Transcript Chiranjeevi Reducing maternal and neonatal mortality

Chiranjeevi
Reducing maternal and neonatal mortality through PPPP
Gujarat experience
in
safe motherhood and child survival
Achieving MDG 5
Dr Amarjit Singh IAS
Principal Secretary (FW) &
Commissioner Health
Government of Gujarat
Currently ED, Population Stabilization Fund,
GOI
26th October, 2009
Why Chiranjeevi?
15% women have
pregnancy related
complications
5 lac deaths
globally
1.5 lacs in India
Huge morbidity
OBGYs
Reqd
Rural
Popu
In
place
Gap
Popu
/gynec
AP
55401067
167
73
94
7.59
Gujarat
31740767
273
7
266
45.5
M’ashtra
55777647
407
202
205
2.7
MP
44380878
229
13
216
3.41
India
742490639
3910
1338
2010
5.55
100
Source
Time
Period
Urban
Rural
NFHS - 1
1992-93
(424)
397
448
NFHS - 2
1998-99
(540)
267
619
80
60
100
80
40
60
20
5
30
10
0
Untrained dai
Quack
Trained dai
ANM
Homeopath
Ayurved
Development of Chiranjeevi
Focus on the marginalised population
•
Development after a year long
consultative process with
–
–
–
–
–
–
Insurance companies
IIM Ahmedabad
Sewa Rural Jhagadiya
GTZ
FOGSI
Public Health Experts
•
Advance to private ObGYNs; Legal support In case of death during delivery
•
One of the interventions in the package of maternal health interventions; the other
interventions like trg SBAs; MOs in CeMOC and BeMOC skills continued
•
Scheme kept simple; Use of existing mechanisms such as BPL cards issued by RDD
Package Rates for Chiranjeevi for Private Institutions (Dollars)
Service
Normal delivery
No. of cases
Rate Per Case
Cost
85
17.8
1511
0.0
Complicated cases
22.2
Eclampsia
Forceps/vacuum/breech
3
22.2
66
17.8
Episiotomy
Septicemia
2
66.7
133
Blood transfusion
3
22.2
66
Cesarean (7%)
7
111.1
777
Predelivery visit
100
2.2
222
Investigation
100
1.1
111
Sonography
30
3.3
100
NICU support
10
22.2
222
Food
100
2.2
222
Dai
100
1.1
111
Transport
100
4.4
444
Total
100
3988
Gynecologist involvement in Chiranjeevi
Total
# enlisted
OBGY
Total # of
under
District Specialists
deliveries
Chiranjee
in the
Performed
vi scheme
district
Average
delivery
per
Doctor
BK
50
72
35060
487
Dahod
18
13
37923
2917
Kutch
47
19
15713
827
P'mahal
29
33
55263
1675
SK
73
45
40852
908
Total
217
182
184811
1015
Chiranjeevi Scheme
Performance January 2006 – September- 2009
Nature of Deliveries
District
Normal
LSCS
Compli
cated
Total
%
LSCS
BK
31716
1591
1753
35060
4.5
Dahod
30302
908
6713
37923
2.4
Kutch
10696
769
4248
15713
4.9
P'mahal
52123
2036
1104
55263
3.7
SK
35994
3555
1303
40852
8.7
Rest of
Gujarat
180146
14296
5668
200110
7.1
Total
340977
23155
20789
384921
6.0
Transport support for delivery
Responded to 8.88 lac emergencies; average 2300 medical emergencies per day;
around 2.76 lac (32%) pregnancies; delivery by EMT 6735 {5256 in ambulance; 1489 at
site} 91% from rural areas;saved around 37,774 lives
Medical Em ergencies & Pregnancy cases
80000
70019
70000
Medical EM & Pregnancy Cases
62015
59134
60000
60291
50869 49888
50000
40602
40000
34490
28095
30000
24435
20396
20000
16191 16974
16780
10075
10000
11656
13403
11274
3476
1445 1846
733
229
18
42
1304
20897 20697
13363
8085
7027
9948
19256
1656
1964
2881
4683
0
Sep
Oct
Nov
Dec
Jan
Feb
Mar
APR
MAY
JUN
JUL
AUG
SEP
OCT
month
Pregnancy
Total Medical EM
NOV
Dec
Jan
Feb
Mar
Outcome of Chiranjeevi (CY) Scheme:
Mothers & New Born babies saved ( Up to Sept-09)
Total
Deliveries
under CY
scheme
Likely
Likely
Maternal
Early NeoMatern
Mothers Neo-Natal
death
Natal death
deaths
al
saved
reported
reported
deaths
under CY
as
per
under CY
under CY
as per
scheme
Current
scheme
scheme
MMR
NNMR
Early
Neonat
es
saved
384921
1732
7469
67
1665
8853
1384
Increase in institutional deliveries
100
•Normal Deliveries:
•C-Section:
•Complicated Deliveries:
•Private specialist enrolled:
340977
23155 (6.0%)
20789 (5.4%)
817/2000
91.8
90
88.3
86.7
87.3
85.1
79.0
80
70.8
72.75
70.55
69.7
70
63.1
62.61
60
56.69 57.1
56.2
64.4
55.39
49.9
50
46
38
40
30
20
10
0
Banaskantha
Dahod
Kutch
2005-06
2006-07
2007-08
Panchmahal
2008-09
Sabarkantha
Source: Form No. 9, State report
Recognition
Issues
Doable- Unprecedented
support from the Private
OBGYNs – potential for
replication in other areas
Surge of demand - boon to the
poor - Unindicated C-section in
check
High level of anemia in women
- Availability of blood???
Demand side effort




SEARO, WHO conference in Gujarat
Asian innovation award
Publication in The Lancet
PM award for excellence in Pub Admn
Prompt payments – awards to
high performers - independent
regulation of contract
Let us join hands to reduce maternal mortality.
We make a living by what we get;
we make a life by what we give!
Dr Amarjit Singh
Principal Secretary, FW, Department of Health & FW
Government of Gujarat, Gandhinagar,
Gujarat