Operationalizing First Referral Units (FRUs) in Jharkhand, India: Experiences from an operations research

Abstract

Background: Till 2008, Jharkhand had only 12 designated first referral units (FRUs) at the district level and none of them were fully functional. This paper focuses on the processes, experiences and health system challenges in operationalizing FRUs in Jharkhand. Methods: In an operations research, a pre and post assessment of designated FRUs in the study area was undertaken using standardized tool during March 2009 and February 2011. Results: There was 33 % (04) increase in availability of obstetricians, surgeons and pathologists across the facilities. The availability of pediatrician was improved in 26% (02) facilities, while there were only 14 % (01) of anaesthetists across all the seven facilities. There was rise in recruitment of medical-officers and there were surplus in number for the designated FRUs. Only 29 % (02) of the facilities operated with a blood bank or blood storage unit. Parenteral-antibiotics and oxytocin availability remained stagnate at 86 % (06) and 57 % (04) respectively across the seven designated FRUs. Magnesium-sulphate availability had improved by 29 % across the facilities. There was rise in availability of Misoprostol in four (57%) facilities and dip in availability of Nifedepine in six (86 %) and lignocaine-hydrochloride in one (14 %). About four (58 %) of the facilities did not have maternal-newborn care equipments. At the end of the project, only three out of seven designated FRUs achieved operational status. Conclusions: This piece of work on small scale generated evidence from Jharkhand made to think strategically to scale-up operationalization of FRUs. Lack of leadership, management, skilled human resources, infrastructure and medical supplies impeded operationalization of FRUs in Jharkhand. Access to comprehensive emergency obstetric and new-born care services (CEmONC) is remaining as a major issue.