Abhilasha Obstetric Care English Issue 9 Mar07-June

8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June

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Preventing Maternal MortalityAddressing obstetric complications

DearReaders,

Thisisacombinedissueo

Abhilasha,addressingconcernson

managingObstetricEmergencies.

ThelastissueoAbhilashadealt

withmaternalandchildhealth

i.e.causesomaternaldeaths,

antenatal,intra-natal,postnatal

careandessentialnewborncare.

Wegotagoodresponserom

readers.Wehopeyouwillkeep

writingandshareyourviewsand

concernsothegrassrootswithus.

Welookorwardtoyoureedback

&suggestionsoruturethemesor

Abhilasha.Oureortsarealways

gearedtowardsmakingAbhilasha

user-riendlyandinterestingorour

readers.

Wespeciallyacknowledgetheeorts

andinputsoDr.DineshAgarwal,

Programmeofcer(RHand

HIV/AIDS)-UNFPAinthiseditiono

Abhilasha.

Yourriends,Alok,Bhavna,Seema,Dr.D.V.Singh,

Veena,Satyapal,Shekar&Ashok.

RRC-VHAI newsletter or MNGOs and FNGOs

Issue 9, February, 2007

R.R.C.-VHAI

C

O

N

T

E

N

T

SCommonComplications

duringpregnancy,labour

andpostpartum:...3

Knowaboutthese

complications: 3

Typesoplacentaprevia...4

RoleoMNGO/FNGOs9

MakingPregnancySafer

TargetingAnemiaEradication

DuringAdolescence...10

APublicPrivatePartnership

initiativeoRegionalResourceCentre-VHAI.....11

ActivitiesoRRC-VHAI...13

Introduction

The tragedy of maternal deaths persists in large part of

the world including India. Maternal mortality has been

linked to the tip of iceberg and maternal morbidity itsbase. This means that more mothers experience diseases

and suffering in consequences of pregnancy than those

who die. Interventions to address maternal mortality such

as high risk approach through Antenatal care, training of

traditional birth attendants proved to have a very limited

direct effect in reducing maternal

mortality in the past.

It is estimated that nearly 15 percent of all pregnantwomen will manifest with life threatening complications

during pregnancy, delivery and post partum period.

UNICEF states that India accounts for more than 20% of

the global maternal and child deaths, and also records 20%

of births worldwide. Approximately 30 million women in

India experience pregnancy annually, and 27 million have

live births. An estimated 1,36,000 women die needlessly

each year due to causes related to pregnancy, childbirth

and abortion. 50-98% of maternal deaths are caused

by direct obstetric causes (hemorrhage, infection, andhypertensive disorders, ruptured uterus, hepatitis, and

anemia), most of which are avoidable. 50% of maternal


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maternal mortalitypreventing

deaths due to sepsis are related to illegal induced abortion.

Reduction of maternal mortality is one of the major goals

of several recent international conferences and has been

included within the Millennium Development Goals.

While there are a number of reasons for the high MMR

including Rights and gender power relations, early marriage

and childbirth, insufcient nutrition intake and absence of

skilled personnel, conversely, vacant posts of doctors and

trained health workers at the village and block levels, lack

of emergency referral transport and adequate health care

facilities also act as an impediment to safe motherhood

practices. The reasons responsible for high MMR in the

country is ignorance and problems which occur due to

three main delays deciding to seek health care, reaching

the health centre and availing the services at the health

centre.The Public Private Partnership proposed by the Government

of India under the National Rural Health Mission, launched

in April, 2005 seeks to improve the availability of and

access to quality health care by the people with a goal to

improve the availability of and access to quality health care

by the people, especially for those residing in rural areas,

the poor, women and children. ASHAs (accredited social

health activists) and the Janani Suraksha Yojana are pivotal

links to government programmes under the comprehensive

NRHM strategy where they will address the health needs of

rural population and help women access the RCH services

on antenatal care, promotion of Institutional deliveries,

postnatal care along with counseling on intake of adequate

nutrition, family planning and breast feeding.

1. Bleedingcausesone

inourmaternal

deathsworldwide.

