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'Our Target Is To Reach Out All Pregnant Women Including Women From Marginalised Communities'

Driving the programme in the Ministry of Health & Family Welfare, Dr Dinesh Baswal, Deputy Commissioner (Maternal Health), Government of India speaks to Ashish Sinha and shares the immense success of PMSMA

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With close to 45,000 women dying annually due to pregnancy-related causes, India has the dubious distinction of accounting for 17 per cent of global maternal deaths-most of these are preventable if women receive antenatal care and plan in advance for births. Unfortunately, less than 19% such women obtain all-encompassing prenatal attention. The Prime Minister ‘Surakshit Matritva Abhiyan’ (PMSMA) is proving to be a big help to all expectant mothers. Driving the programme in the Ministry of Health & Family Welfare, Dr Dinesh Baswal, Deputy Commissioner (Maternal Health), Government of India speaks to Ashish Sinha and shares the immense success of PMSMA.

Edited Excerpt:

What has been the response for PMSMA since its launch?

PMSMA was launched in 2016 and since then under this mission we have been able to conduct over 75 lakh antenatal check-up in over 12000 district, primary health centres and community health centres, hospitals and other facilities across India. One of the objectives of the mission was to mobilize voluntary participation from private sector doctors and the mission has received overwhelming support from over 4000 obstetricians, gynecologists, radiologist and physicians. Response has been quite satisfactory particularly from states like Bihar, Madhya Pradesh and Chhattisgarh, Assam and Rajasthan.

How many beneficiaries have benefitted from PMSMA?

The target is to reach out to all pregnant women and special efforts are being made to get through to those who have not registered for antenatal check-up or have left out or missed ANC. Identifying high-risk pregnancies is a major objective of this mission as it is the most critical step towards saving the mothers and children while planning birth preparedness. Through this mission we have been able to identify over 4 lac high risk pregnancies and all necessary follow–up is in place to ensure safe delivery.

Is there a socio-economic profile of beneficiaries?
The mission is for all pregnant women from urban, rural, underserved and remote areas. As highlighted earlier, the target is to reach out to all pregnant women including women from marginalized communities. We have many inspiring case studies of women from disadvantaged/ vulnerable communities who have registered for antenatal checkups on 9th of every month under this mission.  A large part of the beneficiaries are from those states where maternal and infant mortality has remained higher than national average.

How are you reaching out to these pregnant women particularly in remote and inaccessible regions as well as conflict areas?
Ministry of Health and Family Welfare, Government of India has identified more than 185 high priority districts (HPD). More than 260 private volunteers have provided their services in these priority districts. States and UTs provide free referral transport in difficult areas and they also ensure nutritional food is made available to pregnant women who visit these facilities for check-ups.

Does the government have the infrastructure to deal with increasing demand in rural areas?
The mission has been launched with the highest level of political commitment and support. Support is provided to State Governments and we are taking all possible interventions to ensure that infrastructure should not be a barrier to the success of the mission. Pradhan Mantri Surakshit Matritva Abhiyan is proving to be a revolutionary opportunity to expand coverage and improve the quality of delivery of critical maternal and child health interventions such as antenatal services, birth preparedness planning, early detection of high risk pregnancies etc. We are scaling up month on month to provide services under PMSMA to maximum pregnant women.

How do you mobilize volunteers to reach in difficult areas- like naxal affected or Kashmir or difficult terrain?
PMSMA is an important intervention of the Government of India launched for providing quality antenatal care to pregnant women. A critical feature of this intervention is involvement of private sector providers on a voluntary basis which is a potentially scalable model of public private partnerships. We have instituted awards and recognition to motivate private doctors to provide their services. In difficult areas too our volunteers have reached and done a commendable job.

Doctor’s visit may be not enough. What kind of enabling environment has the government created to attract the target population?

We have asked every facility to give a single window system where the full package of services is provided. We have ensured a smooth step by step process to guide beneficiaries during facility visit. All staff of the health care facility reach an hour in advance on the day of PMSMA to reduce waiting time of beneficiaries and ensure that beneficiaries have their investigation reports when they go to the doctor for consultation.

Do you focus on maternal nutrition as part of examination process or is it just confined to anemia?
Nutrition is an important aspect of maternal and infant health. We are ensuring adequate supply of supplementation. But most important is counseling service by experts to tell pregnant women and their families the importance and benefits of nutrition during pregnancy. Counseling is being done for both under nutrition and over nutrition.

Transportation could be deterrent in many remote areas? How have you addressed these and how?
We have asked the states to identify the pockets of high home deliveries and difficult areas and are providing free ambulance services in these areas. We are also providing transport service to volunteer doctors so that there is no problem for them for travelling in these areas.

What happens to high risk pregnancy after identification?
After identifying high risk pregnancies they are appropriately managed or referred to the higher facility.  A birth preparedness and complication readiness plan is also prepared for each pregnant woman so that if there are any complications during pregnancy, then they are appropriately referred to a district hospital or medical college where the facilities for managing complications are in place.

What are short and long term expectations from the mission?
We want to achieve sustainable development goals in maternal and child care. We want to increase the quality antenatal care service coverage to all pregnant women particularly in remote and underserved areas. Identifying high risk pregnancies and ensuring all necessary follow-up is the ultimate goal of this mission. We want the benefits of mission to reach all and ultimately reduce burden of maternal mortality to 100 per lakh live births by 2020 in the short term and to 70 per lakh live births in the long term.