Dr. H. Bhushan Maternal Health Division MoHFW, India

1. CAPACITY BUILDING THROUGH MULTI SKILL TRAININGS Dr. H. BhushanMaternal Health DivisionMoHFW, India

2. About 28 million pregnancies occur every year in India. 24 million deliveries. 15% of these are likely to develop complications. Complications cannot be predicted. 77,000 avoidable maternal deaths per year. Current Situation: Maternal Health

3. National goals & MDG context

4. Overall MMR decline from 398(1997-98) to 301(2001-03). • Overall decline of 16 points per year. • Decline in EAG and NE States: 14 points per year. • Decline in Southern States: 2 points per year. • Projected MMR is 231 by 2012 at the current rate of decline. Regional Variation in MMR decline

5. CAUSES OF MATERNAL DEATHS • Total Maternal deaths per year: approx. 80,000 • Haemorrhage: 30,400 maternal deaths Source:RGI-SRS 2001-03

6. Reduction of Maternal Deaths-Existing Interventions Source: WBReport2004

7. Technical Strategy • Operationalize FRUs, CHCs and 24 Hrs PHC for provision of : • Essential and Emergency Obstetric Care: • Quality ANC, PNC, Institutional and Safe Delivery : Janani Suraksha Yojana • Skilled Attendance at birth (domiciliary & health facilities). • Strengthen Referral Systems. • Management of RTIs & STIs at PHCs & CHCs/FRUs. • Safe Abortion Services - MVA at PHC level.

8. Required Services vs HR Availability

9. Posting Schedule (18 weeks) Medical College / Training Center Emergency Services/Casualty : Six weeks Operation Theatre General Surgery : Two Weeks Obstetric : Four Weeks District Hospital / Similar Setup : Four to Six Weeks Evaluation of Skills: Perform requisite no. of skills. 2 mid term evaluation during the training and 1 final evaluation at the end of the training. Anesthesia Training-Summary

10. Posting Schedule (18 weeks): Medical College / Tertiary Center (6 weeks): : Classroom training, Hands on the Anatomical Models, Hospital rounds. District Hospital / Similar Setup (10 Weeks): : Comprehensive, hands on training under the supervision of the DHs Master trainers. Evaluation of Skills: Every batch of Medical Officer is followed up twice by ICOG members: At the District Hospital training Site At FRUs where the trained MO is independently managing patients. ICOG certifies the Medical Officers who meet the certification criteria’s. EmOC Training-Summary

11. Training Duration: • For staff nurses: Two to three weeks • For ANMs and LHVs: The total duration of the course will be for a minimum of three weeks which can be extended for six weeks. • Skill Assessment: • Trainee are supervised during client practice. • Perform at least 75% of the recommended number of cases as Performed To Standard (PTS) checklist. • Trainee should get a score of “competency achieved” on at least 80% of steps in checklist. SBA Training-Summary

12. Training Progress

13. Achievements: Anesthesia Training

14. Achievements: EmOC Training

15. Achievement: SBA Training

16. Training Progress-LSAS and EmOC

17. Training Progress-SBA

18. LSAS-Capacity Utilization

19. EmOC-Capacity Utilization

20. Independent Anesthesia Evaluation • UNICEF and DFID initiative through MGIMS, Sevagram. • For assessment of the quality and impact of anesthesia training in provision of EmOC Services. • Includes Assessment of : • Training Site and Trainers: Medical College + DHs. • EmOC Facilities: • Trained personnel posted. • No specialist/trained personnel available. • Stakeholders.

21. Impact of the training ( Gujarat & T.Nadu) Increased in No. of deliveries conducted. Increased in No. of Cesarean Section conducted. Anesthesia administered confidently during Cesarean section. No of Referrals reduced. Confidence in handling complications. Since the training protocol was not adhered to in Chhattisgarh, there was no visible impact.

22. Recommendation from Evaluation LSAS training has improved the EmOC service provision in areas where specialist care is not available. Needs to adherence to GOI guidelines to improve quality and impact. States with High MMR along with shortage of specialist, needs to upscale the training. GOI Recommendation for establishment of quality assurance cell in the states needs to be implemented.

23. Issues in Training… • Linking the Facilities for operationalization with placement of trained personnel. • Strengthening training sites and sites where the trainees be posted after the training. • Selecting the trainees as per the requisite criteria and their willingness for undertaking the training. • Timely nominations of the trainees and release of funds. • Lack of monitoring and supportive supervision. • Placing adequate funds for monitoring visit. • Avoid transfer/deputation of trainers to other facilities. • Strengthening SBA training institutes with logistics such as Tablet Misoprostol, Injection MagSulph and other essential inputs such as partograph etc.

24. Planning for service provision needs to be holistic with linkage to manpower, training, logistics, equipments along with focus on quality service delivery protocols. • Identifying the gaps and use of Facility Assessment Survey. • HR needs, redeployment, multi skilling and contracting. • Procurement of all needed supplies as per service package • Placing monitoring systems involving SPMs/DPMs. • Provision for repairs/renovations/additions . • Quality of Training need attention; • Activate State/District QA systems. • Identify State and District Monitors. • Initiatives to disseminate training and program guidelines. • Standardization LR protocols and practising of the same. Way Forward…

25. THANK YOU