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Innovative strategies to improve antenatal and intrapartum care in tribal districts of …

Innovative strategies to improve antenatal and intrapartum care in tribal districts of Gujarat

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DESCRIPTION Innovative strategies to improve antenatal and intrapartum care in tribal districts of Gujarat D r Dr Amarjit Singh Joint Secretary, Ministry of Human Resource Development, Government of India Nutrition

TRANSCRIPT Innovative strategies to improve antenatal and intrapartum care in tribal districts of Gujarat D r Dr Amarjit Singh Joint Secretary, Ministry of Human Resource Development, Government of India Nutrition Foundation of India, New Delhi August 29 th, 2011 Causes of Maternal Death Haemorrhage 24.8% Infection 14.9% Indirect causes 19.8% Other direct causes 7.9% Unsafe abortion 12.9% Eclampsia 12.9% Obstructed labour 6.9% The setting 15% women have pregnancy related complications 5 lac deaths globally 1.5 lacs in India Huge morbidity Rural Popu OBGYs posts In Place Gap Popu /gynec AP Gujarat M ashtra MP India Source Time Period Urban Rural NFHS (424) Untrained dai Quack Trained dai ANM Homeopath Ayurved NFHS (540) Bonus - saving neonates When do babies die Week Week Week Week Maternal Mortality: UK Sri Lanka; Kerala & TN have done it 200 Maternal Deaths Improvements in nutrition, sanitation Antenatal care Antibiotics, banked blood, surgical improvements Maine 1999. The Gujarat experience Chiranjeevi Looking for a strategy Failure to operationalise FRUs in the last 10 years Efforts to get OBGYs in rural areas fail Efforts to rope in Insurance companies fail Successful example of NPCB Experience of GPs in the UK Tradition of public private participation in Gujarat; involving private sector a viable option The process Long consultative process IIMA; GTZ; insurance companies; SEWA Rural; FOGSI Fixing rates for deliveries with NGOs Meetings with the panchayat functionaries; elected representatives and FOGSI members in the districts Advance to the OBGYs on signing the MOU Taking responsibility of low HB women Ensuring prompt payments Service Package Service No. of cases Rate Per Case Cost Normal delivery Complicated cases Eclampsia 1000 Forceps/vacuum/breech Episiotomy 800 Septicemia Blood transfusion Cesarean (7%) Predelivery visit Investigation Sonography NICU Support Food Dai Transport Grand total Gynecologist involvement in Chiranjeevi District Total OBGY Specialists in the district # enlisted under Chiranjee vi scheme Total # of deliveries Performed Average delivery per Doctor BK Dahod (8.5 million) Kutch P'mahal SK Total Chiranjeevi Scheme - 5 Pilot Districts Performance January 2006 June-2011 District Normal Nature of Deliveries LSCS Compli cated Total % LSCS BK Dahod Kutch P'mahal SK Rest of Gujarat Total Chiranjeevi Yojana Report June-2011 (21 District) Sr # District Name Normal LSCS Compli cated Total % LSCS # of Doctors Enrolled 1 Gandhinagar Mehsana Patan Ahmedabad Kheda Anand Surendranagar Vadodara Bharuch Narmada Surat Tapi Navsari Sr # District Name Normal LSCS Compli cated Total % LSCS # of Doctors Enrolled 15 Ahwa-Dang Rajkot Jamnagar Bhavnagar Amreli Junagadh Porbandar District Total District Total District Total Chiranjeevi Previous post Next post Scheme: Outcomes Mothers & New Born babies saved ( Up to Dec ) Total Deliveries under Healthline Pissn X337X/EISSN NKT Holding A/S / Company Reg. No Chiranjeevi scheme Likely Maternal Deaths Maternal death reported under Chiranje evi Volume 4 Issue 2 July-December PDF (/Nkt-Holding-A-S-Company-Reg-No) scheme Mothers saved under Chiranje evi scheme likely Neo-Natal deaths Early Neo- Natal Jul 29, 2017 (/Healthline-Pissn-X337x-Eissn-Volumedeath reported under Chiranjeevi scheme Early Neonat es saved Normal Deliveries: CSection: (6.2%) Complicated Deliveries: (5.0%) Private OBGYNs enrolled: 662 Package has 4-Issue-2-July-December-Pdf) been revised from Rs.1795 to Rs.2800 per delivery Emergency Medical Response Service Jul 29, 2017 Initiative (EMRI) (August 2007 December 2010) Services Status as on December 2010 Total Ambulances at Services 453 Districts Covered 26 Population Covered 5.70 Cr. Emergency Handled Pregnancy Related Cases Road Traffic Accidents Cardiac Related Cases Respiratory Related Cases Lives Saved Deliveries in Ambulances 16884 Beneficiaries Chiranjeevi Yojana Performance Number of Beneficiaries (Up to Dec -10) Source: Chiranjeevi Yojana Report IIM study -1 The Chiranjeevi scheme is being used by relatively younger mothers and having lesser number of children. Most of the Chiranjeevi users have income levels less than Rs. 12,000 per annum indicating the scheme is able to target the poor families in these three blocks of the district, The expenditure incurred by non-user