Safe Motherhood Programme and emergency medical transport, Gujarat, India Gujarat EMRI Services
Profile of Gujarat State <ul><li>Gujarat is a state in western India.  </li></ul><ul><li>Total population of 51 million(20...
933 921 Sex Ratio (No. of women per 1000 men) 67 75 54 69 80 58 Literacy Rate :  total Male Female 407 (200-300) Maternal ...
Four Tier Health Care System  <ul><li>District hospital  with 4-5 specialist services for 1-3 million people  </li></ul><u...
“ Every Pregnancy Is at Risk:” Current Approach to Reduction of Maternal Mortality Advances in Maternal and Neonatal Health
Maternal Mortality: A Global Tragedy <ul><li>Annually, 585,000 women die of pregnancy related complications  </li></ul><ul...
Maternal Death Watch <ul><li>380 women become pregnant </li></ul><ul><li>190 women face unplanned or unwanted pregnancy </...
Global Causes of Maternal Mortality
But WHY Do These Women Die? <ul><li>Delay in decision to seek care </li></ul><ul><ul><li>Lack of understanding of complica...
Key problems with health infrastructure & services delivery <ul><li>Substantial shortfall in health infrastructure in rura...
Effect on Performance Indicators 54 - - Mothers who received post partum check up within two days of delivery 65 54 43 Del...
Challenges in Safe Motherhood program <ul><li>Human resource for EmOC major problem  </li></ul><ul><li>ANMs and MOs- not S...
Recent GOG Initiatives to improve Maternal Health <ul><li>Chiranjeevi Yojana </li></ul><ul><li>Janani Suraksha Yojana – in...
Chiranjeevi Yojana – a Flagship scheme for delivery care for poor <ul><li>Rationale – very few obgyns in govt system but l...
Changing the World The experience of EMRI as India’s First and Only Professional Integrated Emergency Response Provider
<ul><li>300,000 emergencies occur per day (108 M p.a.)  </li></ul><ul><ul><li>80% are at the bottom of the pyramid  </li><...
<ul><li>EMRI a Non-profit  organisation (commenced in 2005) </li></ul>1. NPO
<ul><ul><li>Single  toll free number ‘ 1-0-8 ’ accessible on land and mobile phones  </li></ul></ul><ul><ul><li>Significan...
<ul><ul><li>Ambulance  design based on best of class - Indianized </li></ul></ul>7. Ambulance
<ul><ul><li>Medical Research  </li></ul></ul><ul><ul><ul><li>Effectiveness of interventions in specific emergency conditio...
<ul><ul><li>Pre-hospital Care / Emergency Medicine  Training  in collaboration with  Stanford </li></ul></ul>9. Training
<ul><li>12,000 + EMRI Associates </li></ul><ul><li>6,800 + Private Hospitals / Nursing homes (31% in AP and 15% in Gujarat...
Medical Emergencies - Gujarat Medical Emergency % of Total Rural % Female % Age Yrs Pregnancy related 34 91 100 23 Injurie...
Robbery – Thief requested wife to dial 108 after 10 minutes to take the injured husband to hospital Extraordinary Performa...
Bomb Blasts Ahmedabad Snake Bite Suicide Attempt Candle Light Delivery 35 Ambulances to Bihar Extraordinary Performance fr...
MMR declining in Gujarat
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Emergency Response service and Maternal health

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  • Emergency Response service and Maternal health

    1. 1. Safe Motherhood Programme and emergency medical transport, Gujarat, India Gujarat EMRI Services
    2. 2. Profile of Gujarat State <ul><li>Gujarat is a state in western India. </li></ul><ul><li>Total population of 51 million(2001) with 15% SC and 7% ST population </li></ul><ul><li>It has 25 districts, 242 towns and 18,618 villages. </li></ul><ul><li>One of the most urbanized states of India - with 37% urban population </li></ul><ul><li>Economically rapidly growing state – SDP 8-10% per year </li></ul>
    3. 3. 933 921 Sex Ratio (No. of women per 1000 men) 67 75 54 69 80 58 Literacy Rate : total Male Female 407 (200-300) Maternal Mortality Rate 3.2 2.9 Total Fertility Rate 58 53 Infant Mortality Rate (2004) 7.50 6.90 Death Rate (2005) 23.80 23.70 Birth Rate (2005) 22.66 21.34 Decadal Growth rate (1991-01) 1027 50.60 Population in million ( 2001) India Gujarat Key Demographic & Health Indicators
    4. 4. Four Tier Health Care System <ul><li>District hospital with 4-5 specialist services for 1-3 million people </li></ul><ul><li>Community Health Center with 1-2 specialist for 100,000 to 300,000 population </li></ul><ul><li>Primary health Center with MO for 30,000 population </li></ul><ul><li>Sub-health Center with ANM for 5,000 pop. </li></ul>
    5. 5. “ Every Pregnancy Is at Risk:” Current Approach to Reduction of Maternal Mortality Advances in Maternal and Neonatal Health
    6. 6. Maternal Mortality: A Global Tragedy <ul><li>Annually, 585,000 women die of pregnancy related complications </li></ul><ul><ul><li>99% in developing world </li></ul></ul><ul><ul><li>~ 1% in developed countries </li></ul></ul>
    7. 7. Maternal Death Watch <ul><li>380 women become pregnant </li></ul><ul><li>190 women face unplanned or unwanted pregnancy </li></ul><ul><li>110 women experience a pregnancy related complication </li></ul><ul><li>40 women have an unsafe abortion </li></ul><ul><li>1 woman dies from a pregnancy-related complication </li></ul>Every Minute...
