National Consultation on Role of Dais in NRHM New Delhi 1 – 2 May 08
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Transcript of National Consultation on Role of Dais in NRHM New Delhi 1 – 2 May 08
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Dai Ma and Her Contribution to Well Being of Mother, Child and Society at Large:
Ground Level Realities and EvidencesEmerging Issues and Concerns
National Consultation on
Role of Dais in NRHM
New Delhi
1 – 2 May 08
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Historical Perspective • DAI MA was not pushed down from top but evolved from
within the society for centuries
• Combined traditional wisdom and knowledge and adopted into local cultural practices
• Not a mere role of giving birth to a baby, but provides all important psycho social and emotional support to mother and her family
• If properly trained and supported, the DAI MA has proved in expanding her role beyond MCH services as she has the respect, trust and acceptance in the community
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in Context to Maternal Mortality
• Insufficient evidence to blame Home Deliveries by Dais as THE cause for higher and persistent MMR – Community in rural, urban, tribal and remote areas
generally opt for home delivery – but even in many of the sub center / PHC / CHC villages
or, urban slums, the situation is no differentWHY…
– because of no. of issues related to socio cultural, economic and accessibility.
– So in such a situation, Dais have been filling up this gap in their own way.
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in Context to Maternal Mortality
– But on other side……. • The quality of training given to them was far from satisfactory• Most of the Public Health Institutions are not functional or not
Mother Friendly for conducting institutional delivery• No back up support readily available for referring and
managing complicated delivery cases. – Attitude of hospital staff: not welcoming at large, disrespectful
and even hostile at times – Real tragedy when ask to move from one place to other. – Many of such cases either deliver or die on the way. – This has been clearly reflected into maternal deaths audit.
– So it’s a collective failure • to provide adequate response to the needs of mothers in such
situations and• for non reduction of Maternal Mortality and Morbidity to
desired levels
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Positive Evidences from Ground Regarding Contribution made by DAI’s
(If Adequately Trained and Supported)
Maternal and Child Care• Intranatal Care: Promote institutional delivery alongwith
Chirinjivi / Janani benefits – if asssured of good, mother friendly nearby centers – and in such cases, accompany as Birth Companion for
providing psycho-social support to mother OR
• If the community wishes and prefers to have HOME DELIVERY in their own, friendly environment, the DAIs are able to….– Conduct Normal Delivery cleanly and safely at home– Provide Immediate New Born Care (Asphxia Management,
Early Breast Feeding, No Bath on First Day) – Identify the delivery complications in time– Ensure prompt transfer of such cases to the nearby functional FRU
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Referral of Maternal Cases by Referral of Maternal Cases by Front Line Workers to Base HospitalFront Line Workers to Base Hospital
at SEWA Rural, Jhagadiaat SEWA Rural, Jhagadia
499
598 610
703
914
400
500
600
700
800
900
1000
03 - 04 04-05 05-06 06-07 07-08
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Complicated Maternal Admissions at Complicated Maternal Admissions at Base Hospital at SEWA Rural, JhagadiaBase Hospital at SEWA Rural, Jhagadia
766 756
860
1191
1308
600
700
800
900
1000
1100
1200
1300
1400
1500
03 - 04 04-05 05-06 06-07 07-08
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Hospital Delivery (%)Hospital Delivery (%)Jhagadia Block 1.71 Lac Pop.Jhagadia Block 1.71 Lac Pop.
(Out of about 3500 Deliveries a Year) (Out of about 3500 Deliveries a Year)
23.1
27.729.4
35
45
15
20
25
30
35
40
45
50
2001-03 2004-05 2005-06 2006-07 2007-08
Only 5% in Govt. Institutions
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Maternal Mortality Ratio (MMR)Maternal Mortality Ratio (MMR)Jhagadia Block Jhagadia Block 171,000 Pop.171,000 Pop.
(about 3500 Deliveries a Year) (about 3500 Deliveries a Year)
594
494
110
360
283
170
100
150
200
250
300
350
400
450
500
550
600
650
700
02 - 03 03 - 04 04-05 05-06 06 - 07 07-08
(4)
(12)
(16)
(19)
(10)
(6)
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Neonatal Mortality RateNeonatal Mortality Rate (NMR)(NMR)Jhagadia Block 171,000 Pop.Jhagadia Block 171,000 Pop.
(about 3500 Deliveries a Year) (about 3500 Deliveries a Year)
47
38
27
37
23
10
15
20
25
30
35
40
45
50
55
60
03 - 04 04-05 05-06 06-07 07-08
(151)
(134)
(90)
(130)
(82)
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TBA as attendant: promoting referral services
111
157 161 157148
187196
205200
187
221
0
50
100
150
200
250
May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
# of TBA = 1930
Emergency Transport Network of Deepak Foundation
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Strengthening Government Health Facilities
ANM ASHA
TBA
24 x7 SC & PHC(101 out of 158 SC)( 19 out of 39 PHCs)
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Deliveries at SCs and PHCs at DCT
(2006-07 & 2007-08)
2006-07 : Total deliveries : 930 (497+433)2007-0 : Total deliveries : 2389 (873+1516) SCs : 76% rise PHCs : 250 %
53%47
47%
36%
64%
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Positive Response from Govt. of Gujaratin Promoting Cause of Dais
• Helped in Registering Dai Sangathan Gujarat in June, 2005 with State NGO Cordinator as one of the members
• State Govt. passing a resolution to enhance and stranghthen the role of Dais in Oct. 2005
• State Govt. formally approving 7 member NGOs of Dai Sangathan as centers for conducting DAI Training and approved the training budget worth of Rs. 2400 per Dai for 10 days training in Nov. 05
• Participation of Govt. officials in Dai TOT organised by Dai Sangathan as well during Dai Training conducted by its NGO members and jointly signing the taining certificates
• Active Participation of Higher Level Health Officials including Health Minister in State level Dai Sammelans organised during April 05 and April 07
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TBA Gathering at State LevelTBA Gathering at State Level
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Govt. of Gujarat Honouring Dais and Dai Sangathan …Govt. of Gujarat Honouring Dais and Dai Sangathan …
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Release of a Dai Training ModuleRelease of a Dai Training Module
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Issues and Concerns
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Public Health System/NRHM
• Not a Uniform Jacket For All, but the Region Specific Strategy to be evolvedNot a Uniform Jacket For All, but the Region Specific Strategy to be evolved• Still scope to mainstream dais in NRHM
• Relationship between dais and ASHAs• Lack of support system for dais and ASHAs• Education criteria prevents dais from becoming ASHAs
• Pressure on dais and others for institutional delivery• Unreliable data on place of delivery
• Need for council of accreditation with minimum standards
• Lack of financial remuneration for dais’ deliveries and referrals to institutions
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Changing Role of Dais
• In many states, traditional roles of dais is changing
• Erosion of traditional practices such as massage, antenatal care, use of herbs and nutrition, and psychosocial support for pregnant women
• Potential to provide a range of health services
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Recognition and Voice
• Varied definitions, roles and skill levels of dais
• Lack of respect for dais’ knowledge and skills
• No formal recognition (ID cards)
• Lack of organisation and empowerment of dais
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Capacity Building
• Low investment in dais’ capacity building• Inappropriate training – content,
methodology, duration • Insufficient recognition and documentation
of traditional practices .• No integrate dais’ needs and realities, or
acknowledgement of their skill base• Inadequate trainer teams
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Thanks for Listening to the Concerns
and Ground Realities