lssmc overhead slides

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INCREASING ACCESS TO EMERGENCY OBSTETRIC
SERVICES EXPERIENCES FROM RAJASTHAN,
INDIA Presenter Hemant Dwivedi Authors
Venkatesh Srinivasan Hemant
Dwivedi Dileep Mavalankar UNITED NATIONS
POPULATION FUND (UNFPA), INDIA
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(No Transcript)
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KEY DEVELOPMENT INDICATORS
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• HEALTH SYSTEM AN OVERVIEW
• Sub-Centers - with an Auxiliary Nurse Midwife
  (ANM) - 5000 population
• Primary Health Centers (PHCs) - Medical Officer
  (MO) and Paramedics - 30,000 population
• Community Health Centers (CHCs) - Specialists
  doctors, MOs and Paramedics - 125,000 population
• District Hospital - Multi Speciality - 2 million
  population
• Medical College and Asso.Hospital - Division level

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PROJECT DETAILS

• Averting Maternal Death and Disability (AMDD)
  project supported by Columbia University with a
  grant from the Bill and Melinda Gates Foundation.
• Implemented as component project under UNFPA
  supported Integrated Population and Development
  (IPD) Project, Rajasthan, India from 2001-2004.
• Project Area
• Seven Districts of Rajasthan, India
• Population covered - 13.5 million
• Facilities Covered
• CEOC - 31 institutions
• BEOC - 52 institutions
• Project Duration
• September 2000 - December 2004
• Implementing Agency
• Government of Rajasthan

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• KEY FINDINGS OF BASELINE STUDY (2000)
• Service Coverage (UN-Process Indicators)
• Number of institutions studied - 83
• of births in facilities - 10.89 (min.gt15)
• met need of EOC - 8 (min.100)
• births by C-section - 0.6 (min.5-15)
• Average CFR - 1.4 (min 1)

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• STATUS OF HEALTH SYSTEM AT BASE LINE SURVEY IN
  2000
• High vacancies of specialists OB/GY and
  anesthetist
• PHCs not offering complete range of BEmOC
• Very few CHCs prepared to address EmOC
• Only 21.5 deliveries in institutions
• Low utilization of services and confidence in
  PHCs
• Delay in reaching institutions

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• PROJECT FOCUS
• Needs Based Differential Approach
• IMPROVING ACCESS TO QUALITY SERVICES
• Improved functional infrastructure
• Provided necessary equipments and supplies
• Skill based trainings - BEOC, IP Training
• Development of management systems
• INCREASE COMMUNITY AWARENESS
• Advocacy Programs for PRIs, NGOs and Media.
• Integrating Safe Motherhood messages into
  existing Community level activities.

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Vacant Positions of Health Functionaries in
Rajasthan
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• WHY FOCUS ON BEmOC?
• 80-85 obstetric complications do not need
  surgical interventions
• Focus on BEmOC will reduce nearly 33-60 maternal
  deaths
• Skills upgradation of service provider is
  feasible
• Over dependence on OB Gy specialist and
  anesthetist reduced
• Reduces congestion at district and medical
  college hospitals

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• INITIATING BEOC SERVICES
• Government in consultation with UNFPA decided to
  train MOs in BEmOC
• 2 weeks training at district hospital
• 62 teams trained BEmOC
• MOs gained confidence in handling cases and
  expressed interest
• Skills upgraded on manual removal of Placenta,
  management of shock, judicious use of Oxytocine,
  stabilizing cases of APH PPH and ensuring
  referral when essential
• Promoted use of evidence based practices

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• ORIENTATION OF CBV

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• MANAGEMENT INFORMATION SYSTEM
• Needs assessment
• Pilot testing of revised MIS
• Revised MIS orientation and implementation
• Monitoring of progress on UN process indicators

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RESULTS OF THE INTERVENTIONS
Health Institutions Providing Basic and
Comprehensive
EmOC
- Rajasthan
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Births in EmOC Institutions Comparison of
Baseline, 2001, 2002 2003
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Births increase in EmOC facilities Comparison
with non-intervention districts in last 4 years
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Comparison of met need of EmOC Intervention
and non-intervention districts
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C-Section in Facilities
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Comparison of Average CFR in Facilities Interventi
on and non-intervention institutions
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• LESSONS LEARNED
• BEmOC services as a feasible strategy in human
  resource scarce settings
• Pragmatic strategies based on local specific
  needs leads to cost effective interventions
• Improved service provision backed up by community
  mobilization increases utilization of services
• Operationalising EmOC services requires
  sustained efforts
• Demonstration projects achievements facilitates
  advocacy at policy level

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• MOVING FROM PILOT TO SCALE
• Logframe of new national RH programme draws on
  Rajasthan experience for strengthening EmOC
  services
• Reduction in maternal morbidity and mortality is
  now a priority agenda of Rajasthan Government
• UN process indicator confirmed as reliable and
  accessible indicators for public health systems
  to measure programme performance

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Maternal death is a personal tragedy and social
disaster.Let us join our hands to avert it.
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• FOR FURTHER INFORMATION.
• HEMANT DWIVEDI
• Sate Programme Coordinator
• UNFPA Rajasthan State Office,
• 29, Srirampura Colony, Civil Lines, Jaipur,
  Rajasthan, India
• Email unfpajpr_at_sify.com
• Telephone [phone]
• Fax [phone]
• VENKATESH SRINIVASAN
• National Programme Officer
• UNFPA, 53, Jorbagh, New Delhi, India
• Email venkatesh.srinivasan_at_unfpa.org.in
• Telephone [phone]
• Fax [phone]