Lok Sabha Question No. 299 (STARRED), answered on 2019-07-12
Subject: Quality Care to Pregnant Women
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Kirit Premjibhai Solanki

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO. 299 TO BE ANSWERED ON THE 12 TH JULY , 2019 QUALITY CARE TO PREG NANT WOMEN

## *299. DR. (PROF.) KIRIT PREMJIBHAI SOLANKI:

Will  the  Minister  of  HEALTH  AND  FAMILY  WELFARE  be  pleased  to state:

- (a) the steps taken by the Government to ensure quality care to pregnant w and neonates;
- (b) the number of Mother and Child Health (MCH) wings that have been set and are presently operational in the country including Gujarat; and
- (c) the criteria for deciding a 'high case load delivery point'?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

- (a) to ( c):  A statement is laid on the Table of the House

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 299* FOR 12 TH JULY , 2019

- a) Followings  Steps  have  been taken  by  the  Government  to  ensure  Quality care to Pregnant Women and neonates;
2. LaQshya (Labour Room Quality Improvement Initiative) :Government of  India  has  launched  'LaQshya  program'  to  improve  quality  of  care  in labour rooms and Maternity Operation Thea tres in public health facilities. The LaQshya programme is evidence based approach to improve quality of maternal  and  newborn  care  and  provide  respectful  care,  particularly during the intrapartum and immediate postpartum periods, which are the  most  vulnera ble  periods  for  a  woman  and  newborn  contribute  to  a significant proportion of maternal and newborn deaths. Its implementation involves  improving  infrastructure  upgradation,  ensuring  availabilit essential equipment, providing adequate human resources, c apacity building of health care workers, and adherence to clinical protocols and impro quality processes including respectful care in Labour room and Matern operation theatres.
3. PMSMA ( Pradhan Mantri Surakshit Matritva Abhiyan ) : The  Pradhan MantriSurakshit Matritva Abhiyan (PMSMA) has been launched in June, 2016. Under PMSMA, all pregnant women in the country are provided fixed day, free of cost assured and quality Antenatal Care (minimum package ANC  including  investigations  and  drugs)  on  the  9 t h of  every  month.  The Abhiyan  also  involves  private  sector  doctors  as  volunteers  to  pro specialist care in Government facilities.
4. Midwifery  Initiative :  In  December  2018,  the  Government  of  India  has taken a landmark policy decision to rollout midwifer y services in the country in order to improve the quality of care and ensure respectful care to pregnant wom en  and  newborns.  The  Initiative aims  to  create  a  cadre  of  Nurse Practitioners in Midwifery who are skilled in accordance to competenc prescribed by  the  International  Confederation of Midwives (ICM) and are knowledgeable  and  capable  of  providing  compassionate  women - centered, reproductive, maternal and newborn health care services
5. First Referral Units (FRUs): FRUs have been operationalized across the country  to  provide  comprehensive  emergency  obstetric  and  newborn  care services and blood transfusion services.
6. Maternal  and  Child  Health  Wings  (MCH  wings): State  of  the  art Maternal  and  Child  Health  Wings  (MCH  w ings) have been sanctioned at Medical Colleges, District Hospitals/District Women's Hospitals and other high case load facilities at sub - district level for providing quality obstetr and neonatal care.
7. Obstetric High Dependency Units (HDUs) and Obstetric Intensive Care Units  (ICUs): In  order  to  increase  access  to  intensive  care  for  moth suffering from life threatening obstetric complications, Obstetric HDUs Obstetric  ICUs  have  been  established  at Medical  colleges  and  District hospitals.
8. Dakshata: Dakshata, a strategic 3 day training capsule for building the of  health  care  providers,  including  doctors,  staff  nurses  and  ANMs, providing quality intrapartum care has been rolled out across States/ UTs.
9. Skill  Labs: Government  of  India  has established  National  Skills Lab ''Daksh'' at Delhi and in NCR region for improving the skills of healthcare providers and has also supported stand - alone skills labs and skills stations i States/ UTs.
10. Training of MBBS doctors in Anaesthesia (Life Saving Anesthesia Skills - LSAS)  and  Emergency  Obstetric  Care  (EmOC)  skills : Capacity building of MBBS doctors in Anaesthesia (Life Saving Anaesthesia Skill -LSAS) and Emergency Obstetric Care including C - se ction (EmOC) has been undertaken  to  overcome  the  shortage  of  specialists  in  these  discip particularly  in  rural  areas.  Additionally,  Skilled  Birth  Attendant training of SNs/ANMs/ LHVs for improving quality of care during delive and childbirth is also conducted.
11. Maternal  Death  Surveillance  and  Response  (MDSR): The  process  of Maternal  Death  Surveillance  and  Response  (MDSR)  including  Maternal Death Reviews has been institutionalized across the country both at fac and  in  the  community  with the  objective  of  taking  corrective  action  at appropriate levels and improving the quality of obstetric care.
12. Mother and Child Tracking System (MCTS) / RCH portal, which is a name, telephone, address based web enabled system, has been introduced Government of India to track every pregnant women and child in order ensure and monitor timely and quality services to them.
13. Comprehensive  Abortion  Care services  are  being  strengthened  through trainings, model Comprehensive Abortion Care Centres etc.
14. Anemi a Mukt Bharat (AMB) Strategy has been formulated for holistic and comprehensive management of anemia across life stages including pregnan lactating women and adolescent girls at health facilities and during ou activities.
- b) Under the National Health Mission, approvals for MCH wings are accorded to States/ UTs based on the proposals received from States. Accordingly, a to 616  MCH  Wings  have  been  sanctioned  across  the  country  based  on  the proposals  received  from  State  Governments.  No  MCH  Wing  has been sanctioned in Gujarat. State wise details of sanctioned and operational CH wings are placed at annexure .
- c) Delivery Points : Delivery Points are health facilities which fulfil Government of India criteria of minimum benchmark of performance, in terms of number of deliveries conducted, from Sub centre to District Hospital benchmarks set for different levels of health facilities are given below.