. Preventanemia,

recognizeandtreat

complicationsearly.3. Postpartumbleeding

isthemostcommon

causeomaternal

deaths.

4. Practiceactive

managementothe

thirdstageolaborin

allcasesto

preventpostpartumheamorrhage.K

E

Y

P

O

I

N

T

S

ThePublicPrivatePartnership

proposedbytheGovernmentoIndiaundertheNational

RuralHealthMission,launchedinApril,005seekstoimprovetheavailabilityoandaccesstoqualityhealthcarebythe

peoplewithagoaltoimprovetheavailabilityoandaccesstoqualityhealthcarebythe

people,especiallyorthoseresidinginruralareas,thepoor,

womenandchildren.


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Common Complications during

pregnancy, labour and postpartum:Following table depicts the common symptoms underlying

different complications, which can occur to a woman in

different phases of pregnancy:

Antenatal period Intra partum period Post partum period

1. Vaginal bleeding

2. Pufness of face, pedal edema (swelling

on legs), generalized swelling

3. Convulsions or ts

4. Palpitations, fatigue, breathlessness

5. Increased frequency and burning during

urination6. Leaking of watery uid per vaginum

(from the vagina)

7. Excessive Vomiting

8. Fever

9. Decreased/Absent fetal movement

10. Vaginal Discharge

11. Mismatch between abdominal girth and

fetal development/ growth

12. Early onset of labour pains.

1. Obstructed

labour

2. Convulsions

3. Hemorrhage

1. Vaginal bleeding

2. Retrained

placenta

3. Vaginal/cervical

tears

4. Fever

5. Vaginaldischarge

Know about these complications:

Vaginal Bleeding:

If vaginal bleeding takes place before 20 weeks of

gestation, this could be due to threatened abortion/

spontaneous abortion or ectopic pregnancy. One should

also be suspicious about violence, which can lead to

spontaneous abortion.

If bleeding occurs after 20 weeks, this is Ante Partum

Hemorrhage (APH) usually due to (a) abnormal location

of placenta mostly in the lower uterine segment (Placenta

Praevia) or (b) premature (early) separation of normally

situated placenta on the upper uterine segment (Abruptio

Placentae or Accidental Bleeding).

During delivery 100-300 ml. blood is normally lost.

If more than 500 ml. of blood is lost within 24 hours

after normal vaginal delivery or 1000 ml. after Cesarean

Section it is termed as Post Partum Hemorrhage (PPH).

Bleeding in the post partum period is also a very common

complication.


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Types of plac enta previa

Abruptio placentae. Left: revealed; right: concealed

Pufness of Face, Generalized swelling, Convulsions:

This could be due to hypertensive disorders of pregnancy

(BP>140/90 mm Hg) and in severe cases >160/110 mm

Hg.

Pre-eclampsia (presence of proteins in urine) with

BP=140/90 mm Hg or more.

ThedevelopmentoObstetric

Fistulaisdirectlylinkedto

oneothemajorcauses

omaternalmorbidityi.e.

obstetriclabor,wherethe

motherspelvisistoosmalltoenablethebabytobe

deliveredwithouthelp.

Worldwide,obstructedlabor

occursinanestimated5%

oliebirthsandaccounts

or8%omaternaldeaths.

Adolescentgirlsare

particularlysusceptibleto

obstructedlabor,becausetheirpelvisesarenotully

developed.Oncetheyoccur,

theyusuallycannothealby

itsel.Over90%owomen

canbecuredwithone

operationandcanresume

activeandulfllinglie,

includinghavingurther

children.D

I

D

Y

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?


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Eclampsia (In worst cases there can be convulsions with high BP(>160/110 mm

Hg), proteins in the urine, swelling all over the body, headache, dizziness, visual

disturbances, epigastric (upper abdominal) pain, and sometimes coma.

Weight gain of 3kg per month or more with restricted fetal growth and scanty liquor

(uid in the uterine bag).

10% maternal mortality in unbooked (unregistered for ANC) eclampsia cases and

Perinatal mortality: still born, preterm baby or growth restricted baby.

Palpitations/fatigue/breathlessness at rest

This is an indication of severe Anaemia (Hemoglobin< 7 gm

%)

Paleness, fatigue, glossitis (soreness of tongue), presence

of edema feet and face etc. are associated signs and

symptoms.

