By Chinki Sinha
KOLKATA, 22 September 2015 -When she was 17 and in labour pain, she cried for attention near the corridor of the Government Medical College in Kolkata. Gouri Mondol had already travelled for more than an hour to reach the hospital in a hired car from her village in 24 South Parganas in West Bengal. With no help coming by, Gouri gave birth to a girl child on the floor in the hospital corridor.
She had been sitting on the ground and saw the baby’s head coming out. She stood up, hitched up her sari to hold the baby as it began to arrive and called out to a nurse. By the time, the hospital staff got to her, the baby was born. She was taken to the post-natal ward where she recuperated on the floor. She returned home and vowed never to go back to the hospital.
The harrowing experience meant that when Gouri got pregnant with her second child in early 2015, she and her family straightaway decided for a home-based delivery. Home based delivery is extremely unsafe and often lead to complications.
Although West Bengal has 75 per cent institutional delivery according to DLHS-4, there are pockets, especially in hard to reach and riverine areas where home based deliveries are still very common. Through generations, midwives have helped mothers to deliver their babies at homes in these regions.
Gouri’s decision was challenged, though, by the Auxiliary Nurse and Midwife (ANM) in her community. While visiting her household the ANM explained her that the services had improved at the Jirangacha Block Primary Health Centre .
“They will send an ambulance the moment you go into labour. The wards are clean and the nurses, dedicated,” Akhtarul Bibi, the ANM promised.
Gouri Mondol trusted Akhtarul Bibi and agreed to deliver her child at the hospital which has witnessed a major transformation in the last year.
Since 2014, the Government of West Bengal in partnership with UNICEF has started an initiative to reorganise the labour rooms in Government hospitals in order to introduce best practices for reducing infant and maternal mortality rate.
Jirangacha was one of the health facilities included in the initial phase, and within a year, the health centre has been transformed and resources utilised efficiently.
‘Transform Labour Rooms’ in hospitals is a project that aims to build the capacity of the staff, improve clinical and managerial practices and reorganise labour rooms, new born corners, and maternity units.
The methodology involves a three-day training sessions and follow-up visits to ensure monitoring and bridging the gaps.
In West Bengal, UNICEF is the lead development partner in the state’s Call to Action, a comprehensive approach to accelerate Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A.), and has been helping reorganise labour rooms, and hospitals’ infrastructure for prompt deliveries, and to improve child survival and safe motherhood.
Through advocacy and technical inputs, the aim is to counter the challenges in the successful implementation of RMNCH+A . The state’s Maternal Mortality Ratio (MMR) at 114 per 100,000 live births; Infant Mortality Rate (IMR) at 31/1000 live births, and Neonatal Mortality rate at 22/1000 live births are better than the national average.
However, the IMR and MMR have stagnated in the last few years, and according to the findings of a gap analysis undertaken, it is the poor quality of the services what is affecting the ratio adversely.
The ‘Transform Labour Rooms’ project which started in 2014 in two districts in West Bengal –Malda and South 24 Parganas- aims at improving the quality of services in these hospitals. Till date, 36 labour rooms have been transformed and another 39 are in for transformation next year. Since the project started, the Jirangacha health centre , under Bhangore II block has seen an increase in deliveries from 230 in 2012-13 to more than 1500 deliveries in 2014-15. In 2015, so far 1000 deliveries have been conducted at this health centre.
"Proper care during and immediately after delivery are critical in saving the lives of mothers and newborns. Therefore, labour rooms play a very important role in reducing maternal and neonatal mortality,” says Dr. Kaninika Mitra, Health Specialist at UNICEF.
UNICEF has tied up with the Society of Midwives in West Bengal and in the future, a reorganisation of the public health centres will be scaled up to other districts of West Bengal, including Murshidabad,Coochbehar and Uttar Dinajpur.
Dr. Avrojit Raha, a Block Medical Officer (BMO), Bhangore II Block, says the training has helped nurses and doctors to understand the importance of sterilising the equipment among other things.
“There was a lack of motivation. The Government policies are in place but we were finding it difficult to implement them,” he says.The female ward almost always remains full, and thanks to an inverter, the wards have a provision of one bulb and one fan during power cuts.