and Child Health program (RCH-II), the quality and reach of antenatal care is planned to be expanded and home-based newborn care using integrated management of neonatal and childhood illness (IMNCI) protocols is envisaged.
The IMNCI strategy encompasses a range of interventions to prevent and manage the commonest major childhood and neonatal illnesses that cause death, that is, acute respiratory infections, diarrhoea, measles, malaria, and malnutrition [16
]. The IMNCI package is planned to be implemented at the level of household and subcentres (through ANMs) and primary health centres (through medical officers, nurses, and lady health visitors). Till October 2011, it has been implemented in 433 districts across the country [17
Facility-based care of neonates (F-IMNCI) is proposed through strengthening of infrastructure, provision of extra nurses, and skills upgradation of physicians and nurses [18
]. The Government, with the help of UNICEF, has started setting up special care newborn units (SCNUs) for managing sick newborns [17
]. These units have been established at district hospitals and are expected to have a minimum of 12 to 16 beds manned by 3 physicians, 10 nurses, and 4 support staff. A total of 293 SNCUs have been established till the year 2011 [17
]. Further, Newborn Stabilization Units (NBSUs) are being set up in First Referral Units (FRUs) and Community Health Centers (CHCs) and they aim to provide care to sick newborns referred from peripheral health facilities [17
]. As of October 2011, 1134 NBSUs have been set up [17
]. A total of 8582 New Born Care Corners (NBCCs), which are special corners within the labour room where resuscitation, infection control, and early breast feeding can be commenced, have been set up, as of 2011 [17
Janani Shishu Suraksha Karyakram (JSSK) was launched on 1 June, 2011 with the aim to promote institutional delivery, eliminate out-of-pocket expenses, and facilitate prompt referral through free transport [21
]. A program on basic newborn care and resuscitation, named Navjaat Shishu Suraksha Karyakram (NSSK), is being launched to address important interventions at the time of birth that is, prevention of hypothermia and infections, early initiation of breastfeeding, and basic newborn resuscitation [22
]. The objective is to have one person trained in basic newborn care and resuscitation at every delivery. This training is being imparted to medical officers, staff nurses, and ANMs at CHC/FRUs and 24 × 7 PHCs where deliveries are taking place [17
]. Provision of Comprehensive Emergency Obstetric and New born Care (CEmONC) Services and Basic Emergency Obstetric and Newborn Care (BEmONC) at various levels has also been given due importance.
Neonatal health is seemingly one of the priority issues in the agenda of the government which gets reflected in the various programs devised and implemented. The worrisome issue is the fact that improving health systems through facility upgradation and ensuring availability of trained manpower and logistics comprise essential prerequisites for the success of these programs/initiatives. The reluctance of trained manpower, especially doctors, to serve in rural areas has become a major impediment in the government's ability to provide quality health services.