1. 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

2. Why Chiranjeevi? SourceTime Period Urban Rural NFHS - 11992-93 (424) 397 448 NFHS - 21998-99 (540) 267 619 Rural Popu OBGYs Reqd In place Gap Popu /gynec AP5540106716773947.59 Gujarat31740767273 7 26645.5 Mashtra557776474072022052.7 MP44380878229132163.41 India7424906393910133820105.55 15% women have pregnancy related complications 5 lac deaths globally 1.5 lacs in India Huge morbidity

3. 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

4. Package Rates for Chiranjeevi for Private Institutions (Dollars) Service No. of casesRate Per CaseCost Normal delivery 8517.81511 Complicated cases 0.0 Eclampsia 22.2 Forceps/vacuum/breech 3 22.266 Episiotomy 17.8 Septicemia 2 66.7133 Blood transfusion 3 22.266 Cesarean (7%) 7 111.1777 Predelivery visit 100 2.2222 Investigation 100 1.1111 Sonography 30 3.3100 NICU support 10 22.2222 Food 100 2.2222 Dai 100 1.1111 Transport 100 4.4444 Total 100 3988

5. Gynecologist involvement in Chiranjeevi District Total OBGY Specialists in the district # enlisted under Chiranjee vi scheme Total # of deliveries Performed Average delivery per Doctor BK5072 35060 487 Dahod1813 37923 2917 Kutch4719 15713 827 P'mahal2933 55263 1675 SK7345 40852 908 Total217182 184811 1015

7. 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

8. 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 3849211732671665885313847469 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 Increase in institutional deliveries

9. Source: Form No. 9, State report

11. 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

12. 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