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Providing round-the-clock Comprehensive Emergency Obstetric and Newborn Care centres, Tamil Nadu
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Subject Area="First Referral Units." Objective="24 hour service."
Details for Reform Option "Providing round-the-clock Comprehensive Emergency Obstetric and Newborn Care centres, Tamil Nadu"

Background: A large number of maternal and infant deaths can be prevented if emergency services are made available within the reach of people’s homes. Though there are 163 designated First Referral Units (FRUs) in Tamil Nadu, round the clock services for obstetric and newborn emergencies are not available in all the FRUs. Action: It was decided to select two to three hospitals in each district and fully equip them with necessary infrastructure and human resources, certify the hospitals and closely monitor them to ensure the availability of services. Sixty-two such hospitals known as Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres were set up all over Tamil Nadu. In the first phase, a minimum of two CEmONC centres have been established in every district – one at the district hospital and the other at either the teaching hospital or the taluk (block) level hospital. These have 4 obstetric and gynaecology specialists, 4 paediatric specialists, two general surgeons and two anaesthetists. The services of private anaesthetists and obstetricians have been hired in places where there has been a shortage of these specialists. In addition, general surgeons have been given training in obstetric and gynaecological surgical interventions and have been empowered to conduct Caesareans. CEmONC centres will focus on blood availability round the clock and a two-day training programme on blood bank services for doctors and staff nurses of these centres was organised by the Directorate of Reproductive and Child Health Project in collaboration with UNICEF. All the nurses, lab technicians and doctors perform grouping, cross matching of blood, transfuse the blood and manage the transfusion reactions without depending on the blood bank staff. Results: Maternal mortality has dropped by 36 per cent between 2001 and 2005.

Cost Blood bank training for all the doctors, nurses and lab technicians in 270 hospitals cost INR 20 lakhs . The recruitment of additional specialists cost around INR 56 million per year. The cost of employing a specialist per annum would be approximately INR 2.4 lakhs per year. As the equipment was already available, no additional cost was involved but it is advisable to conduct a facility survey to asses the infrastructure, equipment and human resource requirements of the CEmONC hospitals before beginning the initiative.
Place Tamil Nadu since August 2004.
Time Frame Facility survey: Six months. Blood bank training: Three months. Procurement of equipments & recruitment of specialists: One year.

Life-saving: Expected to bring about a decrease in the IMR, MMR and morbidity levels. Extends service: Ensure availability of emergency services for complicated deliveries, sick newborns and adequate blood round-the-clock. Quality: Improve the quality of maternal and newborn care.


None perceived.


Government Order. Funding support. Available staffing levels.

Who needs to be consulted

All programme officers at the district and state level. Director of Medical and Rural Health services to provide the training.



Expected to be good, if the funding is available.

Chances of Replication

Already implemented in 62 centres in all the districts of the state. An additional 50 centres will be made functional under RCH 2 so that the mothers can reach a CEmONC centres within half an hour of travel, wherever they live in the district.




Submitted By

Sara Joseph, Researcher, ECTA, October 2004. Updated February 2006.

Status Active
Reference Files
CEmONC_GO.doc GO No. 2D. No 42 dated 2 August 2004 on Identification of Government Hospitals as CEmONC
CEmONC clipping.htm Newspaper clippings dated 20 May 2004
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