Details for Reform Option "Protocols on Emergency Obstetric and Newborn Care, Tamil Nadu"
Most cases of maternal mortality occur due to complications during pregnancy and childbirth. Similarly two-thirds of neonatal deaths occur during the first week.
These deaths can be prevented by early detection and treatment. It is therefore imperative to train and capacitate the birth attendants/health workers to recognise these symptoms and initiate treatment at the earliest possible opportunity.
The Government of Tamil Nadu has developed and implemented standards of care for the management of common obstetric emergencies at the first referral level. Called “Protocols on Emergency Obstetric Care and Newborn Care”, six protocols have been developed for the immediate management of six most common emergencies seen at First Referral Unit (FRU) level in Tamil Nadu.
These protocols are adapted from guidelines for emergency obstetric and newborn care published in the WHO /UNFPA /UNICEF /World Bank manual: “Managing Complications in Pregnancy and Childbirth: a guide for midwives and doctors” and after consultations with senior obstetricians, paediatricians and UNICEF to review and adapt these to the local conditions.
The protocols have been brought out in the form of an easy-to-read chart booklet and supplied to all the district and sub district hospitals in the state. The individual protocols (wall charts) are to be displayed in the labour ward and in all other areas in the hospital where such emergencies are seen.
The technical basis for each protocol is discussed in the booklet and provides the evidence for management of the emergencies. It is intended that the medical officer in charge of the FRU should initially discuss these protocols with his/her medical and nursing colleagues and provide the necessary training and make available necessary equipments/drugs needed to implement this.
These protocols will thus be used in all FRUs whenever a doctor, nurse or health worker is confronted with an obstetric or newborn care emergency.
As a first in the implementation of the use of treatment protocols, a training programme was organised for two doctors - one obstetrician and one paediatrician from each district at Christian Medical College, Vellore. These trained doctors in turn trained all the other obstetricians, paediatricians and other doctors providing delivery care and new born care in the district and sub district hospitals.
The use of these protocols will be reviewed during monthly regional meetings of the chief medical officers. These protocols could also be used as a standard for assessing the quality of care in the obstetric emergencies and it is intended that the quality of care in obstetric emergencies at the FRU should be audited by the team using these protocols.
No evaluation has been undertaken since this is a very new initiative.
Cost of developing protocols:
State level workshop INR 1,00,000
Cost of working group INR1,00,000
Cost of printing INR 200 per chart booklet
Training of trainers INR 1,00,000
Training of doctors in the FRUs-Cost per FRU INR 10,000 (€ 169)
Note : As the treatment manuals are readily available in Tamilnadu,It can be reproduced without any additional cost for development.
All FRUs in Tamil Nadu since January 2004.
The time for development of manuals - 1 month
Trainers training - 3 months
Training of FRU doctors - 2 months ( done simultaneously)
Life-saving: Expected to bring about a decrease in the IMR, MMR and morbidity levels.
Quality: Improve the quality of maternal and newborn care.
Efficiency: It increases the efficiency of doctors, nurses and health workers.
Initiative to be taken by the Department of Health & Family Welfare, involving all stakeholders.
Who needs to be consulted
Reproductive and Child Health (RCH) directorate of the state government, senior obstetricians, gynaecologists and paediatricians and donor agencies working in the field of RCH.
Sustainable as this is a one time intervention.
Chances of Replication
Assumed replicable. No perceived problems with replication.
On a similar initiative, the Government of Chhattisgarh has made available the “Managing Complications in Pregnancy and Childbirth: a guide for midwives and doctors” in a bound form as a training manual for doctors.