For newborns, the answer is hospital plus home, Pg8

Key Highlights:

• On August 24, 2026, three newborns died in an accidental fire at a government women’s hospital in Amravati, Maharashtra.
• This incident is part of a recurring pattern of clustered newborn deaths in government institutions across India.
• Institutional deliveries in India have significantly increased from 39% in 2005-06 to 90% in 2023-24, leading to overcrowding in Special Newborn Care Units (SNCUs).
• The Gadchiroli model demonstrated that Home-Based Neonatal Care (HBNC) by trained Community Health Workers (CHWs) can significantly reduce neonatal mortality.
• Around 8,00,000 Accredited Social Health Activists (ASHAs) are trained to provide HBNC based on the Gadchiroli model.
• A "hospital plus home" strategy is proposed to decongest SNCUs and ensure appropriate care for newborns.

Detailed Insights:

• The absolute number of institutional deliveries rose from 109 lakh in 2005 to 194 lakh in 2024-25, increasing the burden on healthcare facilities.
• Admissions to Special Newborn Care Units (SNCUs) saw a 28% increase in two years, from 11.3 lakh in 2021-22 to 14.45 lakh in 2023-24.
• Government hospitals are increasingly managing high-risk births, including premature, low-birth-weight, and sick newborns referred from peripheral facilities.
• Infrastructure failures, such as oxygen deprivation (Gorakhpur, 2017) and fires (Bhandara, Bhopal, Jhansi, Amravati), pose significant risks in neonatal units.
• Overcrowding, inadequate nurse-to-baby ratios, and poor infection control contribute to hospital-acquired infections in neonatal units.
• The Gadchiroli field trial by SEARCH showed a 62.2% reduction in neonatal mortality through HBNC provided by trained CHWs.
• HBNC involves identifying and managing neonatal infections, supporting breastfeeding and warmth, and managing low-birth-weight and preterm babies at home.
• The proposed three-part strategy includes decongesting neonatal units, strengthening SNCUs with adequate resources and safety measures, and making units intrinsically safe.
• The success of the Janani Suraksha Yojana (JSY) in promoting institutional deliveries highlights the need for a comprehensive newborn health strategy beyond just hospital births.

Key Concepts Involved:

• Special Newborn Care Units (SNCUs): Hospital units providing specialized care for sick and high-risk newborns.
• Home-Based Neonatal Care (HBNC): Care provided to newborns at home by trained health workers, focusing on essential care and early detection of complications.
• Accredited Social Health Activist (ASHA): A community health worker acting as a link between the community and the public health system, providing primary healthcare services.
• Janani Suraksha Yojana (JSY): A safe motherhood intervention under the National Health Mission, promoting institutional delivery by providing cash assistance to pregnant women.