Friday, July 10, 2015
The World Health Organization defines Maternal Mortality Ratio (MMR) as the number of women who die from pregnancy- related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. Now, Maharashtra’s hard labour of 12 years has borne sweet fruit; the state’s MMR dropped from 149 in 2001-03 to 68 in 2011-13 amounting to a whopping 54% reduction. Owing to being accorded the highest compound rate of decline among all Indian states, Maharashtra was elevated to the second spot in the countrywide MMR rankings.
This astounding success could be credited to the ‘10 smart ideas’ that were put forth to address a specific need and to achieve a particular goal. These ideas were as follows:
• Free and cashless delivery/caesarean operation, treatment of normal/sick new born (up to 30 days after birth) in government health institutions.
• Free drugs/consumables, diagnostics, diet during stay in health institution, provision of blood, transport from home, transport between facilities in case of referral as also drop-back from institution after a 48 hour stay.
• Financial assistance of Rs 500 per birth, up to two live births to women above 19 years of age, from Below Poverty Line households; Rs 700 for women from rural areas.
• Each pregnant woman tracked for 270 days (from registration to childbirth).
• Availability of blood bank or blood storage facility in a 50 km radius.
• Instructional video on healthy diet during pregnancy and why nutrition is vital for both mother and child.
• Mobile app to track health of pregnant woman and child (till 1 year old); reminders sent to mother about sonography, tests, medication.
• Area supervisor holds monthly meetings with pregnant women.
• Asha workers visit pregnant women to monitor diet, medication and health.
• Maternal Death Committee meets monthly to review cause of each death at childbirth.
The Centre also integrated 3 campaigns to keep MMR in check, namely Janani Shishu Suraksha Yojana, Janani Suraksha Yojana and Rajmata Jijau Mother and Child Nutrition Mission. "As part of the first two schemes, we have, for the last three years, included district health officers in creating a plan of action. This has helped us identify and register each pregnant woman in every taluka with local hospitals and anganwadis," said Dr Archana Patil, additional director, health services.
To ensure that none of the pregnant women were left unaccounted, the State amassed a strong workforce of 1 lakh Asha workers, each manning an Anganwadi and looking after 200 households. To bolster and motivate the Asha workers, the State gives them incentives for activities such as registering pregnant women, facilitating institutionalised delivery, and bringing HIV positive mothers to a clinic among many other things.
This multi-pronged approach has indeed borne fruit what with the sizeable reduction in MMR. But the Maharashtra government is not yet revelling in the victory; the state has plans to overtake Kerala and assume the position of the first pre and postnatal caregiver. And how does it plan to do so? By equipping Asha workers with tablet devices pre-loaded with instructional videos and increasing the count of blood banks. With this steady pace of efforts yielding a reduced MMR, the Maharashtra government’s model is sure worth being replicated by other Indian states too.
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