Mother India

As always the numbers are very impressive Under the National Rural Health Mission NRHM 8722 doctors 2914 specialists 14529 paramedics 33 413 staff nurses 69662 auxiliary nurse midwives and 10995 doctors and 3894 paramedics practising traditional medicine have been hired to ensure

that everyone in rural India irrespective of where they live and how much they earn have access to basic healthcare
Government data also shows that innovative approaches such as decentralisation flexible financing improved management and incentives have ensured more women were choosing hospitals over home to deliver their babies bringing the maternal mortality rate MMR down from 254 per lakh live births in 2006 to 212 in 2009 and infant mortality rate IMR from 58 per 1000 live births in 2005 to 47 in 2010

Still 125 lakh newborns and 63000 women die each year cause of pregnancyrelated causes and Union health minister Ghulam Nabi Azad admitted as much in Parliament last month

quotUnfortunately Indias IMR and MMR is very bad As bad that it cannot be compared with our neighbours Nepal Sri Lanka and Bangladesh Pakistan is the only country India can be compared withquot he told the Rajya Sabha last month in response to a question on infant deaths in staterun hospitals in West Bengal

Quality challenged
The devil is in the detail An incredible 13 crore 113 million women have benefited from the Janani Suraksha Yojana JSY which offers pregnant women free and cashless deliveries including free caesareansections and a R1400incentive to deliver in a hospital In most cases having a baby in a hospital brings no benefits for new mothers other the R1400 quotThere is lowbirth preparedness that leads to delays in pregnant women reaching a hospital and getting treated for preventable complications An analysis of maternal deaths for example showed that 13 deaths happened on the way to the hospital and 11 after the women return home which shows poor management before and at the hospitalquot said Aparajita Gogoi executive director Centre for Development and Population Activities India an international nonprofit that works to improve adolescent and womens health

Whats clearly lacking is quality said experts at the National Consultation on Safe Motherhood in Jaipur this week quotQuality is lost in the rush to meet targets such as attaining 100 institutional deliveries We have the standards technical tools and the basic infrastructure needed but still the quality of delivery depends on people not on standard compliances The system delivers what the top government asks for so if quality targets are set for babus they will be metquot said Dr Monir Islam director Family Health and Research WHO Southeast Asia region

Measures of quality include better patient outcomes fewer deaths and complications lower infection rates and overall patient satisfaction

Whos to blame
quotI admit that quality is missing and we cannot continue to take pride in institutional deliveries if its just taking deaths from home to hospitals Most government institutions have a take it or leave it approach and dont care if the patients dont like what they offer This attitude needs to change which is tough because in this country we are very tolerant of bad quality No one ever asks a doctor why he is late or absent from the clinic frequentlyquot said Anuradha Gupta additional secretary and mission director NRHM Union ministry of health

A major reason for the national apathy to incompetence is that action is rarely taken against erring government appointees who focus more on hanging on to the job than doing it well

What will improve quality is better tracking and monitoring to identify and eliminate avoidable cause of death and complications help identify areaspecific problems and ensure transparency quotBut the review should not be done by the provider as it usually happens in India There is massive underreporting of deaths with one state reporting only 20 maternal deaths with the doctors listing the deaths under different pregnancyrelated complications such as septicaemia or organ failurequot said Gogoi

The buck stops here
Someone has to take responsibility for the shortfalls just as many throng to take credit for the successes quotYou need ownership We have too much participation in India even cows and dogs visit hospitals Just as a pilot cannot ask all crew for participative flying of a plane you cannot have everyone running the showquot said Dr Dileep Mavalankar dean Indian Institute of Public Health Gandhinagar Gujarat

Date : 15 Apr, 2012
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