Maternal mortality in Andhra Pradesh at home. This indicates the need for early recogni- tion of problems and decision-making and referral at the periphery. A maternal death has implications for the health and survival of the newborn and the care and sup- port that the child receives later in life. The 1997 study in five districts found that, of 82 liveborn babies of mothers who had died, 39 died within a few days after the death of the mother. Another component of this study was to follow up the fami- lies for six months after the death of the woman. Of the 48 husbands of women whose case studies were written, 25 had married within six months af- ter the death of the wife. The surviving children of the men who had remarried were found in the care of grand parents or other relatives. Government initiatives to reduce MMR Andhra Pradesh has been foremost at designing and implementing health and family welfare pro- grammes, such as formulating a state population policy (1997); establishing a university of health sciences (1986); creating a separate department for first-level referral units, etc. The state has recently initiated several innovative schemes for reducing the number of maternal deaths, such as facilitating the availability of 108 emergency vehicles for ru- ral health services (16). This initiative is treated as a model and is now being emulated in other states. The support to women’s groups during the 1990s and the ASHA training programme during this de- cade are described as exemplary programmes of the state. Most notable is the state’s achievement in population stabilization. Some initiatives of the state for reduction in MMR are discussed below. Initiatives to deal with maternal emergencies and complications Ensuring efficient transport to hospital and avail- ability of blood are two factors for addressing maternal emergencies. Under the National Rural Health Mission and RCH 2, the Family Welfare Wing of the Health, Medical and Family Welfare Department of the state is implementing the Ru- ral Emergency Health Transportation Scheme (REHTS) to provide vehicle facility to rural people for emergencies relating to pregnant women, in- fants/children, and accidents. The intervention was first pilot-tested in four districts through NGOs but did not show much success when many orga- nizations were involved. In the second phase, the entire operation was handed over to one organiza- Volume 27 | Number 2 | April 2009 Prakasamma M tion—Emergency Management and Research Insti- tute (EMRI)—operated by a foundation set up by a corporate agency. In total, 502 ambulances have been operationalized in the entire state, each ve- hicle covering a population of 130,000 to 150,000. There is one central call number (108) to avail of an ambulance. This highly successful intervention is taken as a model for other states. The problem of availability of blood is also being addressed to some extent. A memorandum of un- derstanding was signed with the Red Cross Society of Andhra Pradesh to upgrade and maintain blood- banks and blood-storage centres in the state. There are still no clear data on how well they are main- tained. In the meantime, the number of blood- banks in the private sector and those operated by trusts have increased. Both these interventions are beginning to have an impact on service-use. Efforts for enhancing awareness among women and use of health services The Government of Andhra Pradesh initiated several schemes and programmes for enhancing the use of health services from public and private hospitals during pregnancy and childbirth. The Women Health Volunteers (ASHA) programme, a component of RCH 2 (17) needs to be specially mentioned. During 2005-2006, 55,400 Women Health Volunteers were identified by the respective gram panchayats, and 49,000 received training for one month each until February 2007. A three-day refresher training is planned to be conducted every six months. The State Nodal Agency nominated the Academy for Nursing Studies for designing and conducting the training. This scheme is expected to enhance public awareness and increase demand for services. The Woman Health Volunteer is pro- vided a small remuneration according to her per- formance. The scheme favours services to vulner- able groups, such as women from the SC and ST population. Janani Suraksha Yojana (JSY) provides care to ru- ral poor women who undergo institutional deliv- eries whether in a public or private hospital. This programme, implemented with support from the Government of India, has proved to be effective in promoting the shift to hospitals for delivery. Unlike in other states, this money is not paid to women who deliver in the home. The ASHA programme and the JSY programme continue the prac- tice of monetary incentive for performance and service acceptance that were successful in achiev- ing the sterilization targets. 227