How te­lan­gana in­creased baby de­liv­er­ies in govt hospi­tals

In Te­lan­gana, when a baby is born, moth­ers re­ceive a gift ham­per from the govt. This has in­creased the num­ber of de­liv­er­ies in govt hospi­tals and re­duced the num­ber of cae­sare­ans

Governance Now - - CONTENTS - Sree­latha Menon

When a child is born, rel­a­tives and friends bring gifts for the mother and child. Tak­ing cue from that prac­tice, the K Chan­drashekhar rao (KCR) government in Te­lan­gana started giv­ing moth­ers a “KCR kit” – a tin of tal­cum pow­der, baby oil and soap, a towel, di­a­pers, a mos­quito net, a baby ma­tress, and a set of clothes. in ad­di­tion, there’s a cash com­po­nent of ₹12,000. Ap­par­ently the gift has made a huge dif­fer­ence. in the year since the prac­tice was be­gun, the num­ber of de­liv­er­ies in government health­care cen­tres and hospi­tals has gone up; si­mul­ta­ne­ously, the num­ber of cae­sarean sec­tions has gone down.

in­sti­tu­tional de­liv­ery was never a mat­ter of con­cern for Andhra Pradesh or the newly cre­ated Te­lan­gana: 92 per­cent of de­liv­er­ies were in­sti­tu­tional. How­ever, de­liv­er­ies in government in­sti­tu­tions were only 31 per­cent till Jan­u­ary 2017. in essence, peo­ple were pre­fer­ring to go for de­liv­er­ies to pri­vate hospi­tals. This ties to the pro­por­tion of cae­sarean sec­tions too. For pri­vate hospi­tals tend to co­erce pa­tients into

go­ing for child­birth through cae­sarean sec­tion. since the in­tro­duc­tion of the kit, how­ever, de­liv­er­ies in government hospi­tals have gone up to 50.44 per­cent (in septem­ber 2017), and as a re­sult, there have been pro­por­tion­ally fewer cae­sarean sec­tions.

The KCR kit is not a new idea. it was mod­elled on the ‘Amma kit’, first in­tro­duced by for­mer Tamil nadu chief min­is­ter J Jay­alalitha in her state. The scheme also de­rives funds from the Janani surak­sha Yo­jana, which has been ex­is­tence for many years and has been mod­i­fied fur­ther by the NDA government at the cen­tre. in fact, the BJP lead­er­ship in Te­lan­gana has even ques­tioned the state government’s at­tempt to claim credit for the kits, say­ing that it is par­tially funded by the cen­tre.

The fi­nan­cial com­po­nent is given in three tranches: ₹3,000 is put in the mother’s ac­count af­ter com­ple­tion of two ante-na­tal check-ups in the first five months. Later ₹4,000 is added to her ac­count if the baby is male and ₹5,000 if the baby is fe­male. That is not all. An amount of ₹2,000 ac­crues to the mother’s ac­count af­ter the first im­mu­ni­sa­tion – that is, within three months of de­liv­ery – and ₹3,000 af­ter the sec­ond im­mu­ni­sa­tion, within nine months of de­liv­ery. if a girl child is born, the mother gets ₹1,000 ex­tra. About ₹605 crore has been al­lo­cated for the scheme, which also pro­vides a hand­bag and cotton sa­rees for moth­ers.

Piush, a so­cial de­vel­op­ment con­sul­tant, says the scheme seems to ap­peal to women and if it helps in­crease in­sti­tu­tional de­liv­er­ies in government in­sti­tu­tions, why not? Ac­cord­ing to the state government, some two lakh KCR kits have been dis­trib­uted. But has it made a dif­fer­ence by bring­ing down in­fant mor­tal­ity rates? While a clear link can­not be made to the kit pro­gramme, it is as­sumed that an in­crease in in­sti­tu­tional de­liv­er­ies should have helped re­duce in­fant mor­tal­ity.

Ac­cord­ing to the state of in­dia’s new­borns 2014, a na­tion­wide sur­vey re­port on neona­tal health in­di­ca­tors, un­di­vided AP fig­ured at the bot­tom of south­ern states, also com­pris­ing Ker­ala, Kar­nataka and Tamil nadu. The re­port was pre­pared by in­ter­na­tional ngo save the Chil­dren, the Pub­lic Health Foun­da­tion of in­dia (PHFI), All in­dia in­sti­tute of Med­i­cal sciences and the union min­istry of health and fam­ily welfare. The com­pre­hen­sive sur­vey, also sup­ported by the Bill and Melinda gates Foun­da­tion, placed Ker­ala on top with an imr of 12 deaths per 1,000 live births, fol­lowed by Tamil nadu’s imr of 21, Kar­nataka’s of 32 and Ap/te­lan­gana’s imr of 41 deaths.

The then Andhra Pradesh government’s Vaidya Vid­hana Par­ishad, which con­ducted the health pro­grammes, ad­mit­ted fail­ure of cen­trally funded schemes for in­fant and ma­ter­nal health. They had at­trib­uted this to the short­age of pae­di­a­tri­cians in government in­sti­tu­tions as they were un­will­ing to work for a low salary in the government sec­tor.

The Te­lan­gana government is cur­rently work­ing on in­creas­ing the num­ber of labour rooms by at least 100 while stan­dar­d­is­ing the ex­ist­ing 200. The bed strength of ma­ter­nity units is also be­ing in­creased. Ac­cord­ing to a state­ment by health min­is­ter C lak­shma reddy to the me­dia this year, the government wants the in­sti­tu­tional de­liv­er­ies in government hospi­tals to be 50 per­cent of the to­tal de­liv­er­ies in the state, which are about 6.2 lakh.

The Te­lan­gana government seems to be se­ri­ous about the mat­ter as in April it also for the first time in two decades an­nounced re­cruit­ment for 4,000 health posts in the gov­ernemnt ser­vices, which in­cludes 150 gy­nae­col­o­gists, and 172 pae­di­a­tri­cians and 176 anaes­thetists, be­sides paramedics and doc­tors in other spe­cial­i­ties.

The com­mis­sioner of health and the fam­ily welfare depart­ment have been gung-ho about the KCR kits and have said that they are all set to prove that the state is in­deed the best as far as in­fant health is con­cerned. That would hap­pen the day Te­lan­gana over­takes Ker­ala and Kar­nataka in that depart­ment. Will it hap­pen in the near fu­ture?

feed­back@gov­er­nan­cenow.com

An amount of ₹2,000 ac­crues to the mother’s ac­count af­ter the first im­mu­ni­sa­tion – that is, within three months of de­liv­ery – and ₹3,000 af­ter the sec­ond im­mu­ni­sa­tion, within nine months of de­liv­ery. If a girl child is born, the mother gets ₹1,000 ex­tra.

Chief min­is­ter KCR and Goi’s eco­nomic ad­vi­sor Arvind Subra­ma­nian take a look at a sam­ple kit

Twit­ter/kcr

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