    8. 8. Global Causes of Maternal Mortality
    9. 9. But WHY Do These Women Die? <ul><li>Delay in decision to seek care </li></ul><ul><ul><li>Lack of understanding of complications </li></ul></ul><ul><ul><li>Acceptance of maternal death </li></ul></ul><ul><ul><li>Low status of women </li></ul></ul><ul><ul><li>Socio-cultural barriers to seeking care </li></ul></ul><ul><li>Delay in reaching care </li></ul><ul><ul><li>Mountains, islands, rivers — poor organization </li></ul></ul><ul><li>Delay in receiving care </li></ul><ul><ul><li>Supplies, personnel </li></ul></ul><ul><ul><li>Poorly trained personnel with punitive attitude </li></ul></ul><ul><ul><li>Finances </li></ul></ul>Three Delays Model EMRI focus area
    10. 10. Key problems with health infrastructure & services delivery <ul><li>Substantial shortfall in health infrastructure in rural areas </li></ul><ul><li>Problem of availability of specialists in public hospitals </li></ul><ul><li>Lack of accountability – ANMs and MOs not staying at place of posting. – availability very limited </li></ul><ul><li>Too much focus on FP and Immunization – neglect of maternal care esp. delivery care </li></ul>
    11. 11. Effect on Performance Indicators 54 - - Mothers who received post partum check up within two days of delivery 65 54 43 Delivery attended by Doc, nurse, ANM. 8.5 3 Caesarean section 32 20 Private sector 11 15 Public sector deliveries 45 54 65 Domiciliary 55 46 37 Institutional Deliveries 65 61 61 Mothers who received 3 ANC visits NFHS 3 2006 NFHS 2 1998 NFHS 1 1993 Indicator- all values are in %
    12. 12. Challenges in Safe Motherhood program <ul><li>Human resource for EmOC major problem </li></ul><ul><li>ANMs and MOs- not Skilled birth attendants and not accountable for delivery </li></ul><ul><li>Inadequate infrastructure for delivery care – poor O & M, no blood available in rural areas </li></ul><ul><li>Lack of managerial capacity and positions </li></ul><ul><li>Weak vital registration system- poor Maternal death recording </li></ul><ul><li>Absence of socio-political priority MH </li></ul>
    13. 13. Recent GOG Initiatives to improve Maternal Health <ul><li>Chiranjeevi Yojana </li></ul><ul><li>Janani Suraksha Yojana – incentive for institutional delivery </li></ul><ul><li>Training General doctors for BEmOC, CEmOC and Anesthesia </li></ul><ul><li>Skill up gradation training to ANMs </li></ul><ul><li>Emergency transports system: EMRI 108 services </li></ul><ul><li>Establishment of Blood storage units with NGOs </li></ul>
    14. 14. Chiranjeevi Yojana – a Flagship scheme for delivery care for poor <ul><li>Rationale – very few obgyns in govt system but lots in private sector – even in rural areas </li></ul><ul><li>Public Private partnership (PPP) to improve access to institutional delivery for poor </li></ul><ul><li>Voucher - like scheme for poor </li></ul><ul><li>Piloted in five backward districts for 1.5 years now scaled up to all 25 districts </li></ul><ul><li>Package of 100 deliveries including CS given to Private Ob for providing services delivery care, basic newborn care & transport money </li></ul><ul><li>Average per delivery payment to private obgyn is 40 $ </li></ul><ul><li>Payment in advance !!! </li></ul>
    15. 15. Changing the World The experience of EMRI as India’s First and Only Professional Integrated Emergency Response Provider
    16. 16. <ul><li>300,000 emergencies occur per day (108 M p.a.) </li></ul><ul><ul><li>80% are at the bottom of the pyramid </li></ul></ul><ul><ul><li>80% deaths occur in hospitals in the first hour </li></ul></ul><ul><ul><li>4 M deaths p.a. </li></ul></ul><ul><li>Absence of 4 As </li></ul><ul><ul><li>Access </li></ul></ul><ul><ul><li>Availability </li></ul></ul><ul><ul><li>Affectionate Care </li></ul></ul><ul><ul><li>Affordability </li></ul></ul>Emergency Scenario in India Until 2004
    17. 17. <ul><li>EMRI a Non-profit organisation (commenced in 2005) </li></ul>1. NPO
