18 research outputs found
Maternal Health Situation in India: A Case Study
Maternal Health Services are one of the basic health services to be provided by nay government health system as pregnant women are one of the most vulnerable victims of dysfunctional health system, India, in spite of rapid economic progress is still farm away from the goal of lowering maternal mortality to less than 100 per 100,000 live births. It still accounts for 25.7% maternal deaths. The maternal mortality in India varies across the states. Geographical vastness and socio-cultural diversity make implementation of health sector reforms a difficult task. The chapter analyses the trends in maternal mortality and various maternal health programs implemented over the years including the maternal health care delivery system at various levels including the recent innovative strategies. It also identifies the reasons for limited success in maternal health and suggests measures to improve the current maternal health situation. It recommends improvement in maternal death reporting, evidence based, focused, long term strategy along with effective monitoring of implementation for improving Maternal Health situation. It also stress the need for regulation of private sector and proper Public Private Partnership (PPP) policy together with a strong political will for improving Maternal Health.
Trust Deficit in Surgical Systems in an Urban Slum in India Under Universal Health Coverage: A Mixed Method Study
Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India.
Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion.
Results: Responses from the 2 groups for “the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting” scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree (p = 0.076). Results between 2 groups regarding “Patient perceptions of quality” did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed (p = 0.064). Similar observations were made in the in depth interviews and focus group.
Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations
Maternal Health Situation in India: A Case Study
Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India's goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health
Maternal Health in Gujarat, India: A Case Study
Gujarat state of India has come a long way in improving the health
indicators since independence, but progress in reducing maternal
mortality has been slow and largely unmeasured or documented. This case
study identified several challenges for reducing the maternal mortality
ratio, including lack of the managerial capacity, shortage of skilled
human resources, non-availability of blood in rural areas, and
infrastructural and supply bottlenecks. The Gujarat Government has
taken several initiatives to improve maternal health services, such as
partnership with private obstetricians to provide delivery care to poor
women, a relatively-short training of medical officers and nurses to
provide emergency obstetric care (EmOC), and an improved emergency
transport system. However, several challenges still remain.
Recommendations are made for expanding the management capacity for
maternal health, operationalization of health facilities, and ensuring
EmOC on 24/7 (24 hours a day, seven days a week) basis by posting
nurse-midwives and trained medical officers for skilled care, ensuring
availability of blood, and improving the registration and auditing of
all maternal deaths. However, all these interventions can only take
place if there are substantially- increased political will and social
awareness
Maternal Health Situation in India: A Case Study
Since the beginning of the Safe Motherhood Initiative, India has
accounted for at least a quarter of maternal deaths reported globally.
India's goal is to lower maternal mortality to less than 100 per
100,000 livebirths but that is still far away despite its programmatic
efforts and rapid economic progress over the past two decades.
Geographical vastness and sociocultural diversity mean that maternal
mortality varies across the states, and uniform implementation of
health-sector reforms is not possible. The case study analyzes the
trends in maternal mortality nationally, the maternal
healthcare-delivery system at different levels, and the implementation
of national maternal health programmes, including recent innovative
strategies. It identifies the causes for limited success in improving
maternal health and suggests measures to rectify them. It recommends
better reporting of maternal deaths and implementation of
evidence-based, focused strategies along with effective monitoring for
rapid progress. It also stresses the need for regulation of the private
sector and encourages further public-private partnerships and policies,
along with a strong political will and improved management capacity for
improving maternal health
Impact of Alternative Maternal Demand-Side Financial Support Programs in India on the Caesarean Section Rates: Indications of Supplier-Induced Demand
Is Institutional Delivery Protective Against Neonatal Mortality Among Poor or Tribal Women? A Cohort Study From Gujarat, India
Quality of free delivery care among poor mothers in Gujarat, India:A community-based study
Background: Government of Gujarat introduced a public–private partnership scheme called the Chiranjeevi Yojana (CY) in 2005, to improve access to delivery care for poor women. Till date, more than 1 million deliveries have been conducted under CY. Although CY has been evaluated, this is the only study using primary data to evaluate the quality of care. Objective: The objective of this study was to (i) determine the quality of free delivery care and (ii) examine the differences in the quality of care between public sector facilities and accredited private sector facilities. Methodology: The community-based survey was conducted in three districts of Indian state of Gujarat. Trained data collectors used pretested questionnaire in vernacular language between 7th and 10th days of delivery. Overall surveyed mothers were 3858 in the prospective study; analytic sample was 1616 mothers. Statistical analysis includes Chi-square test using IBM SPSS version 20. Results: Quality of care was perceived to be good in both public sector and accredited private sector. When free delivery care was compared between two sectors, private sector was perceived to have better quality of care. This difference was statistically significant for indicators, such as infrastructure, allowed to eat/change positions, application of pressure on abdomen, and weighing of baby. Conclusion: The study highlights the need for engaging private sector to improve access to delivery care for poor women. Quality assurance programs in Gujarat need to address respectful care issues in the public sector. Future research should include qualitative study to understand the drivers of quality delivery care
Maternal Health in Gujarat, India: A Case Study
Gujarat state of India has come a long way in improving the health
indicators since independence, but progress in reducing maternal
mortality has been slow and largely unmeasured or documented. This case
study identified several challenges for reducing the maternal mortality
ratio, including lack of the managerial capacity, shortage of skilled
human resources, non-availability of blood in rural areas, and
infrastructural and supply bottlenecks. The Gujarat Government has
taken several initiatives to improve maternal health services, such as
partnership with private obstetricians to provide delivery care to poor
women, a relatively-short training of medical officers and nurses to
provide emergency obstetric care (EmOC), and an improved emergency
transport system. However, several challenges still remain.
Recommendations are made for expanding the management capacity for
maternal health, operationalization of health facilities, and ensuring
EmOC on 24/7 (24 hours a day, seven days a week) basis by posting
nurse-midwives and trained medical officers for skilled care, ensuring
availability of blood, and improving the registration and auditing of
all maternal deaths. However, all these interventions can only take
place if there are substantially- increased political will and social
awareness
The state-led large scale public private partnership 'Chiranjeevi Program' to increase access to institutional delivery among poor women in Gujarat, India: How has it done? What can we learn?
BACKGROUND: Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there. METHODS: District level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000-2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery. RESULTS: Institutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25-29% and 13-16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat. CONCLUSION: This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women's access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections receive these. Other issues to explore include quality of care, provider attrition and the relatively low coverage