group on the recent delivery at a private facility is Rs The average expenditure incurred by the Chiranjeevi beneficiary on their previous delivery was Rs On index delivery a Chiranjeevi client has spent out-of-pocket on an average Rs. 727 per delivery on medicine (self Rs. 297, child Rs. 358) and transportation Rs. 72 indicating that the delivery is not really cash-less. However, the average amount saved by the Chiranjeevi client by availing the benefit of the scheme is Rs 3273 (Rs minus Rs. 727. IIM study - 2 The average distance travelled by a Chiranjeevi client to reach the health care facility is kms and the average time taken is 44 minutes. The average expenditure on transportation using mostly private transport by a Chiranjeevi client is Rs. 272 as compared to Rs. 200 which the Chiranjeevi client is reimbursed, Private doctors have conducted 41 per cent of deliveries where as rest of the deliveries have been conducted by staff at the private health care facility under the Chiranjeevi scheme, ANMs have been the source of information to 55 per cent of Chiranjeevi scheme users. Anganwadi workers provided information to 17 percent of the clients and Female Health Workers to 10 per cent of the Chiranjeevi clients. Thus, 82 per cent of the total beneficiaries of the Chiranjeevi scheme were provided information by the community health workers. Costs All BPL Gujarat Rs 54 crs All BPL in India 1798 crs 54 poor performing talukas (having less than 70% institutional delivery rate) reduced to 39 Above 80% % Below % OCT 07 OCT 08 Incentive Scheme S. No. Details Normal delivery (Rs) BEMOC (Rs) Caesarian & BT (Rs) 1 MO MO training Anesthesia SN Cl IV RKS OLD LABOUR ROOM LABOUR ROOM OPERATION THEATER Bamanbor - PHC, Surendranagar Gomata PHC (Rajkot) HMIS for effective management of health facilities Blocks performing poorly Institutional Deliveries Vadodara Region Bharuch Vagra Narmada Nandod Dediapada Sagbara Vadodara Nasvadi Kawant Chota Udaipur Dahod Halol Panchmahal Ghoghamba Institutional Deliveries Panchmahal District Institutional Deliveries in the PHCs in a Block in Panchmahal District GRADING OF PHC IN % OF GUJARAT STATE % OF P H C Dec 06 Dec 07 Dec- 08 Dec 06 Dec 07 Dec- 08 Dec 06 Dec 07 Dec- 08 Dec 06 Dec 07 Dec- 08 A B C D GR A D E OF P H C Capacity building Training MBBS doctors in BeMOC, CeMOC & paediatrics Training as SBAs - Midwifery programme Public health training Induction of young professionals in health management Accreditation of hospitals and PHCs Recognising and honouring good performance Institutional deliveries trends Source: State MIS Institutional deliveries % Home % (Up to Dec - 10) The impact - MMR MMR Source: SRS Year Break up of Institutional Deliveries with CY deliveries 100% 90% 80% 70% 60% 50% 40% 30% % % 0% Public Institution Private Institution CY Lessons Not either or / use both talk to the private sector from a position of strength Surge of demand - boon to the poor Unprecedented support from the private practitioners; Explore private sector availability before investing in public sector Unindicated C-section in check Availability of blood Still asking for additional funds from the BPL; Non-BPL beneficiaries also being attended Quality monitoring - Accrediting providers Include cervix cancer, Sterilisation, HIV/AIDS Collaboration with pediatricians Ongoing rigorous evaluation The Gujarat Government initiative is a departure from previous practice in that it took sole responsibility for the reimbursement of private health care providers, rather than relying on intermediary parties such as insurers. The state government is working with professional agencies such as associations, obstetricians and academic organizations to plan and implement the new arrangements. Showing remarkable success, the programme has been expanded from five to all 25 districts of Gujarat. Between January 2006 and January 2009, 869 doctors were enlisted. Nearly 2,79,236 deliveries were performed, with each doctor performing an average of 322 deliveries. SEARO, WHO conference in Guj Asian innovation award Prime Minister s award Bal Sakha Scheme Up to December Pvt. Pediatricians Enrolled 266 Total In-service Government Pediatricians in State-18 (Except Medical Colleges) District No. Of Doctors Ahmedabad 15 Anand 15 Kheda 7 Surendranagar 6 Gandhinagar 13 Mehsana 17 1,21,124 Newborns Attended District No. Of Doctors Patan 9 Sabarkantha 11 Banaskantha 13 Vadodara 12 Bharuch 6 Dahod 20 District No. of Doctors Narmada 1 Panchmahal 12 Surat 18 Tapi 6 Valsad 6 Navsari 4 Dang 1 Bhavnagar 11 Junagadh 13 Amreli 4 Porbander 6 Rajkot 25 Jamnagar 9 Kutchh 6 Let us join hands to save our mothers and children. We make a living by what we get; we make a life by what we give! Dr Amarjit Singh MHRD GOI, New Delhi

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