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Chiranjeevi Maternal Health Financing Issues and Options

Chiranjeevi Maternal Health Financing Issues and Options. Dr Amarjit Singh Secretary Family Welfare Government of Gujarat. Lessons from HSRs. Steer don’t row Finance rather than directly provide Explore options for PPP Regulate quality, cost-effectiveness

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Chiranjeevi Maternal Health Financing Issues and Options

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  1. Chiranjeevi Maternal Health Financing Issues and Options Dr Amarjit Singh Secretary Family Welfare Government of Gujarat

  2. Lessons from HSRs • Steer don’t row • Finance rather than directly provide • Explore options for PPP • Regulate quality, cost-effectiveness • Protect the marginalised groups

  3. Maternal Death Watch-Global • 380 women become pregnant • 190 women face unplanned or unwanted pregnancy • 110 women experience a pregnancy related complication • 40 women have unsafe abortions • 1 woman dies from a pregnancy-related complication Every Minute...

  4. Gujarat – A Profile Recognizing Gujarat potential the Planning Commission set a target growth rate of 10% p.a. for Gujarat

  5. Current Status

  6. OBJECTIVES- Vision 2010, Population Policy & RCH II • Reduce MMR from 389 (in 1998) to 100 per 100,000 live births by 2010 • Reduce IMR from 60 to 30 by 2010 • Stabilize population by reducing TFR from 3.0 to 2.1 by 2010

  7. Timing of maternal deaths-General Conditions

  8. Time from onset of complication to death • PPH 2 hour • APH 12 hour • Ruptured uterus 1 day • Eclampsia 2 days • Obstructed labor 1 day • Sepsis 6 days

  9. Maternal Mortality: UK 1840–1960 Improvements in nutrition, sanitation Antibiotics, banked blood, surgical improvements Antenatal care Maine 1999.

  10. Maternal Mortality ReductionSri Lanka 1940–1985 85% births attended by trained personnel

  11. New Global Understanding ofMMR Reduction • Once major obstetric complication develops- even a trained TBA or a nurse cannot do much at home • These complications require effective back up by trained O&G experts • surgical interventions • injections of antibiotic • blood transfusion • aggressive treatments

  12. Three Delays Responsible for Maternal Deaths • Delay in deciding to seek care (Individual & family) • Lack of understanding of complications • Gender issues, Low status of women • Socio-cultural barriers to seeking care • Poor economic conditions of the family • Delay in reaching care ( Community & System) • Lack or underutilization of transport funds • Non availability of referral transport in remote places • Lack of communication network • Delay in receiving care (System) • Poor facilities, personnel and Supplies • Poorly trained personnel with indifferent attitude

  13. Options • Improve Government Health Service Competent staff Adequate infrastructural facilities User friendly, good quality Competitive Services Marketing of services • Public Private Partnership Outsourcing- Curative services • Health Insurance

  14. Maternal Health- Gujarat Objectives ( by 2010): • Universalize coverage of antenatal care (100%) • Increase the deliveries attended by SBAs 90% • Increase institutional deliveries by 80% • increase access to Emergency Obstetric Care for complicated deliveries • Increase coverage of Post Natal Care (90%) • Increase access to Early & Safe Abortion services • Improve access to RTI/ STI services • Introduce AFHS in all PHC/ CHCs.

  15. Broad Issues • Non - availability of O & G specialists • Accessibility of services-Tribal and urban slums • Poor utilization of services- • Low felt need of health & medical services • Lack of user friendly & quality public health services • Costly private health and medical services • No health insurance coverage

  16. Chiranjeevi Yojna - Options • Service Coverage through outsourcing- voucher system Emergency Obstetric Care & Neonatal Care • Private Gynecs/ GIA in their facility • Payment to Gynecs for working in government hospital

  17. Service Charges

  18. Service Charges

  19. Population and Births

  20. Implementation of Chiranjeevi-1 • District level FOGSI members workshops organized for orientation on Chiranjeevi scheme and enrollment of doctors on the panel • Honorable Health Minister wrote a letter about the scheme to presidents of district and talukas in 5 districts. • District level Advocacy workshops of Presidents of district and taluka panchayat, along with BHO and Chiranjeevi panel doctors organized in each district.

  21. Implementation of Chiranjeevi-2 • In each district IEC activities were undertaken. Awareness through Gramsabhas • Rs 15000/ advance was given to each obstetrician. No delay in reimbursement to doctors. • Regular interaction with Chiranjeevi Panel doctors by CDHOs

  22. Preliminary results

  23. Caesarian/complicated deliveries

  24. Miles to go

  25. Maternal Health- ANC, deliveries, PNC: 2002- 2006

  26. Effect on Government deliveries

  27. Issues • Surge of demand - boon to the poor • Unprecedented support from the private practitioners • Unindicated C-section in check • Availability of blood • Still asking for additional funds from the BPL • Non-BPL beneficiaries also being attended • Under utilisation of Public facilities

  28. Issues in expansion • Additional day’s stay after delivery • Sanitary pads supply • More funds for accompanying person – Dai • Other services Sterilisation/ IUD/ RTI/ STI/ HIV/AIDS/pap smear • More charges for transportation in Kutch • Cost likely to increase to 2,00,000/100 deliveries

  29. The bill for Gujarat

  30. Our Mission: “Save the lives of thousands of Mothers and Children dying with no reason of theirs and prevent the spread of infections and promote healthylife styles” Working together for a healthy Bharat

  31. THANKS

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