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Yuva Fogsi oration 2013 mumbai
1. LIFE OF EVERY MOTHER
AND NEONATE COUNTS!!!!
YUVAFOGSI 2012 –MADURAI
DR.KAMINIRAO ORATION
DR.D.KIRANMAI
ASST. PROFESSOR
MGMH,OMC HYDERABAD
JOINT SECRETARY, OGSH
2. My mother!
You come to me like
heavens caring arms
……………………………..
Your caring hands ,
tenderly removing the
pain,
Your love , your care,
your faith gave me the
strength
To face the world void of
fear
APJ ABDULKALAM
3. 14TH JAN 2012
KOLKATA
Women are not dying because of a disease
we cannot treat
They
are dying because societies have yet to
23 APRIL 2012
RD
make the decision that their lives are
worth saving
MAMOUD FATHALLA,PRESIDENT FIGO 1997
4. WORDS CAN’T DESCRIBE………..
o Health of the
mother When mothers die……….
o The health of
the child
o Human capital A NATIONS
of the nation FUTURE
Motherless HUMAN AND
children die more
frequently,
SOCIAL CAPITAL
IS CRIPPLED.
malnourished,
less likely to
school.
5. Do our mothers and children count?
• WHY SHOULD “WE’ CARE?
• MCH indicators - human
development index .
• Maternal mortality - a proxy indicator
of functioning of a health system.
• An issue of Human rights.
6. WHERE DO WE STAND?
WHAT WENT WRONG?
WHAT HAS TO BE DONE ?
CURRENT STRATEGIES
FUTURE
7. UNFPA,UNICEF 2010 DATA
TOTAL MATERNAL 284000
DEATHS -2010 DEVELOPING
2,87000 NATIONS
212
100-299
550-999.
IN INDIA 56000 WOMEN DIE EVERY YEAR NOT
OF DISEASE BUT CHILD BIRTH
8. INDIA
THE SUPERPOWER
Budget /expenditure
on health
INDUSTRY
India and Nigeria
1/3 of world’s
maternal deaths
SPORTS
134th among 182 in
the human
DEFENCE development index
- 2009.
9. MANY STATES, MANY DISPARITIES
ASSAM AND EAG
308
OTHERS
149
212 -2010
SOUTH STATES
127 134
SRS - 2009
81 97
10. WHERE DID INDIA GO WRONG?
1960-1990
2000-2009
Huge private sector-Not
1966- 1980 utilized
Target oriented
family planning Lack of synergy
Ineffective interventions ANC,
High risk approach Lack of quality supervision,
1980-1991 close monitoring
CSSM, UIP, IFA
ANM & MOs - accountable -
target oriented programs - FP
& UIP-Little impact on MMR
PHC/SC DELIVERIES- not
monitored and neglected.
11. THE SECRET OF SUCCESS OF SRILANKA
AND MALAYSIA…….
400
THAILAND
SRILANKA
MALAYSIA
•MIDWIVES
•SKILLED ATTENDANCE TO BIRTHS
•QUALITY
•STRENGTHENING OF COMMUNITY
HOSPITALS
30
1960-1990
12. 90 percent of maternal
deaths are avoidable.
POSTPARTUM PERIOD
60%
50% in 24
HOURS-
6 CAUSES
3 DELAYS
14. The three delays
Delay.. Delay.. Delay..
The First Delay
(DECISION TO SEEK CARE)
•
A PREGNANT WOMAN
WALKING 5 KMS TO REACH
PHC DAYS BEFORE HER EDD
PREGNANCY IN
RURAL INDIA
15. 2ND DELAY- TO REACH HEALTH CARE
• 70 % do not have a means of
transportation READY
• 40-50% percent of deaths
occur at home or on the way
• Delays occur while trying to
find money or while
transporting the patient.