Increased risk of bleeding after delivery (PPH), Increased risk

of low birth weight baby due to prematurity or intrauterine

growth retardation, still born baby & Increased neonatal

deaths. Folic acid deciency may lead to neural tube defect

(bifurcated backbone) in newborns.

Increased risk of preterm labour and anemic mothers cannot

withstand normal blood loss and may go into cardiac failure

(death).

Increased frequency/urgency/burning/pain during urination(passage of urine)

Frequency/urgency/painduring urination occurs in case of

infection of urinary bladder (Cystitis).

If this is observed with high fever (above 101 degree F), chills, loss of appetite

(anorexia), nausea (sensation of vomiting), and vomiting with pain and tenderness

in one or both kidney regions (lumber) it can be leveled as Infection of the Kidney

(Acute Pyelonephritis)

Combination of the above signs & symptoms can be termed as Urinary Tract Infections

(UTI).

Leaking of watery (amniotic) uids from vagina

In such cases, women report with complaint of wet pads and clothes.

This can be confused with excessive vaginal discharge or passage of urine.

The diagnosis must be conrmed before leveling it as Premature Rupture of

Membranes (PRM).

Excessive vomiting

Vomiting in early weeks (6th -8th week) of pregnancy is very common and passes off

by 12th week.


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In the rst trimester it is mild and the frequency of vomiting

being once or twice in the morning. The quantity of vomitus

is small and it doesnt affect the womans health.

If the vomiting persists, frequency increases, retention of

food is little and the woman loses weight after rst trimester,

this excessive vomiting in pregnancy is called HyperemesisGravidarum.

It can lead to starvation, dehydration and renal failure.

Fever

There can be several causes of fever during pregnancy.

Malaria

It is characterized often by fever, chills & rigors, headache, malaise,

anaemia and jaundice.

The incidence of abortion and preterm labour is increased with

malaria.

Increased fetal loss may be related to placental & fetal infection.

Neonatal infection is uncommon.

Malarial episodes increase signicantly three-four fold during the

last two trimesters of pregnancy and 2 months postpartum.

Chloroquine is the treatment of choice in all forms of malaria

and commonly used anti-malarials are not contraindicated in

pregnancy. National guidelines for management of malaria during

pregnancy should be adhered.

Hepatitis B

It can be one of the commonest causes of fever out of 5 distinct

types of viral hepatitis (A, B, C, D, E).

In many cases the symptoms are subclinical but if clinically

apparent symptoms may precede jaundice by 1-2 weeks.

Nausea, vomiting, headache etc. apart from fever. When jaundice develops, symptoms usually improve but there

may be pain and tenderness over the liver.

Pregnant women with hepatitis require hospitalization and

delivery in a well equipped hospital, since mortality &

morbidity is high.

Obstetric complications include abortion, premature labour,

postpartum hemorrhage and renal failure in severe cases.

Hepatitis B infection can transmit to the fetus.

Maternal complications in pregnancy are more common in

2nd & 3rd trimester. Hepatic failure is more common during

pregnancy.

BE

A

PROUD

MOTHER

B

E

A

P

R

O

U

D

M

O

T

H

E

R

Breastmilkisthemostsufcientandholistic

dietortheinantsespeciallyinthefrstmonthsoitsbirth.Itisanidealoodorthegrowthanddevelopmentoinantsaswellasanintegralpartothereproductiveprocesswithimportantimplications

orthehealthomothers.Breastmilkhasananti-inectivepropertythatprotectstheinantsagainstdiseasesandbuildsitsimmunity.Breasteedingalsostrenghtensthebondbetweenthemotherandchildandshouldbeinitiatedwithinthefrsthourolie.

Exclusivebreasteedingormonthsistheoptimalwayoeedinginants.Ithastherightamountandquality

onutrientstosuittheinantsoodneeds.Itisalsotheeasiestonitsdigestivesystem,therebyreducingthechanceoconstipationordiarrhea.Thereaterinantsshouldreceivecomplementaryoodwithcontinuedbreasteedinguptoyearsoageorbeyond.


