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Issue – 9, February, 2007 RRC-VHAI newsletter for MNGOs and FNGOs
Issue – 9, February, 2007
RRC-VHAI newsletter for MNGOs and FNGOs

Preventing Maternal Mortality

Addressing obstetric complications

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 its base. 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 attendantsproved to have a very limited direct effect in reducing maternal mortality in the past.

direct effect in reducing maternal mortality in the past. It is estimated that nearly 15 percent

It is estimated that nearly 15 percent of all pregnant women 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, and hypertensive disorders, ruptured uterus, hepatitis, and anemia), most of which are avoidable. 50% of maternal

and anemia), most of which are avoidable. 50% of maternal R.R.C.-VHAI Dear Readers, This is a

R.R.C.-VHAI

Dear Readers,

This is a combined issue of “Abhilasha”, addressing concerns on managing Obstetric Emergencies. The last issue of ‘Abhilasha’ dealt with maternal and child health i.e. causes of maternal deaths, antenatal, intra-natal, post natal care and essential new born care. We got a good response from readers.We hope you will keep writing and share your views and concerns of the grassroots with us. We look forward to your feedback & suggestions for future themes for “Abhilasha”. Our efforts are always geared towards making “Abhilasha’” user-friendly and interesting for our readers.

We specially acknowledge the efforts and inputs of Dr. Dinesh Agarwal, Programme officer ( RH and HIV/AIDS)-UNFPA in this edition of ‘Abhilasha’.

Your friends,

Alok, Bhavna, Seema, Dr.D.V.Singh, Veena, Satyapal,Shekar & Ashok.

Common Complications during pregnancy, labour

and postpartum:

Know about these complications: 3

Types of placenta previa

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Role of MNGO/FNGOs 9

Making Pregnancy Safer Targeting Anemia Eradication During Adolescence 10

A Public Private Partnership initiative of Regional

Resource Centre-VHAI

Activities of RRC-VHAI 13

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S T N I O P Y E K preventing maternal mortality The Public Private Partnership

The Public Private Partnership proposed by the Government of India under the National Rural Health Mission, launched in April, 005 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.

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, insufficient 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. Bleeding causes one in four maternal deaths world wide. . Prevent anemia,

recognize and treat complications early.

3. Post partum bleeding is the most common cause of maternal deaths.

4. Practice active management of the third stage of labor in all cases to prevent postpartum heamorrhage.

deaths. 4. Practice active management of the third stage of labor in all cases to prevent
CommonComplicationsduring pregnancy, labour and postpartum: Following table depicts the common symptoms underlying

CommonComplicationsduring 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

1. Obstructed

1. Vaginal bleeding

2.

Puffiness of face, pedal edema (swelling on legs), generalized swelling

labour

2. Retrained

2. Convulsions

placenta

3.

Convulsions or fits

3. Hemorrhage

3. Vaginal/cervical tears

4.

Palpitations, fatigue, breathlessness

5.

Increased frequency and burning during urination

Leaking of watery fluid per vaginum (from the vagina)

4. Fever

6.

5. Vaginal discharge

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.

Knowabout thesecomplications:

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.

it is termed as Post Partum Hemorrhage (PPH). Bleeding in the post partum period is also
it is termed as Post Partum Hemorrhage (PPH). Bleeding in the post partum period is also

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? W O N K U O Y D I D preventing maternal mortality The development

The development of Obstetric Fistula is directly linked to one of the major causes of maternal morbidity i.e. obstetric labor, where the mother’s pelvis is too small to enable the baby to be delivered without help. Worldwide, obstructed labor occurs in an estimated 5% of life births and accounts for 8% of maternal deaths. Adolescent girls are particularly susceptible to obstructed labor, because their pelvises are not fully developed. Once they occur, they usually cannot heal by itself. Over 90% of women can be cured with one operation and can resume active and fulfilling life, including having further children.

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Types of plac enta previa

having further children. 4 4 ◆ Types of plac enta previa Abruptio placentae. Left: revealed; right:

Abruptio placentae. Left: revealed; right: concealed

previa Abruptio placentae. Left: revealed; right: concealed Puffiness of Face, Generalized swelling, Convulsions: 

Puffiness 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.

 Eclampsia (In worst cases there can be convulsions with high BP(>160/110 mm Hg), proteins

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 (fluid 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 deficiency 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).

normal blood loss and may go into cardiac failure (death). Increasedfrequency/urgency/burning/painduringurination

Increasedfrequency/urgency/burning/painduringurination (passage of urine)

Frequency/urgency/pain during 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) fluids 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 confirmed before leveling it as Premature Rupture of Membranes (PRM).

Excessivevomiting

Vomiting in early weeks (6 th -8 th week) of pregnancy is very common and passes off by 12 th week.

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Breast milk is the most sufficient and holistic diet for the infants especially in the first months of its birth. It is an ideal food for the growth and development of infants as well as an integral part of the reproductive process with important implications for the health of mothers. Breast milk has an anti-infective property that protects the infants against diseases and builds its immunity. Breast feeding also strenghtens the bond between the mother and child and should be initiated within the first hour of life.

