Objective="Scope and quality of First Referral Units."
Details for Reform Option "Strengthening community health centres to avoid maternal deaths, Rajasthan"
The Averting Maternal Deaths and Disability (AMDD) project covers a population of 13 million in Rajasthan. According to a need assessment survey conducted in 2000, met need for Emergency Obstetric Care (EmOC) was as low as 8% and institutional births were 11%.
The main cause was that most of the Primary Health Centres (PHCs)/ Community Health Centres (CHCs) were not prepared for EmOC because of an absence of specialists in obstetrics, gynaecology and anaesthesia.
(i) Because the availability of obstetric and gynaecology specialists and anaesthetists at CHCs was low, a training module was finalised to train the available graduates.
(ii) The doctors were trained to manage emergency before, during and after labour including heavy bleeding, fever after childbirth, high blood pressure, obstructed labour, resuscitation of a newborn baby, etc.
(iii) A list of 145 items was prepared including storage facilities, furniture, medical equipments, etc. and was procured through the District RCH Society.
(iv) A mobile maintenance team was set up to service the old instruments.
(v) Essential drugs were also procured.
(vi) The infrastructure of several CHC/ Block PHC structures was renovated to become client-friendly and reduced the risk of infection.
(vii) The state government set up blood storage units at sub district hospitals.
(viii) Staff at 27 institutions were trained for prevention of infection during delivery. For this purpose, 12 teams of master trainers were trained.
(ix) The project also initiated improvement of quality of care. The staff of district hospital – Alwar - were trained in EmOC. A hospital-based action plan was prepared and implemented at the hospital. Efforts were made to assess the status of quality of EmOC services being provided, using a Quality Improvement Module developed by Engender Health.
(x) Community awareness building through orientation workshops for local representatives at state, district, block and Panchayat levels and media campaigns. The main purpose was to orient local representatives about the danger signs during pregnancy and about early referral. Another important message was about donating blood when the situation requires.
The project was completed in December 2003 but the evaluation process hasn’t yet started (March 2004).
But the following results have been recorded:
An increase in institutional births by 16.5% from the baseline figure.
Delivery complications treated increased from 5,607 in 2000 to 9,128 in 2003. This indicates that more cases of complicated deliveries were referred to the project institutions.
The met needs for emergency obstetric care increased from 8.8% in 2000 to 14% in 2003.
On an average, cost of renovation of operation theatre in each hospital was INR 329,000.
Seven districts in Rajasthan- Alwar, Bharatpur, Karol, Sawai Madhopur, Bhilwara, Chittorgarh and Udaipur. From January 2001 – December 2003.
Information not available.
Bottom-up approach: It tackles the problem from the bottom up, ie from the first referral unit level.
Comprehensive: It includes technical, managerial and community empowerment inputs.
Availability and awareness: It aims to ensure availability of the service and at the same time increase community’s awareness about the facilities available and when to refer.
No significant disadvantages recorded.
A needs assessment followed by a comprehensive plan to cover training, renovation and other activities.
Who needs to be consulted
All the stakeholders including the PHC, CHC, medical officers, district hospitals.
Sustainable provided the trained doctors remain at the facilities. It would also require refresher courses for the doctors and nurses.
For financial sustainability, continuous support is required.
Chances of Replication
The programme has already been replicated successfully in 7 districts in Rajasthan.
The AMDD project was implemented as a component project in the UNFPA-supported Integrated Population Development Project with financial support from the Bill and Melinda Gates Foundation.
Sara Joseph, Researcher, ECTA, New Delhi, September 2004.