Maternal death Review- national perspective-wb-2011


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Maternal death Review- national perspective-wb-2011

  1. 1. Maternal Death Review… A National Perspective
  2. 2. Maternal Deaths… unacceptable numbers <ul><li>About 28 million pregnancies per year in India </li></ul><ul><li>26 million live births </li></ul><ul><li>15% of pregnancies likely to develop complications </li></ul><ul><li>67 000 maternal deaths in a year </li></ul>
  3. 3. Maternal Deaths…Causes <ul><li>Direct obstetric and non-obstetric causes - hemorrhage, sepsis, eclampsia, obstructed labour, abortion related, anemia etc </li></ul><ul><li>Underlying/contributory causes </li></ul><ul><li>- Social, behavioral, cultural, economic factors </li></ul><ul><li>The “three delays”: </li></ul><ul><ul><li>Delay in decision making </li></ul></ul><ul><ul><li>Delay in reaching the appropriate health facility </li></ul></ul><ul><ul><li>Delay in receiving health care at the facility </li></ul></ul>
  4. 4. MDG Goals,Targets and Indicators …MDG 5… NRHM /RCH goals in line Goal Target Indicators Achievements MDG-5: To improve Maternal health Reduce by 3/4ths the MMR, 1990-2015. (From 424 (NFHS-I) to approx.106 per 1,00,000 Live-Births in 2015). NRHM/RCH II-Reduce to 100/1,00,000 Live-births MMR Proportion of births attended by SBA. Institutional delivery. MMR : 254 per 100,000 live births ( RGI-SRS 2004-06) UN Interagency Estimates(2008) : 230/100,000 LB 52.6 %Safe Delivery 47% Institutional Delivery 76%Safe Delivery 72.9% Institutional Delivery (UNICEF Coverage Evaluation Survey 2009)
  5. 5. MMR…we need to accelerate pace of decline
  6. 6. MMR Trends…variation across States Source:RGI SRS 2/3rds deaths
  7. 7. Burden of Maternal Deaths... 2001-03 2004-06 Assam 490 480 U.P. / Uttarakhand 517 440 Rajasthan 445 388 M.P. / Chhattisgarh 379 335 Bihar / Jharkhand 371 312 Orissa 358 303 Karnataka 228 213 Punjab 178 192 Haryana 162 186 Andhra Pradesh 195 154 West Bengal 194 141 Maharashtra 149 130 Tamil Nadu 134 111 Kerala 110 95
  8. 8. Policy and Programmes...Goals and Targets National Population Policy 2000
  9. 9. MULTI-PRONGED APPROACH.. MATERNAL HEALTH STRATEGIES Demand Promotion- ( Janani Suraksha Yojana) <ul><li>Provision of services </li></ul><ul><li>Public sector </li></ul><ul><ul><li>1. Essential and Emergency Obstetric Care </li></ul></ul><ul><ul><ul><li>Quality ANC, INC, Safe and Institutional delivery </li></ul></ul></ul><ul><ul><ul><li>Skilled birth attendance </li></ul></ul></ul><ul><ul><ul><li>Multi-skilling </li></ul></ul></ul><ul><ul><li>Operationalize FRU s & 24*7 PHCs </li></ul></ul><ul><ul><li>3. Services for RTIs & STIs – convergence with the NACP </li></ul></ul><ul><ul><li>4. Safe abortion services- New Guidelines </li></ul></ul><ul><ul><li>5. Strengthen referral systems </li></ul></ul><ul><ul><li>Village Health and Nutrition Day.. </li></ul></ul><ul><ul><li>Mother-Child Protection Card </li></ul></ul><ul><li>Provision of Services : Private sector </li></ul><ul><li>Accreditation of Pvt. Health Facilities for RCH services and SBA training </li></ul><ul><li>Fixed package for outsourcing services </li></ul><ul><li>Maternal Death Review </li></ul><ul><li>Pregnancy and Child Tracking –web based system </li></ul><ul><li>Prioritising resources for identified “delivery points” or MCH Centres </li></ul>New
