EMERGENCY OBSTETRIC CARE IN TWO COMMUNITY HEALTH CENTRES IN WARDHA DISTRICT, MAHARASHTRA A RAPID ASSESSMENT STUDY - PowerPoint PPT Presentation

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EMERGENCY OBSTETRIC CARE IN TWO COMMUNITY HEALTH CENTRES IN WARDHA DISTRICT, MAHARASHTRA A RAPID ASSESSMENT STUDY

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EMERGENCY OBSTETRIC CARE IN TWO COMMUNITY HEALTH CENTRES IN WARDHA DISTRICT, MAHARASHTRA A RAPID ASSESSMENT STUDY Conducted by Datta Meghe Institute of Medical Sciences – PowerPoint PPT presentation

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Title: EMERGENCY OBSTETRIC CARE IN TWO COMMUNITY HEALTH CENTRES IN WARDHA DISTRICT, MAHARASHTRA A RAPID ASSESSMENT STUDY


1
EMERGENCY OBSTETRIC CARE IN TWO COMMUNITY HEALTH
CENTRES IN WARDHA DISTRICT, MAHARASHTRA A
RAPID ASSESSMENT STUDY
  • Conducted by
  • Datta Meghe Institute of Medical Sciences
  • Sawangi (M) Wardha Maharashtra

Investigators - Dr S Z Quazi Dr Abhay
Gaidhane
2
Background
  • 5th MDG - reduction of the MMR by three quarters
    by 2015
  • MMR remained relatively unchanged since 1990
  • One woman dies every 5 min from a pregnancy
    related cause
  • Indias MMR 450 / 100000 live birth (Regional
    differences)
  • Maharashtra MMR 145 / 100000 live birth
  • The Challenge
  • 15 of all pregnancies will result in
    complications, which are extremely difficult to
    predict
  • most of these lives could be saved if affordable,
    good-quality emergency OB care available 24X7

The State of World Children 2009, UNICEF
State PIP District PIP
3
Context
  • NRHM promises to provide EmOC through CHC
    conforming to minimum standard set by IPHS under
    NRHM
  • ensuring accessibility and quality of EmOC
    services
  • MMR of Wardha - 400/100000 live birth
  • need for deeper enquiry into the accessibility
    quality of EmOC
  • Therefore a rapid assessment was conducted to
    assess the EmOC services at CHCs in Wardha
    District

source Wardha District PIP 07-08
4
Specific Objectives
  1. To assess the readiness of CHCs in Wardha
    (Maharashtra) in providing EmOC services with
    reference to the IPHS developed under the NRHM
  2. To study the current referral and utilization
    pattern of EmOC
  3. To identify barriers and facilitators for
    providing EmOC at CHCs from both, user as well as
    provider perspectives

5
Study Setting
  • Located in Central India, Maharashtra state,
    Blocks - 8
  • Population - 1.2 million
  • Rural - 73.6
  • Urban - 22.4
  • Sex Ratio - 935 / 1000
  • Birth rate 16.7 / 1000
  • IMR - 35.8/1000 live birth
  • Health Infrastructure
  • Medical College Hospitals 2
  • Civil Hospital 1
  • CHCs 8
  • PHCs - 27

6
Methods
  • Study design - A cross-sectional, qualitative
    study with facility assessment
  • Sampling 2 (Arvi Hinganghat) of 8 CHCs
    randomly chosen
  • Ethical Issues IRB approval obtained
  • Tools of data collection
  • in-depth Interviews
  • focus group discussions
  • observation using a standard checklist

7
Data Collection stakeholders
Issues / objectives Interviews (Women 16 CS 1 MO CHC 2 Local leader 2 Private Provider - 2 Total 23) Observation (Both CHCs Total -2 ) FGDs (One at each CHC Total 2) Record review (Districts 2 CHCs)
EmOC facilities at CHC as per the IPHS Civil Surgeon CHC MO CHC Review of district MIS and CHC data
Facilitators / barriers for providing EmOC Civil Surgeon CHC MO Private provider
Facilitators barriers for accessing EmOC Women (selected from CHC record) Local leader Women
Pattern of EmOC utilization Women (selected randomly from CHC record) Health provider Review of MIS CHC records
8
Definitions
  • Basic EmOC
  • Parenteral administration of antibiotics,
  • Parenteral administration of anticonvulsants,
  • Parenteral administration of oxytocics,
  • Assisted Vaginal delivery
  • Manual removal of placenta retained products of
    conception
  • Comprehensive EmOC
  • Basic EmOC plus
  • Facility for caesarean deliveries and
  • Blood transfusion facilities

