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Yuva Fogsi oration  2013 mumbai
 

Yuva Fogsi oration 2013 mumbai

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a truly cherished moment....Dr.Kamini Rao oration 2013 mumbai.

a truly cherished moment....Dr.Kamini Rao oration 2013 mumbai.
Dr.Kiranmai devineni
Hyderabad

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  • Looking the other way-
  • MEMORISE THIS PIE CHART. THIS IS THE KEY TO THE CLOSED DOOR
  • Khuljasimsim as we say
  • Amtsl –steps, miso-who statement-march 2011,blood in all CEMONC Centres, WHO model list of essential medicines
  • VV IMP GUIDELINES TO BE READ, PROPAGATED,PARCTICED AND DISSEMINATED-SHOULD BE MADE A GLOBALINITIATIVE
  • WITH TRAGEDIES LIKE THIS, MANY ,GIRLS MAY DIE EVEN BEFORE REACHING MOTHERHOOD. WITH MCH INITIATIVES ONLY ,MMR MAY COME DOWN BUT THESE DEATHS MAY CONTINUE.acute shortage of brides in some states---where will be the mothers

Yuva Fogsi oration  2013 mumbai Yuva Fogsi oration 2013 mumbai Presentation Transcript

  • LIFE OF EVERY MOTHER AND NEONATE COUNTS!!!! YUVAFOGSI 2012 –MADURAI DR.KAMINIRAO ORATION DR.D.KIRANMAI ASST. PROFESSORMGMH,OMC HYDERABADJOINT SECRETARY, OGSH
  • My mother!You come to me like heavens caring arms……………………………..Your caring hands ,tenderly removing thepain,Your love , your care,your faith gave me thestrengthTo face the world void offear APJ ABDULKALAM
  • 14TH JAN 2012 KOLKATA Women are not dying because of a disease we cannot treat They are dying because societies have yet to 23 APRIL 2012 RD make the decision that their lives are worth saving MAMOUD FATHALLA,PRESIDENT FIGO 1997
  • WORDS CAN’T DESCRIBE……….. o Health of the mother When mothers die………. o The health of the child o Human capital A NATIONS of the nation FUTURE Motherless HUMAN AND children die more frequently, SOCIAL CAPITAL IS CRIPPLED. malnourished,  less likely to school.
  • Do our mothers and children count?• WHY SHOULD “WE’ CARE?• MCH indicators - human development index .• Maternal mortality - a proxy indicator of functioning of a health system.• An issue of Human rights.
  • WHERE DO WE STAND? WHAT WENT WRONG? WHAT HAS TO BE DONE ? CURRENT STRATEGIES FUTURE
  • UNFPA,UNICEF 2010 DATATOTAL MATERNAL 284000 DEATHS -2010 DEVELOPING 2,87000 NATIONS 212 100-299 550-999.IN INDIA 56000 WOMEN DIE EVERY YEAR NOT OF DISEASE BUT CHILD BIRTH
  • INDIA THE SUPERPOWER Budget /expenditure on healthINDUSTRY India and Nigeria 1/3 of world’s maternal deathsSPORTS 134th among 182 in the humanDEFENCE development index - 2009.
  • MANY STATES, MANY DISPARITIES ASSAM AND EAG 308OTHERS 149 212 -2010SOUTH STATES127 134 SRS - 2009 81 97
  • WHERE DID INDIA GO WRONG? 1960-1990 2000-2009  Huge private sector-Not 1966- 1980 utilized Target oriented family planning  Lack of synergy Ineffective interventions ANC, High risk approach  Lack of quality supervision, 1980-1991 close monitoring CSSM, UIP, IFA ANM & MOs - accountable - target oriented programs - FP & UIP-Little impact on MMR PHC/SC DELIVERIES- not monitored and neglected.
  • THE SECRET OF SUCCESS OF SRILANKA AND MALAYSIA…….400 THAILAND SRILANKA MALAYSIA•MIDWIVES•SKILLED ATTENDANCE TO BIRTHS•QUALITY•STRENGTHENING OF COMMUNITYHOSPITALS 30 1960-1990
  • 90 percent of maternal deaths are avoidable. POSTPARTUM PERIOD 60% 50% in 24 HOURS- 6 CAUSES 3 DELAYS
  • Maternal Deaths Averted With Access To Emergency Obstetric Services-world Bank2004 15%15% 14% 12% 12%10% 70% 8% 5% 7% 0% 3% 1%
  • The three delays Delay.. Delay.. Delay.. The First Delay (DECISION TO SEEK CARE) • A PREGNANT WOMANWALKING 5 KMS TO REACHPHC DAYS BEFORE HER EDDPREGNANCY INRURAL INDIA
  • 2ND DELAY- TO REACH HEALTH CARE• 70 % do not have a means oftransportation READY• 40-50% percent of deathsoccur at home or on the way• Delays occur while trying tofind money or whiletransporting the patient.
