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

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Presentation transcript:

Chiranjeevi Reducing maternal and neonatal mortality through PPPP Gujarat experience in safe motherhood and child survival Achieving MDG 5 Dr Amarjit Singh IAS Principal Secretary (FW) & Commissioner Health Government of Gujarat Currently ED, Population Stabilization Fund, GOI 26 th October, 2009

Why Chiranjeevi? SourceTime Period Urban Rural NFHS (424) NFHS (540) Rural Popu OBGYs Reqd In place Gap Popu /gynec AP Gujarat Mashtra MP India % women have pregnancy related complications 5 lac deaths globally 1.5 lacs in India Huge morbidity

Development of Chiranjeevi Focus 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) Service No. of casesRate Per CaseCost Normal delivery Complicated cases 0.0 Eclampsia 22.2 Forceps/vacuum/breech Episiotomy 17.8 Septicemia Blood transfusion Cesarean (7%) Predelivery visit Investigation Sonography NICU support Food Dai Transport Total

Gynecologist involvement in Chiranjeevi District Total OBGY Specialists in the district # enlisted under Chiranjee vi scheme Total # of deliveries Performed Average delivery per Doctor BK Dahod Kutch P'mahal SK Total

Transport support for delivery 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 Outcome of Chiranjeevi (CY) Scheme: Mothers & New Born babies saved ( Up to Sept-09) Normal Deliveries: C-Section: (6.0%) Complicated Deliveries: (5.4%) Private specialist enrolled: 817/2000 Increase in institutional deliveries

Source: Form No. 9, State report

Issues Doable- 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 Singh Principal Secretary, FW, Department of Health & FW Government of Gujarat, Gandhinagar, Gujarat