Maternal Mortality and Morbidity in Jharkhand: Godda and beyond- the way forward

Meeting of civil society organizations Ranchi 4th August 2012 Top Recommendations for the government and technical agencies I. QUALITY ANTENATAL CARE 1. A standard protocol based on field realities for ANC which includes a history of previous pregnancies should be made. The protocol should include compulsory urine testing, Haemoglobin testing, malaria testing and taking blood Pressure and weight besides TT injections and testing for HIV. 2. Trainings should be provided to ANMs to update their skills in conducting Ante-natal care. 3. Ante-natal care should include clear explanation about danger signs in pregnancy and during labour. 4. ANMs should be instructed to put in reports to the PHC about possible high risk cases after the last trimester ANC, so that there is preparedness at the PHC level and information given to the MAMTA VAHAN in advance. 5. “Birth planning” should include not only micro-planning on part of the family but a map should be provided by the Government indicating the presence of a facility which can be reached within 2 hours where there is blood and C-section services available. 6. Nutrition support for adolescent girls and for pregnant women during pregnancy up to the post-partum period. This will help in prevention/management of malnourishment and anaemia. Further all women should be entitled to compensated maternity leave for six months. II. ROUTINE SERVICES 7. The Janani Sishu Suraksha Karykram (JSSK) needs to be implemented more effectively and reviewed with feedback from CSOs 8. The attitude of public service providers towards pregnant women needs to be changed – providers must treat pregnant women with more empathy and respect III. EMERGENCY OBSTETRIC CARE (EmOC) 9. In cases identified as high-risk cases, clear instructions of where the MAMTA Vahan should take such women should be indicated. MAMTA Vahan should have paramedics which will enable basic treatment to start immediately. 10. There should be a Protocol for Referral and in case of complications the MAMTA Vahan should be allowed to cross state borders in case the closest tertiary facility is situated in a neighbouring state. 11. Ensure the provisioning of essential drugs like Magnesium Sulphate and IFA tablets 12. Ensure the availability of blood in emergencies through a variety of initiatives including increasing storage facilities at CHC level, blood banks and encouraging youth volunteers to donate blood regularly. IV. COMMUNITY LEVEL SERVICES

13. Strengthening community midwives through providing them with proper training and providing at least two Skilled Birth Attendants in institutions which are situated as close to the home as possible 14. Better training of Sahiyas which especially includes recognition of Danger Signs during pregnancy and in the postpartum period. 15. ANMs to pay home visits in the post partum period. 16. Improve the provision of maternal health services (both ANC and postnatal) either near the settlements at sub-centre level or provide them at home. There should be a provision of „Grade A‟ nurses in remote areas. 17. Empower communities by providing information on rights and entitlements through Village Health and Sanitation Committees (VHSCs). Provide sustained support to the community through facilitation of participatory learning and action through women‟s groups and the VHSCs and empower them to the extent that they are able to assess their problems and take a decision on the facility they need to go to V. MATERNAL DEATH REVIEWS 18. Maternal Death Reviews should be conducted by using different models – (i) At the community level by civil society (ii) At the facility level through a Public Health Nurse in the District 19. There should be a compulsory notification of maternal deaths in order to capture the quantum of maternal death occurring. These should be taken into cognisance by government for action aimed at systemic improvements 20. MDRs should be made transparent and promote accountability by making the analysis and remedial action public 21. Pregnant women should be covered by insurance and compensation should be provided for all maternal deaths. Strategies employed to take this forward: Participants also suggested how these key recommendations may be advocated locally with the government and technical agencies. There should be a continuous dialogue within civil society to enable the provision of regular feedback and suggestions from the ground Networks/organizations which are already engaged in regular monitoring of women during pregnancy could also include maternal death surveillance Reporting of maternal deaths in other areas beyond Godda was necessary, especially where NGOs are located Need to collate the reports on maternal deaths at the district level To make each death count, reporting should be taken to the level (district, state) where action can be initiated A forum should be formed where health providers are invited and the community interacts with them (much like a jan sunvai)

Commitments for Monitoring and Advocacy at National and State Level: Who Will do what Jharkhand Committed to regular monitoring of pregnant women and reporting Women’s Health maternal deaths that occurred in their area of work Network Ekjut Rajkumar committed to reporting deaths from the areas that they work and Sarfaraz committed to report maternal deaths that occur in other blocks of Godda District Would continue his work which seems to have had some positive impact and based on this he would create a maternal survival audit which would bring out the factors that have contributed to a reduction in the maternal deaths in the areas where he works 1. Provide training to Sahiyas in ANC 2. Continue with Maternal Death Audits in her hospital 3. Take the results of the Maternal Death Audits back to the community and discuss it with them 1. Once Godda Fact-finding report is made final, will present it to the new NRHM Mission Director (before it is published at national level) 2. Would share maternal deaths with District Collector and discuss the cases with them, share data and case studies, highlight trends. 3. Would bring up the issue of quality of care with the District Collector 4. Would interact with the SPMU and the Mission Director, NRHM to push for including blood testing and urine testing as a mandatory part of ANC 5. To record and report on the quality of ANC provided during the Village and Health Nutrition Day to the Government (Ms. Shampa) Incorporate maternal death reporting format and revisit danger signs in the next module for Sahiyas



PHRN (Suranjeen, Shampa, Rajesh, Gurjeet)


Balram (Right to committed to reporting on maternal deaths Food campaign) Dr. Prabir UNICEF (Dr. Madhulikha and Make a presentation on the three models of reporting maternal deaths and present in all forums 1. Conduct Maternal Death Audits and share the report with the Government 2. To record and report on the quality of ANC provided during the



Village and Health Nutrition Day to the Government 3. Access to Care (MCH1, ANM based) which is currently being piloting by them. This information will be collated and shared with the government 4. To report on maternal deaths in the „silent blocks‟ and disseminate information to the government. 5. To analyse maternal deaths in the framework of social determinants and not in isolation 6. To advocate for training of village midwives 1. Organise Advocacy event at National level on 8 th and 9th October to advocate for regular MDR and better analysis 2. Provide assistance in finalising the Godda Maternal Death Report 3. To place the report before the Parliamentary Standing Committee on Health and Family Welfare and the National Human Rights Commission if Jharkhand organizations agree.

Sign up to vote on this title
UsefulNot useful