dr himanshu bhushan deputy commissioner maternal health division
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Can private healthcare setups shoulder the responsibility of delivering reproductive, maternal and child health services in semi urban areas? Sharing experiences from India. Dr Himanshu Bhushan Deputy Commissioner Maternal Health Division Ministry of Health and Family Welfare - PowerPoint PPT PresentationTRANSCRIPT
Can private healthcare setups shoulder the responsibility of delivering reproductive,
maternal and child health services in semi urban areas?
Sharing experiences from India
Dr Himanshu Bhushan
Deputy Commissioner
Maternal Health Division
Ministry of Health and Family Welfare
Government of India APHA 2013, Boston
Presenter Disclosures
“No relationships to disclose”
Dr. Himanshu Bhushan
Acknowledgements
Government of India MOHFW
The Federation of Obstetric and Gynaecological Societies of India (FOGSI)
Avni Health Foundation Mr. Ajey Bhardwaj, Support Staff
WHO – India Country Office
JHPIEGO
India
World’s Largest Democracy
1 Billion + population
Decadal Growth 17.8%
28 States, 7 Union Territories, 660 Districts
GDP Growth Forecast 3.8% (2013) (Higher than World growth of 2.9%)
22+ Languages, 700 Television Channels (80 beaming only news 24x7), 70,000 newspapers, 900 mio Mobile Subscribers, 100 mio Internet Users
25% people between ages of 18-25 (approx)
Health Facilities/Doctors/Coverage - India
Need is to involve more Private sector providers (esp. in
rural areas) to improve the health
indicators
Approximately 29 million pregnancies
Approximately 27 million deliveries
15% of these are likely to develop complications
Complications cannot be predicted
56,000 avoidable maternal deaths per year
Nearly 1.3 million infant deaths each year
9 lacs in the first 4 weeks of life
7 lacs in the first 1 week of life
Majority in the first 2 days of life
Approximately 3.5 million women still deliver at home
Indicator India UP KeralaInfant Mortality Rate (SRS 2011) 44 57 12Maternal Mortality Rate (SRS 2007-09) 212 359 81
Total Fertility Rate (SRS 2011) 2.4 3.4 1.8
RCH Picture - India
Inter and Intra State Wide
Variations. Need is to involve more health facilities if
we have to improve the
health indicators
Institutional Delivery - India
India has shown improvement, current infrastructure is being upgraded, capacity is being created, manpower is being
equipped etc…however there is a need to broad base the delivery of services since the current health setup is already
being stretched…
Source: HMIS
Access to Institutional Delivery post NRHM and JSY
Source: AHS 2011
Share of Govt. & Private Hospitals in Institutional Delivery
YES !
Private Sector can be involved with;
Systems to ensure Quality
Linkages with Govt.
Equitable Geographic Coverage
What we did ?
Broad-based Service Delivery through the involvement of Private
Players in the Health Sector
Overcoming Issues with Private Sector ?
Location/Level of Standards they follow/ Whom to Involve/What
Standards to Use/How to Monitor Standards on a continuous basis
How… the solution !
Accreditation of
Private Health FacilitiesGoI Defined Guidelines Identify Private Health Facilities meeting criteriaSetup Accreditation Committees – Continuous Monitoring
GOI Accreditation Guidelines
Steps to set up accreditation process and Tools are given in the guideline
A readymade resource database Giving a detailed listing of all existing PHF’s
who meet the accreditation criterion and who have the necessary manpower/infrastructure to offer MCH/RCH services as per GOI guidelines
Giving a detailed listing of all existing PHF’s who need strengthening. Once strengthened they can be involved in supporting the State.
Expected outputs
Based on the tools, identification and accreditation of Private Healthcare
facilities is standardized- Showcasing few Reports -
Sample Description
1
Total PHF
Visited
PHF Excluded
due to lack of
facility
Total PHF
included in
final analysis
Raisen 10 1 9
Narsinghpur 19 8 11
Hoshangabad 33 8 25
M P 62 17 45
Anugul 19 9 10
Sambalpur 14 6 8
Jharsuguda 26 6 20
Orissa 59 21 38
Total 121 38 83
Sample Description
1
•730 data variables
•data entry of approximately 100,000 variables
Mapping Tools
1
Tool Tool Description
Annexure 1 Requirements to be met by a PHF for accreditation for offering Maternal and Child Health Services.
: Number of beds, HR: Ante Natal Care; Intra Natal Care; Post Natal Care services: Services for Child Health, Vaccination: General Equipment, Drugs: Waste Segregation Practices.
Annexure 2 Requirements to be met by a PHF for accreditation for offering Reproductive Health Services.
: Number of beds, HR: Safe Abortion Services: Drugs and Equipment for Medical Abortion and Emergencies. : Sterilization, Counseling, Family Planning
Observations - HR
1
13 PHF in MP and 14 in Orissa met the criteria of onsite availability of 24hours MBBS doctor, OBGYN, Staff Nurse, ANM and a Lab technician.
Observations - ANC
1
Between 80 – 85 % of P’s offered ANC services. The services included Registration, AN Examination, Referral Linkages, TT Immunization, Iron/Folic, Nutritional counseling, Lab investigation, (HB, Albumin, and Blood sugar).
3 PHF in MP and 25 PHF in Orissa were able to provide 100% of ANC services
Observations - INC
1
Observations – Neonatal Equipment
1
Observations – Anesthesia Equipment
1
Challenges
Questions ?
