LIFE OF EVERY MOTHERAND NEONATE COUNTS!!!!       YUVAFOGSI  DR.KAMINIRAO ORATION  AICOG 2013 -MUMBAI                   DR....
WORDS CAN’T DESCRIBE………..       o Health of the       mother          When mothers die……….       o The health of       the...
14TH JAN 2012                              KOLKATA Women are not dying because of a disease we cannot treat They     are...
IT’S A BASIC HUMAN RIGHT!• The right to survive pregnancy and childbirth is a basic  human right• Maternal mortality-grave...
UNFPA,UNICEF 2010 DATA TOTAL MATERNAL                284000   DEATHS -2010              DEVELOPING     2,87000            ...
MANY STATES, MANY DISPARITIES       ASSAM AND EAG 308212 -2010                  OTHERS                     149SOUTH STATES...
WHERE DID INDIA GO WRONG?                   1960-1990           1966- 1980   Target oriented     family planning         ...
90 percent of maternal deaths are avoidable.POSTPARTUM PERIOD 60%         50% in 24          HOURS-     6 CAUSES     3 DEL...
THE SECRET OF SUCCESS OF SRILANKA         AND MALAYSIA…….400                             THAILAND                         ...
Maternal Deaths Averted With Access To      Emergency Obstetric Services-world Bank2004        15%15%                 14% ...
The First Delay           (DECISION TO SEEK CARE)                              PREGNANCY IN                              R...
2ND DELAY- TO REACH HEALTH CARE• 70 % do not have a means oftransportation READY• 40-50% percent of deathsoccur at home or...
•Availability  THE THIRD DELAY-IN RECEIVING CARE                    •Acceptability                                        ...
TO SUMMARISE• WE MISSED ONE CARE  Emergency Obstetric And  Neonatal Care• WE MISSED ONE KEY  FUNCTIONARY  Skilled Professi...
WHAT IS THE SOLUTION???                  • Focuses on 18 low                  performing states, EAG                  Stat...
RISK APPROACH VS EMOC APPROACH• BASIC EmOC Functions                                           6+2• Health centre –No OT  ...
NRHM KEY STRATEGIES -2005-2012                                         IPHS                      DISTRICT                 ...
NRHM-KEY STRATEGY-         ASHA-MICROPLAN OF BIRTH• REGISTRATION OF ANC                                  An ASHA for every...
NRHM-KEY STRATEGY             Emergency Transport System,              EMRI, HSVS,Janani Express   108 THE LIFE SAVER• TOL...
1ST                                                  JANANI SURAKSHA YOJANA A                                             ...
INSTITUTIONAL DELIVERIES –              INDIA -2008-2010CHATTISGARH,JARKHAND,UP,BIHAR                    60-80%        TAM...
NRHM TRIGGERED INNOVATIVE SCHEMES IN STATES• KERALA-    1ST STATE TO ACHIEVE MMR<100• GUJARAT- INNOVATIVE CHIRANJEEVI SCHE...
PPH –QUICKEST OF KILLERS    2 HRS                  PPH   12 HRS                  APH1 DAY-24 HRS            RUPTURE       ...
PPH –KEY INTERVENTIONS                              25%   AMTSL600UG MISOPROSTOL    P/R , ORAL       B-LYNCH/   MODIFIED B...
FIGO GUIDELINESPrevention and treatment of PPH in low resource settings                  (SMNH Committee)          http://...
FIGO GUIDELINES-PPH-                INTERVENTIONS AT CEMOC LEVEL                                                 Aortic co...
Preeclampsia-Direct Cause         Sepsis-Direct causeRetraining in ANC protocols &      POST NATAL CARE VISITSskills - bas...
OBSTRUCTED LABOR/RUPTURE            UTERUS         8%• PARTOGRAM -    TRAINING
NRHM KEY STRATEGY                           13%                CAC Unsafe abortion                      Women centered    ...
LET WOMEN DECIDE……….80 million unintended pregnancies in 2012 in developing            world- Save the Children Report   ...
ANEMIA   80% IN NFHS III -complicates 80% maternal deaths                     (FOGSI STUDY)Hb % at 1st visit         low 2...
India is epicenter of Childhood                      Mortality• 7.6 MILLIONS DIE EVERYYEAR -2010• 2 MILLIONS DIE IN INDIA•...
WHY do newborns in India die?                      Lancet Neonatal Survival Series 2005   Neonatal                        ...
New Child Health Initiative           by GOI Sep 2009  Navjaat Shishu Suraksha Karyakram (NSSK)A new programme on BasicNew...
HOME BASED CARE FOR MOTHER AND      NEWBORN-THE VITAL missing LINK                5 VISITS IN   ASHA                 42 DA...
• INSPITE OF THE INITIATIVES……..STILL A LONG WAY TO GO ……..STILL TO REACH EVERY MOTHER                AND NEONATE         ...
PROGRESS NOT GOOD ENOUGH                           MMR BY 2015  We are 212 in 2010             153  Our goal is 100       ...
4th Dangerous nation for women and              children             June 22,2012                                Baby Fala...
CHILDREN BEARING CHILDREN             AND……..DYING              Save the children -2012 report                            ...
TO REACH EVERY MOTHER AND NEONATE        MEDICAL SOLUTIONS       ARE WELL KNOWN – IT         IS THE STRATEGIC        DIFFI...
EVERY HELPING HAND COUNTS                        IAP
JOIN HANDS TOGETHER•   EVERY POLITICIAN•   EVERY POLICY MAKER•   EVERY OBSTETRICIAN•   EVERY PEDIATRICIAN•   EVERY MEDICAL...
THANK YOU     FOR THIS UNIQUE OPPORTUNITY   FOGSI   MGMH NAYAPUL, OMC   OGSH,DR.P.KSHAH, PRESIDENT, FOGSI   DR.S.SHANT...
REFERENCES•   WHO 2005-EVERYMOTHER AND CHILD COUNTS•   TRENDS IN MATERNAL MORTALITY1990-2010-UNFPA,WHO•   SRS 2006,2008•  ...
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 ...
LLETS REDEDICATE OURSELVES TO SEE SUCH HAPPY MOTHER               AND CHILD EVERY WHERE
mumbai dr.kamini rao oration 2013
mumbai dr.kamini rao oration 2013
Upcoming SlideShare
Loading in …5
×