  • THE THIRD DELAY-IN RECEIVING CARE UNTIMELY INEFFECTIVE UNDER STAFFED UNTRAINED/INADEQUATELY EQUIPPED LACK OF INFRASTRUCTUREUNRESPONSIVE/DISCRIMINATORY SERVICES ABUSE/NEGLECT/POOR QUALITY
  • TO SUMMARISE• WE MISSED ONE CARE Emergency Obstetric And Neonatal Care• WE MISSED ONE KEY FUNCTIONARY Skilled Professional Birth Care for every woman Midwife, staff nurse, doctor• THE THREE DELAYS
  • WHAT IS THE SOLUTION??? •ADDRESSES THREE DELAYS •PROVIDES EMONC CARE •INFRASTRUCTURE •LOGISTICS •STAFF • Focuses on 18 lowAPRIL 12,2005 - performing states, EAG States 2017 • 165 worst districts • To Increase the expenditure on health from 1.1% to 3%
  • RISK APPROACH VS EMOC APPROACH BASIC EmOC Functions 6+2 Health centre –No OT  Comprehensive EmOC Functions1. IV /IM ANTIBIOTICS  OT/District hospitals2. IV/IM OXYTOCICS  All six Basic EmOC3. IV/IM functions plus ANTICONVULSANTS  Caesarean section4. Manual Removal of  Blood transfusion placenta5. Assisted Vaginal delivery6. Removal of retained products 4 BEMOC & 1 CEMOC FACILITY FOR EVERY 5 LAKH PEOPLE
  • NRHM KEY STRATEGIES -2005-2012 IPHS ASHA DISTRICT FRU JSY TRAINING 108 LOGISTICS FRUS 24X7PHC Infrastructure CEMONC CARE BUDGET 24X7 BEMOC CAC CENTRES BLOOD BANK COMPREHENSIVEHUGE IMPROVEMENTS IN INFRASTRUCTURE,MANPOWER AND ABORTION CARE (CAC) ACCESS TO SERVICES NEWBORN CARE
  • NRHM-KEY STRATEGY- ASHA-MICROPLAN OF BIRTH• REGISTRATION OF ANC• 4 VISITS• ARRANGING FOR CASH TRANSFER - JSY• PLANNING PLACE OF BIRTH• TRANSPORT• ACCOMPANYING THE PARTURIENT ADDRESSES THE 1ST DELAY
  • JANANI SURAKSHA YOJANA EVEN BIMARU TURNS HEALTHY Trends in Institutional deliveries 2002-04 to 2007; India 80 70 Introduction of JSY 60Percentage of institutional deliveries 50 40 30 BIHAR - 6 FOLD INC 20 FROM 2005-2011 10 0 3.19 CRORE WOMEN BENEFITED UNDER JSY 2002-2004 2005-06 2006-07 2007-08 1ST AND THIRD DELAY As s am Bihar Madhya Prades h Oris s a Rajas than Uttar Prades h India Trends in Institutional deliverieS (NFHS III), 2006-7, 2007-8 22
  • NRHM-KEY STRATEGY Emergency Transport System 108 THE LIFE SAVER• TOLL FREE 108 24x7 X365• 12 STATES,2919 FOR THE SECOND DELAY AMBULANCES• SAVING LAKHS OF LIVES IN CRUCIAL GOLDEN HOUR 23
  • NRHM TRIGGERED INNOVATIVE SCHEMES IN STATES KERALA- 1ST STATE TO ACHIEVE MMR<100 GUJARAT- INNOVATIVE CHIRANJEEVI SCHEME TAMILNADU- FOCUSSED ON QUALITY NRHM strategies All PHCS 24x7 delivery units MDR/verbal autopsy by collector Rs .6000 cash benefit to poor pregnant women ANDHRA PRADESH 108, ANM Tracking, Amma lalana, Sms alerts, matrudevobhava, ayushmanbhava
  • NOT A RESORT-IT’S A PHC!!!
