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UP’s public health facilities are now geared towards maternal health outcomes

ByHindustan Times
Jun 06, 2022 02:38 PM IST

The article has been authored by Amit Mohan Prasad and Devendra Khandait.

A few months ago, a woman with a complicated pregnancy gave birth to a child through Cesarean section (C– section) in a community health centre (CHC) in Jalaun district of Uttar Pradesh (UP) -- a remote part in the Bundelkhand region of the state. This was a significant milestone for CHC-Jalaun, since the facility had been designated as a First Referral Unit (FRU) not too long ago, in June 2021, following which, an operation theatre was set up and a gynaecologist was posted there. Earlier, in such situations, a pregnant woman had to be rushed to a larger district hospital which would typically be a fair distance away. On Holi, the CHC at Maudaha in Hamirpur also reported their first C- section. Today, similar C-section deliveries, by obstetricians, are being carried out in other remote parts of western UP, including Ujhani, Badaun, Gunnaur and Sambhal, and the list is growing.

C-section deliveries have been started to be growing in parts of western UP, including Ujhani, Badaun, Gunnaur and Sambhal, and the list is growing.(Shutterstock) PREMIUM
C-section deliveries have been started to be growing in parts of western UP, including Ujhani, Badaun, Gunnaur and Sambhal, and the list is growing.(Shutterstock)

This change has been substantial and can potentially save many precious lives. These FRUs have been activated and made functional through well-planned efforts, underlying which are a series of innovative health policies and initiatives rolled out by the government of UP.

The shortage of specialised obstetricians and anaesthetists had been a chronic issue in UP, and this was one of the main reasons for the slow activation of FRUs. As of 2018, only 221 anaesthetists and 198 gynaecologists were working as a part of Provincial Medical Health Services cadre. At this time UP had more than 80% vacancy for these two specialist posts. This shortage had persisted because, while specialist posts were created, MBBS was the minimum qualification for recruitment; postgraduate (specialists) would seldom join the system. Moreover, specialist doctors were recruited at the same pay and same level as MBBS doctors which led to reduced motivation for specialists to join government health services.

But this changed in 2020. An amendment was made to the service rules, to attract specialist doctors at a level higher than MBBS doctors, thereby incentivising specialists to join the system. All postings are done via an open, transparent process and after adequate counselling. Policy changes have also been made to ensure that those getting selected stay in the system. For instance, for the first time, doctors were allowed to be posted in their home districts. Post their joining, sessions are organised for these doctors with the district authorities to ensure that they have the necessary enabling environment and required infrastructure to perform their duties.

Further, the health department initiated walk-in interviews for hiring of contractual specialist doctors and the empanelment of on-call specialists from district hospitals as well as the private sector. Finally, to enhance the supply of specialist cadres, the UP government has increased the number of accredited centres for training of MBBS medical officers in emergency obstetric care and life saving anaesthesia skills.

The second major initiative is the Buddy Buddy Model, which has been responsible for driving FRU activation and effectiveness. The model provides a choice to doctors trained in anaesthetic skills and emergency obstetric and newborn care to pair up together, as obstetrician-gynaecologists and anaesthetists and ensure availability of high-quality services at the FRU. The Buddy-Buddy pair is first supervised by specialist mentors (anaesthetists and gynaecologists) at a district hospital where they are posted for a period of six months. Once trained and ready, they are posted to FRUs across the state.

This system has proved to be very effective. The number of CHC-FRUs conducting C-sections has gone up. An impressive 197 facilities were performing C-section (at least once a month) in February this year, including those in remote districts such as, CHC Patti in district Pratapgarh, CHC Ghorawal of district Sonebhadra, and CHC Deotaha of district Kushinagar, to name few.

Since the time these changes have been made, 24 CHC-FRUs have conducted blood transfusions for the first time; and 100 new blood storage units have been set up ensuring availability of blood banks at the district level. Further, other specialist procedures, for example hernia repair surgeries and nasal septoplasty have been carried out. Several OBGs are also performing mini-lap surgery, as well as post-partum sterilisation for family planning and Medical Termination of Pregnancy procedures. We expect a significant positive impact on maternal health outcomes as a result of availability of specialists and well-functioning FRUs. The overall increased availability of specialists in the system is also likely to have far reaching and multiplier effects on other aspects of health care.

As we think about other health challenges facing UP, we can learn several lessons from the approach taken in this case. First, and perhaps most importantly, complex health problems require multiple levels of deep and wide consultation processes to reveal barriers across the entire supply chain of medical delivery. Secondly, these barriers are not always as simple as lack of medical equipment but could be an outcome of policy architecture which might not create the right incentives for quality service delivery. Thirdly, there is a need to understand local contexts before creating comprehensive, pragmatic, and scalable solutions.

What is required is for public policy makers, health officials and local administrations to think creatively to find local, contextual solutions, that can help address some of the most sticky heath challenges.

 

The authors are (respectively) Additional Chief Secretary Medical Health & Family Welfare, Government of Uttar Pradesh, and Deputy Director, Bill & Melinda Gates Foundation. The views expressed are personal.

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