Wednesday, April 11, 2007

Madhya Pradesh Needs to Invest in Health

The theme of World Health Day on 7 April was 'Invest in Health – Build a Safe Future'. The above theme is more relevant in Madhya Pradesh, central part of India. The State urgently needs to invest in health to help save lives of its own people especially women and children.
The State of Madhya Pradesh has the highest rates of malnutrition among the children in India. As per the latest National Family Health Survey 60 % of its children in age group of 0 – 3 years are under nourished. Similarly as per the growth monitoring drive undertaken by the state 78,000 children in the state are severely malnourished, meaning they need immediate care. Though the state has set up nutritional rehabilitation centers in some of its districts to provide for medical and nutritional care and support to the parents of severely malnourished children but need is of more efforts in this direction or else many may die.

Madhya Pradesh has the highest infant mortality rate and 3rd highest maternal mortality ratio in the country. 76 out of every 1000 children born in the state die before their first birthday and approximately 24 women die everyday in the state. Though the state has introduced many schemes to help combat the same, but due to bureaucratic hassles and corruption the schemes are not yielding the desired results for children and women. As per state's health department web site Madhya Pradesh for its population of 60.38 million (as per 2001 census) has the following health infrastructure:

- District hospitals 48
- Civil hospitals 54
- Community health centers 270
- Primary health centers 1149
- Sub health centers 8834
- Sanctioned beds in district hospitals 8945
- Sanctioned beds in civil hospitals 2775
- Total licensed blood banks by state 41

A NGO namely Collective of Advocacy research and training which advocates on the issues of maternal and infant survival has been calling the issue to attention. They had undertaken an analysis of rural health infrastructure versus the population in the state. As per their statement there is just 'one bed per 5.6 villages' in the state which is alarming!. It is not only the issue of beds or buildings. Even where there are structures or health centers they lack basic minimum facilities as needed and defined by rules and are not sufficient enough to save lives or provide for better health care to its people.

As per Reproductive and Child Health District level household survey (2004) data, out of the 386 primary health centre's surveyed in the state only 224 had drinking water facility. This means that only 58.3 percent primary health centre's had drinking water while others have no such facility. Similarly in case of community health centre's out of the 46 surveyed only 10 had facility of drinking water. In case of vehicles like ambulances out of the 386 primary health centers surveyed only 35 had vehicles which were in running condition and out of 46 community health centre's surveyed 31 had vehicles in the running condition.

Infrastructure investment does not only mean building equipments etc. Human resource which is core in health needs to be focused upon. Not only to fulfill the vacancies of doctors, para-medics, nurses but also providing them with facilities to provide care for the people. When one raises concern on the issue of health there are numbers of different issues which impact lives of people including women and children in the state which needs attention. Probably state needs to revamp and transform its health system and look at the whole issue more holistically. The State needs to peg health of its people as priority number one, transform on immediate basis which is not only limited to public proclamations and announcing schemes but also delivering results at ground level.

anil gulati

(All views expressed in this piece are personal opinions of the writer)

Friday, April 06, 2007

MP Convention on safemotherhood

The Hindu, Staff Correspondent

- Govt. to address women, child-related issues with urgency

- Meeting organised along with UNICEF to make the rural women aware of various schemes
`Govt. is determined to ensure that not a single woman dies due to delivery related complications'

Majhauli (Madhya Pradesh): Thousands of women braved the afternoon sun on Sunday and attended a huge women's convention organised here by the Madhya Pradesh Department of Public Health and Family Welfare and UNICEF to make the rural women aware of various schemes aimed at addressing the problem of maternal and infant mortality and other women and child related issues.

Addressing the convention on safe motherhood at this development block in Jabalpur district, the State health Minister, Ajay Vishnoi said that it is very important to save the life of every woman and child. He said that the State Government is determined to ensure that not a single woman died due to delivery related complications. The Government is committed and policies were being implemented with total urgency for the benefit of every mother and child in the State, he added. The women attending the convention clapped in approval when the Minister informed them about the incentives being given to women in Madhya Pradesh to promote institutionalised delivery and schemes like Bal Shakti and Ladli Lakshmi Yojna. Speaking on this occasion, UNICEF's State Representative, Hamid El-Bashir said that his organization would always work closely with the State Health Administration and other Government departments. He went on to observe: "We are proud of this partnership and were prepared to take it further". He added, "We are ready to work with every agency and organization tackling women and child related issues on priority". He also advised the women to raise their demands saying: "We are ready to listen" and further said: "We want to ensure that maternal and infant mortality is reduced in Madhya Pradesh. We also want to reduce levels of malnutrition and anaemia among infants, girls and women."

