Dr. Darshna Thakker | Health Messenger!

Gynecologist & Obstetrician• Ob. Gyn. Consultant in private practice since 1998 @ Sarjan,

• Resource person to NGO / Govt. Prog. Related to Adolescent Health Education, Reproductive Health Care

• Areas of Interest : Developing IEC (Information, Education & Communication) material for health care providers & various organizations, delivering Health Messages thro’ print, visual media, TV, video production

• Active member of FOGSI – Adolescent Health Committee

• National Coordinator – “Protecting Young Girls” Project

Women Health Issues,Challenges & Solutions

Dr. Darshna ThakkerConsultant Obstetrician & GynecologistSARJAN Maternity & Nursing Home, Vasna,

Ahmedabad-7Member : Adolescent Committee FOGSI,

(Federation of Ob. Gyn. Societies of INDIA)Expert on Panel: Gender Resource Center

Director: Sarjan Communication

Why are we HERE? Agenda for ACTION

• Reaching un- reached…• Serving underserved

• TO FOCUS on the Most Vulnerable. . .– pregnant, newborn, adolescent– Poor , living far from health services

A call to action – We all have a role to play

Key Facts ~ Global Scenario• Every day, approximately 800 women die from

preventable causes related to pregnancy and childbirth.

• 99% of all maternal deaths occur in developing countries.

• Maternal mortality is higher in women living in rural areas and among poorer communities.

• Young adolescents face a higher risk of complications and death as a result of pregnancy than older women.

• Skilled care before, during and after childbirth can save the lives of women and newborn babies.

• Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%

6

Presentation over view

MDG & HER Health

Challenges & Solutions – Our Role

Message to Take Home

Summarizing High Impact Intervention

Women Health Issues – MANY!

Age specific, Problem specific

MDG – 189 countries in 2000 signed!

1. Eradicate Extreme Poverty and Hunger2. Achieve Universal Primary Education3. Promote Gender Equality and Empower

Women4. Reduce Child Mortality5. Improve Maternal Health6. Combat HIV/AIDS, Malaria and TB7. Ensure Environmental Sustainability8. Develop Global Partnership for Development

53 Indicators, 35 relevant to India

GOAL 5: IMPROVE MATERNAL HEALTH

• TARGET 6: Reduce by three quarters, between 1990 and 2015, the Maternal Mortality Rate.– Indicator 16: Maternal Mortality Ratio (MMR)– Indicator 17: Proportion of births attended by

skilled health personnel

The decline in MMR from 1990 to 2009 is 51%.From an estimated MMR level of

437 per 100,000 live births in 1990/1991, India is required to reduce the MMR to 109 per 100,000 live births by 2015

Women Health Issues• Physiological – Physical

– Teenage >> Obesity, PCOS– Child bearing >> Pregnancy & delivery,

Cancer– Menopause >> Cancer

• Emotional & Psychological– Teenage >> Tantrums & stress - career– Child bearing >> ? multitasking– Menopause >> midlife crisis

Women Health Issues

Life cycle approach!• Female fetecide – BIG NO• Adolescent Health – Needs special

attention• Pregnancy & Delivery Care –

Improving, under utilization of services?

• Mid Life Crisis - Menopause• Geriatric problems

The fact! Defining HEALTH!• We are still busy managing

physiological issues. . . • We must not underestimate the

impact of life style, emotional challenges, social & peer pressure on women’ health

• WHO HAS TO PLAY ROLE???

Challenges & Solutions• Sex ratio

• Ignorance about women health

• Affordable care• Under utilization of

available care• Poor linkages• Lack of integration• Commitment &

accountability• Monitoring &

Evaluation

• Mind set management!

• BCC• IEC• Motivation &

mobilization• Integration• Strengthening public-

private partnership• Will & Wish – Passion• Rectify strategy for

implementation

Women & Cancer• Breast, Cervix, Ovaries, Uterus• Screening Programs – PAP,

Mammogram• Poor ratio of regular screening• Late manifestation• Solutions: IEC, Motivation, Reaching

Out

Teen Girl’s Health Issues• ARSH * STIs & RTIs• PCOS, Obesity, HBP, DM• Teenage Pregnancy & Abortions• Vaccine preventable diseases• Solutions: Health Education, FLE,

AFHS, involving community & society at large scale

GOAL 5: IMPROVE MATERNAL HEALTH

• TARGET 6: Reduce by three quarters, between 1990 and 2015, the Maternal Mortality Rate.– Indicator 16: Maternal Mortality Ratio (MMR)– Indicator 17: Proportion of births attended by

skilled health personnel

The decline in MMR from 1990 to 2009 is 51%.From an estimated MMR level of

437 per 100,000 live births in 1990/1991, India is required to reduce the MMR to 109 per 100,000 live births by 2015

Where do WE STAND?• Kerala, Tamil Nadu and Maharashtra have realized the

all India MDG target in 2007-2009 whereas Kerala was

the sole State with this distinction in 2004-2006.

