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Chiranjeevi Welcome To Health and Family Welfare Department

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					         Chiranjeevi

Maternal Health Financing Issues
          and Options


  Department of Health & FW
    Government of Gujarat
            Maternal Death Watch-
                    Global

Every Minute...   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
                    Gujarat – A Profile
                                    Overview

Area                              196,000 km                     6% of India
Population                        50.5 million                   5% of India
Urbanization                          37%                      India avg. 28%
SDP                           Rs 1,425.60 billion              6.33% of India
(2003-04)                       (€ 26.40 bill.)

Per Capita Income                  Rs 26,979                 India average -Rs.
(2003-04)                          (€ 496.24)                      20,989
                                                                 (€ 388.69)


Recognizing Gujarat potential the Planning Commission set a target growth rate of 10% p.a.
                                       for Gujarat
                       Current Status

         Indicator              India     Gujarat


  Maternal Mortality Ratio      453        389



   Infant Mortality Rate         63         57


Maternal Deaths in one year   1,20,000     5000



 Infant Deaths in one year    25,00,000   72000
                 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
           Causes of Maternal Death
                      Haemorrhage
                         24.8%


                                         Infection
                                         14.9%

Indirect
causes
 19.8%

                                         Eclampsia
                                          12.9%
                                    Obstructed labour
       Other direct
       causes          Unsafe              6.9%
                       abortion
        7.9%            12.9%
Timing of maternal deaths-
     General Conditions


   Postpartum
      60%

                             During
                           pregnancy
                              24%



                During
                delivery
                  16%
          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
                    When do babies die

Week 1                                                 73.3

Week 2               13.8

Week 3             8.7

Week 4       4.2

         0     10        20   30   40   50   60   70      80
          Maternal Mortality: UK 1840–1960

       500

       400

       300
                                                       Maternal
       200
                                                       Deaths
       100

          0
            40
            50
            60
            70
            80
            90
            00
            10
            20
            30
            40
            50
            60
         18
         18
         18
         18
         18
         18
         19
         19
         19
         19
         19
         19
         19
Improvements in         Antenatal   Antibiotics, banked blood,
nutrition, sanitation   care        surgical improvements


Maine 1999.
Maternal Mortality Reduction
                                                 Sri Lanka 1940–1985


                                          2000
 Maternal Deaths per 100 000 livebirths




                                          1600
                                                                85% births attended
                                          1200
                                                                by trained personnel
                                          800

                                          400

                                            0
                                            1940–45   1950–55    1960–65    1970–75    1980–85
  New Global Understanding of
             MMR Reduction

Once major obstetric complication
develops- even a trained TBA or a nurse
cannot do much at home

These complications require
– surgical interventions
– injections of antibiotic
– blood transfusion
– aggressive treatments
           Three Delays Responsible for
                         Maternal Deaths

1.   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
2.   Delay in reaching care ( Community & System)
          Lack or underutilization of transport funds
          Non availability of referral transport in remote places
          Lack of communication network
3.   Delay in receiving care (System)
          Poor facilities, personnel and Supplies
          Poorly trained personnel with indifferent attitude
                 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
 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.
               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
Chiranjeevi Yojna - Options


Insurance coverage
Only pregnant woman and neonates
Family coverage


Service Coverage through outsourcing-
 Voucher system
Emergency Obstetric Care &
 Neonatal Care
           Outsourcing



 Private Gynecs/ GIA in their facility


 Payment to Gynecs for working in
  government hospital
                        Service Charges
   Normal delivery                        85   800    68000
Complicated cases
         Eclampsia                             1000
         Forceps/vacuum/breech            3    1000    3000
         Episiotomy                            800
         Septicemia                       2    3000    6000
Blood transfusion                         3    1000    3000
    Cesarean (7%)                         7    5000   35000
    Predelivery visit                 100      100    10000
    Investigation                     100       50     5000
    Sonography                            30   150     4500
   Dai                                100       50     5000
   Transport                          100      200    20000
                                                      179500
                        Service Charges
   Normal delivery                85    200    17000
Complicated cases
          Eclampsia                     300
          Forceps/vacuum/breech    3    300     900
          Episiotomy                    300
          Septicemia               2    300     600
Blood transfusion                  3    300     900
    Cesarean (7%)                  7    1000   7000
    Predelivery visit             100   100    10000
    Investigation
    Sonography                    30    150    4500
    Dai                           100    50    5000
   Transport                      100   200    20000
                                               65900
               Population and Births

Kachchh                          1526321

Banas Kantha                     2502843
Sabar Kantha                     2083416
Panch Mahals                     2024883
Dohad                            1635374

Total                            9772837

Total Births                     234548

BPL births                        58637
               The bill

Monetary requirements for Chiranjivi

   All BPL                    Rs 72    Crs

   BPL in 5 worst districts   Rs 10.5 Crs
     Implementation of Chiranjiv-1
District level FOGSI members workshops
organized for orientation on Chiranjiv 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
Chiranjiv panel doctors organized in each district.
    Implementation of Chiranjiv-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 Chiranjiv Panel doctors
by CDHOs
              Preliminary results

               Normal   LSCS    Complicated   Total

BK               1706     60           164      1930

Dahod            1159     80           307      1546

Kutch             828     53           179      1060

Panchmahal       2380     38             0      2418

Sabarkantha      1918     221            0      2139

Total            7991     452          650      9093
Performance of enrolled doctors

              Total                          Average/
              O&G     Enrolled    Deliveries   doc
BK             50        52         1930       37
Dahod          16        18         1546       86
Kutch          47        20         1060       53
Panchmahal     29        27         2418       90
Sabarkantha    73        46         2139       47
Total         215     163 (75%)     9093       56
         Caesarian deliveries


               Total   LSCS

BK             1930     60      3%

Dahod          1546     80      5%

Kutch          1060     53      5%

Panchmahal     2418     38      2%

Sabarkantha    2139    221      10%

Total          9093    452      5%
                   Miles to go

                             % age against BPL
             District       delivery workload for
                                  4 months

BK                                   23
Dahod                                30
Kutch                                18
Panchmahal                           44
SK                                   38
State                                31
                        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
       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
More charges for transportation in Kutch
Cost likely to increase to 2,00,000/100
deliveries

				
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posted:4/10/2011
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