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Table 3 Maternal health policies, objectives and indicators of MAPEDIR's effectiveness in helping to meet the objectives, and outcomes

From: Maternal death inquiry and response in India - the impact of contextual factors on defining an optimal model to help meet critical maternal health policy objectives

   State (District) Outcomes
National RCH policy District maternal health policy objectives and indicators Rajasthan
(Dholpur)
N (%)
Madhya Pradesh
(Guna and Shivpuri)
N (%)
West Bengal
(Purulia)
N (%)
Register all maternal deaths "Unhide" maternal deaths:
% of expected maternal deaths* reported by district before//after MAPEDIR implementation
Apr, 04-Mar, 05: 4% (5/116 deaths in 4 blocks)//Apr, 05-Mar, 06: 60% (35/58 deaths in 2 blocks) Feb-Dec, 05: 47% (113/239)//Feb-Dec, 06: 57% (136/239) July, 04-June, 05: 119% (114/96)//July, 05-June, 06: 127% (122/96)
Investigate all (or a sample of) reported maternal deaths Gather new evidence:
% of reported maternal deaths investigated by district before//after MAPEDIR implementation
Apr, 04-Mar, 05: 0% (0/5)//Apr, 05-Mar, 06: 100% (35/35) Feb-Dec, 05: 0% (0/113)//Feb-Dec, 06: 100% (136/136) July, 04-June, 05: 0% (0/114)//July, 05-June, 06: 86% (105/122)
Implement RCH programme planning and management:
• Evidence-based
The state uses the new evidence:
New maternal health interventions developed by/with the state health system based on MAPEDIR data
Statewide obstetric help line (implementation delayed); 141 FRU blood storage units equipped None Made all public maternity beds non-paying; expanded JSY to all SC/ST and BPL women; implemented new rural referral transport system
• Decentralized Decentralized MH planning:
New maternal health interventions initiated at district level based on MAPEDIR data
District health society planned and mobilized obstetric helpline and referral transport system by partnering with civil society Guna: mapped maternal deaths to prioritize & upgrade remote SHCs for 24 × 7 safe delivery services; Guna and Shivpuri: ensured 24 × 7 referral transport to all PHCs via call center and secured vehicles None
• Bottom-up Community participation:
New maternal health interventions developed by or with communities based on MAPEDIR data
Taxi union & NGO collaborated with district in implementing and running the obstetric help line and referral transport system Guna: block PRI ensured referral transport for remote villages to upgraded SHC; Guna: communities donated 6 of 22 referral vehicles GP-initiated 8 van rickshaws in 4 remote GPs of 4 Purulia blocks
  1. BPL = below poverty line; FRU = first referral unit; GP = gram panchayat (local governance board); JSY = Janani Suraksha Yojana (institutional care incentive scheme); MH = maternal health; NGO = non-governmental organization; PHC = primary health centre; PRI = Panchayat Raj Institutions (local governance system); RCH = Reproductive and Child Health Programme; SC/ST = scheduled castes and tribes; SHC = sub health centre.
  2. *Expected deaths = District (Block) population*State crude birth rate*State MMR (from 2001-03 Sample Registration System Special Survey of Deaths): Dholpur: 1, 000, 000 (2 blocks = 500, 000)*26/1000*445/100, 000; Guna/Shivpuri: 2, 600, 000*26.5/1000*379/100, 000*(11/12); Purulia: 2, 700, 000*18.4/1000*194/100, 000.