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Role of Dais in Promoting Safe Motherhood and New Born Care In Resource Poor Settings: The SEWA Rural Experience . Family Centred Safe Motherhood and New Born Care Project (2003 onwards). Coverage Whole of Jhagadia Block 168 Villages and 171,000 pop. Rural, Poor and Tribal Pop.
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Role of Dais in Promoting Safe Motherhood and New Born CareIn Resource Poor Settings:The SEWA Rural Experience
Family Centred Safe Motherhood and New Born Care Project (2003 onwards) Coverage • Whole of Jhagadia Block • 168 Villages and 171,000 pop. • Rural, Poor and Tribal Pop. • Working Closely with 6 Govt. PHCs • About 80 % Home Delivery at the Beginning of the Project in 2003 • Less than 1.5 % Delivery in Public Health Institutions • Every Year • Monitoring Every (about 4000) Pregnancy Outcomes • Monitoring Every (about 3600) Neonates 2
Family Centred Safe Motherhood and New born Care Project (2003 Onwards) (168 Villages, 171,000 pop., About 4000 Pregnancy Outcomes Every Year ) Rural, Tribal and Poor Community with 80 % Home Delivery
Base Line Status of Jhagadia Block2001 - 2003 • Complete ANC Care: <10 % • Institutional Delivery: 22 % • In Govt. Institutions: 1.5 % • Immediate New Born Care: 49 % • Initiation of Breast Feeding Within First Hour: 20 % • No Bathing on First Day: • Immediate Post Natal Visit: Negligible
Base Line Status of Jhagadia Block2001 - 2003 • Institutional Delivery: 22 % (in 2001 – 03) • In Govt. Institutions: 1.5 % • Maternal Deaths: 35 (in 2001 - 03) • MMR: 594 • 30 % During Prenatal Period, • 30 % Post Natal Period, • 10 % Unsafe Abortion Practises • Neonatal Deaths: 151 (in 2003 – 04) • NMR: 47 • 50 % on First Day
Maternal Mortality Ratio (MMR)Jhagadia Block 171,000 Pop. (about 3500 Deliveries a Year)
Neonatal Mortality Rate(NMR)Jhagadia Block 171,000 Pop. (about 3500 Deliveries a Year) 8
Family Centred Safe Motherhood and New born Care Project (168 Villages, 171,000 pop., About 4000 Pregnancy Outcomes Every Year ) • Village Level Front Line Volunteers: • TBAs and Arogya Sakhis (200 Each) • Middle Level Supervisory Cadre: • Link Workers (Setu Karyakers) (21) • Field Supervisors (8) • Support From Govt. PHC Staff (6) • Head Quarter Referral Support: • SEWA Rural Base Hospital (FRU) at Jhagadia Providing Comprehensive Emergency Obstretic & Neonatal Care (CEmONC) • Farthest Village about 50 km. away (takes less than two hours to reach Base Hospital)
Core Roles of a Dai at SEWA Rural • Promoting Institutional Delivery and Role of a Birth Companion • If She Has to Attend Home Delivery, then…. (With the Support of Arogya Sakhi) • Conduct Safe and Clean Normal Delivery • Provide Immediate New Born Care • Timely Identification of Delivery Complications and • Ensuring Prompt Referral to an Active FRU
Capacity Building of Dais • Dai’s Tool Kit • Dai in Action • Pairing with Sakhis • Use of Mucus Aspirator
Initiation of Breast Feeding Within First Hour(Among All Live Births)
All Important Back up Support by a Fully Functional First Referral Unit By SEWA Rural’s Base Hospital • Providing Round the Clock Comprehensive Emergency Obstretic and Neonatal Care which includes…. • 24 by 7 Ambulance Response • Presence of Gynecogist, Anaesthetist, Paediatrician and Supporting Staff • Life Saving Medicines and Equipments in Place • Facility of Operation Theator, Blood Bank and Laboratory • Cesarian Section Rate: About 15 % • Clean Wards Ensuring Water, Light and Food
All Important Back up Support by a Fully Functional First Referral Unit By SEWA Rural’s Base Hospital • Providing Round the Clock Comprehensive Emergency Obstretic and Neonatal Care which includes…. • Hospital Staff Sensitive and Receptive to Referral from Field • Allowing Field Staff to be with the Mother in the Labor Room • Close Linkage and To and Fro Feedback Mechanism With the Field Staff • Detailed Documentation of All Maternity Admissions (Which Includes About 1500 Deliveries a Year) • Susidised Charges with Safety Net for Poor • Approved Under Chirinivi / Janani Schemes
All Important Back up Support by a Fully Functional First Referral Unit By SEWA Rural’s Base Hospital • Ambulance (Round the Clock) • Health Education in OPD • Front line Workers Welcomed in Labor Room • Operation Theater • Blood Transfusion • Neonatal Intensive Care Unit
Hospital Delivery (%)Jhagadia Block 1.71 Lac Pop. (Out of about 3500 Deliveries a Year)
Referral of Maternal Cases by Front Line Workers to Base Hospital
Possible Solutions for Improving Safe Motherhood and New Born Care in Resource Poor Settings • Not a Uniform Jacket For All, but the Region Specific Strategy is the Answer • Maternal, Foetal and Neonatal Care Should Go Together in a Combined Package • Evidences Have Shown That In Resource Poor Settings and Where Community Continues to Delivering at Home… • Not the Expensive Gadgets and Infrastructure, but Locally Adaptable Simple and Cheaper Interventions Can Make A Big Difference • The Front Line Workers including TBAs (Dais) HAVE the Potential to Play a Critical Role
Possible Solutions for Improving Safe Motherhood and New Born Care in Resource Poor Settings • What is Important is Skilled Attendance at Birth and not Necessarily Institutional Delivery • What These Front Line Workers Need is…. • Respect, Trust and Sustained Efforts Towards Capacity Building in True Sense • Sound Telecommunication & Transportation Network for Timely Referral of a Case with Complications • All Important Back up Support of a Fully Functional FRU
247 Practising Dais & 163 Arogya Sakhis Experience
247 Practising Dais & 163 Arogya Sakhis Education
Looking Ahead……. • A Dai on an average conducting about 10 deliveries a year • Considered as “Dharam nu Kam”, Not much Monetary Gain • About 25 % of villages have now less than 15 % home Delivery (only 2 – 3 Delivery a year) • No Dai in about 20 % of villages at present • About 25 Arogya Sakhis in remote villages have started conducting deliveries and were given formal training • Direct Role in Prenatal Care, Post natal Care both for mother and New Born baby and expanded role continues, birth companion during delivery
Looking Ahead……. Birth companion during delivery ? Worth Debating…… • Why not Normal Delivery be Conducted Safely and Cleanly in the Conducive Environment at Home by A Skilled Person like A DAI ? IF…… • She can timely identify delivery complications … • Transport Network in place for prompt referral of a complicated case …..and • Back up Support of a Functopnal FRU providing CEmONC is in Place..