Shillong (Meghalaya), Dec 23 : Driven by an objective to address the Clinical dimension aspect that is one of the three identified dimensions contributing to high MMR and IMR in Meghalaya, the State Government has approved a policy for addressing shortage of medical specialists in Meghalaya, which will be implemented through the Adoption of Alternate models for Responding to Shortage of medical specialists (ADARSH) project. This project is an attempt to scale up alternate models for responding to the critical shortage of medical specialists in the state by training doctors in the public sector.
To further this, the State Government has also partnered with Public Health Foundation of India (PHFI)- Indian Institute of Public Health (IIPH). Under this initiative, the district hospitals will witness a strengthening of their capital infrastructure as well as the staffing of specialists. It is anticipated that the presence of post graduate trainees in the hospital around the year will lead to better services and higher utilization. The State has also adopted a College of Physicians and Surgeons (CPS) model which allows the State Government to reserve all seats for candidates who are domiciles of the State and preference is given to in-service doctors. CPS is one of the oldest post graduate medical education institutions in India.
It has been recognised that medical specialists are scarce in Meghalaya and availability of specialists like gynaecologists, paediatricians, anaesthesiologists and radiologists is crucial to provide care to high risk pregnant mothers and low birth weight children as well as to conduct CS operations. It has been identified that critical and specialist health workforce is important to achieve health and wider development objectives over the next few decades.
Speaking on this policy, Sampath Kumar, IAS, Commissioner & Secretary, Department of Health & Family Welfare said, ” Around 7000 villages are remotely located and therefore, there are glaring geographical challenges in reaching out to people in far flung areas. It becomes even more challenging for the pregnant mothers to reach the nearest PHCs/CHCs. Further, whenever a woman whose pregnancy has been identified as a high risk and a complicated one approaches the nearest health centre, presence of specialists like gynaecologists, paediatricians, anaesthesiologists and radiologists are fundamental for saving mothers and children in the State” .
Throwing more light on the policy, he added, “This policy is aimed at addressing this gap and building the health system in the long run. Currently, there are 141 vacancies in the State but there are no medical specialists to fill up the posts. Of course, getting admission for post graduation specialisation is not an easy task but it is time to nip this problem in the bud. If this is left to be continued like this, it will be extremely difficult to reduce the State’s MMR and IMR in the absence of specialists. The vision is that in the next 5-10 years, we should be able to train our own in-service doctors who can be positioned even at the remote CHC level”.
It may be mentioned that since the month of May 2020, the State Government has upped its ante against high MMR and IMR by conducting regular weekly meetings with all districts to effect a granular monitoring system of Reproductive, Maternal, Neonatal, Child, Adolescent Health (RMNCH). The close monitoring has led to an increase in data reporting thereby initiating discussions and sensitizing the masses about the seriousness of the situation. The maternal mortality status of Meghalaya is 182 per live one lakh deliveries, which is higher than the National average of 122 per one lakh deliveries.
The weekly review meetings has led to the identification of three important dimensions that needs to be considered pertaining to the prevalence of high rate of MMR and IMR:
I. Clinical dimension: This implies availability of medicines, testing facilities, medical specialists and other essential medical procedures at the PHCs/CHCs and sub centre level to cater to pregnancies in rural areas.
II. Public Health dimension including extensive training of doctors and grassroot healthcare providers: This aspect lays focus on quality of Antenatal and PostNatal care, while focusing on training of grass root healthcare workers. This indicates the overall health seeking behaviour prevalent among people, especially women.
III. Social and gender dimension: This aspect focuses the various social, cultural, economic and gender barriers that prove to be a hindrance in reducing MMR and IMR in the State.
Meanwhile, steps are already being taken to address the other two dimensions including the public health as well as social and gender dimension. In August this year, Meghalaya passed an enabling policy for women’s empowerment by effecting 50 per cent reservation for women in VECs (community institution / a local body), a first of its kind in India, to enable increased women’s participation in development activities. Further, the MOTHER app, launched in August 2019 is already in place to track and monitor all pregnant women in the State. This app is currently being used by medical doctors and officers of all PHCs and CHCs to track all expecting mothers, especially those who are experiencing high risk pregnancies. All efforts are being made to ensure that these mothers are taken to the nearest healthcare centres 1-2 weeks prior to the delivery date. Technology and data is being used to minutely track mothers and children through the MOTHER App.