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Hepatic coma is a fatal complication in undelivered cases

and in mothers who deliver, post partum hemorrhage is

a fatal complication.

Post partum infection:

High Fever may also be present in the post partum period

(after delivery) as one of the symptom of the Post partum

infection.

unclean repeated vaginal examinations in labour,

intrauterine manipulations, trauma to genital tract

(vaginal, perineal and cervical lacerations) and

prolonged membrane rupture and labour are some of

the predisposing factors.

Fever is always present in cases of genital tract infection,

breast engorgement (swollen), mastitis (infection of the

milk glands), UTI, etc. during postpartum period.

Normally present bacteria/organisms (commensals)

in the vagina, cervix and perineum in the presence of

trauma of labour/damaged tissues become pathogenic

and lead to infection.

Vaginal Discharge

This may be due to RTIs and STIs.

The common RTIs/STIs during pregnancy are Trichomoniasis,

moniliasis/Candidiasis, gonorrhea, syphilis etc.

Vaginal discharge in Trichomoniasis is thin, greenish

yellow/milky and frothy offensive discharge per

vaginum.

Vaginal discharge in case ofMoniliasis is thick, curdy

white and in akes, often adherent to the vaginal walls.

Pruritis is common in both these cases.

Incase of Gonorrhea, the infection is limited to lower

genital tract including cervix, urethra etc. It causesabortion, premature labour, preterm premature rupture

of membranes, and infection in women.

In newborns it causes infection of the eyes(ophthalmia

neonatorum).

Symptoms include vaginal discharge with pain/burning/

frequency/urgency during urination, local pain and

discharge per urethra.

In case of Syphilis, 2nd trimester abortions are

common. Prematurity or premature delivery especially

if the fetus is infected.

PufnessoFace,Generalized

swelling,Convulsions:

Thiscouldbeduetohypertensivedisorderso

pregnancy(BP>140/90

mmHg)andinsevere

cases>10/110mmHg.

Chloroquineisthe

treatmentochoicein

allormsomalaria

andcommonlyusedanti-malarialsarenot

contraindicatedin

pregnancy.

Pregnantwomen

withhepatitisrequire

hospitalizationand

deliveryinawell

equippedhospital,sincemortality&morbidityis

high.

Normallypresent

bacteria/organisms

(commensals)in

thevagina,cervix

andperineuminthe

presenceotraumaolabour/damagedtissues

becomepathogenicand

leadtoinection.


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Placenta becomes large, pale, greasy and heavier than

usual.

Congenital syphilis (syphilis by birth) manifests (shows)

with large abdomen, edema, ascites (uid in the

abdominal cavity) jaundice and red spots on the skin,

enlargement of lymph glands and nasal discharge orpneumonia in new born babies.

In post partum infections also there can be discharge.

Infected normal vaginal discharge after delivery (Lochia)

may lead to profuse and foul smelling discharge. This

may lead to puerperal sepsis; the symptoms are those

of post partum fever.

Obstructed Labour

Labor lasting for more than 24 hours. There can be several causes of obstructed labour

like Cephalo-pelvic disproportion (mismatch between

head of the baby and birth canal of mother), Fetal

Malpresentations, false labour pains, failure of cervical

dilatation (opening of cervix) etc.

Maternal effects of prolonged/obstructed labour are

exhaustion, dehydration, early rupture of membrane,

placental detachment, intrauterine (inside the womb)

infection etc. It may lead to maternal death.

Fetal hypoxia (deciency of oxygen for baby), fetalinjuries, meconium aspiration (swallowing of fecal matter

by fetus in the womb), intrauterine (inside the womb)

fetal infection (pneumonia) and rupture-uterus (bursting

of uterus) may lead to fetal death in some cases.

Vaginal/cervical tear

These are injuries whichmay take place duringdelivery especially byunskilled personnel.

Retained Placenta Placenta is retained if not delivered within one hour of delivery of the baby.

It can be due to adhesions, atonic uterus and constriction ring at the internal

os.

It may lead to postpartum hemorrhage, shock, infection etc.

In home deliveries it is the main cause of PPH and maternal deaths in rural

areas.