16. THE THIRD DELAY-IN RECEIVING CARE
UNTIMELY
INEFFECTIVE
UNDER STAFFED
UNTRAINED/INADEQUATELY EQUIPPED
LACK OF INFRASTRUCTURE
UNRESPONSIVE/DISCRIMINATORY SERVICES
ABUSE/NEGLECT/POOR QUALITY
17. TO SUMMARISE
• WE MISSED ONE CARE
Emergency Obstetric And
Neonatal Care
• WE MISSED ONE KEY
FUNCTIONARY
Skilled Professional Birth
Care for every woman
Midwife, staff nurse, doctor
• THE THREE DELAYS
18. WHAT IS THE SOLUTION???
•ADDRESSES THREE DELAYS
•PROVIDES EMONC CARE
•INFRASTRUCTURE
•LOGISTICS
•STAFF
• Focuses on 18 low
APRIL 12,2005 - performing states, EAG States
2017 • 165 worst districts
• To Increase the expenditure
on health from 1.1% to 3%
19. RISK APPROACH VS EMOC APPROACH
BASIC EmOC Functions
6+2
Health centre –No OT Comprehensive EmOC
Functions
1. IV /IM ANTIBIOTICS OT/District hospitals
2. IV/IM OXYTOCICS All six Basic EmOC
3. IV/IM functions plus
ANTICONVULSANTS Caesarean section
4. Manual Removal of Blood transfusion
placenta
5. Assisted Vaginal delivery
6. Removal of retained
products 4 BEMOC & 1 CEMOC FACILITY
FOR EVERY 5 LAKH PEOPLE
20. NRHM KEY STRATEGIES -2005-2012
IPHS
ASHA DISTRICT
FRU
JSY TRAINING
108 LOGISTICS
FRUS 24X7
PHC Infrastructure
CEMONC CARE BUDGET
24X7 BEMOC
CAC
CENTRES BLOOD BANK
COMPREHENSIVE
HUGE IMPROVEMENTS IN INFRASTRUCTURE,MANPOWER AND
ABORTION CARE
(CAC) ACCESS TO SERVICES
NEWBORN CARE
21. NRHM-KEY STRATEGY-
ASHA-MICROPLAN OF BIRTH
• REGISTRATION OF ANC
• 4 VISITS
• ARRANGING FOR CASH
TRANSFER - JSY
• PLANNING PLACE OF BIRTH
• TRANSPORT
• ACCOMPANYING THE
PARTURIENT
ADDRESSES THE 1ST DELAY
22. JANANI SURAKSHA YOJANA
EVEN BIMARU TURNS HEALTHY
Trends in Institutional deliveries 2002-04 to 2007; India
80
70
Introduction of JSY
60
Percentage of institutional deliveries
50
40
30
BIHAR - 6 FOLD INC
20
FROM 2005-2011
10
0 3.19 CRORE WOMEN BENEFITED UNDER JSY
2002-2004 2005-06 2006-07 2007-08
1ST AND THIRD DELAY
As s am Bihar Madhya Prades h Oris s a
Rajas than Uttar Prades h India
Trends in Institutional deliverieS
(NFHS III), 2006-7, 2007-8 22
23. NRHM-KEY STRATEGY
Emergency Transport System
108 THE LIFE SAVER
• TOLL FREE 108 24x7 X365
• 12 STATES,2919 FOR THE SECOND DELAY
AMBULANCES
• SAVING LAKHS OF LIVES
IN CRUCIAL GOLDEN HOUR
23
24. NRHM TRIGGERED INNOVATIVE SCHEMES
IN STATES
KERALA-
1ST STATE TO ACHIEVE MMR<100
GUJARAT- INNOVATIVE CHIRANJEEVI SCHEME
TAMILNADU- FOCUSSED ON QUALITY
NRHM strategies
All PHCS 24x7 delivery units
MDR/verbal autopsy by collector
Rs .6000 cash benefit to poor pregnant women
ANDHRA PRADESH
108, ANM Tracking, Amma lalana,
Sms alerts, matrudevobhava, ayushmanbhava
26. Trend in Maternal Mortality Rate-Tamil Nadu
160
140
145
120 109
MMR
100
80 AMTSL,
79
LSAS Blood
training, storage
60 facility, AN
Hiring of
Specialists protocol, EMRI
40 etc
20
2000-2001
2004-2005 2008-2009
0
Before RCH RCH
NRHM
Source DPH & PM
YEAR
27. GPS MAPPING TO IDENTIFY SUITABLE HOSPITALS
TAMILNADU
At least two fully equipped and operational Em OC
centers in each of the 32 districts which can be reached within 1
hour from any part of the district
29. CHILD BIRTH A JOYFUL EVENT –
CAN TURN INTO TRAGEDY
POST
PARTUM
PERIOD
ACCOUNTS
FOR 60% OF
MATERNAL
AND 50% OF
CHILD
MORTALITY
30. PPH –QUICKEST OF KILLERS
2 HRS PPH
12 HRS APH
1 DAY-24 HRS RUPTURE
UTERUS
2DAYS-48HRS ECLAMPSIA
3 DAYS-72HRS OBSTRUTED
LABOR
6 DAYS-1 WEEK SEPSIS
SOURCE: maine D:safe motherhood programmes: options and issues, centre for
population and family health
32. FIGO GUIDELINES
