More women die at childbirth in India than anywhere in the world. This can be fixed only if the government focuses on the quality, not quantity, of healthcare it is providing.
“As is always, the numbers are very impressive”. Under the National Rural Health Mission (NRHM), 8,722
doctors, 2,914 specialists, 14,529 paramedics, 33, 413 staff nurses, 69,662 auxiliary nurse midwives, and 10,995 doctors and 3,894 paramedics practicing traditional medicine have been hired to ensure that everyone in rural India—irrespective of where they live and how much they earn — have access to basic healthcare facilities.
Government data also shows that decentralisation, flexible financing, improved management and incentives — have ensured more women were choosing hospitals over home to deliver their babies, bringing the maternal mortality rate (MMR) down from 254 per lakh live births in 2006 to 212 in 2009. Still, 12.5 lakh newborns and 63,000 women die each year cause of pregnancy- related causes.
QUALITY CHALLENGED
The devil is in the detail. An incredible 1,3 crore (11.3 million) women have benefited from the Janani Suraksha Yojana (JSY), which offers pregnant women free and cashless deliveries, including free caesarean-sections, and Rs. 1,400/- incentive to deliver in a hospital. There is low-birth preparedness that leads to delays in pregnant women reaching a hospital and getting treated for preventable complications.
An analysis of maternal deaths, for example, showed that 13% deaths happened on the way to the hospital and 11% after the women return home, which shows poor management before and at the hospital. What’s clearly lacking is quality. Quality is lost in the rush to meet targets, such as attaining 100% institutional deliveries. We have the standards, technical tools and the basic infrastructure, needed, but still the quality of delivery depends on people, not on standard compliances.
WHO’S TO BIAME?
The quality is missing and hospitals cannot continue to take pride in institutional deliveries, if it’s just taking deaths from home to hospitals. Most government institutions have a take it or leave it approach and don’t care if the patients don’t like what they offer. This attitude needs to change, which is tough because, in this country, we are very tolerant of bad quality.
A major reason for the national apathy to incompetence is that action is rarely taken against erring government appointees, who focus more on hanging on to the job than doing it well. What will improve quality is better tracking and monitoring to identity and eliminates avoidable cause of death and complications help identify areas specific problems and ensure transparency.
But the review should not be done by the provider, as it usually happens in India. There is massive underreporting of deaths, with one state reporting only 20% maternal deaths, with the doctors listing the deaths under different pregnancy- related complications, such as septicaemia or organ failure.
Source: UNITED NATIONS
Hindustan Times – Delhi
Merck India - Biopharma 