Chiranjeevi Reducing maternal and neonatal mortality through PPPP Gujarat experience in safe motherhood and child survival Achieving MDG 5 Dr Amarjit Singh.

Chiranjeevi Reducing maternal and neonatal mortality through PPPP

Gujarat experience in

safe motherhood and child survivalAchieving MDG 5

Dr Amarjit Singh IAS

Principal Secretary (FW) &Commissioner Health

Government of Gujarat

Currently ED, Population Stabilization Fund, GOI

26th October, 2009

Why Chiranjeevi?

100

80

60

30

10

5

0

20

40

60

80

100

Untrained dai Quack Trained dai ANM Homeopath Ayurved

Source Time Period

Urban Rural

NFHS - 1 1992-93(424)

397 448

NFHS - 2 1998-99(540)

267 619

 Rural Popu

OBGYs Reqd

Inplace

GapPopu

/gynec

AP 55401067 167 73 94 7.59

Gujarat 31740767 273 7 266 45.5

M’ashtra 55777647 407 202 205 2.7

MP 44380878 229 13 216 3.41

India 742490639 3910 1338 2010 5.55

15% women have pregnancy related complications5 lac deaths globally1.5 lacs in IndiaHuge morbidity

Development of ChiranjeeviFocus on the marginalised population

• Development after a year long consultative process with

– Insurance companies– IIM Ahmedabad– Sewa Rural Jhagadiya– GTZ – FOGSI– Public Health Experts

• Advance to private ObGYNs; Legal support In case of death during delivery

• One of the interventions in the package of maternal health interventions; the other interventions like trg SBAs; MOs in CeMOC and BeMOC skills continued

• Scheme kept simple; Use of existing mechanisms such as BPL cards issued by RDD

Package Rates for Chiranjeevi for Private Institutions (Dollars)

ServiceNo. of cases Rate Per Case Cost

Normal delivery 85 17.8 1511

Complicated cases   0.0

Eclampsia   22.2

Forceps/vacuum/breech 3 22.2 66

Episiotomy   17.8

Septicemia 2 66.7 133

Blood transfusion 3 22.2 66

Cesarean (7%) 7 111.1 777

Predelivery visit 100 2.2 222

Investigation 100 1.1 111

Sonography 30 3.3 100

NICU support 10 22.2 222

Food 100 2.2 222

Dai 100 1.1 111

Transport 100 4.4 444

Total  100   3988

Gynecologist involvement in Chiranjeevi

District

Total OBGY

Specialists in the

district

# enlisted under

Chiranjeevi scheme

Total # of deliveries Performed

Average delivery

per Doctor

BK 50 72 35060 487

Dahod 18 13 37923 2917

Kutch 47 19 15713 827

P'mahal 29 33 55263 1675

SK 73 45 40852 908

Total 217 182 184811 1015

Chiranjeevi Scheme Performance January 2006 – September- 2009

District

Nature of Deliveries

Normal LSCSComplicated

Total%

LSCS

BK 31716 1591 1753 35060 4.5

Dahod 30302 908 6713 37923 2.4

Kutch 10696 769 4248 15713 4.9

P'mahal 52123 2036 1104 55263 3.7

SK 35994 3555 1303 40852 8.7

Rest of Gujarat

180146 14296 5668 200110 7.1

Total 340977 23155 20789 384921 6.0

Transport support for delivery

Medical Emergencies & Pregnancy cases

9 18 42 229 733 1304 1656 1964 28814683

808511274

1336316191 16974

1925620897 20697

24435

948 1445 18463476

702710075

1165613403

16780

20396

28095

34490

40602

50869 49888

5913462015

60291

70019

0

10000

20000

30000

40000

50000

60000

70000

80000

Sep Oct Nov Dec Jan Feb Mar APR MAY JUN JUL AUG SEP OCT NOV Dec Jan Feb Mar

month

Me

dic

al E

M &

Pre

gn

an

cy C

ase

s

Pregnancy Total Medical EM

Responded to 8.88 lac emergencies; average 2300 medical emergencies per day; around 2.76 lac (32%) pregnancies; delivery by EMT 6735 {5256 in ambulance; 1489 at

site} 91% from rural areas;saved around 37,774 lives

Total Deliveries under CY scheme

Likely Matern

al deaths as per MMR

Maternal death

reported under CY scheme

Mothers saved

under CY scheme

Likely Neo-Natal deaths

as per Current NNMR

Early Neo-Natal death

reported under CY scheme

Early Neonat

es saved

384921 1732 67 1665 8853 1384 7469

Outcome of Chiranjeevi (CY) Scheme:

Mothers & New Born babies saved ( Up to Sept-09)

•Normal Deliveries: 340977•C-Section: 23155 (6.0%)•Complicated Deliveries: 20789 (5.4%)•Private specialist enrolled: 817/2000

56.2

49.946

38

64.462.61

70.55

56.69 55.39

72.7570.8

85.1

57.1

63.1

87.386.7 88.3

69.7

79.0

91.8

0

10

20

30

40

50

60

70

80

90

100

Banaskantha Dahod Kutch Panchmahal Sabarkantha

2005-06 2006-07 2007-08 2008-09

Increase in institutional deliveries

Source: Form No. 9, State report

IssuesDoable- Unprecedented support from the Private OBGYNs – potential for replication in other areas

Surge of demand - boon to the poor - Unindicated C-section in check

High level of anemia in women - Availability of blood???

Demand side effort

Prompt payments – awards to high performers - independent regulation of contract

SEARO, WHO conference in Gujarat Asian innovation award Publication in The Lancet PM award for excellence in Pub Admn

Recognition

Let us join hands to reduce maternal mortality.

We make a living by what we get;

we make a life by what we give!

Dr Amarjit SinghPrincipal Secretary, FW, Department of Health & FW Government of Gujarat, Gandhinagar,Gujarat