Programmes

Maternal Health

Maternal Health is vital component of health systems and refers to the health of women during pregnancy, childbirth and the postpartum period. Motherhood is often a positive and fulfilling experience, whereas for too many women it is associated with suffering, ill-health and even death. Maternal Health is important to communities, families and the nation due to its profound effects on the health of women, immediate survival of the newborn and long term well-being of children, particularly girls and the well-being of families.

Improvement of maternal health & decline of maternal mortality ratio requires availability of large number of health services early in pregnancy. These include early antenatal registration, Consumption of Iron Folic Acid tablets as prophylaxis and therapy, regular antenatal check-ups, monitoring of blood pressure, Tetanus Toxoid immunization, Timely detection of high risk Antenatal cases and their timely referral, delivery in safe and hygienic environment by skilled birth attendant, timely referral in case of obstetric emergency for management of hemorrhage with blood transfusions, availability of caesarean section facility and minimum 3 post-natal visits.

Fifth Indicator of Millennium Development Goal (MDG) is reduction of maternal mortality ratio. Reducing maternal mortality has arrived at the top of health and development agendas. To achieve the Millennium Development Goal of 75% reduction in the maternal mortality ratio between 1990 and 2015, countries throughout the world are investing more energy and resources in providing equitable, adequate maternal health services. This requires a focused attention as current MMR for the year 2010-12 (SRS) is 122 per 100000 live births. Therefore, focused interventions within ongoing maternal health program through sustenance of the strategies have been suggested for ensuring the progress towards the goal.

Though National Rural Health Mission has led to substantial investment and attention in revitalizing public health systems with strengthening of community process, increase in deployment of skilled human resource and improved management and decentralized planning. The challenge for the State in Maternal Health is to sustain and improve the acceleration in maternal health indicators especially the maternal mortality ratio in the year 2014-15.

Objectives

  • To reduce Maternal Mortality Ratio..
  • To increase the Early ANC registration.
  • To ensure 3 or more than 3 ANCs to all the expectant mothers and special attention to high risk pregnancies
  • To decrease the incidence and progress of anaemia in pregnant and lactating women.
  • Provide adequate opportunities for safe deliveries and to increase institutional deliveries.
  • To improve the coverage of post partum care.
  • To increase access to Emergency Obstetric Care for complicated deliveries through strengthening of FRUs.
  • To increase access to early and safe abortion services
  • To ensure the Maternal Death audit of all Maternal Deaths.
  • To ensure JSSK entitlements in all Govt. institutions deliveries.

Improving Maternal Health is one of the Sustainable Development Goal and a vital component towards achieving Continuum of Care. Gujarat has made considerable progress over the last decade in Maternal and Child Health by providing accessible qualitative health services especially for rural areas, out reached areas and the poor. 98 percent of deliveries are institutional deliveries and 43 percent of home deliveries are conducted by Skill Birth Attendants in current year. Maternal Mortality Ratio (MMR) of Gujarat has reduced from 172 per 1 lakh live births in year 2001 – 2003 to 91 per 1 lakh live births in year 2014 – 2016 (SRS).

Chart

This improvement in reduction can be attributed to various Schemes of Government of Gujarat such as Mamta Diwas, 108 ambulances, Improvement in government facilities and quality, continuous tracking of pregnant mothers through E-Mamta, Chiranjeevi Yojana, Kasturba Poshan Sahay Yojana, Mamta Ghar, Free drop back to home after institutional delivery using Khilkhilat etc.

Currently Gujarat is 6th among the states with lower maternal mortality ratio.

Chart

Services to Pregnant women

  • All pregnancies are registered by health workers.
  • All registered pregnant women are provided three antenatal checkup which also include Blood Pressure measurement and ruling out any complications, high risk factors
  • The Pregnant Women are given two doses of tetanus toxoid immunisation. The Pregnant women are also provided Iron Folic Acid tablets and Calcium Supplementation.
  • Deliveries by trained personnel in safe and hygienic surroundings are encouraged.
  • Institutional deliveries are encouraged for women having complications.
  • In case of complication referrals are made to First Referral Units for Management of obstetric emergencies.
  • Three postnatal checkups are given to mothers after the delivery
  • Spacing of at least three years between children is encouraged.