mumbai dr.kamini rao oration 2013

1,653 views

Published on

2 Comments
3 Likes
Statistics
Notes
No Downloads
Views
Total views
1,653
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
2
Likes
3
Embeds 0
No embeds

No notes for slide
  • 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
  • mumbai dr.kamini rao oration 2013

    1. 1. LIFE OF EVERY MOTHERAND NEONATE COUNTS!!!! YUVAFOGSI DR.KAMINIRAO ORATION AICOG 2013 -MUMBAI DR.D.KIRANMAI ASST. PROFESSOR MGMH,OMC HYDERABAD SCIENTIFIC CONVENER AICOG,2011 JOINT SECRETARY, OGSH
    2. 2. 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.
    3. 3. 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
    4. 4. IT’S A BASIC HUMAN RIGHT!• The right to survive pregnancy and childbirth is a basic human right• Maternal mortality-grave violation of “Right to Life”• Other Rights – right to liberty, security and right to freedom from cruel, inhuman and degrading treatment• The scale of maternal mortality is an affront to humanity .It is a human rights violation no less than torture, disappearance, arbitrary detention and prisoners of conscience-Mary Robinson
    5. 5. UNFPA,UNICEF 2010 DATA TOTAL 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
    6. 6. MANY STATES, MANY DISPARITIES ASSAM AND EAG 308212 -2010 OTHERS 149SOUTH STATES127 134 81 97 SRS - 2009
    7. 7. WHERE DID INDIA GO WRONG? 1960-1990 1966- 1980 Target oriented family planning  Huge private sector-Not utilized Ineffective interventions ANC, High risk approach  Lack of synergy  Lack of quality 1980-1990 CSSM, UIP, IFA-Little impact on MMR  Supervision Institutional deliveries not monitored and neglected.  close monitoring
    8. 8. 90 percent of maternal deaths are avoidable.POSTPARTUM PERIOD 60% 50% in 24 HOURS- 6 CAUSES 3 DELAYS
    9. 9. THE SECRET OF SUCCESS OF SRILANKA AND MALAYSIA…….400 THAILAND SRILANKA MALAYSIA•MIDWIVES•SKILLED ATTENDANCE TO BIRTHS•QUALITY•STRENGTHENING OF COMMUNITYHOSPITALS 30 1960-1990
    10. 10. Maternal Deaths Averted With Access To Emergency Obstetric Services-world Bank2004 15%15% 14% 12% 12%10% 8% 70% 5% 7% 0% 3% 1%EMOC SERVICES
    11. 11. The First Delay (DECISION TO SEEK CARE) PREGNANCY IN RURAL INDIA <20% 40% 60%80%WOMEN GIVEN COMPLETE ANCS
    12. 12. 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.
    13. 13. •Availability THE THIRD DELAY-IN RECEIVING CARE •Acceptability •Accessibility March 2010 •Quality• 30% of PHC - no building Only• 40% - no vehicle •58% Do DELIVERIES •6%- Do MTPS• 70 % - no linkage to district blood bank •22% Neonatal Care• Too far, Too little, Too Late •65% IUDS •41% Sterilisations IN CHCS 55.2% Obstetricians 70% Pediatricians short fall
    14. 14. 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
    15. 15. WHAT IS THE SOLUTION??? • Focuses on 18 low performing states, EAG States • 165 worst districtsAPRIL 12,2005 - 2017 • To Increase the expenditure on health from NRHM 1.1% to 3%
    16. 16. 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 EmOC functions3. IV/IM ANTICONVULSANTS plus4. Manual Removal of • Caesarean section placenta • Blood transfusion5. Assisted Vaginal delivery6. Removal of retained 4 BEMOC & 1 CEMOC FACILITY FOR EVERY products 5 LAKH PEOPLE
    17. 17. NRHM KEY STRATEGIES -2005-2012 IPHS DISTRICT FRU JSY TRAINING LOGISTICS FRUS 24X7 PHC 108 Infrastructure CEMONC CARE BUDGET 24X7 BEMOC CAC CENTRES BLOOD BANKASHA COMPREHENSIVE ABORTION CARE HUGE IMPROVEMENTS IN INFRASTRUCTURE,MANPOWER AND (CAC) ACCESS TO SERVICES NEWBORN CARE