Vaginal/cervical tear These are injuries which may take place during delivery especially by unskilled

personnel.

Vaginal tear is commonly the extension of perineal tear (tear of private parts)

and cervical tear is common following forceps delivery.

It could result into continuous postpartum hemorrhage and shock. Maternalmortality & morbidity is relatively high in such cases.


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Role of MNGO/FNGOs

1. Community level: FNGO shouldIncrease Awareness on following issues:

Importance of seeking ANC care in time Importance of delivering in a hospital

Symptoms and signs of complications and need to seek treatment

immediately. Identication of high risk cases and reporting to ANM.

Identication of blood storage facilities for blood in management of

some complications ( FNGOs should also have list of facilities where

C section can be conducted or facilities offering skilled attandance at

Birth..)

Support/facilitate development of a functional/reliable transport plan for

each pregnant woman, so as to prevent delay during transportation.

2. Individual level Identify each pregnant women and encourage her to register for ANCand JSY, if eligible.

Facilitate her attendance during service delivery sessions on village

health and nutrition day.

Help in developing a birth plan and encourage her to seek post partum

care.

Whenever a pregnant woman develops acute abdominal pain with or

without vaginal bleeding or painless vaginal bleeding, she should inform

all the family member immediately so that they call the ANM/LHV/MO

(PHC) to perform a rapid assessment of the general condition of the

woman including vital signs (pulse, BP, respiration, temperature etc)and advice and seek help in the form of arranging vehicle through self

or ASHA and money, blood donor etc. to the nearest health facility.

Appropriate referral i.e. woman should be taken soon to a hospital where

all the facilities (Gynecologist/Obstetrician/Anesthetist, functional OT &

Labour room, Blood storage & donation facilities etc.) are available.

She should not forget to carry the ANC/MCH/JSY-card with her.

In case of Rajasthan, JSY-Helpline (155310) can be utilized to seek help

in case of emergency.

Ensure that the blood (for transfusion) is duly tested for HIV, Hepatitis

B and other life threatening infections.

3. Health System Level

Ensure that village health and nutrition days are organized as per

schedule and quality ANC services are available

Ensure that identied facilities provide services for management of complications.

Ensure that clients rights are protected in the facilities.

Avail the incentives payable under JSY-Scheme of NRHM on institutional delivery.

Let the Obstetrician decide and perform further management of the disease.

Ref:(1) TextbookofObstetric,Neonatology&Reproductive&ChildHealthEducation,Revised16

th

edition,2004byDr.C.S.Dawn;(2)ClinicalObstetrics,10 thedition,2005byA.L.Mudaliar&M.K.KrishnaMenoneditedbySaralaGopalan&VanitaJain;(3)Pregnancy,Childbirth,PostpartumandNewborncare:aguideforessentialpractice2 ndeditionbyWHO,Geneva,2006

1. Community level:

FNGO shouldIncreaseAwareness on

ollowing issues:

Importance oseeking ANC carein time

Importance odelivering in a

hospital

Symptomsand signs ocomplications

and need to seek treatmentimmediately.

Identifcation ohigh risk casesand reporting toANM.

Identifcation

o blood storageacilities or bloodin managemento somecomplications( FNGOs should

also have list o acilities whereC section canbe conducted or

acilities oering

skilled attandanceat Birth.. )


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Making Pregnancy SaferTargeting Anemia Eradication During Adolescence

Launch of the12 by 12 Initiatives

by GOI, WHO,UNICEF & FOGSI collaboration

Overall goals of 12 by 12 initiative and implementation strategies

To decrease the prevalence of anemia in adolescents to ensure healthyparenthood

To increase adolescent awareness about anemia and appropriate

nutrition

Specifc objectives

To determine the prevalence of low Hb in children between 10-12years

To provide nutritional guidelines to these children To treat those detected to be anemic. To deworm all adolescents and to vaccinate all girls against rubella

Overall strategy

`Core Implementation Committee will prepare a blue print of activities andcountry statement on prevention and control of adolescent anemia. The strategywill focus on having an integrated public health approach which will include:

Health and nutrition education increasing public awareness and knowledgeabout health risks associated with anemia and importance of having an optimalHb level.