  • Trend in Maternal Mortality Rate-Tamil Nadu 160 140 145 120 109MMR 100 80 AMTSL, 79 LSAS Blood training, storage 60 facility, AN Hiring of Specialists protocol, EMRI 40 etc 20 2000-2001 2004-2005 2008-2009 0 Before RCH RCH NRHM Source DPH & PM YEAR
  • GPS MAPPING TO IDENTIFY SUITABLE HOSPITALS TAMILNADU At least two fully equipped and operational Em OC centers in each of the 32 districts which can be reached within 1 hour from any part of the district
  • TAMILNADU AND INDIA
  • CHILD BIRTH A JOYFUL EVENT – CAN TURN INTO TRAGEDY POST PARTUM PERIOD ACCOUNTS FOR 60% OF MATERNAL AND 50% OF CHILD MORTALITY
  • PPH –QUICKEST OF KILLERS 2 HRS PPH 12 HRS APH1 DAY-24 HRS RUPTURE UTERUS2DAYS-48HRS ECLAMPSIA3 DAYS-72HRS OBSTRUTED LABOR6 DAYS-1 WEEK SEPSIS SOURCE: maine D:safe motherhood programmes: options and issues, centre for population and family health
  • PPH –KEY INTERVENTIONS 25% AMTSL600UG MISOPROSTOL P/R , ORAL B-LYNCH/ MODIFIED B-LYNCH 22% PREVENTABLE STEPWISE DEVSCULARISATION EMERGENCY HYSTERCTOMY
  • FIGO GUIDELINESPrevention and treatment of PPH in low resource settings (SMNH Committee) http://www.figo.org/projects/prevent/pph EVERY MOTHER SHOULD BE OFFERED AMTSL BY SBA EVERY SBA MUST BE TRAINED IN AMTSL BRISTOL AND HINCHING BROOKE STUDIES -AMTSL (5.9% VS 17.9%) IN EXPECTANT MANAGEMENT MISOPROSTOL AS ESSENTIAL DRUG FOR PPH-WHO
  • FIGO GUIDELINES-PPH- INTERVENTIONS AT CEMOC LEVEL Aortic compressionExt bimanual comp Int. Bimanual Comp Video demonstrations NASGEGYPT NIGERIA / ZAMBIA, ZIMBABWE Intra uterine balloon tamponade
  • Preeclampsia-Direct Cause Sepsis-Direct causeRetraining in ANC protocols & POST NATAL CARE VISITSskills - basic BP measurement IPP in labor rooms andMagnesium sulphate in post natal wards-Eclampsia Forty eight hour stay in PHC IEC/ BCC messages to new mothers on danger signs 27% To overcome cultural taboos of26% leaving home before one week
  • OBSTRUCTED LABOR/RUPTURE UTERUS 8%• PARTOGRAM - TRAINING
  • NRHM KEY STRATEGY 13% CAC Unsafe abortion Women centered Comprehensive Abortion•22% of pregnancies- Careinduced abortions • Emergency contraception • Medical abortion•50% -unsafe • Safe MTP Protocol by MVA•95% occur in developingcountries • CONCURRENT• In India- 4 Million unsafe CONTRACEPTIONabortions
  • LET WOMEN DECIDE……….80 million unintended pregnancies in 2012 in developing world- Save the Children Report  If all unwanted pregnancies are prevented ,  If there is no unmet need for contraception  Up to 1 lakh maternal deaths can be prevented –WHO 2005  Spacing - crucial for child survival  Spacing of 36 months after previous child birth can prevent 1.8 million child deaths (25%)  Policy shift from permanent to temporary methods  PPIUCD
  • ANEMIA 80% IN NFHS III -complicates 80% maternal deaths (FOGSI STUDY)Hb % at 1st visit low cost, 20wks,28wks, effective, Health Iron acceptable strategies fortification 34 wks iron. Cooking in De worming iron utensils IV IRON Foot wear SUCROSE A real boon 20%
  • WHAT ABOUT ME?
  • India is epicenter of Childhood Mortality• 7.6 MILLIONS DIE EVERYYEAR -2010• 2 MILLIONS DIE IN INDIA• 1 MILLION ARE NEONATES• 50% DIE WITH IN 1 HOUR• 75% DIE WITH IN 1 WEEK Worldwide distribution of child death Each dot represents 5000 deaths Lancet 2003
  • WHY do newborns in India die? Lancet Neonatal Survival Series 2005 Neonatal Breast feeding resuscitation 55-87% Neonatal 6-42% Birth Tetanus asphyxia and 23% others10 %Hypothermiamanagement, Pre-Term Severe Kangaroo Births Infections Communitymother care- (25%) (36%) based 18-51% pneumoniaWHO World health statistics 2007 management
  • New Child Health Initiative by GOI Sep 2009 Navjaat Shishu Suraksha Karyakram (NSSK)A new programme on BasicNewborn Care andResuscitation, launched nationallyby GOI to address importantinterventions of care at birthGOI and IAP have signed a MoU for training FOGSI important partner
