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Dr. H. Bhushan Maternal Health Division MoHFW, India

Current Situation: Maternal Health. About 28 million pregnancies occur every year in India.24 million deliveries.15% of these are likely to develop complications. Complications cannot be predicted.77,000 avoidable maternal deaths per year.. 3. National goals

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Dr. H. Bhushan Maternal Health Division MoHFW, India

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    1. Dr. H. Bhushan Maternal Health Division MoHFW, India CAPACITY BUILDING THROUGH MULTI SKILL TRAININGS

    2. Current Situation: Maternal Health About 28 million pregnancies occur every year in India. 24 million deliveries. 15% of these are likely to develop complications. Complications cannot be predicted. 77,000 avoidable maternal deaths per year.

    3. 3 National goals & MDG context

    4. Regional Variation in MMR decline Overall MMR decline from 398(1997-98) to 301(2001-03). Overall decline of 16 points per year. Decline in EAG and NE States: 14 points per year. Decline in Southern States: 2 points per year. Projected MMR is 231 by 2012 at the current rate of decline.

    5. 5

    6. Reduction of Maternal Deaths-Existing Interventions

    7. Technical Strategy Operationalize FRUs, CHCs and 24 Hrs PHC for provision of : Essential and Emergency Obstetric Care: Quality ANC, PNC, Institutional and Safe Delivery : Janani Suraksha Yojana Skilled Attendance at birth (domiciliary & health facilities). Strengthen Referral Systems. Management of RTIs & STIs at PHCs & CHCs/FRUs. Safe Abortion Services - MVA at PHC level.

    8. Required Services vs HR Availability

    9. Anesthesia Training-Summary Posting Schedule (18 weeks) Medical College / Training Center Emergency Services/Casualty : Six weeks Operation Theatre General Surgery : Two Weeks Obstetric : Four Weeks District Hospital / Similar Setup : Four to Six Weeks Evaluation of Skills: Perform requisite no. of skills. 2 mid term evaluation during the training and 1 final evaluation at the end of the training.

    10. EmOC Training-Summary Posting Schedule (18 weeks): Medical College / Tertiary Center (6 weeks): : Classroom training, Hands on the Anatomical Models, Hospital rounds. District Hospital / Similar Setup (10 Weeks): : Comprehensive, hands on training under the supervision of the DHs Master trainers. Evaluation of Skills: Every batch of Medical Officer is followed up twice by ICOG members: At the District Hospital training Site At FRUs where the trained MO is independently managing patients. ICOG certifies the Medical Officers who meet the certification criteria’s.

    11. SBA Training-Summary Training Duration: For staff nurses: Two to three weeks For ANMs and LHVs: The total duration of the course will be for a minimum of three weeks which can be extended for six weeks. Skill Assessment: Trainee are supervised during client practice. Perform at least 75% of the recommended number of cases as Performed To Standard (PTS) checklist. Trainee should get a score of “competency achieved” on at least 80% of steps in checklist.

    12. Training Progress

    13. Achievements: Anesthesia Training

    14. Achievements: EmOC Training

    15. Achievement: SBA Training

    16. Training Progress-LSAS and EmOC

    17. Training Progress-SBA

    18. LSAS-Capacity Utilization

    19. EmOC-Capacity Utilization

    20. Independent Anesthesia Evaluation UNICEF and DFID initiative through MGIMS, Sevagram. For assessment of the quality and impact of anesthesia training in provision of EmOC Services. Includes Assessment of : Training Site and Trainers: Medical College + DHs. EmOC Facilities: Trained personnel posted. No specialist/trained personnel available. Stakeholders.

    21. Impact of the training ( Gujarat & T.Nadu) Increased in No. of deliveries conducted. Increased in No. of Cesarean Section conducted. Anesthesia administered confidently during Cesarean section. No of Referrals reduced. Confidence in handling complications. Since the training protocol was not adhered to in Chhattisgarh, there was no visible impact.

    22. Recommendation from Evaluation LSAS training has improved the EmOC service provision in areas where specialist care is not available. Needs to adherence to GOI guidelines to improve quality and impact. States with High MMR along with shortage of specialist, needs to upscale the training. GOI Recommendation for establishment of quality assurance cell in the states needs to be implemented.

    23. Issues in Training… Linking the Facilities for operationalization with placement of trained personnel. Strengthening training sites and sites where the trainees be posted after the training. Selecting the trainees as per the requisite criteria and their willingness for undertaking the training. Timely nominations of the trainees and release of funds. Lack of monitoring and supportive supervision. Placing adequate funds for monitoring visit. Avoid transfer/deputation of trainers to other facilities. Strengthening SBA training institutes with logistics such as Tablet Misoprostol, Injection MagSulph and other essential inputs such as partograph etc.

    24. Way Forward… Planning for service provision needs to be holistic with linkage to manpower, training, logistics, equipments along with focus on quality service delivery protocols. Identifying the gaps and use of Facility Assessment Survey. HR needs, redeployment, multi skilling and contracting. Procurement of all needed supplies as per service package Placing monitoring systems involving SPMs/DPMs. Provision for repairs/renovations/additions . Quality of Training need attention; Activate State/District QA systems. Identify State and District Monitors. Initiatives to disseminate training and program guidelines. Standardization LR protocols and practising of the same.

    25. THANK YOU

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