Globally, 78 percent of newborn deaths are from conditions where timely and adequate access to medical oxygen can make a difference, including preterm birth, birth asphyxia, sepsis, and pneumonia. Collectively, newborns require an estimated 16.8 million cubic meters of oxygen annually. While improving quality of care during antenatal periods and delivery is essential, timely identification of respiratory distress and the safe, reliable use of oxygen are also critical.
Over the last two decades, India has achieved substantial progress in reducing newborn mortality, with a 70 percent decline compared to just 54 percent globally. The country has established a strong facility-based newborn care network, including 1,114 special newborn care units (SNCUs), 3,215 newborn stabilization units, and over 23,000 newborn care corners, complemented by community-based services, such as home-based newborn care.
Yet, prematurity and low birth weight (45 percent), birth asphyxia and birth trauma (15 percent), and neonatal pneumonia (10 percent) remain the three major causes of newborn deaths in India. To meet the Sustainable Development Goal target to reduce newborn mortality, progress must be accelerated.
Factors in accelerating progress in newborn care
Although many facilities are well-equipped with medical oxygen systems, significant gaps persist across all levels of the health system in health workers’ skills in the rational and safe use of oxygen for newborns.
Health workers often face challenges in early recognition and assessment of respiratory distress, leading to delayed initiation of appropriate oxygen therapy. Core competency gaps include accurate oxygen saturation monitoring, effective newborn resuscitation, proper probe placement and oxygen titration, and the appropriate use of diagnostic tools. Errors with using continuous positive airway pressure (CPAP) machines further compromise treatment outcomes.
Gaps in clinical staff skills are compounded by limited capacity to ensure the safe production and storage of medical oxygen. These gaps can lead to contamination risk, inconsistent management of medical gas piping and other respiratory care devices, lack of routine calibration, and missed safety checks, all of which directly undermine the reliable delivery of oxygen. Collectively, these skill gaps, rather than equipment availability, remain a critical bottleneck to ensuring high-quality respiratory support and reducing newborn mortality.
These gaps are further intensified by the stark rural-urban divide in skilled workforce availability. While trained pediatricians, SNCU nurses, and biomedical staff are concentrated in major cities, rural, district, and tribal health facilities often operate with limited skilled staff who are capable of managing newborn respiratory complications. To address this, PATH has adopted a multidimensional, systems-based approach to address skill gaps and specialist shortages and improve the rational use of oxygen for newborns.
Telemedicine services for small and sick newborns
PATH and the All India Institute of Medical Sciences (AIIMS) Nagpur implemented a tele-SNCU hub-and-spoke model in Dharni, a tribal block in Maharashtra’s Melghat region, to address critical gaps in specialist availability, uneven quality of newborn care, and the challenges posed by remote geographies.
This innovative service leverages 360-degree cameras, high-speed connectivity, and digital health records to enable real-time remote monitoring, expert-guided clinical decision-making, and virtual rounds by neonatologists. Through continuous mentoring, case discussions, and skill-based support, tele-SNCU strengthens the capacity of on-the-ground medical and nursing staff, ensuring adherence to standard protocols and improving the management of respiratory distress, sepsis, and very low birthweight newborns.
This model has reduced newborn deaths by 44 percent and referrals by 43 percent over two years. It demonstrates how technology-enabled specialist support can overcome geographic and human resource constraints, enhance care quality, reduce out-of-pocket costs, and provide a step toward universal health coverage for newborns.
Improvements in newborn health outcomes after implementation of the tele-SNCU initiative.
“Tele-SNCU services have reshaped neonatal care by extending specialist support from tertiary centers to remote and resource-limited hospitals, closing critical expertise gaps where they matter most.”— Dr. Nishant Banait, Department of Neonatology, AlIMS Nagpur
Specialized hands-on and eLearning training package on newborn oxygen use
Under the leadership of the government of India and in collaboration with leading neonatal experts across the country, PATH supported the development of a dedicated training package on oxygen support systems for newborns, addressing key causes of newborn death and illness. Through a national technical expert group, a hybrid training program, “Safe and Effective Use of Oxygen and CPAP in Newborns,” was designed to strengthen evidence-based respiratory care practices for newborns.
The program uses a blended learning model that combines virtual learning with hands-on clinical practice. Online prelearning sessions included short webinars and videos covering essential concepts such as respiratory distress management, safe oxygen administration, optimal CPAP use, and safety considerations. Participants then took part in a 1.5-day hands-on workshop with skill stations, case-based discussions, and supervised practical sessions, followed by a skills assessment and individualized feedback. Participants are required to complete all online modules before attending the workshop to maximize practice-based learning.
These modules were recently launched by the government of India and will be integrated into existing government digital platforms for wider dissemination. Globally, this is a first-of-its-kind training package dedicated specifically to medical oxygen systems for newborns. The modules will be pilot tested in field settings and refined based on feedback gathered during implementation.
National launch of training modules on the safe and effective use of oxygen and CPAP in newborns during National Newborn Week 2025. Photo: Ministry of Health and Family Welfare, India.
Empowering health care workers with newborn resuscitation skills
PATH, in collaboration with the National Neonatology Forum (the professional association of neonatologists in India) and the state governments of Maharashtra and Uttar Pradesh, rolled out a competency-based blended training curriculum to address critical gaps in newborn care, with a strong focus on safe oxygen delivery, CPAP use, thermoregulation, feeding support, infection prevention, and quality improvement practices.
The program includes six weeks of online learning featuring webinars, instructional videos, job aids, and interactive WhatsApp discussions on low birthweight care, respiratory distress, oxygen therapy, CPAP, neonatal seizures, emergency triage, assessment and treatment, and retinopathy of prematurity screening, followed by two hands-on workshops offering practical skill sessions.
Participants are awarded certificates only after successfully clearing objective structured clinical examination skill assessments, thereby ensuring competency and readiness to apply the practices in clinical settings. Beyond classroom and practical training, PATH partnered with experts to carry out on-site mentorship and provide continued guidance to staff within their facilities.
“Despite having [oxygen equipment], we lacked skills and confidence to use them, leaving them unused and leading to frequent referrals. Skill-based training rebuilt our confidence, enabling us to manage asphyxia cases at our facility.”— Vishal Paithankar, Nursing In-Charge, SNCU, Dharni, Maharashtra
PATH conducts a basic and advanced newborn resuscitation training for SNCU staff in Satara, Maharashtra. Photo: PATH.
Every breath matters. Despite progress, thousands of newborns still die from preventable causes linked to inadequate oxygen therapy in India. PATH, together with its partners, is working to close critical skill gaps, strengthen oxygen systems, and bring lifesaving care to even the most remote regions. Addressing these systemic challenges is essential to achieving the Sustainable Development Goals of reducing neonatal mortality and ensuring universal access to quality newborn care by 2030.
