Initiatives Taken to Improve Maternal Health in Bikaner, Rajasthan.

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The Department of Administrative Reforms & Public Grievances, Government of India, organized the 2nd 'District Collectors Conference', which took place on the 6th & 7th of September in New Delhi. Over 30 district collectors participated, making presentations on best practices to overcome challenges faced in the sectors of rural development, education, urban development, law & order, and disaster management. 



The Planning Commission is providing these presentations for the public to see examples of the good work being done by young IAS officers in the field, and to promote cross-learning and innovation.

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Initiatives Taken to Improve Maternal Health in Bikaner, Rajasthan.

  1. 1. Towards Improved Maternal Health Reducing MMR in Bundi and Bikaner Arti Dogra District Collector, Bikaner
  2. 2. Mamta’s Story
  3. 3. Rajasthan – Bikaner & Bundi Data Bundi Bikaner Population 1113725 2367745 MMR `261 263 Gender Ratio 922 903
  4. 4. • Difficult terrain prone to drought • Early marriage • Dominant feudal system • Inadequate control over resources for women • Low literacy • Social customs( eating last) • Under nutrition , high levels of anaemia Why Maternal Mortality is high
  5. 5. Rajasthan Over Time
  6. 6. Causes of Maternal Deaths
  7. 7. Maternal Deaths District Population Crude Birth Rate (CBR) 2007-09 (Median 2008) Estimated births 2007- 09 (Median 2008) MMR 2007- 09 (Median 2008) Est MDs 2007-09 (Median 2008) Avg Reported MDs, 2007- 08 to 2009- 10 Crude Birth Rate (CBR) 2010 Estimated births 2010 MMR 2010 Est MDs 2010 Reported MDs, 2010- 11 Bikaner 2,367,745 24.9 58,957 343 202 2 24.6 58,247 263 153 11 Bundi 1,113,725 23.7 26,395 343 91 21 23.3 25,950 261 68 36 Rajasthan 68,621,012 24.7 1,694,939 331 5,610 1,089 24.4 1,674,353 264 4,420 952
  8. 8. Reported Maternal Deaths District Reported MDs 2007-08 Reported MDs 2008-09 Reported MDs 2009-10 Avg Reported MDs 2007-08 to 2009-10 Reported MDs 2010-11 Reported MDs 2011-12 Reported MDs 2012-13 ikaner 5 0 0 2 11 4 38 undi 23 22 17 21 36 28 16 Rajasthan 1219 987 1062 1,089 952 763 1,116
  9. 9. • Implementation of SQRS (Small Query Reporting System)-Tracking medical activities through SMS • Increase the number of health facilities providing safe delivery and newborn care • Systematic Improvement in Labour Rooms • Tracking of High Risk Pregnancies • Quality improvement of MCHN Days • Video Conferencing upto PHC Level New Initiatives
  10. 10. Online Reporting through SMS • Shift from reporting and analysis at the end of the month to daily reporting • 1 SMS within 160 characters • Coverage to all major health related activity like ANC Registration, Deliveries, OPD-IPD, Maternal Deaths • Review every day by CMHO and Block CMHO
  11. 11. • Launched Jan 12th , 2011 • Divided focus Health Activities in 10 types of Coding from R1 to R10. • District, Block, PHCs & Sub Center level staff trained • PHCs level Monitoring can be done in real time. SQRS Implementation
  12. 12. Process 101
  13. 13. Analysis on Inbound SMS • Benefits – Real Time Analysis on activities of • ANM, MO-IC PHC, CHC, Janana and District Hospital • Ideal for Collector, CMHO and DPM to have a Bird-Eye- View on a particular activity ANC Registration (Jan 01, 11 – Jan 26, 11) Total No of ANC Registration Total No of BPL Registration Total Amount Paid to BPL 40 11 5500
  14. 14. Analysis on Inbound SMS
  15. 15. Benefits • Real Time Reporting Solution • Economical Reporting • Everyday assessment of their own work • Faster response time during Critical Situations • Instant Action on Absenteeism • Ready tool for inspections and monitoring
  16. 16. Maternal deaths
  17. 17. Maternal Deaths Rajasthan
