Maternal Health

The state of Uttarakhand is all set to provide quality health care services to pregnant women and their new born baby through various interventions and programs aimed at reducing preventable mortality and morbidity.
One of the most critical steps to reduce maternal mortality and morbidity is to address the health status of the women during pregnancy, child bearing and the post partum. The program aims to address the major causes of mortality and morbidity among women and provide assured dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman visiting public health facility and provide positive birthing experience.
Maternal health program is designed and developed as an innovative and integrated approach for improving RMNCH+A Health Outcomes. The initiative has been built upon both Community & Facility Level Interventions with focus on improving both demand and delivery of services & for ensuring Respectful & Quality Care across all levels. Successful implementation of the initiative would lead to decrease in Maternal & Newborn Mortality in the State.

AIM: Achieving Positive Pregnancy experience & outcomes.

Primary Objectives:

Delivery of Respectful & Quality Care
Better Antenatal (ANC) Services during pregnancy
Better Care around Birth (Delivery) Services
Better Postnatal (PNC) Services during post delivery period
Strengthen Maternal & Neonatal Death Surveillance & Response System

Priority Interventions:

Organize Fixed ANC & PNC Service Day (Samman Divas) at Sub-Center Level every Monday
Focus on ANC Counseling & Birth Planning and use of ANC Counselling & Training Wall & Birth Plan cards.
Conduct Facility Level Emergency Drills in the Labor Room every week.
Track and ensure availability of Key commodities as listed in GOI RMNCH+A 5×5 Matrix.
Ensure regular Online Data Reporting on Samman portal, SNCU Online and PMSMA Portal. Use of Scorecards for recognizing Health Providers & Teams and address gaps.
Organizing Quarterly Review & Facilitation Event at District level

Respectful Care – Seven Client Rights:

Freedom from Harm
Informed Choice
Privacy & Confidentiality
Dignity & Respect
Equality
Highest Level of Healthcare
Freedom from Coercion

Five Key ANC Goals

Ensure completeness of 4 ANC visits;
One additional visit to Higher Center where Blood Grouping test is available;

Build Beneficiary awareness on

Nutrition
Danger Signs in Pregnancy & Post Pregnancy Period
Government Programs – JSY, JSSK, Maternity Benefit Scheme, 108, 104 Schemes

Ensure 180 IFA & 360 Calcium + Vit. D3 consumption during ANC & PNC Period ;

Complete TT Vaccination

Support the women in choosing her Post-Pregnancy family Planning Method (PPFP).
Help the pregnant women in selecting her delivery point based on her PPFP needs
Prepare the pregnant women for exclusive breast feeding.

Important Schemes under Maternal Health

Pradhan Mantri Surakshit Matritva Abhiyan:

This scheme is being implemented since year 2016. The objective is improving the quality and coverage of Antenatal Care by doing timely detection, referral, treatment and follow-up of high risk pregnancies. It aims at reaching out to all pregnant women who are in the 2nd & 3rd trimesters of pregnancy. The check-up is envisaged on 9th day of every month.
Janani-Shishu Suraksha Karyakram
Janani Shishu Suraksha Karyakram (JSSK) was launched in Uttarakhand in the year 2011. The scheme is to benefit pregnant women who access Government health facilities for their delivery so as to improve Maternal and Child healthcare and to alleviate out-of-Pocket expenditure on health care. Under JSSK programme, there is an entitlement of free drugs, free referral transport, diagnostics including diet during the duration of stay for every pregnant women and sick neonate up to one year of age.

Free Entitlements for pregnant women:

Free and cashless delivery
Free C-Section
Free drugs and consumables
Free diagnostics
Free diet during stay in the health institutions
Free provision of blood
Exemption from user charges
Free transport from home to health institutions
Free transport between facilities in case of referral
Free drop back from Institutions to home after 48hrs stay

Free Entitlements for sick infants:

Free treatment
Free drugs and consumables
Free diagnostics
Free provision of blood
Exemption from user charges
Free Transport from Home to Health Institutions
Free Transport between facilities in case of referral
Free drop Back from Institutions to home.

Janani Suraksha Yojana (JSY): It is a centrally sponsored scheme launched in the year 2005. The objective is to reduce the number of maternal and infant deaths by promoting institutional delivery among pregnant women. In this scheme, pregnant women are entitled for cash assistance for giving birth in a government or accredited private health facility. The cash assistance for mothers in rural and urban area is Rs 1400/- and Ra. 1000/- respectively. The Cash assistance is also given to ASHA worker.

Comprehensive Abortion Care Services: Comprehensive and safe abortion services are provided at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs including the Delivery Points. Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy is undertaken.

Capacity Building of Medical officers is being done routinely in safe MTP Techniques. ANMs, ASHAs and other field functionaries are trained to provide confidential counselling for MTP and promote post-abortion care including adoption of contraception.

Provision of RTI/STI services: Under NHM, provision of STI/RTI care services is an important strategy to prevent HIV transmission and to promote sexual and reproductive health services in all the FRUs, CHCs and at 24 X 7 PHCs.

Village Health Sanitation and Nutrition Day: Village Health Sanitation & Nutrition Day (VHSNDs) is organized at Anganwadi center at least once every month. It is a platform to provide ante natal/ post partum care for pregnant women, promote institutional delivery, immunization, Family Planning & nutritional counseling.

Quality Service Provision

Quality Ante Natal care: Quality and comprehensive ANC incorporates minimum of at least four ANCs including early registration and first ANC within first trimester. The ANC package includes physical and abdominal examinations, Hb estimation, screening for Gestational Diabetes Mellitus, Thyroid disorders, HIV/Syphilis and urine investigation, T.T/Td, Immunization, distribution of IFA tablets & Calcium (6 months during Antenatal period & 6 months during postnatal period) and counselling for nutrition etc. Early detection of high-risk pregnancies, follow up and management are important components of Antenatal care.
Essential Obstetric Care during Delivery: Free institutional delivery at all public health facilities including Sub-centre, primary health centres, community health centres, sub-district hospital, districts hospital etc, to reduce maternal & neonatal morbidity and mortality. In order to provide essential obstetric care services, Uttarakhand is operationalizing the 24 X 7 PHCs services and providing training to SNs/ANMs under Skilled Attendance at Birth.
Post natal care for Mother and New born:-Ensuring post-natal care within first 24 hours of delivery and subsequent home visits on 3rd, 7th, 14th and 42nd day is the important component for identification and management of emergencies occurring during post-natal period. The ANMs and staff nurses are being oriented and trained for tackling emergencies identified during these visits.
Provision of Emergency Obstetric and Neonatal Care at FRUs: Provision of Emergency Obstetric and Neonatal Care at FRUs is been done by operationalizing all FRUs in Uttarakhand.
Augmentation of skilled human resources for Maternal Health:
To overcome the shortage of skilled manpower particularly Anaesthetists and Gynaecologists, the following key skill based training programs are being implemented:
- 18 Weeks Life Saving Anaesthesia Skills (LSAS) Training Programme for MBBS Doctors for Emergency Obstetric Care.
- 16 weeks EmOC Training programme for MBBS Doctors for imparting Obstetric Management Skills including C-Section in collaboration with Federation of Obstetric and Gynaecological Society of India.
- 10 days Training Programme in Basic Emergency Obstetric Care for Medical Officers (BEmOC)
- 3 weeks Training Programme for ANMs/SNs/LHVs as Skilled Birth Attendants (SBA)
- Skills Labs (Daksh training) for improving the skills of healthcare providers and to enhance their capacity for providing quality RMNCH +A services. Uttarakhand has established 2 Skills Labs.