MATERNAL MORTALITY : Still an issue of concern for India

by: Ms.Supriya Goswami, MHA-Health (2011-13)

In 1987, the “International community” resolved to reduce maternal mortality by the “safe motherhood initiative”. In 1994, “The International Conference on Population and Development” recommended reduction in maternal mortality by at least 50 percent of the 1990 levels by the year 2000 and further one half by the year 2015. The 2000 Millennium Declaration signed in US by 189 countries including India, has set the target of achieving 200 maternal deaths per lakh of live births by 2007 and 109 per lakh of live births by 2015. Out of the 8 Millennium Development Goals (MDG), the MDG 5 specifically focuses to Improve Maternal health.

The repeated needs of initiatives were due to failure in achieving the objectives every time.

In India, the “Janani Suraksha Yojana”(JSY), a conditional cash transfer scheme to incentivize women to have institutional delivery, was launched in 2005. The aim of JSY, also known as “Safe motherhood scheme”, is to decrease maternal and neonatal deaths.

According to JSY guidelines, after delivery in a Government or accredited private hospital, women would receive financial assistance as: In Non-high focus states, eligible women would receive Rs.600 in Urban areas and Rs.700 in Rural areas. Eligibility criterion is - having 1^st or 2^nd live-birth and carrying government issued BPL card or belonging to SC/ST. In the 10 High-focus states, all women irrespective of socio-economic status or parity would receive Rs.1000 in urban areas and Rs.1400 in rural areas. JSY also gives a small incentive of Rs. 500 to a BPL card holding women of age 19 years and older, for delivering at home, for 1^st two live births.

JSY implementation occurs through community health workers as ASHAs, who receive Rs.200 in Urban areas and Rs.600 in rural areas per in-facility delivery assisted in high-focus states.

India’s Maternal mortality ratio(MMR) still being high, i.e. 212 per 1,00,000 live-births in the period of 2007-09, as indicated by Sample Registration System, clearly indicates the failure for proper implementation of JSY.

Government provision is needed but it is not enough for success as other factors too exist. Several possible explanations are there which need to be considered. Actually targeted population of poorest and uneducated women did not benefit much, so approaches to raise awareness and encourage them to take benefit are needed, such as communication strategies not based on literacy etc. Physical access to accredited facilities as well as Cultural barriers needs to be addressed. Quality of obstetric care needs to be taken care of with the load increasing on Health facilities due to JSY. The quality aspect could be considered by innovative strategies as - PPP based “Chiranjeevi Yojana” of Gujarat etc., but strict monitoring of healthcare quality maintained there is needed.

An important aspect is the continuous monitoring and evaluation of the programme, when it is progressing, as it would give an idea of what is working and what is not. This would give idea of what better could be done for making this country a safe place for the “mothers” as well as “infants”-the life that depends on them.

P.S. an interesting read on the issue of maternal mortality, 'Maternal Mortality: A Human Rights Emergency'

Marketing hospitals: a tight-rope walk

by: Ms.Khushboo Kumari, MHA-Hospital (2010-12)

Healthcare is a basic human need; and hospitals are the institutions, which cater to that need. There is no denying the fact that hospitals do need marketing, especially in the present day context, when healthcare is seen as an industry and when the competition is getting increasingly tougher with mushrooming private players. Customer focus has become primarily important in order to improve the bottom-line (profit/surplus). As a matter of fact, financial success of a hospital often depends on its marketing ability.

But the ethicists have always raised brows on this subject. Is marketing a healthcare institution ethical? What are the ethical standards that must be maintained while marketing the hospital services? Apparently, there is a huge knowledge gap between the providers and the customers (patients) in case of medicine. Hence these concerns are valid; and there is need of a strong healthcare marketing ethics model.

In case of hospitals, patients’ welfare should always be the prime motive, and not the profit. Marketing should never lead a patient to accept unnecessary service/s, irrespective of the costs or risks involved. A supplier (hospital)-induced demand for unnecessary services must be vehemently discouraged in healthcare. For instance, including X-ray as a part of routine check-up procedure or promoting cosmetic surgeries etc.

Advertisements should never be misleading, whether of any new equipment employed or of any new facility or service, introduced at experimental level. The best marketing is marketing that educates, i.e. letting people know what’s true; being honest and helping them to make an informed choice.

Customers are the best marketing agents that an organization can secure; and this can be achieved only by means of building up the confidence in them that their welfare is being given highest priority. This confidence further can be instilled only by means of offering honest and sincere services to them. The marketing team in a hospital must concentrate on relationship management with customers, aimed at improving their satisfaction level.

The 4P of marketing must be integrated with the 4Cs, i.e. Product as Customer solution, Price as Customer Cost, Place as Convenience to Customer and Promotion as Customer Communication. A satisfied customer base automatically improves the market share and consequently, the profit.

AYUSH and Public Health System in India

By: Dr. Sarosh and Vanita Singh
MHA-Health (2011-13)

Ayurveda, Unani, Siddha and Homeopathy (AYUSH) are rationally recognized systems of medicine and have been integrated into the national health delivery system. The NRHM seeks to revitalize the traditional medicine system of our country and to mainstream AYUSH to strengthen the public health system at all levels.

It is a rational decision because these systems have age-old acceptance in our country. Ayurveda is the oldest system with known efficacy. Yoga is gaining popularity as it has been found very effective in treating life-style diseases, which are on a rise presently. Homeopathy propagates indigenous knowledge aimed largely on chronic illness and preventive care e.g skin conditions, sinusitis, hair-loss etc. Many prefer these systems over Allopathic system because of the latter’s known side-effects.

The lack of state patronage in the past had prevented this form of medicine to be practiced at the same platform as Allopathy, which has a more scientific base and approach. Pharmacopial standards in manufacturing of AYUSH drugs, standard teaching institutes and scientific research which will answer the 'what' 'when' 'how' and 'why' will lead to more acceptance of this system. The increase in budget allocation for AYUSH is the right step in that direction. Integrating AYUSH with other system of medicine at lower levels like CHCS, PHCS in rural areas will definitely strengthen our public health system because this system enjoys a popular base in the mass rural population and is slowly attracting urban inhabitants as well.

Also, preventive care emphasis is universally accepted for its benefits in day to day life as prevention is surely better than cure. Hence, AYUSH can and will be a helpful adjunct to the system of medicine for curative and preventive aspect of public health.