Capacity building by mobilizing all FOGSI society members and otherpartner societies, community involvement through NGOs and in involvementof school principals and teachers.

Increasing iron intake by improving dietary pattern which would includediet rich in iron and other nutrients, improving bioavailability of dietary iron,increasing ascorbic acid intake, not taking iron with phytates and /or calcium,tea or coffee and food fortication etc.

Iron supplementation children will be provided weekly iron tablets,as current research has shown that weekly supplementation improves ironabsorption with fewer side effects compared to daily supplementation and isequally effective in correcting and preventing anemia.

Control of infection deworming by single dose Albendazole 400 mg three

times in a year and treating malaria etc. Immunization Rubella/TT vaccination.


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A Public Private Partnership initiative ofRegional Resource Centre-VHAI with support from

National Rural Health Mission, Government of Rajasthan and UNICEF

JSY Helpline, a pioneering project of RRC-VHAI and NRHM, GoR was launched in

November, 2006 with the objective of reducing the rate of maternal mortality and

infant mortality in the state of Rajasthan. The JSY Helpline aims at promoting prompt

emergency referral services and ensuring safe delivery of women with obstetric

emergencies at the health facility in order to reduce the rate of maternal mortality

by tackling the three main delays deciding to seek health care, reaching the health

centre and availing the services at the health centre. The project is operational at the

Community Health Centers in the selected 28 blocks in 28 districts of Rajasthan and is

being run in partnership with experienced NGOs

of the State, most of which are Mother NGOs

and Field NGOs of RRC-VHAI. In this entire

project, since inception, VHAI is acting as the

nodal agency for the overall coordination and

Rajasthan Voluntary Health Association at Jaipur

is the State Resource Center.

The Janani Suraksha Yojana Helpline in Rajasthan

is receiving a promising response in all its 28locations. The easy accessibility of the JSY

Helpline toll number-155310 and its 24/7 service

has led to an increase in the total number of

registration of pregnant women and institutional

deliveries. The Helpline initiative has been successful in prompt arrangement of

referral transport, effective networking with ANMs , ASHAs, and PRIs, community

awareness, and involvement ,information dissemination through IEC activities like

wall paintings at strategic locations in every village, Aaganwadi centres, Sub centers,

PHCs, and CHCs and use of attractive print media and audio jingles to promote the

services of the Helpline.

Effective networking is the key to the

success of the project with BSNL partnering

to provide 178 mobile handsets to the 200

eld facilitators and coordinators working

24/7 to achieve the set objectives.

The project envisages creating an active

network of NGOs/ CBOs and effectively

utilizing the existing government networks

in every district to reduce the rate of

maternal mortality and infant mortality inRajasthan.


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CASE STUDY Availing services of the JSY helpline in Rajasthan

Synergetic efforts/Dedicated service delivery

Time was 9 at night on 28th January 2007. Village: Kund Ka Lamba.

Gram Panchayat : Shergarh, Block : Masuda, District Ajmer, in

Rajasthan.

The health of Hagami, wife of Teju Ram Jat had turned into a serious

condition, as her uterus had prolapsed. Her delivery was due and she

was in a critical condition. Her little brother, who was with her, could

not understand the seriousness of her ill health and there was no one

at home. All family members had gone to the nearby village to attendthe marriage procession of their relative.

Hagami belonged to a BPL family. She had realized that her condition

was deteriorating and timely treatment could save her life. She asked

her brother to call the ASHA Sahayogini to give support. Mrs. Kaushalya,

the ASHA Sahayogini, was aware of the JSY Helpline services by

RRC-VHAI and had also registered Hagami for ANC with the ANM. She

immediately called the Helpline from the PCO. Mr. Harkaran, the Helpline

Facilitator was on duty, who took steps to provide the referral transport

and to facilitate the case. He quickly called the taxi owner Mr.RamGopal Vaishnav to take Hagami to the CHC-Masuda. Since the vehicle

hiring charges had already been negotiated and xed by the Helpline

in advance, they saved the precious moments of the life of Hagami to

reach the CHC. Meanwhile the Helpline Facilitator spoke to the Doctor

on duty and told her about the complexity of the case. She rushed to

the CHC, alerted the LHV and other support staff to make necessary

preparations before the vehicle reached the CHC. As soon as Hagami

reached the hospital, Dr. Sunita initiated her treatment for a prolapsed

uterus. Hagami gave birth to a healthy baby girl.

