The innovations initiative: Technological approaches for addressing maternal, newborn and child health

Abstract

coverage and quality of critical interventions. A key constraint in many low resource settings is the lack of available health facilities capable of delivering critical MNCH interventions, leading to large investments in expanding physical infrastructure and human resources. Efficient allocation of resources requires information about the existing availability of services and key gaps in service configuration. However, this information is not often available. The University of Manitoba’s Centre for Global Public Health is implementing a Technical Support Unit embedded within the Government of Uttar Pradesh (GoUP) to provide support for the planning and implementation of MNCH programs under the National Health Mission. There is a specific focus on 25 high priority districts (population approximately 60 million), which contribute disproportionately to maternal, neonatal and infant mortality. To improve the GoUP’s planning and scale-up of the availability of MNCH services, we mapped facilities in the public and private sectors to assess availability, identify gaps and develop a planning roadmap for efficiently increasing service availability through the National Health Mission. Methods: We conducted a rapid, large scale mapping and assessment of health facilities in the public and private sectors in 25 high priority districts of Uttar Pradesh in India. The mapping tools were designed to capture details of population, physical infrastructure, staff, drugs, equipment, supplies, services (antenatal care, delivery, postpartum, postnatal, abortion, newborn and child health), certain service statistics and use of facilities’ untied funds. The mapping occurred over a three month period and covered a total of 7,560 public facilities (90% response rate) and 1,150 private facilities (63% of those identified as providing delivery care). Consent was obtained from the primary respondents at the facilities. Findings: The mapping found that only 44% of an estimated 429,315 deliveries occurred in public facilities (39%) or identified private facilities (5%). The large majority of deliveries in public facilities occurred in block (sub-district) level facilities (52%) or district hospitals (15%). There were large gaps in the availability of delivery points, general infrastructure, human resources, equipment, drugs and supplies in the public sector at all levels of care, with large disparities between and within the 25 districts. Interpretation: Facility mapping data were used to develop a strategic plan to expand service delivery points across the state and within each district, through a mix of enhancing the signal functions of existing facilities and activating dormant delivery points. This planning was incorporated into the National Health Mission project implementation plans at the district and state levels, and these plans are being tracked through ongoing assessments of the expansion of service availability. Funding: Bill & Melinda Gates Foundation. Abstract #: 01ITIS027