Kounteya Sinha | February 11, 2012
Time: 1. 40 am February 6
Deepak Tiwari, posted at Mandla district hospital’s 24X7 call centre, receives a call informing him that Biriyabai from the tribal village of Sarra has gone into labour. He immediately dispatches an ambulance. At 2. 30 am, Biriya arrives at the Nainpur community health centre (CHC), 32 km from her home, and safely delivers a baby girl.
Time: 1. 05 am February 4
Shiv Kali Maravi from Bamnigaon is in labour. Her family calls Rameshwar Khudape who is now manning the same call center. An ambulance is dispatched. At 2. 16 am, the patient reaches the CHC at Niwas, 33 km away. Soon after, Maravi gives birth to a baby boy.
While new born babies continue to die in hospitals across West Bengal – a tragedy that chief minister Mamata Banerjee calls “fictional, ” drama of a different kind is being played out in Madhya Padesh’s remote villages – one that can teach Banerjee a lot.
A fleet of 669 ambulances and 176 staffers in 48 call centres across 50 districts of Madhya Pradesh are working 24×7 to maximise institutional deliveries in distant tribal villages of the state. Jointly run by the state government in association with Unicef, Janani Express is now a major success story in the field of public health. The results talk for themselves.
More than 7, 00, 000 pregnant women have been transported free of charge across the state between January 2008 and December 11, 2011. Fewer children in the state are now being delivered outside hospitals. While the number of Janani Express beneficiaries was 2, 691 in 2007, it has steadily increased to 23, 545 in 2008, 35, 076 in 2009 and over 1. 7 lakh in 2010. In 2011, 4. 81 lakh pregnant women have delivered in hospital settings while 10, 000 new born children have benefited from it.
Each district in the state now has a call centre with a dedicated phone number. Around 22 vehicles are placed at different delivery points. “Somebody in a village has to have a phone. A single call now ensures a mother’s safety, ” says Dr Gagan Gupta, Unicef health specialist.
The infant mortality rate in Madhya Pradesh saw a fall of five points in 2010 – from 67 per 1, 000 to 62 per 1, 000 – the highest such fall recorded in the state. This is also the most dramatic fall documented in a year in the last decade, according to the registrar general’s latest data. “The analysis of two pilot call centres from Guna and Shivpuri for 50, 000 pregnant women transported from 2008-2011 revealed that half of the beneficiaries belonged to scheduled castes and tribes and half of the women were transported in the night hours between 8 pm and 8 am. In addition, 90 per cent of patients were transported within two hours of a call to a health facility, ” says Dr Gupta.
So how did the scheme start? In order to promote institutional delivery of children, the Union health ministry started the Janani Surakhsha Yojna (JSY) scheme which entitled all wouldbe mothers to free delivery, including a Caesarean section, in hospitals. They would be entitled to free transport from their homes to government health facilities and between facilities in case they are referred on account of complications. They would also be offered free drop back to their homes soon after.
This initiative was estimated to benefit more than one crore would-be mothers and newborns every year in both urban and rural areas. Under the scheme, accredited social health activists (ASHAs) were given Rs 250 as transportation charge for bringing pregnant women on the verge of delivering to the closest health facility. But an analysis showed that the lack of organised transport in the hinterland meant that it was hard for ASHAs to reach pregnant women to health facilities in time. Often they would be transported in lorries and on bike pillions.
Using a public-private partnership model, MP then decided to tie up with a private transport company – chosen through a tender – to start the Janani Express. “The cost of hiring of the vehicles is met from the Rs 250 marked for transportation under JSY funds. These funds are pooled based on number of institutional deliveries and provided to chief medical officers to make payments to the hired agency, ” says Dr Gupta.
The first call centre was set up in Guna in 2006. Each centre is manned by four people. Says Tania Goldner, chief of UNICEF Madhya Pradesh of the project: “Such 24×7 call centres, the Janani Express, strengthening of health sub-centres and cash linked maternity benefits, are part of the continuum of care for pregnant women and contributed to a significant increase in institutional deliveries in MP and progressive decrease of the maternal mortality ratio for the state. ”
Dr Archana Mishra, deputy director, maternal health at that state directorate of health services, says the state is committed towards reduction of high maternal mortality rate and maternal deaths caused by the shortage of referral transport facilities.
“The scheme is providing free referral transport facilities to pregnant women coming for delivery. Nearly 50 per cent of pregnant women going for institutional delivery are availing the free services under the scheme. These facilities are available to both the mother and the new born after discharge from the government health institutions, ” says Dr Mishra.