The NGO facilitator with the support from Dr.Sunita arranged medicines

and took good care of her. The family expressed their gratitude to the

Helpline facilitator, ASHA and Dr Sunita for extending timely and prompt

support to Hagami. JSY incentive was given to her on the spot and the

ASHA Sahayogni Mrs Kaushilya Devi also received her incentive. The

ASHA also felt motivated and has subsequently brought other cases to

the CHC to ensure safe institutional delivery for women.

Tahasildar Mr. Madan Chauhan and Pradhan, Masuda Mr. Virendra Singh

Kanawat appreciated the joint efforts made by the JSY Helpline and

the CHC.


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Activities of RRC-VHAIRRC-VHAI has a network of 46 MNGOs and approximately

141 FNGOs across 5 States Delhi, Rajasthan, Himachal

Pradesh, Uttarakhand and Jammu & Kashmir. All the old

and new MNGOs have received complete training. RRC-

VHAI has been continuously networking and

advocating to promote RCH services at the

grassroots.

Capacity Building workshops 2 Induction Trainings: Induction training was

given to Mahabodhi International Society, Leh at

VHAI on 3rd-4th April, 2006. The third batch of 7

new MNGOs of Rajasthan were given Induction

Training on 15th and 16th January, 2007 atVHAI also. The new MNGOs were acquainted

on revised MNGO guidelines, on NRHM

and the role of ASHAs, and basic statutory

administrative and nancial requirements.

2 First round of ToTs: Training of Trainers

on BLS and FGD was organized for 10 New

MNGOs of HP, J&K and Delhi at Parimahal,

Simla from 4th-9th June, 2006. The same was

organized for 10 New MNGOs of Rajasthan

at Jaipur from 31st July, 2006 to 5th August,

2006. Participants were given training onissues related to RCH service delivery,

baseline survey, conducting Focused Group

Discussions, gender issues and social cultural

determinants of health.

Data Entry Package Trainings: Organized

TOT Workshop on Data Entry Package at

Vishwa Yuva Kendra from 21st -22nd August,

2006 for new MNGOs of HP, Uttaranchal and

Delhi. The same was organized for Women

Children welfare Society, Jammu and Kashmir

on the 28th

and 29th

September, 2006 at VHAI.At Jan Jagriti Education Society complex, new

MNGOs of Delhi were given training from 5 th-

6th October, 2006. Finally, New MNGOs of

Rajasthan and J&K were trained at VHAI on

17-18th January, 2007.

2 Final round of ToTs on Project Proposal

Development Training: New MNGO of

Uttaranchal, Himachal Pradesh and one

MNGO of Delhi was trained at VHAI from

11th 15th September, 2006. New MNGO of

Rajasthan, Delhi and Jammu & Kashmir weregiven training on the same at VHAI from 6th-9th

February, 2007.


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Networking and AdvocacyRRC-VHAI has been constantly networking with the State Governments of Rajasthan,

Delhi and Jammu & Kashmir for the approval of pending project proposals and release of

funds to the old MNGOs in their respective State. While the release of funds is in process

in Delhi, the Project Director of NRHM in Rajathan

has assured RRC-VHAI that the pending projectproposals of old MNGOs in the State would be

approved shortly in a months time. One old MNGO

of Jammu & Kashmir has been released full grant

for the implementation of the MNGO scheme in its

project area. There has been on-going advocacy

at the Rajasthan State level to operationalize the

JSY Helpline at the Block levels.

The old MNGOs of Himachal Pradesh and

Uttaranchal have also received 18 months of

grant to implement the MNGO scheme in theirrespective areas.

NGO Selection Committee MeetingRCC-VHAI was a part of the State NGO selection meeting at Jaipur for III round of

selection of MNGOs for Rajasthan on 5th September, 2006 and in Shimla on 21st and

22nd January, 2007. 7 new MNGOs have been selected in Rajasthan for the Districts of

Jodhpur, Hanumangarh, Bhilwara, Nagaur, Sikar, Udaipur and Barmer. Ankur has been

selected for Hamirpur district of H.P.

