Post on 12-Nov-2014
description
Towards Improved Maternal Health
Reducing MMR in Bundi and Bikaner
Arti Dogra
District Collector, Bikaner
Mamta’s Story
Rajasthan – Bikaner & Bundi
Data Bundi Bikaner
Population 1113725 2367745
MMR `261 263
Gender Ratio 922 903
• Difficult terrain prone to drought• Early marriage• Dominant feudal system• Inadequate control over resources for women• Low literacy • Social customs( eating last)• Under nutrition , high levels of anaemia
Why Maternal Mortality is high
Rajasthan Over Time
Causes of Maternal Deaths
Maternal Deaths
District Population
Crude Birth Rate (CBR)
2007-09 (Median
2008)
Estimated births 2007-09 (Median
2008)
MMR 2007-09 (Median
2008)
Est MDs 2007-09 (Median
2008)
Avg Reported
MDs, 2007-08 to 2009-
10
Crude Birth Rate (CBR)
2010
Estimated births 2010
MMR 2010Est MDs
2010
Reported MDs, 2010-
11
Bikaner2,367,745 24.9
58,957
343 202 2
24.6 58,247
263 153 11
Bundi1,113,725 23.7
26,395
343 91 21
23.3 25,950
261 68 36
Rajasthan 68,621,012 24.7 1,694,939
331 5,610
1,089
24.4 1,674,353 264 4,420 952
Reported Maternal Deaths
DistrictReported MDs
2007-08Reported MDs
2008-09Reported MDs
2009-10Avg Reported MDs 2007-08 to 2009-10
Reported MDs 2010-11
Reported MDs 2011-12
Reported MDs 2012-13
Bikaner5 0 0
2
11 4 38
Bundi23 22 17
21
36 28 16
Rajasthan 1219 987 1062 1,089
952 763 1,116
• Implementation of SQRS (Small Query Reporting System)-Tracking medical activities through SMS
• Increase the number of health facilities providing safe delivery and newborn care
• Systematic Improvement in Labour Rooms• Tracking of High Risk Pregnancies• Quality improvement of MCHN Days• Video Conferencing upto PHC Level
New Initiatives
Online Reporting through SMS
• Shift from reporting and analysis at the end of the month to daily reporting
• 1 SMS within 160 characters• Coverage to all major health related activity like
ANC Registration, Deliveries, OPD-IPD, Maternal Deaths
• Review every day by CMHO and Block CMHO
• Launched Jan 12th, 2011• Divided focus Health
Activities in 10 types of Coding from R1 to R10.
• District, Block, PHCs & Sub Center level staff trained
• PHCs level Monitoring can be done in real time.
SQRS Implementation
Process 101
Analysis on Inbound SMS
• Benefits– Real Time Analysis on activities of
• ANM, MO-IC PHC, CHC, Janana and District Hospital• Ideal for Collector, CMHO and DPM to have a Bird-Eye-
View on a particular activity
ANC Registration (Jan 01, 11 – Jan 26, 11)
Total No of ANC RegistrationTotal No of
BPL RegistrationTotal AmountPaid to BPL
40 11 5500
Analysis on Inbound SMS
Benefits
• Real Time Reporting Solution• Economical Reporting• Everyday assessment of their own work• Faster response time during Critical Situations• Instant Action on Absenteeism • Ready tool for inspections and monitoring
Maternal deaths
Maternal Deaths
Rajasthan
Improvement in Maternal Death Reporting
• Reporting of maternal death through immediate SMS• Enquiry of maternal deaths through verbal autopsy• Block level teams of 3 people including ASHA
facilitators• Maternal Death Audit in District Health Society
monthly• Alternative verification
• To reduce maternal death (min 8-10% pregnancies are high risk)
• High risk pregnancies should be identified & special care , checkup , follow up
• Quality of ANC checkup for high risk lady..• Identification of institution for safe delivery of
that lady• Maintenance of HRP Database
High Risk Pregnancy Tracking
• Obstetrics Risk factor– Previous still Birth– Preterm baby– Continuous abortion– C-Section delivery– Eclmpsia & Pre-eclampsia history
• Medical Risk Factor– High Blood Pressure– Heart Disease– Diabetes– Epilepsy– Sever Anemia
• Physical Risk Factor– Age– Height– Cervix and Uterus Problems– Weight
Factors for detection of High Risk Pregnancy
Implementation Methodology
• Sensitization of ANM, LHV, MO & Program Manager about High Risk Pregnancy.
• High Risk booklet launched on 20th May 11 by Hon. Health Minister
• High Risk booklet in which all record of High Risk lady is maintained by ANM.
• 4 ANC checkups are being done for High Risk lady & last checkup is done by Doctor.
• Awareness to family members of that lady regarding high risk & special care.
• Review in District Health Society Meeting.
High Risk Pregnancy Tracking
• Sensitisation of family
• HRP Circle on the house
• Lists at Gram Panchyat , CHC,PHC
• Referral and check up facility
• Verification
High Risk
Workload of PBM Hospital Bikaner, Labour Room
Workload in Janana, BundiAlternative Needed for Janana Hospital
• Increase the number of primary health facilities providing safe institutional delivery and new born care in Bundi
• Strengthen the capacity of ANMs to manage and refer maternal and neo-natal complications
• Enhance community participation in improving maternal and new born survival
ASTHA Project - Objectives
• Assessed– Gaps in Labour Room Infrastructure– Strengthen Human Resource Capacity – Performance of Facilities– Practices in labour room
Activities Undertaken
• Emphasis on good quality routine antenatal care
• Training on basics like Delivery care practices, pre-discharge assessment, quality ANC.
• SBA re-orientation and training of program managers , doctors and ANMs
Doctors and Staff Orientation
Success Metric Before project started ( on 28 Aug 11)
Facilities functioning 24* 7 6 10
No of ANMs / GNMs posted 39 45
No of ANMs / GNMs provided intensive 5 day training
0 31
No of doctors oriented on quality of delivery neonatal care
0 24
Number of deliveries conducted in previous month
277 511
Success @ ASTHA Kendra
Post Training Analysis
• Safe delivery and newborn care practice• How to identify and report maternal deaths • ASHAs have been instructed to report all maternal
deaths in selected blocks on phone• verbal autopsy technique• Monitoring High Risk Pregnancies
Asha Training
Improved MCHN Day
• Stress on quality ANC
• Tracking Anaemia and Blood Pressure
• Effective training and monitoring
• Identification of transport options and possible delivery points
• Effective use of Mamta card
Video Conference at Health Facilities
• Micro level monitoring
• Immediate feedback
• Prompt redressal
Involving the People
• SAKHI - Special program by student NSS volunteers
• Two panchayats covered every week. • Use of traditional music and dialect.• Involving public represntatives
• Quality ANC Checkup • Regular follow-up is being done by ANM or Doctor.• Facility wise interaction and engagement of referral transport
at the village level• Maintenance of lists at CHC control room and CMHO office• Monthly Review at Block level and District Level• Random checks by SDM and District Collector
• Motto:Healthy Mother & child
Post Programme Analysis