|Subject Area="First Referral Units."
||Objective="24 hour service."
|Details for Reform Option "Certification of Comprehensive Emergency Obstetric and Newborn Care Centres, Madhya Pradesh"
Madhya Pradesh has a high Maternal and Infant Mortality Rate (MMR and IMR). Data indicates that 75 % of all maternal deaths take place during the natal and postnatal periods with one fifth of all deaths taking place during transfer to an appropriate and affordable health facility following the onset of an obstetric emergency.
Given this background, it was decided that MMR and IMR depends crucially on the availability of 24-hour Emergency Obstetric services, thus all First Referral Units (FRUs) are now expected to provide these round-the-clock services and are referred to as Basic or Comprehensive Emergency Obstetric and New Born Care service (BEmONC or CEmONC) centres. (BEmONC centres provide 24 hour delivery and neonatal services while CEmONC centres offer additional services including Caesarean section or blood transfusions).
To maintain standards, it was decided to introduce a process of certification for CEmONC centres to ensure they were properly staffed and equipped and functioning efficiently.
The State Government passed a Government Order identifying what services and facilities a CEmONC Centre must provide. (See References for full details).
(i) Easy access, 24-hour service and accountable staff providing quality service.
(ii) List of services.
(iii) Obstetric and paediatric casualty facilities (including anaesthetist) available round-the-clock.
(iv) Staff nurses trained in labour room procedures, new born resuscitation, blood bank operations and operation theatre work.
(v) Hiring of private anaesthetist and obstetrician where applicable.
(vi) Functional blood bank and storage with fully trained staff available 24 hours.
(vii) Functioning equipment and 24-hour availability of essential drugs.
(viii) Sanitary conditions with responsibility assigned to officer in charge of the institution.
(x) Monthly coordination/review meetings for FRU staff and Medical Officers/ Lady Health Volunteers/Auxiliary Nurse Midwives from local Primary Health Centres/Sub Centres to improve referral and service delivery.
(xi) Minimum staff structure and infrastructure requirements.
The same Government Order also details the process for certification of each centre:
(i) A committee of gynaecological, paediatric, surgery, anaesthetist and technical experts from district hospitals, state headquarters and development partners was formed and empowered to certify centres.
(ii) The committee visits each CEmONC centre only after the Chief Medical and Health Officer (CMHO) has declared that the centre meets the necessary criteria of CEmONC to the Directorate of Public Health and Family Welfare (DPHFW).
(iii) Each centre is visited by this ‘certification agency’ and must prove it meets the necessary criteria based on the requirements listed above. (See References for Criteria form).
(iv) Reports are also examined by an accreditation committee at State level chaired by the DPHFW.
(v) Once the centre has been accredited it may display a board publicizing that it has been certified by the State Government as a 24-hour provider of CEmONC services.
Motivation is provided with the promise of assured placement of manpower, training and prioritised and additional budgets for repair of buildings and equipment.
Standards are ensured by monthly reporting (see Results section).
The first round of accreditation was being carried out at the time of writing (February 2006). The committee has been told it must complete inspection and accreditation where applicable of 38 district hospitals by March 31 2006. There are a further 132 institutions (including Civil Hospitals and Community Health Centres) which then need to be inspected.
However at the time of writing, the process of certification was not yet complete due to slow progress having the facilities operationalised.
The local Development Partners Technical Assistance Team is also designing a new reporting mechanism for these facilities (170 CEmONC and 500 BEmONC) which will include the following five UN indicators:
(i) Quantum of EmOC services available.
(ii) Geographical distribution of EmOC facilities.
(iii) Proportion of all births in BEmONC and CEmONC facilities.
(iv) Met need for EmOC.
(v) Caesarean sections as a percentage of all births.
(vi) Case Fatality Rate.
||INR 437,000 for the first round of inspections (38 institutions).
||Madhya Pradesh since January 2006.
Evaluation: Ensures all CEmONC centres achieve minimum standards in healthcare provision, staffing levels and infrastructure.
Accountability: The inspections make medical and paramedical staff feel more responsible for the services they are delivering.
Coordination: Improves communication and therefore referrals between the districts or rural areas and the FRU.
Sustainability: Must ensure repeat inspections to maintain standards. Special inspections are to be commissioned if significant deficiencies are noticed in the monthly performance report.
Criteria for accreditation.
|Who needs to be consulted
Secretary Medical Education.
Directors of Medical Services and Medical Education.
Deans of Medical Colleges.
Directorate of Health Services directors.
Chief Medical and Health Officers.
As the reform is new, this is difficult to judge. It will require a sustained effort by policy and decision makers in the Department of Health and Family Welfare.
|Chances of Replication
Judged to be very good.
GS Sachdev, ECTA State Facilitator, Bhopal. March 2006.