Delivering Joy. Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) – Best Practices in Tamil Nadu

Posted In:    Process documentation    Delhi    India    Maternal Mortality Rate    Millennium Development Goals    IMR    PPTCT    success    emergency    commitment    Family Planning    MDGs    MMR    CEmONC    Infant Mortality Rate    Reproductive and Child Health – RCH    Tamil Nadu Health Systems Project    TNHSP    family welfare    First Referral Unit    FRU    Chief Medical Officer    CMO    Neonatal Intensive Care Unit    NICU    pediatricians    obstetricians    Prevention of Parent to Child Transmission Center    infrastructure    English    Health    Nutrition    Tamil Nadu    2010   

Introduction of several CEmONC center in Tamil Nadu had reduced the maternal deaths in the State. The total percentage of complicated deliveries in the CEmONC centers had increased manifold. The number of referrals – out, which was quite high, had been drastically reduced. An insight into the public health system in the state and more particularly, in its maternal and child health services

In the course of the 20th century, first as Madras Presidency, then as Madras State, and finally, as Tamil Nadu, the state has seen the growth of a flourishing health and medical education system, in both public and private sectors. Owing several firsts to its credit, particularly in relation to maternal health, the city hosted the first All India Obstetric & Gynecology Congress. In 1939 Madras was the first presidency to pass a Public Health Act.

A pool of skilled health service providers, which is being constantly renewed and added to, is a basic and almost taken for granted, strength that has facilitated successful implementation of many schemes including CEmONC. Two other contributing factors that strengthen the state’s health system are political will and bureaucratic commitment.

Earning one’s own business, managing a small business, maintaining accounts, dealing with bank and government officials, representing one’s group in the SHG (self-help groups) federation, perhaps even up to the state level, being trained in a variety of skills and knowledge including health and nutrition, had made numerous women in rural Tamil Nadu empowered and self-confident. The village health nurse’s (VHN) activity, visibility and status in the community, increased substantially.

Well before Integrated Child Development Scheme (ICDS) was implemented in the country, in 1960s Tamil Nadu had initiated the noon-meal scheme in the primary schools and when ICDS was introduced, there was already awareness among rural women of the benefits of a government run meal scheme for young children.

In Tamil Nadu, the success of a pilot programme in family planning in Thanjavur District in the early 1970s resulted in other districts adopting the same effective model. A World Bank report states that fertility decline accelerated in the state in the late 1970s and through the 1980s as a result. A major aspect of the Maternal Child Health - -MCH/Reproductive Child Health - RCH approach in India had been the promotion of institutional delivery. The fact that the state has one of the widest networks of functioning public health centers, makes institutional care physically possible for almost everyone of the expectant mothers.

A CEmONC is a hospital where everything that is required for emergency obstetric and newborn care is provided, on all days and at all times, without delay and with the additional service of free transport on call from anywhere in the state to the nearest CEmONC center. Phase I from August 2004 to June 2006 51 district and sub-district hospitals and 15 medical colleges had been identified as CEmONC centers. In the Phase II that started from July 2006 to December 2007 another 32 hospitals were designated as CEmONC centers. With Phase III started from 2008, is now having a CEmONC center for every five-lakh population.

To ensure the best possible care for complicated and emergency cases, the load of normal delivery cases referred to CEmONC centers is being reduced. This is achieved by providing better facilities, staffing and training at PHCs and HSCs, followed by motivation to increase the numbers of normal deliveries conducted at these primary level institutions through the state. This reduction in load on the one hand had enabled the centers to provide better care for emergency/complicated cases on the other.

NC had done the documentation and design of the document for this project.

Website - Tamil Nadu Health Systems Project, CEmONC