Prevention and treatment of PPH in low resource settings
(SMNH Committee)
http://www.figo.org/projects/prevent/pph
EVERY MOTHER SHOULD BE OFFERED AMTSL BY SBA
EVERY SBA MUST BE TRAINED IN AMTSL
BRISTOL AND HINCHING BROOKE STUDIES
-AMTSL (5.9% VS 17.9%) IN EXPECTANT MANAGEMENT
MISOPROSTOL AS ESSENTIAL DRUG FOR PPH-WHO
33. FIGO GUIDELINES-PPH-
INTERVENTIONS AT CEMOC LEVEL
Aortic compression
Ext bimanual comp Int. Bimanual Comp
Video demonstrations
NASG
EGYPT NIGERIA / ZAMBIA, ZIMBABWE Intra uterine balloon tamponade
34. Preeclampsia-Direct Cause Sepsis-Direct cause
Retraining in ANC protocols & POST NATAL CARE VISITS
skills - basic BP measurement
IPP in labor rooms and
Magnesium sulphate in post natal wards-
Eclampsia
Forty eight hour stay in PHC
IEC/ BCC messages to new mothers
on danger signs
27%
To overcome cultural taboos of
26% leaving home before one week
36. NRHM KEY STRATEGY 13%
CAC
Unsafe abortion Women centered
Comprehensive Abortion
•22% of pregnancies- Care
induced abortions • Emergency contraception
• Medical abortion
•50% -unsafe
• Safe MTP Protocol by
MVA
•95% occur in developing
countries • CONCURRENT
• In India- 4 Million unsafe CONTRACEPTION
abortions
37. LET WOMEN DECIDE……….
80 million unintended pregnancies in 2012 in developing
world- Save the Children Report
If all unwanted pregnancies are prevented ,
If there is no unmet need for contraception
Up to 1 lakh maternal deaths can be prevented –WHO
2005
Spacing - crucial for child survival
Spacing of 36 months after previous child birth can prevent
1.8 million child deaths (25%)
Policy shift from permanent to temporary methods
PPIUCD
38. ANEMIA
80% IN NFHS III -complicates 80% maternal deaths
(FOGSI STUDY)
Hb % at 1st visit low cost,
20wks,28wks, effective, Health Iron
acceptable strategies fortification
34 wks iron.
Cooking in
De worming
iron utensils
IV IRON
Foot wear SUCROSE
A real boon
20%
40. India is epicenter of Childhood
Mortality
• 7.6 MILLIONS DIE EVERY
YEAR -2010
• 2 MILLIONS DIE IN INDIA
• 1 MILLION ARE NEONATES
• 50% DIE WITH IN 1 HOUR
• 75% DIE WITH IN 1 WEEK
Worldwide distribution of child death
Each dot represents 5000 deaths
Lancet 2003
41. WHY do newborns in India die?
Lancet Neonatal Survival Series 2005
Neonatal Breast feeding
resuscitation 55-87%
Neonatal
6-42%
Birth Tetanus
asphyxia and
23% others10
%
Hypothermia
management, Pre-Term Severe
Kangaroo Births Infections Community
mother care- (25%) (36%) based
18-51% pneumonia
WHO World health statistics 2007 management
42. New Child Health Initiative
by GOI Sep 2009
Navjaat Shishu Suraksha Karyakram (NSSK)
A new programme on Basic
Newborn Care and
Resuscitation, launched nationally
by GOI to address important
interventions of care at birth
GOI and IAP have signed a MoU for training
FOGSI important partner
43. NRHM INITIATIVES FOR NEW BORN AND
CHILDHEALTH
IMNCI 433 DTS-4,92,611 TRAINED
Navjat Sishu Suraksha karyakram 50000 trained
Special Newborn Care Units (SNCU) 293
Newborn Stabilization Units(NBSU) 1134
Newborn Care Corners
Home based (NBCC)
new born care
44. HOME BASED CARE FOR MOTHER AND
NEWBORN-THE VITAL missing LINK
5 VISITS IN
ASHA
42 DAYS
RS 50/1HR
D1,3,7,10 42
VISIT
Weight BCG,OPV,DPT
monitoring Completion
Safety of
Registration both mother
of birth and child at
42 days
45. Home visits for young
infants: Objectives
KANGAROO IDENTIFY
MOTHER ILLNESS,
CARE REFERRAL
EXCLUSIVE CORD CARE
BREAST HAND
FEEDING WASHING
46. Expected outcomes
