Chiranjeevi Maternal Health Financing Issues and Options

1. Chiranjeevi Maternal Health Financing Issues and Options Dr Amarjit Singh Secretary Family Welfare Government of Gujarat

2. Lessons from HSRs Steer don�t row Finance rather than directly provide Explore options for PPP Regulate quality, cost-effectiveness Protect the marginalised groups

3. Maternal Death Watch-Global 380 women become pregnant 190 women face unplanned or unwanted pregnancy 110 women experience a pregnancy related complication 40 women have unsafe abortions 1 woman dies from a pregnancy-related complication

5. Gujarat � A Profile

6. Current Status

9. Timing of maternal deaths-General Conditions

12. Maternal Mortality: UK 1840�1960 Other interventions can make a difference, but not as substantial as skilled attendants. For example, in this graph, the implementation of antenatal care did not reduce maternal mortality in the UK. Improvements came only with skilled attendants who could provide surgical intervention if needed, and who had access to and could use appropriate antibiotics and blood products. Nevertheless, antenatal care remains an important intervention in maternal care because it provides an opportunity to detect problems and be prepared to handle them.Other interventions can make a difference, but not as substantial as skilled attendants. For example, in this graph, the implementation of antenatal care did not reduce maternal mortality in the UK. Improvements came only with skilled attendants who could provide surgical intervention if needed, and who had access to and could use appropriate antibiotics and blood products. Nevertheless, antenatal care remains an important intervention in maternal care because it provides an opportunity to detect problems and be prepared to handle them.

13. Maternal Mortality ReductionSri Lanka 1940�1985 Even with TBA�s and other interventions, maternal mortality decreased in Sri Lanka. The reduction, however, was the greatest (maternal mortality was the lowest) after having births attended by skilled providers The government�s commitment to this intervention was crucial.Even with TBA�s and other interventions, maternal mortality decreased in Sri Lanka. The reduction, however, was the greatest (maternal mortality was the lowest) after having births attended by skilled providers The government�s commitment to this intervention was crucial.

14. New Global Understanding ofMMR Reduction Once major obstetric complication develops- even a trained TBA or a nurse cannot do much at home These complications require effective back up by trained O&G experts surgical interventions injections of antibiotic blood transfusion aggressive treatments

15. Three Delays Responsible for Maternal Deaths Delay in deciding to seek care (Individual & family) Lack of understanding of complications Gender issues, Low status of women Socio-cultural barriers to seeking care Poor economic conditions of the family Delay in reaching care ( Community & System) Lack or underutilization of transport funds Non availability of referral transport in remote places Lack of communication network Delay in receiving care (System) Poor facilities, personnel and Supplies Poorly trained personnel with indifferent attitude Multiple factors affect WHY a woman dies during pregnancy. The �three delays� model�: Delay in decision to see care: lack of information about problems/warning signs, social factors Delay in reaching care: having transportation, road conditions Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnelMultiple factors affect WHY a woman dies during pregnancy. The �three delays� model�: Delay in decision to see care: lack of information about problems/warning signs, social factors Delay in reaching care: having transportation, road conditions Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel

16. Options Improve Government Health Service Competent staff Adequate infrastructural facilities User friendly, good quality Competitive Services Marketing of services Public Private Partnership Outsourcing- Curative services Health Insurance

18. Broad Issues Non - availability of O & G specialists Accessibility of services-Tribal and urban slums Poor utilization of services- Low felt need of health & medical services Lack of user friendly & quality public health services Costly private health and medical services No health insurance coverage

19. Chiranjeevi Yojna - Options Service Coverage through outsourcing- voucher system Emergency Obstetric Care & Neonatal Care Private Gynecs/ GIA in their facility Payment to Gynecs for working in government hospital

20. Service Charges

21. Service Charges

22. Population and Births

23. Implementation of Chiranjeevi-1 District level FOGSI members workshops organized for orientation on Chiranjeevi scheme and enrollment of doctors on the panel Honorable Health Minister wrote a letter about the scheme to presidents of district and talukas in 5 districts. District level Advocacy workshops of Presidents of district and taluka panchayat, along with BHO and Chiranjeevi panel doctors organized in each district.

24. Implementation of Chiranjeevi-2 In each district IEC activities were undertaken. Awareness through Gramsabhas Rs 15000/ advance was given to each obstetrician. No delay in reimbursement to doctors. Regular interaction with Chiranjeevi Panel doctors by CDHOs

25. Preliminary results

26. Caesarian/complicated deliveries

27. Miles to go

29. Effect on Government deliveries

30. Issues Surge of demand - boon to the poor Unprecedented support from the private practitioners Unindicated C-section in check Availability of blood Still asking for additional funds from the BPL Non-BPL beneficiaries also being attended Under utilisation of Public facilities

31. Issues in expansion Additional day�s stay after delivery Sanitary pads supply More funds for accompanying person � Dai Other services Sterilisation/ IUD/ RTI/ STI/ HIV/AIDS/pap smear More charges for transportation in Kutch Cost likely to increase to 2,00,000/100 deliveries

32. The bill for Gujarat