    18. 18. <ul><ul><li>Single toll free number ‘ 1-0-8 ’ accessible on land and mobile phones </li></ul></ul><ul><ul><li>Significance of 1-0-8 in </li></ul></ul><ul><ul><ul><li>1 1 X 2 2 X 3 3 </li></ul></ul></ul><ul><ul><ul><li>Sacred number in Hinduism in many ways (Pillars, Nama Japa, Krishna dances with 108 Gopies, Natraja dances in 108 poses) </li></ul></ul></ul><ul><ul><ul><li>Distance of the sun from the earth divided by the diameter of the sun </li></ul></ul></ul><ul><ul><ul><li>In Japan, at the end of the year a bell is chimed 108 times to finish the old year and welcome the new one. Each ring represents one of 108 earthly temptations a person must overcome to achieve Nirvana </li></ul></ul></ul><ul><ul><ul><li>Number of minutes cosmonaut Yuri Gagerin orbited earth during the first manned space flight </li></ul></ul></ul><ul><ul><ul><li>The number of stitches on a base ball </li></ul></ul></ul>4. 1-0-8
    19. 19. <ul><ul><li>Ambulance design based on best of class - Indianized </li></ul></ul>7. Ambulance
    20. 20. <ul><ul><li>Medical Research </li></ul></ul><ul><ul><ul><li>Effectiveness of interventions in specific emergency conditions </li></ul></ul></ul><ul><ul><ul><li>Integration with hospital care </li></ul></ul></ul><ul><ul><ul><li>Innovations in interventions, capacities and capabilities </li></ul></ul></ul><ul><ul><li>Systems Research - Best-practices in EMS / prevention of emergency </li></ul></ul><ul><ul><ul><li>Processes </li></ul></ul></ul><ul><ul><ul><li>PCR </li></ul></ul></ul><ul><ul><ul><li>Prevention </li></ul></ul></ul><ul><ul><ul><li>Education and Training </li></ul></ul></ul><ul><ul><li>Operations research (Analytics) </li></ul></ul><ul><ul><ul><li>Predict future state of healthcare, disease incidence </li></ul></ul></ul><ul><ul><ul><li>Better utilization of resources </li></ul></ul></ul><ul><ul><ul><li>Reconfiguring processes </li></ul></ul></ul>MR SR OR 8. Research
    21. 21. <ul><ul><li>Pre-hospital Care / Emergency Medicine Training in collaboration with Stanford </li></ul></ul>9. Training
    22. 22. <ul><li>12,000 + EMRI Associates </li></ul><ul><li>6,800 + Private Hospitals / Nursing homes (31% in AP and 15% in Gujarat - patients admitted in pvt hospitals) </li></ul><ul><li>2,000 Police / Fire Stations </li></ul><ul><li>366 M population covered in 8 States </li></ul><ul><ul><li>91% calls taken in first ring </li></ul></ul><ul><ul><li>7,200 emergencies handled ( 2.5 Million annualized) </li></ul></ul><ul><ul><li>1,500 Ambulances - 5+ trips a day </li></ul></ul><ul><ul><li>< 10 minutes (2/3 rd of RTA and Cardiac) ambulances reached </li></ul></ul><ul><ul><li>< 15 minutes (73% of urban) and < 25 minutes (68% of rural) Ambulances reached </li></ul></ul><ul><ul><li>100% virtual handholding (in ambulance) by EMTs and physicians </li></ul></ul><ul><li>130+ lives were saved (50,000+ till now) and 7,070 victims received timely, high-quality pre-hospital care </li></ul>a Andhra Pradesh Gujarat Sikkim Karnataka Orissa Haryana Punjab Himachal Pradesh Uttar Pradesh Chattisgarh Jharkhand West Bengal Bihar Arunachal Pradesh Meghalaya Tripura Manipur Nagaland Mizoram Uttarakhand Madhya Pradesh Tamil Nadu Jammu & Kashmir Maharashtra Rajasthan Assam Goa Delhi Today at EMRI Kerala
    23. 23. Medical Emergencies - Gujarat Medical Emergency % of Total Rural % Female % Age Yrs Pregnancy related 34 91 100 23 Injuries 18 60 21 29 Cardiac related 5 61 39 51 Respiratory related 5 59 37 51 Acute Abdomen 4 78 42 37 Suicide related 1 65 41 26
    24. 24. Robbery – Thief requested wife to dial 108 after 10 minutes to take the injured husband to hospital Extraordinary Performance from Ordinary People 3 Hour Neonate (Baby Girl) Buried Firing - Between Army Commanders and Naxalites Cyclist– Fell on road divider rod
    25. 25. Bomb Blasts Ahmedabad Snake Bite Suicide Attempt Candle Light Delivery 35 Ambulances to Bihar Extraordinary Performance from Ordinary People
    26. 26. MMR declining in Gujarat

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