In June 2014, the Government of India (GOI) published the policy guidelines, Use of Antenatal Corticosteroids in Preterm Labour, (Under Specific Conditions by Auxiliary Nurse Midwives), Operational Guidelines. With the release of this policy the Ministry of Health and Family Welfare (MOHFW)/ GOI is rolling out ACS including support for ANMs to administer a pre-referral dose of ACS to pregnant women in preterm labor at public health facilities. Both the India Newborn Action Plan (INAP), and the WHO Recommendations on Interventions to Improve Preterm Birth Outcomes acknowledge the benefit of ACS. The WHO recommendations lay out that ACS therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:
- Gestational age assessment can be accurately undertaken;
- Preterm birth is considered imminent (within 7 days);
- There is no clinical evidence of maternal infection;
- Adequate childbirth care is available (including the core functions of emergency obstetric care); and
- The preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use).
The implementation of the GOI policy guidelines provides a timely opportunity to identify the essential preconditions within the health system for the implementation of a safe and effective ACS program from the PHCU to the district hospital. The MOHFW has requested Every Preemie to assess the current implementation of ACS in one district in Haryana State and Every Preemie envisions three phases of engagement:
Phase 1: Assess current availability and use of ACS in selected sites in Haryana and compliance with the MOHFW Flow Chart for ACS Administration, and identify critical pre-conditions needed to safely administer pre-referral first dose ACS within the PHCU setting.
Phase 2: Disseminate the findings of the assessment and work with GOI stakeholders to review current implementation practices vis a vis the GOI policy for ACS use. If necessary, update the Flow Chart for ACS Administration to align with the WHO Recommendations on Interventions to Improve Preterm Birth Outcomes.
Phase 3: Evaluate, in one or two districts, standard practice of the Updated Flow Chart for ACS administration in facilities that meet the health system preconditions. Develop a program implementation guide for use by state and district officials to scale ACS use at all levels of the health system including pre-referral first dose of ACS by ANMs.