Dr Pritam Pal, Shikha Wadhwa, Dr Pavitra Mohan
Ramsakhi, an expectant mother, resident of a remote village ‘Kankari’ in Dholpur district of Rajasthan is alive today, thanks to the Janani Surakasha (Safe Motherhood) Obstetric Helpline. She was rushed to the hospital and her life was saved, due to mobility support provided by Mangalam Seva Samiti, an NGO, piloting the program with support from UNICEF Rajasthan and the Government health system of the district. Janani Suraksha Obstetric HelpLine was formally launched on 11 April 2006. It was initiated in January 2006 and has already supported more than five hundred cases.
Ramsakhi is fortunate to be alive today. The maternal mortality ratio in Rajasthan is 445. Most of these deaths do not even get notified nor registered, because of the low social status of women and the lack of awareness in the family and community. Lives of most expectant mothers can be saved if health facilities are easily accessible and are able to provide emergency quality care to poor women living in the remote areas.
30 year old Ramsakhi, is the wife of Pappu, a migrant labourer working in Hyderabad, approximately 900 kms from his village. She has three living children: two sons and a daughter. Her first child – a daughter – was delivered by caesarian section, but could not be saved. After that, she had three normal deliveries, at home, without any complications. This was her fifth pregnancy and she developed a life threatening complication, due to obstructed labor. This time too, her family thought the baby would be born normally, at home. But the position of the baby was transverse. Delivery at home was not possible and due to prolonged obstructed labour, her uterus ruptured and she started bleeding internally.
She was brought to the doctor at the Community Health Center in Badi (nearest first referral unit) at 7.00 p.m. Seeing her critical condition the doctor advised that she be rushed immediately to the district hospital. The doctor also called on the 24 hours Janani Suraksha Obstetric Helpline and briefed the district hospital about her condition. By this time, the baby had already died in the womb.
With the assistance of the Helpline transport was arranged immediately and she was taken to the district hospital. When she finally reached there, at 8:30 PM her condition was critical. The doctor on duty was apprehensive of performing the surgery without adequate blood supply and technical support. The district magistrate and the principal medical officers intervened and ordered for four units of blood. A team of doctors was mobilised to assist in the surgery. After two and a half hours of negotiations and preparations, Ramsakhi was operated on at 11.15 p.m. and her uterus removed. By the next morning, her condition had stabilized and she recovered subsequently.
Janani Suraksha Obstetric Help line is a 24 hrs telephone service set up at the Community Health Centre (CHC), Badi in Rajasthan. (A Community Health Centre (CHC) is at the block level, catering to a population of approximately 100,000.) It has been set up as a model for Referral Transport for Emergency Obstetric care, with the support of UNICEF, Rajasthan and the Government Health system. This initiative is part of the UNICEF Maternal Mortality Reduction Advocacy Project funded by United Kingdom’s Department for International Development (DFID).
UNICEF inputs includes technical support, funding to train resource persons and grassroots functionaries; IEC activities to familiarize the communities with the Helpline system, especially the emergency phone number, workshop with private vehicle operators and the infrastructure cost.
When a call comes in, the Helpline immediately organizes a vehicle from the private taxi stand and sends it to the village to take the women to the CHC or the district hospital. If a woman reaches on her own to the first referral unit, re-imbursement of transportation expenditure is made under Janani Suraksha Yojna scheme of the government. In case she is not registered under Janani Suraksha Yojna, as a beneficiary, payment is made for the transport by Janani Suraksha Yojna helpline. A corpus fund through voluntary donation is being set up to sustain the project. This initiative has the potential of financial self-sustainability and act as a role model for “Public-private partnership” toward reducing maternal deaths in the country.