AVERTING MATERNAL DEATHS, EVIDENCE BASED INTERVENTIONS TO SCALE

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AVERTING MATERNAL DEATHS, EVIDENCE BASED
INTERVENTIONS TO SCALE
Tamilnadu Experience INDIA

• Dr. Jayanthi
• UNICEF
• Tamilnadu, India

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DEMOGRAPHIC PROFILE
Source Registrar General DPHPM
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MATERNAL DEATHS REPORTING, ANALYSIS REVIEWS

• Sensitization of Health functionaries, line
  listing of all maternal deaths - 1996
• Investigation and Institution based audit - 1996
• Almost 100 reporting data analysis since 2001
  
• Investigation of maternal deaths using verbal
  autopsy format.
• District level Maternal death audit
• State reviews

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POSITIVE OUTCOMES

• Identified both medical and contributory causes
  that led to the maternal deaths
• Identified the gaps in the existing health care
  delivery systems
• Made the administrators to look beyond the data
  analysis
• Showed directions for future initiatives
• Unicef has been a major partner in all the key
  initiatives taken by the State

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KEY FINDINGS

• Maldistribution of FRUs / Specialists shortage
  of specialists.
• Sub standard care in the institutions
• - Delay in arranging transfusion
• - Poor Accountability of service providers
• - No Standard treatment protocols
• Unnecessary Referral
• - want of blood specialists
• - No obstetric first aid before referral
• - 30 deaths were during transit.

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INITIATIVES

• Re distribution of specialists
• Training for MBBS doctors in Obstetric anesthesia
• Hiring of Anesthetists

• Birth companion initiative

• Community blood donation campaign
• Establishment of CEmONC centres _at_ 2 to 3 per
  district

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COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN
CARE CENTERS (CEmONC)

• ROUND THE CLOCK
• Caesarean services
• Separate casualty for obstetrics, newborn and for
  general cases.
• Blood bank / storage centre services

62 functioning, would be scaled up to another 32
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COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN
CARE CENTERS

• Ensured availability of Specialists
• Training
• On use of emergency treatment protocols for
  maternal newborn complications
• On standard operating procedures for Blood bank
• General surgeons in performing Caesarean section.
  
• Certification of CEmONC centres
• Review of Quality of care

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EMERGENCY TRANSPORT

• Lack of transport facilities/ Inability to pay
  for transport under utilization of Govt.
  ambulances
• One fully equipped ambulance per block (100,000
  population) 385 ambulances.
• NGO run, permitted to collect user fees
• BPL families exempted from payment
• Free transport for deliveries (voucher system)
• Central emergency help line (central control room
  for each district) with common toll free
  number- 1056

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24 HOUR DELIVERY PHCs

• Poor utilization of Primary Health Care services
• Staff nurses were posted on 8 hours shift duty
  in PHCs, this ensured round the clock
  availability of Services
• Initiated in 90 PHCs in 1999- 2000, Now in in
  780 , remaining 637 would be covered in the next
  2 years

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DISTRIBUTION OF DELIVERIES IN 1999- 2000 TO
2007 -2008
Domi.
Pvt.
GH
PHC
HSC
Source PHC Records
- upto July 2007
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FAMILY WELFARE SERVICES

• 6. Unmet need for safe abortion services /
  contraception
• 6 of maternal deaths due to denial of MTP
  services
• Unmet need for family welfare services - 13
• Focus to provide family welfare services in the
  PHCs
• Hiring of private anesthetists
• Provision of operation theatre contingencies
• Formation of district operating team for PHCs
• PHC OTs to be made functional
• Safe abortion services - Manual Vacuum
  Aspiration

MD verbal autopsy report NFHS - 1999
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COMMUNITY AWARENESS

• Lack of community Awarness
• Out reach services strengthened
• Counselling mothers on birth preparedness
  complication readiness
• Educating mothers family on ealry
  identification of danger signs
• Location and Service provision in CEmONC centres
  popularized
• Toll free no of emergency transport popularized

Chennimalai PHC
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ESTABLISHMENT OF BASIC EMERGENCY OBSTETRIC
NEWBORN CARE CENTRES

• Poor skills among health providers, No obstetric
  first aid lack of BEmONC Services
• All Nurses trained on Essential Obstetric
  Newborn Care
• 385 strategically located PHCs_at_ one per one for
  every 100,000 population upgraded
• Upgrading the skills of nurses to provide first
  aid for Obstetric and Newborn emergencies
• Infrastructure Strengthening
• USG, Semi auto analyser, Radiant Warmer,
  Phototherapy Unit etc supplied

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MATERNAL DEATHS REPORTED
Source RCH
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TREND OF MATERAL MORTALITY RATIO
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CHALLENGES AND CONCERN

• Quality of AN / IN / PN care at all levels
• 53 of women in the reproductive age group are
  anaemic.
• Scaling up emergency transport system
• Poor Urban health services.

In Tamilnadu, Even today 2 women die every day
due to Obstetric complications, which is not
acceptable WE NEED TO SUSTAIN THE EFFORTS TAKEN
AND PLAN FOR NEW STRATEGIES TO ADDRESS THE
CHALLENGES
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Thank you