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INCREASING ACCESS TO EMERGENCY OBSTETRIC SERVICES : EXPERIENCES FROM RAJASTHAN, INDIA Presenter: Hemant Dwivedi Aut PowerPoint Presentation
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INCREASING ACCESS TO EMERGENCY OBSTETRIC SERVICES : EXPERIENCES FROM RAJASTHAN, INDIA Presenter: Hemant Dwivedi Aut - PowerPoint PPT Presentation


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INCREASING ACCESS TO EMERGENCY OBSTETRIC SERVICES : EXPERIENCES FROM RAJASTHAN, INDIA Presenter: Hemant Dwivedi Authors : Venkatesh Srinivasan Hemant Dwivedi Dileep Mavalankar UNITED NATIONS POPULATION FUND (UNFPA), INDIA. KEY DEVELOPMENT INDICATORS.

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slide1

INCREASING ACCESS TO

EMERGENCY OBSTETRIC SERVICES : EXPERIENCES FROM RAJASTHAN, INDIA

Presenter: Hemant Dwivedi

Authors : Venkatesh Srinivasan

Hemant Dwivedi

Dileep Mavalankar

UNITED NATIONS POPULATION FUND (UNFPA), INDIA

slide4

HEALTH SYSTEM AN OVERVIEW

  • Sub-Centers - with an Auxiliary Nurse Midwife (ANM) - 5000 population
  • Primary Health Centers (PHCs) - Medical Officer (MO) and Paramedics - 30,000 population
  • Community Health Centers (CHCs) - Specialists doctors, MOs and Paramedics - 125,000 population
  • District Hospital - Multi Speciality - 2 million population
  • Medical College and Asso.Hospital - Division level
slide5

PROJECT DETAILS

  • Averting Maternal Death and Disability (AMDD) project supported by Columbia University with a grant from the Bill and Melinda Gates Foundation.
  • Implemented as component project under UNFPA supported Integrated Population and Development (IPD) Project, Rajasthan, India from 2001-2004.
  • ProjectArea

Seven Districts of Rajasthan, India

Population covered - 13.5 million

  • Facilities Covered

CEOC - 31 institutions

BEOC - 52 institutions

  • Project Duration

September 2000 - December 2004

  • Implementing Agency

Government of Rajasthan

slide6

KEY FINDINGS OF BASELINE STUDY (2000)

  • Service Coverage (UN-Process Indicators)
  • Number of institutions studied - 83
  • % of births in facilities - 10.89 (min.>15%)
  • % met need of EOC - 8% (min.100%)
  • % births by C-section - 0.6 (min.5-15%)
  • Average CFR - 1.4 (min 1%)
slide7

STATUS OF HEALTH SYSTEM AT BASE LINE SURVEY IN 2000

  • High vacancies of specialists OB/GY and anesthetist
  • PHCs not offering complete range of BEmOC
  • Very few CHCs prepared to address EmOC
  • Only 21.5% deliveries in institutions
  • Low utilization of services and confidence in PHCs
  • Delay in reaching institutions
slide8

PROJECT FOCUS

  • Needs Based Differential Approach
  • IMPROVING ACCESS TO QUALITY SERVICES
  • Improved functional infrastructure
  • Provided necessary equipments and supplies
  • Skill based trainings - BEOC, IP Training
  • Development of management systems
  • INCREASE COMMUNITY AWARENESS
  • Advocacy Programs for PRIs, NGOs and Media.
  • Integrating Safe Motherhood messages into existing Community level activities.
slide10

WHY FOCUS ON BEmOC?

  • 80-85% obstetric complications do not need surgical interventions
  • Focus on BEmOC will reduce nearly 33-60% maternal deaths
  • Skills upgradation of service provider is feasible
  • Over dependence on OB & Gy specialist and anesthetist reduced
  • Reduces congestion at district and medical college hospitals
slide11

INITIATING BEOC SERVICES

  • Government in consultation with UNFPA decided to train MOs in BEmOC
  • 2 weeks training at district hospital
  • 62 teams trained BEmOC
  • MOs gained confidence in handling cases and expressed interest
  • Skills upgraded on manual removal of Placenta, management of shock, judicious use of Oxytocine, stabilizing cases of APH & PPH and ensuring referral when essential
  • Promoted use of evidence based practices
slide13

MANAGEMENT INFORMATION SYSTEM

  • Needs assessment
  • Pilot testing of revised MIS
  • Revised MIS orientation and implementation
  • Monitoring of progress on UN process indicators
slide14

RESULTS OF THE INTERVENTIONS

Health Institutions Providing Basic and

Comprehensive

EmOC

- Rajasthan

slide16

% Births increase in EmOC facilities : Comparison with non-intervention districts in last 4 years

slide17

Comparison of met need of EmOC :

Intervention and non-intervention districts

slide19

Comparison of Average CFR in Facilities

Intervention and non-intervention institutions

slide20

LESSONS LEARNED

  • BEmOC services as a feasible strategy in human resource scarce settings
  • Pragmatic strategies based on local specific needs leads to cost effective interventions
  • Improved service provision backed up by community mobilization increases utilization of services
  • Operationalising EmOC services requires sustained efforts
  • Demonstration project’s achievements facilitates advocacy at policy level
slide21

MOVING FROM PILOT TO SCALE

  • Logframe of new national RH programme draws on Rajasthan experience for strengthening EmOC services
  • Reduction in maternal morbidity and mortality is now a priority agenda of Rajasthan Government
  • UN process indicator confirmed as reliable and accessible indicators for public health systems to measure programme performance
slide23

FOR FURTHER INFORMATION….

HEMANT DWIVEDI

Sate Programme Coordinator

UNFPA Rajasthan State Office,

29, Srirampura Colony, Civil Lines, Jaipur, Rajasthan, India

Email : unfpajpr@sify.com

Telephone : 91-141-2220028/2220224

Fax : 91-141-2222277

VENKATESH SRINIVASAN

National Programme Officer

UNFPA, 53, Jorbagh, New Delhi, India

Email : venkatesh.srinivasan@unfpa.org.in

Telephone : 91-11-24651801

Fax : 91-141-24641679