Odisha’s health workers fight maternal deaths

The National Rural Health Mission (NRHM) may have made a dent in many backward regions of India, but here in this coastal district of Odisha mothers continue to die at childbirth, highlighting the state’s reputation as one of India’s worst performers in maternal deaths.

With a maternal mortality rate (MMR) of 258 (per 1,000 live births), the state is way below the national average of 212– which in turn is still far away from the Millennium Development Goal of 109 by the year 2015.

According to doctors and other health workers, while several initiatives have been taken – government schemes launched, institutional deliveries pushed up, more doctors hired – it’s the quality of care and lack of seemingly small blocks of infrastructure that is acting as a major hindrance.

Take Balasore for example. A coastal district in the northeast of Odisha, it has a lot of pluses to save women from dying at childbirth. High literacy level, almost 90 percent institutional deliveries and specialists in the first level health facility…yet, at least 50 maternal deaths were recorded last year in the district hospital alone.

“The problem lies with lack of infrastructure. Even a trained nurse can conduct a normal delivery, but for a C-section or caesarean birth, you need more facilities – like a blood bank in the case of emergency,” Nabakishore Pradhan, the chief medical officer of a Community Health Centre (CHC) in Remuna, in the same district, told IANS.

While it takes pride in having three doctors, which includes a gynaecologist and paediatrician, in its rolls, the CHC – like many other first level health facilities in the state – lacks a blood bank.

Under the Janani Shishu Suraksha Karyakram (JSSK) programme which was launched last November, every hospital, till the level of the CHC, entitles a pregnant woman free transportation to the hospital, cashless delivery, free drugs and diagnostics, free access to the blood bank and free diet.

“If a health centre does not have a blood bank, the case is referred to the district hospital. Sometimes, in a high risk case, the woman may lose her life while being transferred to the district hospital. At any given time, at least 15 percent cases are high risk ones. So lack of one poses a major risk to a woman,” he added.

Sudhanshu Dash of the NGO White Ribbon Alliance India added: “This lack of infrastructure also means there is under-utilisation of the services of the specialists in the CHC and an automatic over-burdening in the district hospital”.

S.B. Acharya, the additional district medical officer of Balasore, agrees.

“The problem of overcrowding in the district hospital is because of the lack of proper delivery system in the primary health facilities. There is no blood bank, there are no anaesthetics…all necessary to conduct a C-section. Thus, cases are constantly referred to us and a lot of times, women come to us directly instead of going to the primary health centre,” Acharya told IANS.

On any given day, the district hospital gets at least 20 referred cases from other health facilities. Added to its own cases, the hospital conducts at least 40 deliveries every day.

“At the moment our 35-bed maternity ward has more than 80 women. It’s a situation we cannot help,” he added.

Therefore, much in contrast to the serene atmosphere at the Remuna CHC, where a lonesome nurse waited outside the delivery room, the scene at the maternity ward in the district hospital was chaotic.

Overcrowded, several women with their new borns lay on the floor waiting to be attended to. A nurse admitted that because of the crowding, proper sterilisation of tools and hygiene are “often ignored”.

Then again, while the JSSK promises free transportation of pregnant women from villages to the hospital, lack of enough vehicles poses a hindrance.

“There is just one Janani vehicle in this block and sometimes when we call for it, it’s busy elsewhere. Once we had to wait for so long for the vehicle that the woman went into labour and delivered at home. Thankfully nothing unfortunate happened, but you can’t rule out the risk,” said Nishamoni Behra, an accredited social health activist (ASHA) in the Bhanjachura village in Balasore.

Acharya stressed the need for more fourth grade staff and trained nurses.

“I would still maintain that the National Rural Health Mission (NRHM) has improved our health scenario a lot and there has been a dip in maternal deaths. But the situation is still grave and a lot more needs to be done,” Acharya said.