Where there is no obstetrician – increasing capacity for emergency obstetric care in rural India: An evaluation of a pilot program to train general doctors

Evans, Cherrie; Maine, Deborah; McCloskey, Lois; Feeley, Frank G.; Sanghvi, Harshad

doi:10.1016/j.ijgo.2009.09.006

Cited by 36 publications

(46 citation statements)

References 3 publications

(2 reference statements)

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“…This disparity in health services is greatest in rural areas [14]. Furthermore, higher antenatal care coverage has been associated with lower rates of antepartum stillbirth [12].…”

Section: Discussionmentioning

confidence: 99%

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

et al. 2017

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Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)–Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013–2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women’s and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013–2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013–14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

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“…This disparity in health services is greatest in rural areas [14]. Furthermore, higher antenatal care coverage has been associated with lower rates of antepartum stillbirth [12].…”

Section: Discussionmentioning

confidence: 99%

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

et al. 2017

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“…For instance the post operative outcomes of C sections performed by non physician providers in Malawi were comparable to those of doctors [22]. However the only available ,though early, evaluations of task shifting for EmOC-for both C section and anaesthesia in India are not encouraging and demand greater support [23,24]. The choice revolves around what is the most effective way to improve coverage, reach and quality of EmOC services and reduce its costs in the specific contexts.…”

Section: Discussionmentioning

confidence: 99%

Contracting in specialists for emergency obstetric care- does it work in rural India?

Randive

Chaturvedi

Mistry

2012

BMC Health Serv Res

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BackgroundContracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India.MethodsFacility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped.ResultsTwo schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility.ConclusionsDensity and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.

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“…Additionally, a very limited number of health services offer 24-hour coverage by skilled birth attendants or anesthesiologists [2]. The shortage of human resources in these countries constitutes one of the most frequent barriers to safe cesarean delivery [4,21]. As previously noted, the percentage of deliveries performed by skilled providers (range 10%-71%) positively correlated with the lower rates of cesarean deliveries (range 1.5%-7.1%) in the 16 Sub-Saharan countries evaluated (Table 1).…”

Section: Countrymentioning

confidence: 99%

Challenges affecting access to cesarean delivery and strategies to overcome them in low‐income countries

Irani

Deering

2015

Intl J Gynecology & Obste

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Where there is no obstetrician – increasing capacity for emergency obstetric care in rural India: An evaluation of a pilot program to train general doctors

Cited by 36 publications

References 3 publications

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

Contracting in specialists for emergency obstetric care- does it work in rural India?

Challenges affecting access to cesarean delivery and strategies to overcome them in low‐income countries

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