## Benchmarks for delivery points

| Health Facility                          | For all Other States    | For 8 North - east states includ ing Sikkim and hilly areas of State/   |
|------------------------------------------|-------------------------|-------------------------------------------------------------------------|
| Sub Centres                              | >3 deliveries per month | >2 deliveries per month                                                 |
| Primary Health Centres                   | >10 deliveries per      | month>6 deliveries per month                                            |
| Non - FRU Community Health Centres (CHC) | >10deliveries per month | >6 deliveries per month                                                 |
| FRU - CHC/SDH                            | >20 deliveries per      | month>20 deliveries per                                                 |
| District Hospital                        | >50 deliveries per      | month>30 deliveries per                                                 |
| Medical Colleges                         | >50 deliveries per      | month>50 deliveries per                                                 |

MCH Wings are sanctioned at high case load delivery point's i.e delivery points which have more than 70% bed occupancy rate of the maternity beds.

Annexure

| States            |   No. of MCH Wings Sanctioned | Functionality Status   |
|-------------------|-------------------------------|------------------------|
| Andhra Pradesh    |                            10 | 1                      |
| Arunachal Pradesh |                             1 | 1                      |
| Assam             |                            14 | 5                      |
| Bihar             |                            21 | -                      |
| Chhattisgarh      |                            27 | 1                      |
| Delhi             |                             1 | 1                      |
| Himachal Pradesh  |                            10 | 0                      |
| J&K               |                            10 | 8                      |
| Karnataka         |                            27 | 0                      |
| Kerala            |                            13 | 0                      |
| Maharashtra       |                             5 | 0                      |
| MP                |                            13 | 8                      |
| Meghalaya         |                             4 | 4                      |
| Odisha            |                            61 | 31                     |
| Punjab            |                            25 | 13                     |
| Rajasthan         |                           154 | 153                    |
| Telangana         |                            23 | 7                      |
| Tamil Nadu        |                            18 | 4                      |
| Tripura           |                             3 | 0                      |
| Uttar Pradesh     |                           159 | 0                      |
| Uttarakhand       |                             1 | 1                      |
| WB                |                            16 | 7                      |
| India             |                           616 | 245                    |