Technical Series

Schemes/Initiatives

Pradhan Mantri Surakshit Matrutava Abhiyan (PMSMA)

  • To reduce Maternal Mortality ratio and to ensure qualitative Maternal Health services, various programms & schemes is been implimented in State.
  • Pradhan Mantri Surakshit Matrutava Abhiyan (PMSMA) is been implimented since 09th June 2016 aross state to ensure early identification & prompt treatment of high risk pregnant womens of 2nd / 3rd trimesters under guidance of specialist.
  • Across state 09th of every month \Pradhan Mantri Surakshit Matrutava Abhiyan (PMSMA) clinic is been organized at every Public Health Institute.
  • Under this abhiyan essential Anatenatal care & other necessary health services in been provided by specialist at every Public Health Institute at 09th of every month.
  • In the 31st July 2016 episode of "Man ki Baat” Honable Prime Minister has appealed to private sector obstetricians/ physicians to volunteer their services for this programme.
  • Pradhan Mantri Surakshit Matrutava Abhiyan (PMSMA) is being monitored by web portal, under PMSMA specialist/ physician can do registeration by self for volunteer services by SMS (5616115) & on website (www.pmsma.nhp.gov.in).
  • 314 (March end , 2018) private obstetricians/ physicians is been enrolled for providing volunteer services in state.
  • Pradhan Mantri Surakshit Matrutava Abhiyan clinic is been organized at all Community Health centre, Sub district Hospital, District Hospital & Medical Collge Hospitals.
  • All essential Antenatal examinations, check up, Hemoglobin, Urine, Routine Blood Sugar, Malaria, HIV, Blood grouping etc essential laboratory services is also ensured, even if required USG services also been provided to all pregnant women.
  • Pradhan Mantri Surakshit Matrutava Abhiyan (PMSMA) ensures essential examination of pregnant women and early identification of pregnant women with high risk factors and also ensures necessary medical check up, treatment & laboratory investigations under guidance of specialist. If it is required than pregnant women is also referred for essential medical check up & treatment to higher level public health institutes. All these services is been provided free of cost to all pregnant women at all public health institutes.
  • More than 12 lakh pregnant women are examined & out of which total 79,242 High Risk Pregnancy is been identified under the campaign.
program

Janani Surakha Yojana (JSY)

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Health Mission (NHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Scheme has contributed immensely in increasing the Institutional deliveries among the BPL, ST and SC population. The progress of Scheme has been remarkable since inception and is expected to achieve good results in the years to come.

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Janani Shishu Suraksha Karyakram (JSSK)

Janani Shishu Suraksha Karyakram (JSSK) is an initiative of Govt. of India & Govt. of Gujarat to assure completely free and cashless services to pregnant women including normal deliveries and caesarean operations, postnatal women upto 42 days and sick Infants (up to 1 year after birth) in Government health institutions.

JSSK Entitlements are as follows:

  • Free and zero expense Delivery and Caesarean Section
  • Free Drug & Consumables
  • Free Diagnostic services
  • Free Diet during stay in the health institutions
  • Free provision of Blood Transfusion
  • Free transportation service from Home to Health Institutions, between facilities in case of referral and drop back to home
  • Exemption from all kind of user charges

Referral Transport

Referral transport from home to health Facility

EMRI Ambulance Services (108-Ambulance Service) are currently available throughout Gujarat through the toll free number 108, which is controlled by state level call centre. The pre hospitalization emergency care provided by EMRI is free and the patient is admitted to a hospital of her or his choice.

Inter Facility Transfer

The free inter facility Transfer are provided by state owned CHC ambulances and by PHC vehicles and 108.

Drop back from the facility to home

Drop back services provided through state owned ambulances or by hired vehicles. Drop back vehicles (khilkhilat vans) are deployed to each district.

Khilkhilat drop back van Photo call on 0797140505050

Janani Shishu Suraksha Karyakram Helpdesk

JSSK Helpdesk along with one counsellor is established at 41 Centers which includes selected Medical College Hospitals, District Hospitals, Sub-District Hospitals & CHCs in order to facilitate all entitlements implementation and coordination with Khilkhilat.

Performance:

Financial Year Beneficiaries availed
Free Drugs & consumables
Beneficiaries availed
Free Diet
Beneficiaries availed
Free Diagnostic
Beneficiaries availed
Free BT
Beneficiaries availed
Free RT
April 2017 to March 2018 247801 113410 404040 10488 154992

Chiranjivi Yojana.

The Health & Family Welfare Department has initiated a scheme involving private sector specialists in providing services related to safe delivery, primarily for socio economically weaker sections, which is named as Chiranjivi Yojana. The scheme was launched on pilot basis in December 2005. In the initial stage, this scheme is made operational in five most under served, tribal, desert and bordering districts i.e. Kutch, Banaskanta, Sabarkanta, Panchamahals and Dahod as a pilot project in the State. The beneficiaries are the mothers from BPL, since 26/03/2007 APL-Non Income Tax Paying families are also incorporated in beneficiary criteria. The Initial package of Rs 1, 85,000 for 100 deliveries, which was modified by Govt. Resolution No.: FPW/102013/73/B-1 dated 29/07/2013, now revised package of 100 deliveries is Rs. 3,80,000. In Chiranjeevi Yojana, there is provision of Rs. 2500/- per Caesarian Section if enrolled Private gynaecologists conduct Caesarian Section in Government health facility. The package also includes Rs. 200/- for transportation of the pregnant motherChiranjeevi Yojana has so far served to more than 12 lakh pregnant mothers.

