September 26, 2016

Chronicles of Deaths Foretold: Part 2 - Policy recommendations

Data from the health ministry shows that only 42% of maternal deaths are being reported. Out of them 67% are institutional deliveries. Nearly 20% of women are dying during transit.
Experiences from the field indicate the same.

“We have 120 medical colleges, only 55 are reporting maternal deaths to us. We have sensitized them, but it is not picking up,” saidDr. Veena Dhawan from the Ministry of Health and Family Welfare.
She listed many initiatives of the government to reduce maternal deaths. “But the implementation lies in the hands of the State governments. We can only make policies at the Centre,” she said.  
The report was presented to Dr. Veena Dhawan, assistant commissioner, maternal health, Ministry of Health and Family Welfare and Dr. Prasanth of National Health System Resource Centre.


In the two-day consultation, organized during the release of report “Chronicles of Deaths Foretold,” activists strongly demanded accountability for lapses when a woman dies. They said that there should be enquiry into maternal deaths, responsibility fixed and culprits punished. When there are protocols, then someone should be punished if they are not followed and lead to deaths.

Based on the report and the consultation on maternal health, the civil society organizations came up with recommendations. Five suggestion that NAMHHR believes have to be implemented immediately are:
  1. Ante-natal check-up (ANC) must identify high-risk cases – use RED FLAG to signify a high risk for all providers
  2. EMERGENCY HELP DESK in all facilities used by ‘populations at risk’ with compounded vulnerabilities
  3. Develop Adverse Outcome Management protocols, monitor use in HPDs
  4. Blood storage at all FRUs; in emergency situations, no donor requirement
  5. Free REFERRAL transport to tertiary facilities with paramedic (EMT)- even if across state border; a simple PHONE CALL to next facility  
The 10 medium-term recommendations are
  1. System of using MCTS information to prevent/prepare for any adverse outcomes
  2. Skill training of all nurses and ANMs in safe childbirth, including ANMs in sub-centres/community
  3. Adequate  nurse/ANM posts & appointments according to case-load
  4. Ensuring visits to each CHC by a Gynaecologist at least once every 15 days
  5. Ensuring  essential drugs for maternal survival are available, and using generics
  6. Providing Iron-sucrose injections for very anaemic women at CHC/PHC
  7. Strong feedback loops for JSSK, with User participation
  8. Acknowledgement and Regulation of the private sector  including informal providers
  9. Stronger monitoring of data based on AHS estimates; counting numbers of anaemic women, checking maternal death reports and doing CB-MDR with CSO support
  10. Involvement of PRIs in identification of maternal deaths, process of death review & community awareness
  11. Free hearse service for bereaved families
Dr. Abhijit Das, director, Centre for Health and Social Justice, said that the government should create a feedback mechanism from community experience. We can use ICT for a platform through which every citizen can provide their experience. It will be anonymous but will have important indicators like geographical area and facility where the person was treated. This can further be consolidated and feedback sent to specific facilities for their improvement.

“We do not need new schemes and announcements. We need to ensure implementation of what already exists. We need to hold people accountable when they do not implement policies,” said Renu Khanna from Sahaj, Gujarat.
Jashodhara Dasgupta from Sahayog, nodal organization that prepared the report, said that an overhaul of the current system is the need of the hour. “Our evidence through the report shows that the current way of working has not produced results. The model of JSY+ ASHA+ EmOC/JSSK has not worked, especially in marginalised areas and communities. We have rethink and look beyond the existing system”.

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