Development and dissemination of BCC and IEC material trainingRRC-VHAI website, www.vhai-rrc.org has been regularly updated to seek feedback fromall the stakeholders.

It has given its comments on Technical contents for 3 FNGO- Modules to ARC

and provided their inputs for ASHA modules as requested by MOHFW. It has

also provided the ARC with the data on all the MNGOs and FNGOs.

JSY Helpline logo has been designed by RRC-VHAI and approved by the Mission

Director, NRHM, GoR. All State VHAs, RRCs, the ARC and PACS partners have been sent a brief

background note on the JSY Helpline.Posters, leaets and brochures on JSY

Helpline have been designed and printed

both in English and Hindi. Jingles have

also been prepared on JSY Helpline and

Maternal & Child Health.

The JSY guidelines have also been made

simpler for the beneciaries as some

of its clauses related to the payment of

ASHAs were causing a lot of problems at

the grassroot level. The guidelines havebeen distributed to all the stakeholders in

the Community Health Centers.

14



15/16

15

The editorial team of Abhilasha is thankful to all its readers for theirsupport, encouragment and valuable suggestions regarding the themeof the newsletter. On popular demand by many of the MNGOs we havecome up with a double edition ofAbhilasha with elaborate explanations onEmergency Obstetric Care, Essential Obstetric Care, Basic Obstetric Care

and Comprehensive Care. We hope our readers would greatly benet fromthis issue and we await more feedbacks on the same.

Some of the IEC

materials brought

out by JSY Helpline


16/16

NewPublications

1


AbhilAshA

Vountary heat Aocaton of indaB-40, Qutab Institutional Area, New Delhi - 110016Phones : 41688152-53, 26518071-72, 26515018Fax : 26853708Email : [email protected], [email protected] : www.vhai.org, www.vhai-rrc.org

About VhAiVoluntary Health Association o India (VHAI) is a non-proft, registeredsociety ormed in the year 1970. It is a ederation o 27 State VoluntaryHealth Associations, linking together more than 4500 health care institutionsand grassroots level community health programmes spread across the

country.

VHAIs primary objective is to make health a reality or the people o Indiaby promoting community health, social justice and human rights related tothe provision and distribution o health services in India.

VHAI tries to achieve these goals through campaigns, policy research,advocacy, need-based training, media and parliament interventions,publications and audio-visuals, dissemination o inormation and runningo health and development projects in some difcult areas.

VHAI works or people-centred policies and their eective implementation. Itsensitises the general public on important health and development issues or

evolving a sustainable health movement in the country with due emphasison its rich health and cultural heritage.

A RRC - VHAI newsletter or

Mother NGOs & Field NGOsEdtora Team

Dr. D.V. Singh, Seema Gupta & Veena SharmaDegn & Producton

Bhavna Mukhopadhyay, Brajagopal Paul,Subhash Bhaskar, Yogesh ChadhaOter Contrutor

Narendra Singh and JSY Team

QU?Z

1) What are the risk factors associated with pregnancy?

2) What are the complications which can take place due to vaginal bleeding during

pregnancy ?

3) What do you understand by postpartum examination of the mother?

4) What is Obstetric Fistula?

First 5 Correct replies to these questions will receive a gift hamper!

For the majority of us, a doctor is virtually God - one who isbeyond questions or doubts and has solutions to all our ills. Butwhile understanding the pressures of the medical profession, aspatients, we are often at the mercy of our doctors time, diagnosisand treatment. Few among us are aware that just as a doctor hascertain duties towards his profession, a patient too has certainrights to health care.

This book is an attempt to put together the rights of patients, embedded undervarious laws. It raises several concerns - regarding choice and access to health careservices, correct and timely diagnosis, information about illnesses, preventive measures,personalized treatment, right to complain and other issues. A must-read for everyone,especially patients and their families, health professionals, NGOs, care providers and

health workers.

Documents

Abhilasha Obstetric Care English Issue 9 Mar07-June