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Saving lives of children and women in Guna district of Madhya Pradesh: Just a call away

© UNICEF/ 2009
Call centre is life saving for Halki and her sons

Veena Bandopadhyay

Guna, Madhya Pradesh: Around 5 pm on December 26, expectant mother Halki Bai of Berkhari village felt the first contractions of labour. Her husband, Raja Kewat, a farmer, rushed to inform the village health worker, Shamim Bano, that Halki was ready for delivery. Bano is a Madhya Pradesh state Accredited Social Health Activist, known as “ASHA”. She walked over to the nearest telephone in the village and dialed 102. “We are expecting a child delivery and need an emergency transport,’’ she spoke to a call-centre, 20 kms away.

Often women undergo labour and have given birth in crowded buses enroute to the hospital. Madhya Pradesh has one of the highest maternal mortality rates in the country.

“This is village Berkheri. The patient’s name is Halki Bai and I am the village ASHA worker, Shamim Bano. The nearest delivery centre is the Guna district hospital.” She hung up and looked at Raja Kewat. “Don’t panic. They are sending an ambulance. Let’s get her ready.’’ In less than half-an-hour an ambulance arrived in the village. By 6:30 that evening, Halki Bai was admitted in the delivery ward of Guna district hospital and later gave birth to a healthy baby boy.

First call centre for emergency transport of pregnant women
 
Had this situation arisen 18 months ago, there would be no ambulance to transport Halki Bai from her residence to the district hospital for the delivery of her baby boy. She would probably have been taken to the hospital either in a field tractor or an overcrowded bus. Often women undergo labour and have given birth in crowded buses enroute to the hospital. Madhya Pradesh has one of the highest maternal mortality rates in the country (378/100,000 live births).

In September 2007, UNICEF and the Government of Madhya Pradesh set-up a call centre in the Guna district hospital to exclusively provide 24x7 emergency transport for pregnant women, new born and sick children with the aim to: link communities to the facilities of hospitals; reduce maternal mortality and; increase the number of institutional deliveries. The State Government has named it the Janani Express Yojana and provides this service free of charge.

A survey before the call-centre

According to the State Health Department, a Maternal and Perinatal Death Inquiry and Response was conducted jointly by UNICEF and the state health department on maternal mortality. It was found that deaths of expectant mothers occurred at three levels. First, at the grassroots community level because the village could not decide when, where and how to avail the health service facility. Second, if they were aware of the health facilities, the village did not know how to reach the hospitals or delivery centres. Thus, lack of transportation has been a major cause of maternal mortality and a controlled mechanism to provide prompt transport facility was needed. Third, even when they reached the hospital there was a lack of specialized staff and medicines which led to the deaths.

© UNICEF/ 2009
Community meeting being held by the ASHA

Saving life on wheels

“There are 25 government-run institutional delivery centres spread across five blocks in the district including, this hospital. These centres have been provided with an ambulance facility and drivers have been given mobile phones. The call-centre is the control room with two phone lines and three operators working in eight hour shifts. Anyone who needs a vehicle to take an expectant mother can dial 102 or 251560,” sitting in his office in Guna district hospital, Shahnawaz Khan, in-charge of the call centre explained. “Our operator receives the call and notes down the patient’s name, village where the ambulance should be sent, the nearest delivery centre where she will be transported and the identity of the caller.”

Guna has witnessed a spurt in the number of institutional deliveries after this unique facility was introduced. In April 2007, the number of institutional deliveries in the district was 1,500 which rose to 2,258 by April 2008 – eight months after the call centre started functioning. In June 2008, the number of institutional deliveries was 2,476 and rose to 2,972 in July. The latest available data of October 2008 claims 2,920 or 96 percent of pregnant women underwent institutional deliveries.

With all necessary information, the operator calls the ambulance driver of the nearest delivery centre from the patient’s residence. The driver’s job is to ensure the safe arrival of the patient to the delivery centre. But while the pregnant mother is on the way to the hospital, the call-centre dials the number of the delivery centre and alerts them on the arrival of the patient. ``By this, the hospital or delivery centre is ready with specialized care and medicine when the patient reaches,’’ Shahnawaz Khan said. More than 40 percent of total delivery patients opt for call-centre transport.

Sudden rise in institutional deliveries

Guna has witnessed a spurt in the number of institutional deliveries after this unique facility was introduced. In April 2007, the number of institutional deliveries in the district was 1,500 which rose to 2,258 by April 2008 – eight months after the call centre started functioning. In June 2008, the number of institutional deliveries was 2,476 and rose to 2,972 in July. The latest available data of October 2008 claims 2,920 or 96 percent of pregnant women underwent institutional deliveries.

Enthused by this tremendous success and response from Guna district, UNICEF and the Madhya Pradesh State has scaled up the call centre intervention to Shivpuri and Mandsaur districts and the Government of Madhya Pradesh will replicate it in another 15 districts. Tcall centres have been established with a one-time investment of Rs 1.5 lakh each. The entire approach has gained success in building strong community linkages with health care providers. “Improved access to quality health care has become a reality in Guna and Shivpuri in Madhya Pradesh,” says UNICEF Office’s State Representative for Madhya Pradesh, Hamid El-Bashir.

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