The State Director Public Health and Family Welfare, Yogiraj Sharma said in his speech that maternal mortality is very high in Madhya Pradesh and every hour one mother dies in the State. He said that every one was responsible for this grim scenario and that women would have to come forward and take the benefits of various schemes being implemented by the Government for their welfare, particularly the incentives being offered for institutionalised delivery. The Jabalpur Collector, Sanjay Dubey emphasised that all steps should be taken to protect the newly born and to combat the problem of infant mortality. He said that children should be protected from malnutrition and women should not be allowed to go through pregnancy related complications.

Ms. Alka Vishnoi, the State Health Minister' wife set the tone for the women's convention named as the "Saas-Bahu Sammelan" (convention of mothers-in-law and daughters-in-law).

Tackling maternal mortality in MP

By Rashme Sehgal

Shivpuri and Guna districts in Madhya Pradesh have one of the highest maternal mortality rates in India. But in a PHC in Satanvara block, two young doctors have ensured not a single maternal death in 257 deliveries they’ve handled over one year

The ravines of Chambal have given birth to many legends woven around the lives of notorious dacoits. One such legend is being woven around Ram Babu Gadaria, a shepherd by profession, who became a dacoit after his wife was raped by upper-caste landlords.

What has Gadaria got to do with the pressing issue of maternal mortality in a backward state like Madhya Pradesh? He has almost brought the tottering health system to a halt with his Phoolan Devi-like antics. He is said to kidnap doctors and health workers for ransom, releasing them after receiving hefty amounts from their families. Recently he kidnapped two private doctors with sizeable practises and released them after being paid astronomical sums of money.
Two young women doctors in their mid-20s, Manisha Yadav and Sandhya Gupta, working at a primary health centre (PHC) in the Satanvara block of Shivpuri district, adjacent to the Chambal valley, are terrified of Gadaria and his gun-toting gang. Both Manisha and Sandhya have been working at this PHC for over a year and have already handled more than 257 deliveries. But since many of these deliveries take place at night, these young women have to make their way from their rented accommodation to the PHC in the dead of night.
“It's very scary. Both of us have studied in Gwalior and the very thought of coming face-to-face with a member of this gang is alarming. The local villagers have told us that the Gadaria gang are quite active here,” said Manisha.

Both these doctors decided to accept this challenging assignment because they would receive a starting salary of Rs 15,000 per month. Salaries of doctors willing to accept field postings were recently hiked by the state government which realised that several PHCs and district hospitals were inadequately staffed. These two doctors claim credit for not having had a single maternal death so far. “Of the 257 deliveries we have conducted so far, we have not had a single maternal death,” they say.

The birth of two female children the night before by two tribal women has boosted their confidence further. Both the mothers and their babies are sleeping in a room adjacent to the makeshift operation theatre. One of the reasons for the absence of maternal deaths could be that caesarean and other complicated delivery cases are directed from here to the district hospital. “We have had three cases of stillborn babies. One case was of a mother running continuous high-grade fever giving birth to seven-month-old twins. Fortunately, the mother survived,” Manisha pointed out.

The district of Shivpuri, which falls in the Gwalior-Chambal zone, has one of the highest maternal mortality rates in India . A maternal death audit conducted by Unicef and local NGOs has brought to light that while 50 maternal deaths took place in Shivpuri in 2006, the figure in Guna district was 56. Guna is the parliamentary constituency of the high-profile Congress MP Jyotiraditya Scindia. The deaths were reported by the ANMs (auxiliary nurse midwives) and by local NGOs.