  10. 10. NRHM…Overarching Umbrella <ul><li>Intersectoral Convergence </li></ul><ul><li>Accredited Social Health Activist (ASHA) – </li></ul><ul><li>one per 1000 population </li></ul><ul><li>Facility Strengthening / Improving Access </li></ul><ul><li>Strengthening of Infrastructure- IPHS </li></ul><ul><li>Improving availability of Human Resource - Contractual Appointments </li></ul><ul><li>Availability of funds at facilities-Untied funds ,Annual Maintenance Grants, Grants to Rogi Kalyan Samitis. </li></ul><ul><li>Village Health and Nutrition Days </li></ul><ul><li>Village Health and Sanitation Committees </li></ul><ul><li>Public-private Partnerships. </li></ul><ul><li>Flexible Funding through NRHM/RCH Flexi-pool. </li></ul><ul><li>Innovative Strategies </li></ul>Communitisation Decentralisation Flexible Funding
  11. 11. Maternal Death Review
  12. 12. Policy on Maternal Death Reviews …spelt out in implementation framework of RCH II <ul><li>Strengthen Monitoring/ </li></ul><ul><li>Records/Audit procedures </li></ul><ul><li>Monitor State and Regional level MMR </li></ul><ul><li>Introduce mother-child linked card </li></ul><ul><li>Conduct review of maternal deaths at the hospital and community levels </li></ul><ul><li>Develop tools for maternal death review and reporting </li></ul>
  13. 13. Maternal Death Reviews Initiatives…fragmented
  14. 14. Why conduct MDR? <ul><li>Reduce maternal mortality and morbidity </li></ul><ul><li>Improve quality of obstetric care </li></ul><ul><li>Understand determinants of maternal death </li></ul><ul><li>Provide stimulus for action at all levels </li></ul><ul><li>Take corrective action to fill the gaps in service provision </li></ul><ul><li>Prerequisite: </li></ul><ul><li>A commitment to act upon the findings </li></ul><ul><li>Not for punitive action </li></ul>
  15. 15. MDR Process Five approaches to help understand why women die ... <ul><ul><li>Maternal deaths in the community (CBMDR) </li></ul></ul><ul><ul><li>Maternal deaths in facilities (FBMDR) </li></ul></ul><ul><ul><li>Confidential enquiries into maternal deaths </li></ul></ul><ul><ul><li>Learning from women who survived: “near miss” cases </li></ul></ul><ul><ul><li>Evidence-based clinical audit </li></ul></ul>
  16. 16. All these approaches... <ul><li>Identify cases (maternal deaths) </li></ul><ul><li>Review cases confidentially and no blame </li></ul><ul><li>Look for avoidable factors </li></ul><ul><li>Promote change in practices </li></ul><ul><li>Review the outcome of these changes </li></ul><ul><li>Refine and develop </li></ul>
  17. 17. The maternal death surveillance cycle.. Identify cases Recommendations for action Collect information Analyse results Implement, evaluate and refine No Punitive Action
  18. 18. Challenges... to roll out the process <ul><li>Creating awareness in community... Need for effective BCC/IEC </li></ul><ul><li>Mobilising communities and the health system </li></ul><ul><li>Resolving infrastructure and human resource issues </li></ul><ul><li>Building partnerships between govt. systems and others (prof. bodies ,tech. agencies ,NGOs ) </li></ul><ul><li>Resolving ethical issues </li></ul><ul><li>Developing guidelines and simple implementable tools </li></ul><ul><li>Orientation of a wide range of functionaries --policy makers, programme officers, frontline HWs, community workers, PRIs... capacity building of the states </li></ul>
  19. 19. Each maternal death is ………… a tragedy Bigger tragedy, however, is……................ failing to learn lessons from her death!!