  • NRHM INITIATIVES FOR NEW BORN AND CHILDHEALTHIMNCI 433 DTS-4,92,611 TRAINEDNavjat Sishu Suraksha karyakram 50000 trainedSpecial Newborn Care Units (SNCU) 293Newborn Stabilization Units(NBSU) 1134Newborn Care Corners Home based (NBCC) new born care
  • HOME BASED CARE FOR MOTHER AND NEWBORN-THE VITAL missing LINK 5 VISITS IN ASHA 42 DAYS RS 50/1HRD1,3,7,10 42 VISIT Weight BCG,OPV,DPTmonitoring Completion Safety ofRegistration both mother of birth and child at 42 days
  • Home visits for young infants: ObjectivesKANGAROO IDENTIFY MOTHER ILLNESS, CARE REFERRALEXCLUSIVE CORD CARE BREAST HAND FEEDING WASHING
  • Expected outcomes41% of institutional deliveries Greater impact in 90% trained states with higher15-30% reduction in neonatal mortality NNMR
  •  INSPITE OF THE INITIATIVES……..STILL A LONGWAY TO GO ……..STILL TO REACH EVERY MOTHER AND NEONATE 3.7 2012
  • PROGRESS NOT GOOD ENOUGH MMR BY 2015 We are 212 in 2010 153 Our goal is 100 We are 63 in 2010 Under 5 Our goal is 38 mortality by 2015 54
  • YET TO REACH EVERY MOTHER AND NEONATE 30% of PHC - no building PHCS Only •58% Do DELIVERIES 40% - no vehicle •6%- Do MTPS 70 % - no linkage to district blood bank •22% Neonatal Care •65% IUDS Blood bank sources vital but neglected •41% Sterilisations Too far, Too little, Too Late 55.2% ObstetriciansCHC 70% Pediatricians short fall
  • 4th Dangerous nation for women and children June 22,2012 Baby Falak Baby Afreen Worst child sex ratio of 914:1000
  • CHILDREN BEARING CHILDREN AND……..DYING Save the children -2012 report Pregnancy the biggest killer of teenage girlsIMR 77/1000 MMR 5 times more in girls <15 2/3rd - before 20 yrs 1/5th - before 15 yrs Population council of india
  • OTER KEY ISSUES FEMALE FETICIDE  PNDT FEMALE INFANTICIDE  DOMESTIC VIOLENCE ACT POVERTY  GENDER EQUITY DOMESTIC VIOLENCE  EDUCATION SEXUAL ABUSE/RAPE  EMPOWER MENT ILLITERACY  SCHEMES FOR GIRL CHILD DISCRIMINATION AT  MATERNITY LEAVE WORK PLACE
  • TO REACH EVERY MOTHER AND NEONATE MEDICAL SOLUTIONS ARE WELL KNOWN – IT IS THE STRATEGIC DIFFICULTIES WHICH NEED ATTENTION
  • EVERY HELPING HAND COUNTS IAP
  • JOIN HANDS TOGETHER EVERY POLITICIAN EVERY POLICY MAKER EVERY OBSTETRICIAN EVERY PEDIATRICIAN EVERY MEDICAL OFFICER EVERY HW EVERY ANM EVERY ASHA TO MAKE every MOTHER AND NEWBORN count
  • LONG ROAD AHEAD, BUT• THERE IS NO REASON WHY WE SHOULD LAG BEHIND
  • THANK YOU FOR THIS UNIQUE OPPORTUNITY FOGSI MGMH NAYAPUL, OMC OGSH,DR.P.KSHAH, PRESIDENT, FOGSI DR.S.SHANTAKUMARI DR.P.INDIRA DEVI SRI.D.V.RAIDU IAS SIX DECADES OF RCH IN INDIA –MS.SUJATA RAO IAS PROF: RATNAKUMAR, DILEEP MAVLANKAR-SUCCESS STORIES OF TAMILNADU ,GUJARAT
  • REFERENCES• WHO 2005-EVERYMOTHER AND CHILD COUNTS• TRENDS IN MATERNAL MORTALITY1990-2010-UNFPA,WHO• SRS 2006,2008• NRHM-WEBSITE, WHO,mohfw.nic.in• www.iapnrpfgm.org• Lancet series on RCH,MATERNAL AND NEONATAL• Presentations;• Six decades of RCH in India –Ms.Sujata Rao IAS• PROF: Ratnakumar, Dileep Mavlankar-success stories of Tamilnadu ,Gujarat
  • GREETINGS FROM HYDERABADFROM ONE MOTHER TO ANOTHER
  • SONG OF YOUTH As a young citizen of India, armed with technology, knowledge and love for my nation, I realize, small aim is a crime. I will work and sweat for a great vision, the vision of transforming India into a developed nation powered by economic strength with value system. I am one of the citizens of the billion;Only the vision will ignite the billion souls. It has entered into me ;The ignited soul compared to any resource,is the most powerful resourceon the earth, above the earth and under the earth.I will keep the lamp of knowledge burningto achieve the vision - Developed India
  • LLETS REDEDICATE OURSELVES TO SEE SUCH HAPPY MOTHER AND CHILD EVERY WHERE