Dr Nandita Palshetkar, President, Federation of Obstetricians and Gynaecological Societies of India emphasises on the importance to prevent maternal mortality rate with private and government initiatives
A lot has been said and written about the role of the government in delivering universal healthcare coverage for maternal health. However, I believe that there many ways in which private healthcare providers can step up to play a greater role in ensuring better health coverage. The private sector forms a critical part of India’s maternal healthcare ecosystem, accounting for 30 per cent of babies delivered in an institution in rural India and more than half of institutional deliveries in urban areas.
The overwhelming concern is that in spite of unprecedentedly high levels of women opting to have their babies under institutional care (78 per cent as per the last National Family Health Survey), this has not led to India achieving desirable improvements in maternal health care indicators. For instance, while India — and Maharashtra in particular — has made tremendous progress in reducing the maternal mortality rate (MMR), it still remains high compared to developed nations.
The key factor contributing to low performance in maternal care is the lack of a strong regulatory framework for quality standards. Private maternity care in India is largely unorganised and unregulated as service providers do not have adequate opportunities to improve their care s maternal mortality rate ervices. There is no body or authority to ensure that private clinics or hospitals follow the norms for safety, hygiene, clinical care, equipment, etc. so that mothers can deliver safely.
It is well past time for the private sector to step up and self-regulate to achieve higher standards for maternal care. Globally, health reforms are driven by Professional Medical Associations (PMAs). Since these organisations represent medical professionals — nurses, pharmacists, physicians, mid-wives, etc. — they have the resources to drive education and training and the capabilities to set much-needed standards and guidelines.
Thankfully, India is seeing a similar trend. FOGSI (Federation of Obstetricians and Gynaecological Societies of India) is one of India’s premier PMAs, with about 35,000 obgyns under its umbrella. Three years ago, FOGSI took a major step towards quality enhancement and capacity building at private maternal care facilities. It started driving Manyata, which is a quality care certification programme for clinical and facility standards in maternal health. Manyata has been quite a success story. Rolled out in five states (Uttar Pradesh, Jharkhand, Rajasthan, Karnataka and recently launched in Maharashtra), Manyata has impacted over 250,000 deliveries in 475 hospitals and trained over 3,000 service providers in adhering to clinical standards.
The accreditation programme, which is supported by MSD for Mothers, Jhpiego and MacArthur Foundation, enables registered facilities to train their doctors and nursing staff to comply with 26 quality standards, which include both clinical and facility standards. Thus, it can help smaller facilities even in remote areas to strengthen their service delivery and offer better conditions of care. Moreover, the quality accreditation improves the chances of such facilities coming under the private insurance umbrella. This will not only support their business viability, but also allow more patients to receive financial support via medical insurance. The partnership will especially help in reaching the last mile and thus in improving universal healthcare coverage. A win-win situation all around.
Government partnership is key to delivering scale and ensuring sustainability in quality enhancement initiatives. Recognising the vital role played by the state in driving healthcare coverage, FOGSI has joined hands with the Maharashtra state government to launch ‘LaQshya-Manyata’. The aim is to improve access to quality care, particularly for women living in rural and semi-urban areas, and thus drive an upswing in maternal health indicators. It has been thrown open to all the districts in Maharashtra and will help overcome the inherent bottlenecks in the state’s healthcare system.
LaQshya Manyata is a shining example of what can be achieved through strong public-private partnerships and collaborative solutions — a more robust healthcare system that will offer equitable access to all communities across economic strata and the rural-urban divide.
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