Chiranjeevi Chiranjeevi Maternal Health Maternal Health Financing Issues Financing Issues and Options and Options Dr Amarjit Singh Dr Amarjit Singh Commissioner Health & Commissioner Health & Secretary Family Welfare Secretary Family Welfare Government of Gujarat Government of Gujarat
35
Embed
Chiranjeevi Maternal Health Financing Issues and Options Dr Amarjit Singh Commissioner Health & Secretary Family Welfare Government of Gujarat.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Chiranjeevi Chiranjeevi
Maternal Health Maternal Health Financing Issues Financing Issues
and Optionsand Options
Dr Amarjit SinghDr Amarjit SinghCommissioner Health & Commissioner Health &
Secretary Family Welfare Secretary Family Welfare Government of GujaratGovernment of Gujarat
Lessons from HSRsLessons from HSRs
Steer don’t rowSteer don’t row
Finance rather than directly provideFinance rather than directly provide
New Global Understanding ofNew Global Understanding ofMMR ReductionMMR Reduction
Once major obstetric complication Once major obstetric complication develops- even a trained TBA or a nurse develops- even a trained TBA or a nurse cannot do much at home cannot do much at home
These complications require effective back These complications require effective back up by trained O&G expertsup by trained O&G experts
surgical interventions surgical interventions injections of antibiotic injections of antibiotic blood transfusion blood transfusion aggressive treatments aggressive treatments
Three Delays Responsible for Three Delays Responsible for Maternal DeathsMaternal Deaths
1.1. Delay in deciding to seek careDelay in deciding to seek care (Individual & family) (Individual & family) Lack of understanding of complicationsLack of understanding of complications Gender issues, Low status of womenGender issues, Low status of women Socio-cultural barriers to seeking careSocio-cultural barriers to seeking care Poor economic conditions of the familyPoor economic conditions of the family
2.2. Delay in reaching careDelay in reaching care ( Community & System) ( Community & System) Lack or underutilization of transport fundsLack or underutilization of transport funds Non availability of referral transport in remote placesNon availability of referral transport in remote places Lack of communication networkLack of communication network
3.3. Delay in receiving careDelay in receiving care (System) (System) Poor facilities, personnel and SuppliesPoor facilities, personnel and Supplies Poorly trained personnel with indifferent attitudePoorly trained personnel with indifferent attitude
Delay in problem recognition and decision makingSECOND DELAYSECOND DELAY
Delay in reaching a referral facility
FIRST DELAYFIRST DELAY
THIRD DELAYTHIRD DELAY
Delay in getting care at the health facility
WHY Do Women Die?WHY Do Women Die?
OptionsOptions
Improve Government Health ServiceImprove Government Health ServiceCompetent staffCompetent staff
Maternal Health- GujaratMaternal Health- GujaratObjectives ( by 2010):Objectives ( by 2010):
Universalize coverage of antenatal care Universalize coverage of antenatal care (100%)(100%)
Increase the deliveries attended by SBAs Increase the deliveries attended by SBAs 90% 90%
Increase institutional deliveries by 80%Increase institutional deliveries by 80% increase access to Emergency Obstetric increase access to Emergency Obstetric
Care for complicated deliveries Care for complicated deliveries Increase coverage of Post Natal Care Increase coverage of Post Natal Care
(90%) (90%) Increase access to Early & Safe Abortion Increase access to Early & Safe Abortion
servicesservices Improve access to RTI/ STI servicesImprove access to RTI/ STI services Introduce AFHS in all PHC/ CHCsIntroduce AFHS in all PHC/ CHCs..
Broad IssuesBroad Issues
Non - availability of O & G specialistsNon - availability of O & G specialists
Accessibility of services-Tribal and Accessibility of services-Tribal and urban slumsurban slums
Poor utilization of services- Poor utilization of services- Low felt need of health & medical servicesLow felt need of health & medical services Lack of user friendly & quality public health Lack of user friendly & quality public health
servicesservices Costly private health and medical servicesCostly private health and medical services No health insurance coverageNo health insurance coverage
Service Coverage through Service Coverage through outsourcing- voucher systemoutsourcing- voucher system
Emergency Obstetric Care & Emergency Obstetric Care & Neonatal CareNeonatal Care
Private Gynecs/ GIA in their facilityPrivate Gynecs/ GIA in their facility
Payment to Gynecs for working in Payment to Gynecs for working in government hospitalgovernment hospital
Service ChargesService Charges
Normal delivery 85 800 68000
Complicated cases
Eclampsia 1000
Forceps/vacuum/breech 3 1000 3000
Episiotomy 800
Septicemia 2 3000 6000
Blood transfusion 3 1000 3000
Cesarean (7%) 7 5000 35000
Predelivery visit 100 100 10000
Investigation 100 50 5000
Sonography 30 150 4500
Dai 100 50 5000
Transport 100 200 20000179500
Service ChargesService Charges
Normal delivery 85 200 17000
Complicated cases
Eclampsia 300
Forceps/vacuum/breech 3 300 900
Episiotomy 300
Septicemia 2 300 600
Blood transfusion 3 300 900
Cesarean (7%) 7 1000 7000
Predelivery visit 100 100 10000
Investigation
Sonography 30 150 4500
Dai 100 50 5000
Transport 100 200 20000
65900
Population and BirthsPopulation and Births
Kachchh 1526321
Banas Kantha 2502843
Sabar Kantha 2083416
Panch Mahals 2024883
Dohad 1635374
Total 9772837
Total Births 234548
BPL births 96432
Implementation of Chiranjeevi - 1Implementation of Chiranjeevi - 1
District level FOGSI members workshops District level FOGSI members workshops organized for orientation on Chiranjeevi scheme organized for orientation on Chiranjeevi scheme and enrollment of doctors on the paneland enrollment of doctors on the panel
Honorable Health Minister wrote a letter about the Honorable Health Minister wrote a letter about the scheme to presidents of district and talukas in 5 scheme to presidents of district and talukas in 5 districts.districts.
District level Advocacy workshops of Presidents of District level Advocacy workshops of Presidents of district and taluka panchayat, along with BHO and district and taluka panchayat, along with BHO and Chiranjeevi panel doctors organized in each Chiranjeevi panel doctors organized in each district. district.
Implementation of Chiranjeevi - 2Implementation of Chiranjeevi - 2
In each district IEC activities were undertaken. In each district IEC activities were undertaken. Awareness through Gramsabhas Awareness through Gramsabhas
Rs 15000/ advance was given to each Rs 15000/ advance was given to each obstetrician. No delay in reimbursement to obstetrician. No delay in reimbursement to doctors.doctors.
Regular interaction with Chiranjeevi Panel Regular interaction with Chiranjeevi Panel doctors by CDHOsdoctors by CDHOs