    18. 18. NRHM-KEY STRATEGY- ASHA-MICROPLAN OF BIRTH• REGISTRATION OF ANC An ASHA for every• 4 VISITS village-2,50,000 ASHAS• ARRANGING FOR CASH TRANSFER - JSY• PLANNING PLACE OF BIRTH• TRANSPORT• ACCOMPANYING THE PARTURIENT ADDRESSES THE 1ST DELAY
    19. 19. NRHM-KEY STRATEGY Emergency Transport System, EMRI, HSVS,Janani Express 108 THE LIFE SAVER• TOLL FREE 108 24x7 X365• 22 STATES,4500 AMBULANCES• Another 6 states -3000 ambulances- 60% of population• India’s largest and perhaps most successful public private partnership in the health FOR THE SECOND DELAY sector 19
    20. 20. 1ST JANANI SURAKSHA YOJANA A 80 Trends in Institutional deliveries 2002-04 to 2007; IndiaN ASSAM, BIHAR ,MP, ORISSA ,RAJASTHAN ,UP 70 D Introduction of JSY T 60 Percentage of institutional deliveries H 50 I 40 R 30 BIHAR - 6 FOLD INC FROMDD 20 2005-2011 E 3.19 CRORE WOMEN BENEFITED UNDER JSY 10 L 0 A 2002-2004 2005-06 2006-07 2007-08 Y Assam Rajasthan Bihar Uttar Pradesh Madhya Pradesh India Orissa Trends in Institutional deliverieS 20 (NFHS III), 2006-7, 2007-8
    21. 21. INSTITUTIONAL DELIVERIES – INDIA -2008-2010CHATTISGARH,JARKHAND,UP,BIHAR 60-80% TAMILNADU >80% KERALA
    22. 22. 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
    23. 23. 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
    24. 24. PPH –KEY INTERVENTIONS 25% AMTSL600UG MISOPROSTOL P/R , ORAL B-LYNCH/ MODIFIED B-LYNCH 22% PREVENTABLE STEPWISE DEVSCULARISATION EMERGENCY HYSTERCTOMY
    25. 25. 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
    26. 26. FIGO GUIDELINES-PPH- INTERVENTIONS AT CEMOC LEVEL Aortic compressionExt bimanual comp Int. Bimanual Comp Video demonstrations NASGEGYPT NIGERIA / ZAMBIA, ZIMBABWE Intra uterine balloon tamponade
    27. 27. 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
    28. 28. OBSTRUCTED LABOR/RUPTURE UTERUS 8%• PARTOGRAM - TRAINING
    29. 29. 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
    30. 30. 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 65% unmet need in 1st yr post partum in India Policy shift from permanent to temporary methods PPIUCD Spacing of 36 months after previous child birth can prevent 1.8 million child deaths (25%)
    31. 31. ANEMIA 80% IN NFHS III -complicates 80% maternal deaths (FOGSI STUDY)Hb % at 1st visit low 20wks,28wks, cost, effective Health Iron , acceptable strategies fortification 34 wks iron. Cooking in De worming iron utensils IV IRON Foot wear SUCROSE A real boon 20%
    32. 32. 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
    33. 33. 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
    34. 34. 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
    35. 35. 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
    36. 36. • INSPITE OF THE INITIATIVES……..STILL A LONG WAY TO GO ……..STILL TO REACH EVERY MOTHER AND NEONATE 3.7 2012
    37. 37. 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
    38. 38. 4th Dangerous nation for women and children June 22,2012 Baby Falak Baby Afreen Worst child sex ratio of 914:1000
    39. 39. 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
    40. 40. TO REACH EVERY MOTHER AND NEONATE MEDICAL SOLUTIONS ARE WELL KNOWN – IT IS THE STRATEGIC DIFFICULTIES WHICH NEED ATTENTION
    41. 41. EVERY HELPING HAND COUNTS IAP
    42. 42. 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
    43. 43. 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
    44. 44. 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
    45. 45. GREETINGS FROM HYDERABADFROM ONE MOTHER TO ANOTHER
    46. 46. 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
    47. 47. LLETS REDEDICATE OURSELVES TO SEE SUCH HAPPY MOTHER AND CHILD EVERY WHERE

    ×