9
Scoring for facility assessment
Services Available Max Score
Manpower 15 28.85
Infrastructure 10 19.23
Drugs 8 15.38
Equipment 6 11.54
Emergency services (OB) 5 9.62
Training 4 7.69
Transport / Ambulance 4 7.69
All services (total score) 52 100
  • Ground realities considered for designing score

10
Percentage Scores for facility assessment -
Hinganghat CHC
Poor
Needs improvement
Satisfactory
Good
11
Percentage Scores for facility assessment Arvi
CHC
Poor
Needs improvement
Satisfactory
Good
12
Findings
  • Both CHC
  • Functional 24X7
  • Adequate physical infrastructure for
    comprehensive EmOC
  • Average distance for women to CHC is 20 Km and
    money spent for travel 20 to 200 Rs
  • Blood bank - functional at one CHC, supplies
    frequently out of stock
  • EmOC Drugs frequently in short supply.
  • Patients have to purchase from nearby 24X7
    private pharmacy
  • usually all drugs are available)
  • Referral ambulance in working condition at one
    CHC.

13
Findings
  • Unavailability of full time specialist at both
    CHC
  • Two contractual specialists at Hinganghat CHC
  • Obstetrician from Hinganghat town
  • Anesthesiologist called from Wardha town (60 km /
    2 hrs)
  • Other barriers
  • unawareness and lack of involvement of private
    provider
  • lack of EmOC training of available staff at one
    CHC
  • poor economic status of people

14
Referral / utilization pattern
From experiences of 10 women received EmOC in
recent 6 months
Hinganghat CHC Arvi CHC
Referral in to CHC Self 2 2
Referral in to CHC PHC 2 1
Referral in to CHC GP 1 2
Services received at CHC Delivered at CHC 1 (next day morning - assisted) Immediately referred to tertiary care hospital (low birth weight baby) 1 (normal) Next day referred to tertiary care hospital for blood transfusion
Services received at CHC LSCS 1 (anesthesiologist called from Wardha) 0
Reasons for out referral Immediate referrals Obstructed labour (1) Hemorrhage (2) Blood transfusion (2) Hemorrhage (1) Multiple pregnancy (1)
15
Referral / utilization pattern
  • Users prefer CHC - less time cost for
    transportation
  • ... I went there (CHC) as it was nearest
    facility from my home (mother 8)
  • CHCs refer most EmOC cases to tertiary centers
  • Specialist unavailable at CHC during emergency
  • ... we had to refer ...no other option.. as
    there are no specialist and blood is also not
    available most of time (Medical Officer Arvi)
  • Caesarean delivery costs
  • CHC (elective CS) - Rs 1,500 to 12,000
  • Tertiary Centers - Rs 2,000 to 5,000
  • .... we have to call the anaesthesiologist from
    Wardha (60 Km / 2 hrs distance) and he charged Rs
    2500 (mother - 3)

16
Conclusions
  • Readiness for EmOC Availability of physical
    infrastructure however no full time specialists
  • Hinganghat CHC - Mostly assisted deliveries
    elective caesarean
  • Arvi CHC - only normal deliveries
  • Services at CHC expensive than at tertiary
    centers
  • Women seek EmOC care at CHC, but most referred to
    tertiary centers after supportive treatment
  • EmOC service delivery and utilization pattern
    highly skewed towards tertiary centers
  • Complicated deliveries are not receiving EmOC at
    CHCs in its true sense

17
Limitation of this study
  • Direct care seekers at tertiary centers possibly
    missed
  • Patients seeking services from the private
    provider were not studied, therefore we could not
    comment the pattern of EmOC services utilization
    from private providers
  • Findings may not be generalizable to other states
    or regions, however across Maharashtra State the
    infrastructure and health manpower problem is
    relatively similar.

18
Recommendations
  • Physical Health Infrastructure remains
    underutilized in absence of specialists
  • Therefore, need to address the health workforce
    crisis comprehensively to provide EmOC services
    at CHC level
  • Appointment of contractual specialists for EmOC
  • Preferably from the same town
  • Skill building of staff for EmOC
  • Better involvement of private providers in EmOC
    services (PPP)
  • Involvement of Medical College unto the level of
    CHC
  • Round the clock posting of specialist (24 X 7)

19
Thank you
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