41% of institutional
deliveries Greater impact in
90% trained states with higher
15-30% reduction in neonatal mortality
NNMR
47. INSPITE
OF THE INITIATIVES……..STILL A LONG
WAY TO GO ……..STILL TO REACH EVERY MOTHER
AND NEONATE
3.7 2012
48. PROGRESS NOT GOOD ENOUGH
MMR BY 2015
We are 212 in 2010 153
Our goal is 100
We are 63 in 2010 Under 5
Our goal is 38 mortality
by 2015
54
49. YET TO REACH EVERY MOTHER AND
NEONATE
30% of PHC - no building PHCS
Only
•58% Do DELIVERIES
40% - no vehicle
•6%- Do MTPS
70 % - no linkage to district
blood bank •22% Neonatal Care
•65% IUDS
Blood bank sources vital but
neglected •41% Sterilisations
Too far, Too little, Too Late
55.2% Obstetricians
CHC 70% Pediatricians short fall
50. 4th Dangerous nation for women and
children
June 22,2012
Baby Falak
Baby Afreen
Worst child sex ratio of 914:1000
51. CHILDREN BEARING CHILDREN
AND……..DYING
Save the children -2012 report
Pregnancy the
biggest killer of
teenage girls
IMR 77/1000
MMR 5 times
more in girls <15
2/3rd - before 20 yrs
1/5th - before 15 yrs
Population council of india
52. OTER KEY ISSUES
FEMALE FETICIDE PNDT
FEMALE INFANTICIDE DOMESTIC VIOLENCE ACT
POVERTY GENDER EQUITY
DOMESTIC VIOLENCE EDUCATION
SEXUAL ABUSE/RAPE EMPOWER MENT
ILLITERACY SCHEMES FOR GIRL CHILD
DISCRIMINATION AT MATERNITY LEAVE
WORK PLACE
53. TO REACH EVERY MOTHER AND NEONATE
MEDICAL SOLUTIONS
ARE WELL KNOWN – IT
IS THE STRATEGIC
DIFFICULTIES WHICH
NEED ATTENTION
56. JOIN HANDS TOGETHER
EVERY POLITICIAN
EVERY POLICY MAKER
EVERY OBSTETRICIAN
EVERY PEDIATRICIAN
EVERY MEDICAL OFFICER
EVERY HW
EVERY ANM
EVERY ASHA
TO MAKE every MOTHER AND NEWBORN
count
57. LONG ROAD AHEAD, BUT
• THERE IS NO REASON WHY WE SHOULD LAG
BEHIND
58. THANK YOU
FOR THIS UNIQUE OPPORTUNITY
FOGSI
MGMH NAYAPUL, OMC
OGSH,DR.P.KSHAH, PRESIDENT, FOGSI
DR.S.SHANTAKUMARI
DR.P.INDIRA DEVI
SRI.D.V.RAIDU IAS
SIX DECADES OF RCH IN INDIA –MS.SUJATA RAO IAS
PROF: RATNAKUMAR,
DILEEP MAVLANKAR-SUCCESS STORIES OF
TAMILNADU ,GUJARAT
59. REFERENCES
• WHO 2005-EVERYMOTHER AND CHILD COUNTS
• TRENDS IN MATERNAL MORTALITY1990-2010-UNFPA,WHO
• SRS 2006,2008
• NRHM-WEBSITE, WHO,mohfw.nic.in
• www.iapnrpfgm.org
• Lancet series on RCH,MATERNAL AND NEONATAL
• Presentations;
• Six decades of RCH in India –Ms.Sujata Rao IAS
• PROF: Ratnakumar, Dileep Mavlankar-success stories of
Tamilnadu ,Gujarat
61. SONG OF YOUTH
As a young citizen of India,
armed with technology, knowledge and love for my
nation,
I realize, small aim is a crime.
I will work and sweat for a great vision,
the vision of transforming India into a developed nation
powered by economic strength with value system.
I am one of the citizens of the billion;
Only the vision will ignite the billion souls.
It has entered into me ;
The ignited soul compared to any resource,
is the most powerful resource
on the earth, above the earth and under the earth.
I will keep the lamp of knowledge burning
to achieve the vision - Developed India
MEMORISE THIS PIE CHART. THIS IS THE KEY TO THE CLOSED DOOR
Khuljasimsim as we say
Amtsl –steps, miso-who statement-march 2011,blood in all CEMONC Centres, WHO model list of essential medicines
VV IMP GUIDELINES TO BE READ, PROPAGATED,PARCTICED AND DISSEMINATED-SHOULD BE MADE A GLOBALINITIATIVE
WITH TRAGEDIES LIKE THIS, MANY ,GIRLS MAY DIE EVEN BEFORE REACHING MOTHERHOOD. WITH MCH INITIATIVES ONLY ,MMR MAY COME DOWN BUT THESE DEATHS MAY CONTINUE.acute shortage of brides in some states---where will be the mothers