Benefits

This scheme empowers the poor in several ways:

  • It provides them entitlement for free delivery care in private sector.
  • It provides immediate access to Emergency Obstetric Care (EmOC) when needed.
  • Reduction in out of pocket expenditure.
  • It also provides them choice of several providers nearby from which they can choose from.
  • It also shows that it is possible to develop large scale partnership with private sector to provide skilled birth attendance and EmOC to poor women at a relatively small expenditure
  • The Chiranjeevi scheme is now linked with Emergency Management and Research Institute (EMRI) services for elimination of transportation time delay. EMRI is providing free ambulance services to all sections of the society in entire Gujarat state.

Identification and Tracking of High Risk Mother

Categories:

Previous pregnancy complications:

  • Anaemia
  • Caesarean Section
  • Ante partum Haemorrhage(APH)/Post partum Haemorrhage (PPH)
  • Pre Eclampsia/ Eclampsia
  • Abortion
  • Obstructed labour

Preexisting Chronic Illnesses

  • Tuberculosis
  • Diabetes Mellitus.
  • Heart/Kidney Diseases
  • HIV
  • Sickle cell Anemia
  • Thalessemia

Preexisting Chronic Illnesses

  • Extreme age (less than 18 and more than 35 years)
  • Weight (less than 45 kg)
  • Haemoglobin (less than 7 gm/dl)
  • Blood Pressure (More than 140/90), oedema or urine protein or blurred vision
  • Malaria
  • Gestational diabetes mellitus
  • Hypothyroidism during pregnancy
  • Twin Pregnancy
  • Mal presentation
  • Interval between two pregnancy (less than 18 Months)

Monitoring and tracking:

A special module is incorporated in E-mamta (state specific MCTS) portal to ensure tracking of high risk mother.

Mamta Ghar

One of the major determinants in some areas of the State is the ability to bring the necessary technical skills – economic, geographical, and operational – to the women in need of help. Access to a continuum of care, including appropriate management of pregnancy, delivery, post partum care and access to life-saving obstetric care when complications arise are crucial to Safe Motherhood.

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Mamta Sakhi ( Birth Companion Scheme)

Under this scheme a female family member allow to be at the side of pregnant woman at the time of delivery in government institutions. The presence of birth companion during childbirth meant that a woman was never left alone during this intensely stressful and frightening time of her life.

Mamta Doli

Reduction in delay due to transportation to the health facility for Institutional Delivery is of utmost importance for bringing down the MMR. In view of the above the State Govt. has decided to implement the Mamta Doli initiative in certain inaccessible areas of Gujarat.

The purpose of the initiative is to bring the pregnant women to the nearest motorable point from where she can be picked up from ambulance receiving point for further transportation by EMRI 108 vehicle for Institutional Delivery or transportation of the pregnant women directly by the Mamta Doli service providers.

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Maternal Death Surveillance Response

Improving Maternal Health is one of the Sustainable Development Goal and a vital component towards achieving Continuum of Care. Gujarat has made considerable progress over the last decade in Maternal and Child Health by providing accessible qualitative health services especially for rural areas, out reached areas and the poor. Maternal Mortality Ratio (MMR) of Gujarat has reduced from 172 per 1 lakh live births in year 2001 – 2003 to 91 per 1 lakh live births in year 2014 – 2016 (SRS).

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Mamta Abhiyan

Outreach preventive and promotive services for ANC and PNC are designed under MAMTA Abhiyan. MAMTA Abhiyan has four components including MAMTA Divas (Health & Nutrition Day), MAMTA Mulakat (PNC Home visit), MAMTA Sandarbh (Referral services) and MAMTA Nondh.

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Mamta Card (Mother & Child Protection Card)

In the Gujarat Mother and Child Protection card is known as Mamta Card. The Mamta Card has been developed as a tool for families to learn, understand and follow positive practices for achieving good health of pregnant women, young mothers and children.

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Comprehensive Abortion Care

After International Conference on Population Development (ICPD) in 1994 the need to improving reproductive health of women to enhance the overall human welfare and development has aroused. With its commitment to reproductive health, Government of India (GOI) has launched the Reproductive and Child Health Program since October 1997.Among the various components of reproductive health, abortion though legalized in India has remained neglected so far.

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Skills Lab

Skills lab is an important intervention to improve Maternal and Child Health. Skills lab are designed with the aim of up gradation of the skills of healthcare providers to enhance their capacity to provide quality RMNCH+A services leading to improved health comes. At present, there are nine skills lab operationalized in Gujarat in year 2013-14

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Obstetric ICU

Background:

Gujarat has come a long way in improving Maternal Health. Maternal Mortality Ratio (MMR) has declined from 172 Maternal Death per 1,00,000 live births in 2001-03 to 112 Maternal Deaths per 1,00,000 live births in 2011-13, a 34% decline. (SRS Bulletins). Yet many women lose their life during pregnancy, child birth or during post-partum period due to complications of pregnancy.

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