• The States of Kerala, West Bengal and

Bihar and Jharkhand are likely to achieve

their State level MMR targets by 2015,

with the current trend continuing. The remaining

States are likely to miss the targets by 18 to 52 points

• Despite this progress,

India is expected to fall

short of the 2015

target by 26 points

Source: Sample Registration System, Office of Registrar General of India

Institutional deliveries in India

Source MDG _ REPORT_ INDIA 2011

With the existing rate of increase in deliveries by skilled personnel,

the likely achievement for 2015 is only to 62%, which is far short of the targeted universal coverage

Causes of Maternal death

Trends of Institutional Deliveries

Underutilization of ANC/PNC• Poverty• Distance• Lack of information• Inadequate services• Cultural practices• Fact#10MH: The main obstacle to

progress towards better health for mothers is the lack of skilled care. This is aggravated by a global shortage of qualified health workers

Happy side of the story!• under the National Rural Health

Mission (NRHM) 2005, ASHA (Accredited Social Health Activist) providing support for increasing utilization

• Promoting safe delivery at home by ensuring the use of SBAs (Skilled Birth Attendants) has been another important initiative

Alarming Facts• Among the age group of 15-49 years, 63% of the

maternal deaths were females in the age group of 20-29 years as per the 2007-09

Gujarat State

Health Indicators Current StatusTarget 2015

MDG

Target 2017

12th Plan

Maternal Mortality Ratio

(MMR)

148 (2007-09 SRS) /

1lac live births100 <90

Infant Mortality Rate (IMR)

38 (SRS 2012) / 1000

live births29 24

Under 5 Mortality Rate (U5MR)

52 (SRS 2011) / 1000

live births42 35

Total Fertility Rate (TFR)

2.4 (SRS 2011)

2.2 2.1

INITIATIVES . . .• Chiranjeevi Yojana - aimed at encouraging institutional

deliveries and establishing a model of public-private partnership to reduce maternal mortality. Launched in December 2005, it began as a one-year pilot project in five backward districts of Gujarat. 2007> to implement the scheme throughout Gujarat; the Central Government is also recommending the scheme to other states to improve institutional deliveries

• focuses on providing free delivery care to women below poverty-line (BPL) through a private obstetrician

• As of February 2008, 852 of 2,000 available private specialists have joined the scheme and conducted 1,65,278 deliveries. Of these, 10,278 (6.21%) were caesarean sections, and 11,118 (6.7%) were complicated deliveries J Health Popul Nutr. 2009 April; 27(2): 235–248.

PMCID: PMC2761782Maternal Health in Gujarat, India: A Case Study

Dileep V. Mavalankar, Kranti S. Vora, K.V. Ramani, Parvathy Raman, Bharati Sharma, andMudita Upadhyaya

Looking back…Training of MBBS doctors on emergency

obstetric care• In 2005, the Obstetrics and Gynecology Association of India (FOGSI)

started an initiative, along with the Government of Gujarat, to train general doctors (Medical Officers with MBBS degree) in comprehensive EmOC. The design of the course and technical backstopping was done by JHPIEGO and the AMDD project. Master trainers from teaching hospitals were trained at the Christian Medical College, Vellore.

• Training of MBBS doctors on anaesthesia - anaesthesia society is not involved in this training and is somewhat opposed to it

• Training of skilled birth attendants for normal deliveries - Unfortunately, there is no systematic MIS to record if these trained ANMs have been providing more or better maternal care

The guidelines

They are many!Country Specific & State

Specific Relevance & Impact

How can we achieve MDG?• Scaling up and prioritizing a package

of high-impact interventions• Strengthening health systems• . . . and INTEGRATING efforts

Male Involvement matters!

Innovation in Health Care!• More than 100countries are now

exploring the use of mobile phones to achieve better health

• using innovation to increase efficiency and impact

Women Health Issues can be dealt with

• Addressing socio – cultural context• Following country specific guidelines• Up scaling of High Impact

Intervention

• Keeping in mind…– Short & Long term benefits – Achieving MDG

Changing scenario• Demands re-designing strategy &

planning• Early menarche• Age @ Marriage / sexual activity• Increased prevalence of cancer –

breast & cervix• Changing life style• Changing environment & exposure

Investing in Preventive Health

• Wiser way to reach MDG• Can minimize disease burden• Save time, money & energy!• HOLISTIC approach to health management

Changing Trend in Health Care

• HR issues at Govt Hospitals• Cost Issues at Private hospitals• Neglected Women Health Dept at

Corporate Hospitals• Availability + Affordability +

Accessibility is a major challenge!• ? EBM practice, Quality Check &

Documentation – Needs improvement

Need of the time..• Being accountable for

commitments• Political leadership• Community engagements• Beyond numbers > Focusing on

quality… Janani Suraksha Yojana (JSY) ISD 7.39 lakhs in 2005-06 to about 1 crore in 2009-10.

. . . Solutions• Educate, engage and mobilize communities• Scale up implementation of the most

appropriate interventions • Share best practice, test new approaches,

use the best tools possible and audit clinical practice

• Track progress and hold all stakeholders (including themselves) accountable for their commitments

• Develop and test innovative approaches to delivering essential services

Innovative solutions?! • Target specific

intervention– Target Population– Target Age / Literacy

• Mobile apps!• Social networking –

Facebook & others• BISAG & Doordarshan

prog with newer ideas

Innovation in thought process & action

• Sex Education – Boon or Boomerang ?!• Abortion – Legal & SAFE?!• Reaching out via different channels

like coffee shops / spa / saloon / SHG /

• CORPORATES joining health management

• Multidisciplinary approach & synergistic action plans

Sharing Data & Sensitizing• Being Sensitive & Sensitized – two

different aspects!• Data on fingertips – e.g. Tamilnadu

Strengthening Public-Private Partnership

Clinical experience & observation

• Catching them young really works!• Mass communication MUST have

correct messages• Integrated efforts – better accepted• Follow up & helpline – very essential• Well designed IEC material helps

many. . .

Educational material ! free!!!

Building confidence, sharing evidences

• Counseling program• TRUE value based information

regarding available options

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Thank YOU . . .

Presentation designed & developed By

Dr Darshna ThakkerConsultant Gynecologist & ObstetricianIEC Consultant

info@sarjanhealthcare.comwww.sarjanhealthcare.com

+91 98240 69989