Dr Ramani Atkuri, of Unicef, Bhopal , pointed out, “This is the tip of the iceberg. We believe many more women have died from childbirth but their deaths go unreported.”
“The majority of deaths take place because of haemorrhage, severe anaemia, eclampsia, malaria and sepsis,” Atkuri added.

Internal bleeding, eclampsia and obstructed labour are just some of the factors that are responsible for the high number of maternal mortality deaths in Madhya Pradesh. Every five minutes, India suffers one maternal death. The number of women who die due to pregnancy, childbirth and abortion-related complications is estimated at 60,630. The maternal mortality ratio (MMR) for India presently is 301 deaths per 100,000 live births. Uttar Pradesh alone accounts for close to 21,450 maternal deaths per year.

The maternal audit also highlighted that less than 25% of babies born to women who died have a chance of surviving. This was borne out in Guna district. Ram Swarup Batham sits outside his mud hut in Shivpuri village surrounded by his three young children all below the age of five. His wife Veeja died recently in a hospital in Gwalior while giving birth to her ninth child.
Describing how he tried to save her, Batham says, “I rushed her to the district hospital in Shivpuri. The doctor there informed me she needed to be taken to Gwalior . I took her to Gwalior Medical College but she died soon after being admitted there.”

Batham, a tribal, is fortunate to own 25 bighas of land. “I borrowed Rs 15,000 for her treatment. I'll sell my land if I cannot repay the loan,” he adds. One RNTCP official says: “The lack of integration between the TB programme and the general healthcare system is the main reason why the programme has not attained its goals. The PHC health staff do not support the TB programme because it does not offer cash incentives. These vertical programmes are creating distortions, and there is no collaboration in the implementation of programmes.”
The death of his wife has plunged their family into chaos. For one, the entire responsibility of looking after the children has fallen on his aged mother who admits she simply cannot cope. Sitting on the mud-caked floor in their front courtyard, the old woman mutters, “The doctors were completely callous. Veeja died within five minutes of being given an injection.”

The tragedy of Veeja's death is that it could have been easily prevented. Hamid al-Bashir, Unicef's state representative in Bhopal , believes, “Most maternal deaths could be prevented if women had access to appropriate healthcare during pregnancy, childbirth and immediately after delivery. When a mother dies during pregnancy, the family suffers a further increase in poverty.”

“One of the key methods to improve maternal survival would be to review all maternal deaths at the community level,” al-Bashir adds. The official explains that the situation has been repeatedly highlighted before RNTCP officials in Delhi. “But,” he says, “they are avoiding the issue and tell us to try solving the problem locally.”

Dr Aparajita Gogoi, National Coordinator for the White Ribbon Alliance India , describes these MMR deaths as a “silent tsunami”. “Over 200,000 families have been devastated by these deaths which have left 350,000 kids orphaned. Another 600,000 women have been left disabled because of pregnancy-related disorders.”

Gogoi says, “We have not been able to stem this tide of maternal deaths despite having 20,000 obstetricians, 5 lakh trained doctors and 25 lakh nurses and midwives.” Even poor countries like Bangladesh , Bolivia and Honduras have reduced MMR in similar resource settings. Countries like China , Indonesia and Sri Lanka have built up teams of skilled birth attendants and well-connected frontline providers.

The statistics in Madhya Pradesh are more alarming because in rural areas, local NGOs point out, for every 5.6 villages (average population of 2,000 per village) only one hospital bed is available. Over 82% of the children suffer from anaemia while 58% of pregnant women are also found to be anaemic.

Unicef believes one of the ways to strengthen community initiatives is by holding maternal death audits. Another such audit was recently held in Purulia in West Bengal between May 2005 and June 2006. It was found that of 55,000 deliveries there were 106 maternal deaths.
This figure was arrived at after interviewing family members of the deceased. It was believed that the number of deaths was actually around 140 since most families continue to under-report maternal deaths.

The audit revealed that the average age of marriage for girls in Purulia was 17. None of the girls interviewed had been to school while the average number of years their husbands had spent in school was four years. While 61% of deaths occurred in a health facility, 24% died at home and another 13% died en route to a health facility. The majority of deaths occurred during labour and in the post-partum period.

InfoChange News & Features, March 2007