Exclusive breastfeeding for months is the optimal way of feeding infants. It has the right amount and quality of nutrients to suit the infants’ food needs. It is also the easiest on its digestive system, thereby reducing the chance of constipation or diarrhea. Thereafter infants should receive complementary food with continued breast feeding upto years of age or beyond.

In the first trimester it is mild and the frequency of vomiting being once or twice in the morning. The quantity of vomitus is small and it doesn’t affect the woman’s health.

If the vomiting persists, frequency increases, retention of food is little and the woman loses weight after first trimester, this excessive vomiting in pregnancy is called Hyperemesis Gravidarum.

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 significantly 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.

HepatitisB

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

Hepatic coma is a fatal complication in undelivered cases and in mothers who deliver, post partum hemorrhage is

a fatal complication.

Post partuminfection:

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.

is thick, curdy

Vaginal discharge in case of Moniliasis

white and in flakes, 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 causes abortion, 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, 2 nd trimester abortions are

common. Prematurity or premature delivery especially

if the fetus is infected.

or premature delivery especially if the fetus is infected. Puffiness of Face, Generalized swelling, Convulsions: This
or premature delivery especially if the fetus is infected. Puffiness of Face, Generalized swelling, Convulsions: This

Puffiness of Face, Generalized swelling, Convulsions:

This could be due to hypertensive disorders of pregnancy (BP>140/90 mm Hg) and in severe cases >10/110 mm Hg.

Chloroquine is the treatment of choice in all forms of malaria and commonly used anti-malarials are not contraindicated in pregnancy.

Pregnant women with hepatitis require hospitalization and delivery in a well equipped hospital, since mortality & morbidity is high.

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.

preventing

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preventing maternal mortality Vaginal/cervical tear These are injuries which may take place during delivery especially by

Vaginal/cervical tear

These are injuries which may take place during delivery especially by unskilled personnel.

Placenta becomes large, pale, greasy and heavier than usual.

Congenital syphilis (syphilis by birth) manifests (shows) with large abdomen, edema, ascites (fluid in the abdominal cavity) jaundice and red spots on the skin, enlargement of lymph glands and nasal discharge or pneumonia 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.

ObstructedLabour

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 (deficiency of oxygen for baby), fetal injuries, 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.

RetainedPlacenta

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. Maternal mortality & morbidity is relatively high in such cases.

Role of MNGO/FNGOs 1. Community level: FNGO should Increase Awareness on following issues:  Importance

Role of MNGO/FNGOs

1. Community level: FNGO should

Increase 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. Identification of high risk cases and reporting to ANM.

Identification 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 ANC and 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.

1. Community level:

FNGO should Increase

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. Identification of high risk cases and reporting to ANM.

Identification 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

3. Health System Level

Ensure that village health and nutrition days are organized as per schedule and quality ANC services are available

Ensure that identified facilities provide services for management of complications.

Ensure that client’s 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) Textbook of Obstetric, Neonatology & Reproductive & Child Health Education, Revised 16 th edition, 2004 by Dr. C.S. Dawn; (2) Clinical Obstetrics, 10 th edition, 2005 by A.L. Mudaliar & M.K. Krishna Menon edited by Sarala Gopalan & Vanita Jain; (3) Pregnancy, Childbirth, Postpartum and Newborn care: a guide for essential practice 2 nd edition by WHO, Geneva, 2006

preventing

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Making Pregnancy Safer Targeting Anemia Eradication During Adolescence

Launch of the 12 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 healthy parenthood

To increase adolescent awareness about anemia and appropriate nutrition

Specific objectives

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

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 and country statement on prevention and control of adolescent anemia. The strategy will focus on having an integrated public health approach which will include:

Health and nutrition education – increasing public awareness and knowledge about health risks associated with anemia and importance of having an optimal Hb level.

Capacity building – by mobilizing all FOGSI society members and other partner societies, community involvement through NGOs and in involvement of school principals and teachers.

Increasing iron intake – by improving dietary pattern which would include diet 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 fortification etc.

Iron supplementation – children will be provided weekly iron tablets, as current research has shown that weekly supplementation improves iron absorption with fewer side effects compared to daily supplementation and is equally 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.

A Public Private Partnership initiative of Regional Resource Centre-VHAI with support from National Rural Health
A Public Private Partnership initiative of Regional Resource Centre-VHAI with support from National Rural Health

A Public Private Partnership initiative of Regional 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 28 locations. 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.

and audio jingles to promote the services of the Helpline. Effective networking is the key to

Effective networking is the key to the success of the project with BSNL partnering to provide 178 mobile handsets to the 200 field 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 in Rajasthan.

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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 28 th 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 attend the 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.Ram Gopal Vaishnav to take Hagami to the CHC-Masuda. Since the vehicle hiring charges had already been negotiated and fixed 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.

