The programme Maternal Obstetric Monitoring (MOM) was started in March 2016 in Shorapur Taluka in Yadagiri district of north Karnataka. Shorapur Taluka is 50 kms away from the Yadagiri district headquarters and has 14 Primary Health Centres (6 bedded), 1 Community Health Centre (30 bedded) and a Taluka hospital (100 bedded) covering 284 villages with a population of 4,42,775. The pregnant women taking consultations at the government facilities, the National Health Mission, the government health facilities in the Taluka and the Narayana Health CSR team (HR, technology and equipment) are the stakeholders in the project.
A baseline survey conducted by the NH CSR team found that 43% of pregnant women surveyed didn’t know warning symptom/ signs during pregnancy, delivery as well as after delivery. 100 % of women surveyed had got their USG examination done in private facilities, thereby incurring significant out-of-pocket expenses since the entire District did not have a government nominated radiologist. 30% of the pregnant women surveyed had iron supplementation on an irregular basis. Our study found that anaemia was responsible for 80% of high risk pregnancies.
There is an average vacancy level of 76% across all specialist posts. The relevance of antenatal care and awareness towards causes of high-risk pregnancy were lacking as the Taluka lacks government nominated Obstetrician and Gynaecologist. The entire district lacked a government nominated radiologist and most USGs were conducted in private settings with considerable out-of-pocket expenditure. The program therefore aimed at identifying High-Risk Pregnancies (HRPs) through relevant technology ( the Mobile Obstetric Monitoring software application), strengthening the first referral unit, USG examination of all pregnant cases, clinical examination and follow up of the HRPs by NH clinical team as well as early referral and safe confinement of HRPs prior to their expected date of delivery.
Since November 2016, over 4000 women have received free USG reviews by NH radiologists. The radiologists from NH travelled to the Government General Hospital to conduct USG scans. Of the pregnant women who underwent USGs, 27% were diagnosed as high-risk pregnancies and this was shared with the government health officials for further follow-up. Through the Maternal Obstetric Monitoring (MOM) app, NH Obstetricians have been able to review cases and provide an objective scoring of pregnant women cases into high, moderate or low-risk pregnancies. This is further corroborated with USG images which are attached to the reports. With implementation of technology and workflow innovations, there has been a 50% rise in detection of such cases, compared to what is being captured by the public health system MIS.