IIMA studies FRUs in Gujarat to strengthen midwifery and EmOC

With an aim to prevent maternal deaths and assess the Gujarat's capacity for implementing emergency obstetric care through first referral units (FRU), a study by Indian Institute of Management, Ahmedabad (IIMA) has assessed the regional and district level capacity of the state government to operationalise FRUs for providing Emergency Obstetric Care (EmOC) in order to prevent maternal mortality and laid down recommendations to strengthen EmOC.

The study, 'Assessing the regional and district capacity for operationalising emergency obstetric care through First Referral Units in Gujarat', conducted by faculty at the institute —Parvathy Sankara Raman, Bharati Sharma, Dileep Mavalankar and Mudita Upadhyaya, gives an insight into the functioning of various health facilities and highlights the results from the basic to the more comprehensive level of EmOC services. The study also gives recommendation on various measures to rectify shortcomings noticed and make EmOC a more effective at different levels in the state of Gujarat.

The findings of the study indicate a lack of infrastructure in labour rooms, non-recording of maternal deaths occuring both in and out of institutions, lack of midwives dedicated to maternal health, inadequate trained staff, unavailability of information related to functioning of FRUs with the management information system of the state health department, to name a few. The study is a part of a larger project to help strengthening midwifery and Emergency Obstetric Care in India, coordinated by IIM Ahmedabad, supported by the Midwifery and EmOC Development Project and funded by the Swedish International Development Agency (Sida).

The study states that EmOC is crucial for preventing maternal deaths for which the policy has been to establish FRUs. Twenty seven facilities from 6 districts from each administrative region of Gujarat were studied to understand the management of EmOC at regional, district and below the district levels. In all 7 district hospitals, 8 FRUs, 4 community health centers (CHC) and 8 round the clock primary health centers (PHC) were selected. Observation checklists, semi-structured interviews with service providers were used to collect data.

The study shows that the monitoring capacity at the regional and the district levels is very limited and hence FRUs are not fully functional. The study recommends that functioning of FRUs could improve if there is a dedicated officer for maternal health in the regional office who can liaison with both the directorates at state level and the CDHO and CDMO at district level. Coordination between the Directorate of Medical Services and Family Welfare should be strengthened in order to ensure proper monitoring FRUs from the state level. It would be ideal if there is a dedicated officer for maternal health and/or midwifery at the district level. This would ensure regular visits to the FRUs and day-to-day monitoring of implementation, better management of logistics and supply of drugs and equipment, maintenance of equipment, referral transport etc. for round the clock emergency services.

According to the study, public health initiatives over the last two to three decades have helped India to improve health indicators such as life expectancy and total fertility rate to a great extent, but some crucial indicators like maternal mortality rate (MMR) and infant mortality rate (IMR) have stagnated at around 300-400 per 100,000 live births and 53 per 1000 live births respectively in the 90s. In-spite of the rural health infrastructure, even now about one million (20% of global) women and 2.1 million (21%) of child mortality are in India, in which 50 per cent of child morality is due to neo-natal reasons which is the highest for any country.

As per the Sample Registration System mentioned in the study, the current maternal mortality ratio for India is 301 per 1 lakh live births.