High-risk pregnant women to get random calls in Punjab

CHANDIGARH: Struggling with a high maternal mortality rate (MMR), Punjab has decided to begin making random calls to high-risk pregnant women to identify gaps in the current system and develop a focused action plan to reduce maternal deaths in the state.
The maternal mortality ratio, a crucial indicator of healthcare quality within a state, currently stands at 105 per lakh live births in Punjab, compared to the national average of 97.The central govt has set a target of reducing the MMR to less than 70 per lakh live births.
States like Kerala (19), Maharashtra (33), Andhra Pradesh (45), Tamil Nadu (54) and Gujarat (57) have already achieved this target.

Between Feb 19 and Feb 25, Punjab witnessed nine maternal deaths and all these deaths were reviewed by the principal health secretary Ajoy Sharma, following which directions were issued for taking corrective measures.
All civil surgeons, district family planning officers (DFPOs) and senior medical officers (SMOs) have been instructed to maintain an up-to-date list of high-risk pregnant women containing details of accredited social health activists (ASHA), auxiliary nurse midwives (ANM), and community officers (CHO) concerned, along with the expected date of delivery.
District officials are tasked with making random calls to these identified high-risk pregnant women to inquire about their health status and birth preparedness.
The primary objective of these random calls is to evaluate the quality of care provided to high-risk pregnant women and identify areas for improvement.
‘Compile Detailed Presentations’
Districts are required to compile detailed presentations outlining the outcomes of the random calls, highlighting any identified gaps, and detailing the corrective actions implemented to rectify them.
To facilitate communication regarding the management of similar complications, officials have been instructed to share details of maternal deaths in public domains, including both public and private hospitals.
Officials have to maintain confidentiality, ensuring that no individual's name, identity, hospital name, or district name is disclosed.
The services of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh can be utilised through teleconsultation for critical health issues such as Immune Thrombocytopenia during pregnancy, where specialised consultation is required.
Instructions have also been issued to director health services to formulate and circulate protocols related to the labour room, perineum care and emergency referral to the districts. All high-risk pregnancies will be followed up until 45 days post-delivery by the ASHAs.
Medical officers and community health officers will be designated to ensure regular tracking and follow-up of high-risk pregnant women.
Senior medical officers (SMOs) will oversee the community health officers for tracking high-risk pregnancies.
To Rope In AACs
To address the challenge of manpower shortage, it has been decided to involve Aam Aadmi Clinics (AACs) in providing consultations to pregnant women.
During the review meeting chaired by the principal health secretary, it was observed that the antenatal care (ANC) registration of a deceased pregnant woman from Ludhiana was missed due to the high population load on the ANM, who was responsible for a population of 90,000 in the area.
To tackle this issue, a mapping of AACs will be conducted in areas where the number of ASHAs and ANMs is inadequate. Directions have been given to sensitise the staff of AACs to provide healthcare services to pregnant women.
They will undergo training to identify high-risk pregnancies and provide a minimum of five-minute consultations to pregnant women visiting AACs. The health department will develop a standardised IT module for pregnant women in AACs.
Emphasis has been placed on ensuring effective coordination among SMOs, AAC staff, CHOs, ANMs, and ASHAs to provide quality care to pregnant women and reduce MMR. Instructions have been given to prominently display the names and contact details of SMOs, CHOs, ANMs, and ASHAs in every hospital and AAC.