  18. 18. Improvement in Maternal Death Reporting • Reporting of maternal death through immediate SMS • Enquiry of maternal deaths through verbal autopsy • Block level teams of 3 people including ASHA facilitators • Maternal Death Audit in District Health Society monthly • Alternative verification
  19. 19. • To reduce maternal death (min 8-10% pregnancies are high risk) • High risk pregnancies should be identified & special care , checkup , follow up • Quality of ANC checkup for high risk lady.. • Identification of institution for safe delivery of that lady • Maintenance of HRP Database High Risk Pregnancy Tracking
  20. 20. • Obstetrics Risk factor – Previous still Birth – Preterm baby – Continuous abortion – C-Section delivery – Eclmpsia & Pre-eclampsia history • Medical Risk Factor – High Blood Pressure – Heart Disease – Diabetes – Epilepsy – Sever Anemia • Physical Risk Factor – Age – Height – Cervix and Uterus Problems – Weight Factors for detection of High Risk Pregnancy
  21. 21. Implementation Methodology • Sensitization of ANM, LHV, MO & Program Manager about High Risk Pregnancy. • High Risk booklet launched on 20th May 11 by Hon. Health Minister • High Risk booklet in which all record of High Risk lady is maintained by ANM. • 4 ANC checkups are being done for High Risk lady & last checkup is done by Doctor. • Awareness to family members of that lady regarding high risk & special care. • Review in District Health Society Meeting.
  22. 22. High Risk Pregnancy Tracking • Sensitisation of family • HRP Circle on the house • Lists at Gram Panchyat , CHC,PHC • Referral and check up facility • Verification
  23. 23. High Risk
  24. 24. Workload of PBM Hospital Bikaner, Labour Room
  25. 25. Workload in Janana, Bundi Alternative Needed for Janana Hospital
  26. 26. • Increase the number of primary health facilities providing safe institutional delivery and new born care in Bundi • Strengthen the capacity of ANMs to manage and refer maternal and neo-natal complications • Enhance community participation in improving maternal and new born survival ASTHA Project - Objectives
  27. 27. • Assessed – Gaps in Labour Room Infrastructure – Strengthen Human Resource Capacity – Performance of Facilities – Practices in labour room Activities Undertaken
  28. 28. • Emphasis on good quality routine antenatal care • Training on basics like Delivery care practices, pre-discharge assessment, quality ANC. • SBA re-orientation and training of program managers , doctors and ANMs Doctors and Staff Orientation
  29. 29. Success Metric Before project started ( on 28 Aug 11) Facilities functioning 24* 7 6 10 No of ANMs / GNMs posted 39 45 No of ANMs / GNMs provided intensive 5 day training 0 31 No of doctors oriented on quality of delivery neonatal care 0 24 Number of deliveries conducted in previous month 277 511 Success @ ASTHA Kendra
  30. 30. Post Training Analysis
  31. 31. • Safe delivery and newborn care practice • How to identify and report maternal deaths • ASHAs have been instructed to report all maternal deaths in selected blocks on phone • verbal autopsy technique • Monitoring High Risk Pregnancies Asha Training
  32. 32. Improved MCHN Day • Stress on quality ANC • Tracking Anaemia and Blood Pressure • Effective training and monitoring • Identification of transport options and possible delivery points • Effective use of Mamta card
  33. 33. Video Conference at Health Facilities • Micro level monitoring • Immediate feedback • Prompt redressal
  34. 34. Involving the People • SAKHI - Special program by student NSS volunteers • Two panchayats covered every week. • Use of traditional music and dialect. • Involving public represntatives
  35. 35. • Quality ANC Checkup • Regular follow-up is being done by ANM or Doctor. • Facility wise interaction and engagement of referral transport at the village level • Maintenance of lists at CHC control room and CMHO office • Monthly Review at Block level and District Level • Random checks by SDM and District Collector Post Programme Analysis

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