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Despite More Deliveries at Health Facilities, India's Healthcare is Failing its Own Standards: Study

The lack of quality is why increased coverage of facility-based births has not successfully translated to desired improvement in health outcomes for mothers and newborns, as the study points out.

Aradhna Wal | News18

Updated:June 6, 2018, 11:24 AM IST
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Despite More Deliveries at Health Facilities, India's Healthcare is Failing its Own Standards: Study
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With only 94 percent of community health centres (CHCs) and 60 percent of primary health centres (PHCs) providing round the clock services for the delivery of babies, India’s health care is failing its own standards.

A new study in the British Medical Journal (BMJ), published June 5, showed that the “overall capacity for basic intrapartum care [care from the onset of labour to the delivery of the placenta] was lower than the basic IPHS standard in both PHCs and CHCs”.

The Indian Public Health Standards are used a yardstick here to judge not just the availability of services but, crucially, the quality, for pregnant women in rural and urban India.

Of the 8,536 PHCs and 4,810 CHCs surveyed by the authors — from the George Institute for Health, New Delhi, and Harvard TH Chan School of Public Health, USA — 30 percent of PHCs and 5 percent of CHC were found not offering any intrapartum care.

PHCs are often the first points of contacts for people needing medical help. They also serve as referral points for CHCs. The fact that they lagged behind CHCs in most things is a matter of concern.

However, even where services were, ostensibly available, gaps were felt in the quality. Only 59.7 percent, or 4,798 of rural and 62.7 percent or 312 of urban PHCs, and only 92.7 percent or 3578 of rural and 94.9 percent or 895 of urban CHCs offered 24-hour intrapartum care.

The study said, “Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index... compared with 21% of districts otherwise.”

Among the Empowered Action Group (EAG) states, Uttar Pradesh had the greatest concentration of poor capacity facilities, with 84% of districts receiving scores in the lowest third. Uttar Pradesh and Bihar are the states with the two highest maternal and newborn mortality rates in the country.

The lack of quality is why increased coverage of facility-based births has not successfully translated to desired improvement in health outcomes for mothers and newborns, as the study points out. There has been a concerted effort by the government, in a bid to reduce maternal and newborn mortality, to get women into facilities for deliveries, and decrease home births.

About 80.1% of all deliveries in rural India are facility based, of which about 70% are in public facilities. For urban areas, 89.5% of births are institutional, 47.4% of which are in public facilities. However, as successive reports of India’s Rural Health Statistics show, these structures exist without adequate manpower and equipment.

Lack of skilled manpower meant that large gaps in provision of assisted vaginal deliveries (13% of PHCs vs 30% of CHCs), administration of parenteral magnesium sulfate (54% vs 70%) and management of postpartum haemorrhage (53% of PHCs vs 69% of CHCs).

The state of affairs in PHCs remained the same in rural and urban areas, though urban CHCs seemed to perform better than their rural counterparts.

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