The Hindu : Tamil Nadu / Chennai News : World Bank commends mother and child health programme in State

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Tuesday, May 03, 2011
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Tamil Nadu

Tamil Nadu - Chennai

World Bank commends mother and child health programme in State

Ramya Kannan

CHENNAI: The World Bank has commended the Tamil Nadu Government for its work in bringing down maternal and child mortality in the State. This achievement has largely been possible due to the establishment of comprehensive emergency obstetric and neonatal care (CEmONC) centres all over the State, it has said.

“Rural women in the State of Tamil Nadu in India can now reach a comprehensive emergency obstetric and neonatal health facility within a half an hour from their homes,” the report has said (available on the website www.worldbank.org.in).

The World Bank-funded Tamil Nadu Health Systems Project (TNHSP) in Tamil Nadu began adopting, and enhancing the number of CEmONC since 2006.

Starting with 62 centres then, the State had a total of 121 centres in about three years. “The CEmONC centres were set up as a deliberate effort to bring down child and maternal mortality in the State,” S. Vijayakumar, Project Director, TNHSP, said.

While the infant mortality rate had fallen since the 1990's the State was still battling high maternal mortality. The IMR then began to stagnate, with no further reduction in the rate.

The World Bank report reasoned that “the high mortality among mothers and babies indicated that the quality of care in the State's secondary level health facilities was poor, especially since almost 80 per cent of births took place in these facilities.” There was less than the recommended number of CEmONC centres as per the WHO's standards (one for at least 2,50,000 people).

That was set to change with the TNHSP getting into the act. Pushing funds to enhance infrastructure, and equipment, and mobilising human resources into service, the State upped the number of CEmONC centres over the years, and made sure they were functional 24 hours to cater to emergencies. Wherever needed, the Public Private Partnership mode was commissioned to make sure there was no lapse on the part of the Centre, because of lack of funds, equipments or personnel.

The results began to trickle in as the State set about sensitising pregnant women about the advantages of institutional delivery, the need for regular antenatal checkups and early admission in case of emergency.

At least two hospitals in every district were fully equipped to function as CEmONC centres, the World Bank noted. What really tipped the balance was the provisioning of ambulance services to take women who develop complications during labour to the nearest CEmONC centre within half an hour of being called.

Trained technicians in the ambulance informed the centre of the case details, including blood group, in order that care can be provided immediately on arrival. A concerted effort was also made to establish CEmONC centres near isolated and vulnerable communities, including tribals, according to the World Bank.

According to a study commissioned by the TNHSP, researchers from the National Institute of Epidemiology found that the per cent of maternal deaths (among women treated for complications) had dropped from 0.21 in 2006 – 2007 to 0.15 in 2009-2010. The accepted level is under one per cent.

The caesarean section rate has also increased, while earlier, the mothers would have to be referred to a larger hospital if a surgery was needed.

“However, the NIE study showed that 20 per cent of the caesarean cases in the State are handled by the CEmONC centres. This can be improved further definitely. Also, we are targeting further improvements in neonatal health, though we have been able to bring down the number of cases due to birth asphyxia,” Dr. Vijayakumar added.

Currently, the IMR for Tamil Nadu is 28 per 1000 live births, and the MMR is 85 per 1,00,000 live births, according to him.

The World Bank has also indicated that further improvements in the quality of emergency obstetric and neonatal care are required. This “will also be needed to bring the state's IMR closer to its better-performing neighbours such as Kerala (IMR is 14/1000) and Sri Lanka (IMR 18.8/1000).”

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