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Operationalisation of a First Referral Unit, Maharashtra
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Subject Area="First Referral Units." Objective="Access to RCH services."
Details for Reform Option "Operationalisation of a First Referral Unit, Maharashtra"

Background: The population of Osmanabad district is 1,472,256, of whom the vast majority (1,239,009), live in rural areas. This population was served by three Primary Health Centres (PHCs), one of them situated at Washi, which referred patients to the District Hospital at Osmanabad, 65km from Washi. The rates of maternal mortality (MM) and infant mortality (IM) were high in the district and institutional deliveries were low. In 1999 a Women’s Right to Life and Health (WRLH) project was implemented in Maharashtra under UNICEF’s border district cluster strategy (BDCS). Its aims were to reduce MM and IM by providing 24-hour comprehensive emergency obstetric care (C-EMOC) through identified First Referral Units (FRUs). Under a pilot scheme, four FRUs from Osmanabad district were selected as EMOC centres. Washi rural hospital was one of them. Washi operated as an FRU from 1999 but was not fully operationalised until 2002 since the specialists at the clinic during that time were not able to perform emergency operations. Action: In 2002 Washi rural hospital was upgraded and provided with a dedicated EMOC team consisting of three specialists: a gynaecologist, an anaesthetist and a paediatrician. The unit also employed an additional Medical Officer and seven staff nurses as well as a laboratory technician, x-ray technician, ophthalmic assistant and various support staff. Facilities at FRU Washi, including an operating theatre equipped with instruments supplied by UNICEF, and 24-hour water and electricity supply, enable it to offer the following: (i) Out patient and in patient services (ii) C-EMOC services including blood transfusion (iii) Laboratory services (iv) Major and minor operations in theatre (v) X-ray facility (vi) Ambulance services (v) Medico-legal work including post-mortems. The unit also follows six National Health Programmes: (i) Family planning (ii) Maternal and child health (iii) Revised national tuberculosis control (iv) Leprosy control (v) Malaria control (vi) Control of blindness Results: Between 2000 and 2005, FRU Washi has seen steady improvement in the number of obstetric admissions, live births and successfully treated complications. (i) Obstetric admissions have risen from 562 in 2000 to 971 in 2004. (ii) Deliveries have more than doubled from 328 to 700. (iii) Live births have risen from 325 to 685. (iv) Obstetric complications treated have gone from nil to 164. (v) There have been no maternal deaths at the hospital since July 2002. Additional training has also resulted in: (i) sensitisation of staff. (ii) improvements to the ante-natal clinic including screening of high risk patients. (iii) monitoring of progress of labour using partograph. (iv) effective infection prevention practises and disposal of waste. (v) use of anaesthesia during obstetric surgery. (vi) efficient record keeping.

Cost Information not available.
Place Rural hospital Washi, Nr Kunthalgiri, Osmanabad, Maharashtra.
Time Frame Two and a half years from implementation of WRLH project to operationalisation of FRU, Washi. Following upgrade and posting of specialists in 2002, comprehensive emergency obstetric care services took immediate effect.

Access to obstetric care: Provides emergency and non-emergency specialist care to patients who would have had to travel long distances to district hospital. Increased institutional deliveries: Proximity of services encourages patients to choose institutional over home delivery.


Dependent on specific skills mix: Should one specialist be transferred there is no guarantee of another of the same specialisation being posted there. Without the current skill mix the FRU would not be able to provide the same services.


Availability of specialists. Funding from UNICEF or other donor for initial upgrade and maintenance of equipment.

Who needs to be consulted

Health officials at State and district levels; donor agency.



Depends on skills mix within FRU.

Chances of Replication

Depends on funding from donor and availability of specialists.




Submitted By

Tessa Laughton, Research Consultant, ECTA, New Delhi. February 2005.

Status Active
Reference Files
FRU Washi, Maharashtra.jpg FRU Washi, Maharashtra
Maternity ward, FRU Washi, Maharashtra.jpg Maternity ward, FRU Washi, Maharshtra
OT equipment, FRU Washi, Maharashtra.jpg OT equipment, FRU Washi, Maharashtra
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