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Thursday, November 8, 2007

PHCs deliver better performance

CHENNAI: Nearly a year’s sustained efforts at improving emergency obstetric care in rural areas in Tamil Nadu seem to have resulted in better usage of the facilities at the PHC-level.

If the actual count of the deliveries in a PHC is to be taken as a measure of success of the government’s campaign, then it is an impressive tale of achievement; total number of deliveries went up by about 59 per cent between 2006 and 2007. Between April and October 2006, there were 45,950 deliveries. In 2007, during the same period, the number went up to 72,946.

“This indicates that PHCs have, indeed, become the first choice for pregnant women in rural areas, because they are able to provide good care. Earlier, the number of private sector deliveries used to be higher in rural areas, with PHCs not up to scratch,” says Apoorva, Commissioner of Maternal and Child Health.

The number of deliveries has been steadily increasing since April 2007, climbing to an all time high of 15,009 in October this year.

Comparatively, even at its peak performance last year, there were only 6,895 deliveries in October.
Top performers

Eight health unit districts (two health units on an average in a district) in the State have contributed quite significantly to the improved performance by tipping the average. PHCs in Vellore, Poonamallee, Dharmapuri, Tiruvallur, Tirupattur, Madurai and Salem have improved their performance to average between 15-32 deliveries per PHC per month. Vellore and Tiruvallur are the top performers, increasing the number of deliveries by over 2,000 in a year.

In 14 other districts, the average number of deliveries has been 10-14 per PHC this year. The Nagercoil HUD has the lowest record of an average of two deliveries a month. Six other HUDs that are in the ‘red zone’ are centres that have an average of 4, 5, 6 deliveries per PHC every month. It is this area that requires working on, health department officials say. “The ideal would be about 30 deliveries per month,” Ms. Apoorva says. Better performance can also be demanded of other centres that are notching between 7 and 13 deliveries a month per PHC.

She attributes the improved performance over the last year to a bunch of factors that have freshly come to play in that period. For one, a flush of funds have come in from the Centre’s National Rural Health Mission project — every PHC gets additional funds totting up to Rs.1.75 lakh per annum under various categories. This is apart from the regular State budgeting.

Another big contributor is the decision to keep PHCs open for 24 hours. Three staff nurses are on call constantly. “We want the PHCs to take care of all deliveries that do not have any complications. Earlier, the PHCs would be closed when the women went or would refer them to other centres. Now, we have given them strict instructions to refer only those patients developing complications,” she said.

Constant monitoring of the processes, providing training and sensitisation of doctors and staff too have had a role to play in encouraging the locals to come to the PHC rather than seek the services of a private practitioner.

The challenge, however, is to keep up the good performance and to get other PHCs to show good results as well.

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