Table 3.
Maternal health policies, objectives and indicators of MAPEDIR's effectiveness in helping to meet the objectives, and outcomes
| State (District) Outcomes | ||||
|---|---|---|---|---|
| National RCH policy | District maternal health policy objectives and indicators | Rajasthan (Dholpur) N (%) |
Madhya Pradesh (Guna and Shivpuri) N (%) |
West Bengal (Purulia) N (%) |
| Register all maternal deaths |
"Unhide" maternal deaths: % of expected maternal deaths* reported by district before//after MAPEDIR implementation |
Apr, 04-Mar, 05: 4% (5/116 deaths in 4 blocks)//Apr, 05-Mar, 06: 60% (35/58 deaths in 2 blocks) | Feb-Dec, 05: 47% (113/239)//Feb-Dec, 06: 57% (136/239) | July, 04-June, 05: 119% (114/96)//July, 05-June, 06: 127% (122/96) |
| Investigate all (or a sample of) reported maternal deaths |
Gather new evidence: % of reported maternal deaths investigated by district before//after MAPEDIR implementation |
Apr, 04-Mar, 05: 0% (0/5)//Apr, 05-Mar, 06: 100% (35/35) | Feb-Dec, 05: 0% (0/113)//Feb-Dec, 06: 100% (136/136) | July, 04-June, 05: 0% (0/114)//July, 05-June, 06: 86% (105/122) |
| Implement RCH programme planning and management: • Evidence-based |
The state uses the new evidence: New maternal health interventions developed by/with the state health system based on MAPEDIR data |
Statewide obstetric help line (implementation delayed); 141 FRU blood storage units equipped | None | Made all public maternity beds non-paying; expanded JSY to all SC/ST and BPL women; implemented new rural referral transport system |
| • Decentralized |
Decentralized MH planning: New maternal health interventions initiated at district level based on MAPEDIR data |
District health society planned and mobilized obstetric helpline and referral transport system by partnering with civil society | Guna: mapped maternal deaths to prioritize & upgrade remote SHCs for 24 × 7 safe delivery services; Guna and Shivpuri: ensured 24 × 7 referral transport to all PHCs via call center and secured vehicles | None |
| • Bottom-up |
Community participation: New maternal health interventions developed by or with communities based on MAPEDIR data |
Taxi union & NGO collaborated with district in implementing and running the obstetric help line and referral transport system | Guna: block PRI ensured referral transport for remote villages to upgraded SHC; Guna: communities donated 6 of 22 referral vehicles | GP-initiated 8 van rickshaws in 4 remote GPs of 4 Purulia blocks |
BPL = below poverty line; FRU = first referral unit; GP = gram panchayat (local governance board); JSY = Janani Suraksha Yojana (institutional care incentive scheme); MH = maternal health; NGO = non-governmental organization; PHC = primary health centre; PRI = Panchayat Raj Institutions (local governance system); RCH = Reproductive and Child Health Programme; SC/ST = scheduled castes and tribes; SHC = sub health centre.
*Expected deaths = District (Block) population*State crude birth rate*State MMR (from 2001-03 Sample Registration System Special Survey of Deaths): Dholpur: 1, 000, 000 (2 blocks = 500, 000)*26/1000*445/100, 000; Guna/Shivpuri: 2, 600, 000*26.5/1000*379/100, 000*(11/12); Purulia: 2, 700, 000*18.4/1000*194/100, 000.