Activities of RRC-VHAI RRC-VHAI has a network of 46 MNGOs and approximately 141 FNGOs across

Activities of RRC-VHAI

RRC-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 Buildingworkshops

2 Induction Trainings: Induction training was given to Mahabodhi International Society, Leh at VHAI on 3 rd -4 th April, 2006. The third batch of 7 new MNGOs of Rajasthan were given Induction Training on 15 th and 16 th January, 2007 at VHAI also. The new MNGOs were acquainted on revised MNGO guidelines, on NRHM and the role of ASHAs, and basic statutory administrative and financial 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 4 th -9 th June, 2006. The same was organized for 10 New MNGOs of Rajasthan at Jaipur from 31 st July, 2006 to 5 th August, 2006. Participants were given training on issues 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 21 st -22 nd August, 2006 for new MNGOs of HP, Uttaranchal and Delhi. The same was organized for Women Children welfare Society, Jammu and Kashmir on the 28 th and 29 th September, 2006 at VHAI. At Jan Jagriti Education Society complex, new MNGOs of Delhi were given training from 5 th - 6 th October, 2006. Finally, New MNGOs of Rajasthan and J&K were trained at VHAI on 17-18 th 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 11 th – 15 th September, 2006. New MNGO of Rajasthan, Delhi and Jammu & Kashmir were given training on the same at VHAI from 6 th -9 th February, 2007.

Delhi and Jammu & Kashmir were given training on the same at VHAI from 6 t
Delhi and Jammu & Kashmir were given training on the same at VHAI from 6 t

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NetworkingandAdvocacy

RRC-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 project proposals 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

Uttaranchal have also received 18 months of grant to implement the MNGO scheme in their respective areas.

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of Himachal Pradesh and

NGOSelectionCommitteeMeeting

RCC-VHAI was a part of the State NGO selection meeting at Jaipur for III round of selection of MNGOs for Rajasthan on 5 th September, 2006 and in Shimla on 21 st and 22 nd 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 training

RRC-VHAI website, www.vhai-rrc.org has been regularly updated to seek feedback from all 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.

provided the ARC with the data on all the MNGOs and FNGOs. JSY Helpline logo has

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, leaflets 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 beneficiaries as some of its clauses related to the payment of ASHAs were causing a lot of problems at the grassroot level. The guidelines have been distributed to all the stakeholders in the Community Health Centers.

Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha
Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha
Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha
Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha
Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha

Some of the IEC materials brought out by JSY Helpline

Some of the IEC materials brought out by JSY Helpline The editorial team of Abhilasha is

The editorial team of Abhilasha is thankful to all its readers for their support, encouragment and valuable suggestions regarding the theme of the newsletter. On popular demand by many of the MNGOs we have come up with a double edition of Abhilasha with elaborate explanations on Emergency Obstetric Care, Essential Obstetric Care, Basic Obstetric Care and Comprehensive Care. We hope our readers would greatly benefit from this issue and we await more feedbacks on the same.

preventing

maternal mortality

Publications New

one who is

beyond questions or doubts and has solutions to all our ills. But

while understanding the pressures of the medical profession, as

patients, we are often at the mercy of our doctor’s time, diagnosis and treatment. Few among us are aware that just as a doctor has

certain duties towards his profession, a patient too has certain

For the majority of us, a doctor is virtually God -

certain For the majority of us, a doctor is virtually God - rights to health care.
certain For the majority of us, a doctor is virtually God - rights to health care.
certain For the majority of us, a doctor is virtually God - rights to health care.

rights to health care.

of us, a doctor is virtually God - rights to health care. This book is an

This book is an attempt to put together the rights of patients,

regarding choice and access to health care

services, correct and timely diagnosis, information about illnesses, preventive measures,

embedded under

various laws. It raises several concerns -

personalized treatment, right to complain and other issues. A must-read for everyone, especially patients and
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.
QU?Z
First 5 Correct replies to these questions will receive a gift hamper!
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?

About VhAi Voluntary Health Association of India (VHAI) is a non-profit, registered society formed in the year 1970. It is a federation of 27 State Voluntary Health Associations, linking together more than 4500 health care institutions and grassroots level community health programmes spread across the country.

VHAI’s primary objective is to ‘make health a reality for the people of India’ by promoting community health, social justice and human rights related to the provision and distribution of 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 of information and running of health and development projects in some difficult areas.

VHAI works for people-centred policies and their effective implementation. It sensitises the general public on important health and development issues for evolving a sustainable health movement in the country with due emphasis on its rich health and cultural heritage.

with due emphasis on its rich health and cultural heritage. A RRC - VHAI newsletter for

A RRC - VHAI newsletter for Mother NGOs & Field NGOs

Editorial Team

Dr. D.V. Singh, Seema Gupta & Veena Sharma

Design & Production

Bhavna Mukhopadhyay, Brajagopal Paul, Subhash Bhaskar, Yogesh Chadha Other Contributors Narendra Singh and JSY Team

AbhilAshA

Voluntary health Association of india

B-40, Qutab Institutional Area, New Delhi - 110016 Phones : 41688152-53, 26518071-72, 26515018 Fax : 26853708 Email : vhai@vsnl.com, vhairrc@vhai-rrc.org website : www.vhai.org, www.vhai-rrc.org