Chiranjeevi Maternal Health Financing Issues and Options

1. Chiranjeevi Maternal Health Financing Issues and Options Dr Amarjit Singh Commissioner Health & Secretary Family Welfare Government of Gujarat

2. Lessons from HSRs • Steer don’t row • Finance rather than directly provide • Explore options for PPP • Regulate quality, cost-effectiveness • Protect the marginalised groups

3. Maternal Death Watch-Global • 380 women become pregnant • 190 women face unplanned or unwanted pregnancy • 110 women experience a pregnancy related complication • 40 women have unsafe abortions • 1 woman dies from a pregnancy-related complication Every Minute...

5. Gujarat – A Profile Recognizing Gujarat potential the Planning Commission set a target growth rate of 10% p.a. for Gujarat

6. Current Status

7. OBJECTIVES- Vision 2010, Population Policy & RCH II • Reduce MMR from 389 (in 1998) to 100 per 100,000 live births by 2010 • Reduce IMR from 60 to 30 by 2010 • Stabilize population by reducing TFR from 3.0 to 2.1 by 2010

9. Timing of maternal deaths-General Conditions

10. Time from onset of complication to death • PPH 2 hour • APH 12 hour • Ruptured uterus 1 day • Eclampsia 2 days • Obstructed labor 1 day • Sepsis 6 days

12. Maternal Mortality: UK 1840–1960 Improvements in nutrition, sanitation Antibiotics, banked blood, surgical improvements Antenatal care Maine 1999.

13. Maternal Mortality ReductionSri Lanka 1940–1985 85% births attended by trained personnel

14. New Global Understanding ofMMR Reduction • Once major obstetric complication develops- even a trained TBA or a nurse cannot do much at home • These complications require effective back up by trained O&G experts • surgical interventions • injections of antibiotic • blood transfusion • aggressive treatments

15. Three Delays Responsible for Maternal Deaths • Delay in deciding to seek care (Individual & family) • Lack of understanding of complications • Gender issues, Low status of women • Socio-cultural barriers to seeking care • Poor economic conditions of the family • Delay in reaching care ( Community & System) • Lack or underutilization of transport funds • Non availability of referral transport in remote places • Lack of communication network • Delay in receiving care (System) • Poor facilities, personnel and Supplies • Poorly trained personnel with indifferent attitude

16. WHY Do Women Die? FIRST DELAY Delay in problem recognition and decision making SECOND DELAY THIRD DELAY Delay in reaching a referral facility Delayingettingcare at the health facility

17. Options • Improve Government Health Service Competent staff Adequate infrastructural facilities User friendly, good quality Competitive Services Marketing of services • Public Private Partnership Outsourcing- Curative services • Health Insurance

18. Maternal Health- Gujarat Objectives ( by 2010): • Universalize coverage of antenatal care (100%) • Increase the deliveries attended by SBAs 90% • Increase institutional deliveries by 80% • increase access to Emergency Obstetric Care for complicated deliveries • Increase coverage of Post Natal Care (90%) • Increase access to Early & Safe Abortion services • Improve access to RTI/ STI services • Introduce AFHS in all PHC/ CHCs.

19. Broad Issues • Non - availability of O & G specialists • Accessibility of services-Tribal and urban slums • Poor utilization of services- • Low felt need of health & medical services • Lack of user friendly & quality public health services • Costly private health and medical services • No health insurance coverage

20. Chiranjeevi Yojna - Options • Service Coverage through outsourcing- voucher system Emergency Obstetric Care & Neonatal Care • Private Gynecs/ GIA in their facility • Payment to Gynecs for working in government hospital

21. Service Charges

22. Service Charges

23. Population and Births

24. Implementation of Chiranjeevi - 1 • District level FOGSI members workshops organized for orientation on Chiranjeevi scheme and enrollment of doctors on the panel • Honorable Health Minister wrote a letter about the scheme to presidents of district and talukas in 5 districts. • District level Advocacy workshops of Presidents of district and taluka panchayat, along with BHO and Chiranjeevi panel doctors organized in each district.

25. Implementation of Chiranjeevi - 2 • In each district IEC activities were undertaken. Awareness through Gramsabhas • Rs 15000/ advance was given to each obstetrician. No delay in reimbursement to doctors. • Regular interaction with Chiranjeevi Panel doctors by CDHOs

26. Chiranjiv Yojna - performance as on June 2006

27. Specialist Involvement

28. Miles to go

29. Maternal Health- ANC, deliveries, PNC: 2002- 2006

30. Effect on Government deliveries

31. Issues • Surge of demand - boon to the poor • Unprecedented support from the private practitioners • Unindicated C-section in check • Availability of blood • Still asking for additional funds from the BPL • Non-BPL beneficiaries also being attended • Under utilisation of Public facilities

32. Issues in expansion • Additional day’s stay after delivery • Sanitary pads supply • More funds for accompanying person – Dai • Other services Sterilisation/ IUD/ RTI/ STI/ HIV/AIDS/pap smear • More charges for transportation in Kutch • Cost likely to increase to 2,00,000/100 deliveries

33. The bill for Gujarat & India

34. Our Mission: “Save the lives of thousands of Mothers and Children dying for no fault of theirs and prevent the spread of infections and promote healthylife styles” Working together for a healthy Bharat

35. THANKS