Pakur

ACTION PLAN-HEALTH
 Problems Identified:

After assessing the latest assessments done by NHFS and HMIS for the on the health
indicatorts. Following are the key issues which were observed:
 Reduction of Infant Mortality Rate and Maternal Mortality Rate.
 Anaemia
 Infrastructure
 Complete Immunization
 Complete Ante-Natal Care
 Overview

As Pakur being one of the remotest district in the Jharkhand state. Most of the villages are
situated in the hilly terrain where connectivity is very poor and also there is no such
transportation facility is available for commuting locally, which makes a tough job to deliver
services in such areas for ambulances to reach also ANMs aand other health professionals
face problems in delivering their due service. VHSNDs are organised every month in the
village to provide immunization, counselling and to provide other benefits of government run
health schemes.
Nearly half of all deaths in children under 5 are attributable, limited reach of Ambulances,
lack of skilled birth attendants during home delivery, under nutrition; under nutrition puts
children at greater risk of dying from common infections, increases the frequency and
severity of such infections, and delays recovery. The interaction between under nutrition and
infection can create a potentially lethal cycle of worsening illness and deteriorating
nutritional status. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted
growth, which is associated with impaired cognitive ability and reduced school and work
performance.
 Proposed Solution to the Problem

Reduction of IMR and MMR

 Procurement of bike ambulance.
 Improve delivery services in rural health care facilities
 Focus on First 1000 days of a child

Anaemia
 Focus on supply chain management for IFA and ensure availability and generate demand
 Use Anemia Mukt Bharat Dashboards for monitoring data and initiate test and treatment.
 Address non nutritional causes of anemia in endemic pockets eg: Heamoglobinopathies
and malaria
 IMR and MMR

 Infant mortality rate (IMR) is the number of deaths per 1,000 live births of
children under one year of age. The rate for a given region is the number
of children dying under one year of age, divided by the number of live
births during the year, multiplied by 1,000.
 Maternal mortality rate (MMR) refers to deaths due to complications from
pregnancy or childbirth. From 2000 to 2017, the global maternal mortality
ratio declined by 38 per cent – from 342 deaths to 211 deaths per 100,000
live births, according to UN inter-agency estimates.
 IMR causes

Other
Haemorrhage
, 38%
‘3 Delays’
Conditions, • Delay in decision to seek professional care
34%
• Delay in reaching the appropriate health
facility
• Delay in receiving care after arriving at a
Sepsis, 11%
Abortion, 8% hospital
Obstructed
Labour, 5% Hypertensive
disorders, 5%

Source- RGI-SRS 2001-03

MMR causes

Injuries
3% Others
Measles 14%
3%
Diarrhoe
al
disease Neonatal Infections 33
12% causes Prematurity 35
Pneumon
53% Asphyxia 20
ia
15%

Source- RGI-SRS 2001-03

 Status of IMR and MMR: Pakur

According to the Annual Health Survey (2010- 2011), Pakur district had the third highest Infant
Mortality Rate (IMR) in the state, with 59/1,000 live births, second highest neonatal mortality rate
with 36/1,000 live births and highest Maternal Mortality Ratio (MMR), with 325 per 100,000 live births.
These figures were comparatively high in terms of the state averages (41 IMR, 26 NMR, and 278
MMR).
Many of the causes of maternal and child deaths are due to poor access to primary health care.
In Pakur, low accountability and lack of capacity within the system resulted in poorly trained front-
line health workers and inconsistent availability of health services, which exacerbated the low
community demand for services. Meanwhile, lack of knowledge, poverty, remote villages and
difficult terrain hindered care-seeking amongst the local population. According to the District Level
Health Survey (DHLS)-3 (2007-2008), only 17% of pregnant women in Pakur received 3 or more ANC
visits, nearly 90% of deliveries took place outside of a healthcare facility, and only 21% of mothers
received a post-natal visit within two days of delivery.

(Soucre: Pakur Mother and Child Survival Project (2011 to 2015)

 Objective

 Implementation of more effective, gender-sensitive interventions and

services related to maternal, newborn and child health in the district.
 Increased shared decision making at the household level about practices
in the district.
 Bike Ambulance

Motorbike ambulance services, as a reliable mode of medical transportation, are gaining in

popularity today. These ambulances are essentially bikes used in conjunction with a side-car or a
trailer which is utilized for transporting the patient to a hospital. Apart from medicines, these
vehicles have a paramedic or a first responder on-board to attend to the patient in an
emergency. Owing to their size and performance capabilities, the response time of medical
emergency motorcycles are superior to the conventional ambulance services. This is because
unlike a car, van or fire engine they do not get stuck in the traffic during an emergency
 What’s the need?

 Bike ambulances are equipped with GPS and communication devices

along with a portable oxygen cylinder, first aid kit, air splints.
 The survival rate of patients is found to be much higher who are
transported through bike ambulances than any other vehicle during
heavy traffic.
 Bike ambulances are equipped to carry more than 16 types of medical
equipment. They provide urgent medical care to victims of road
accidents, strokes, bone fractures
 Bike ambulance will help reach the delivery services where ambulances
can’t go or where ambulances takes time to reach being a heavy vehicle.
Proposed activity

 Engagement of a monitoring unit.

 Identification of hard to reach priority areas.
 Collaboration with government Ambulance call center
 Procurement of Bike ambulances.
 Facilitate training to the ambulance driver.
 Develop a monitoring mechanism and regular review.
 Proposed timeline

• Formation of a monitoring unit.

• Identification of hard to reach areas.
Quarter 1 • Issue tender for procurement.

• Procurement of bike ambulances.

• Recruitment of drivers.
Quarter 2 • Facilitate training to the drivers.

• Develop a monitoring mechanism.

Quarter 3
 Budget

No. of No. of No. of No. of Cost of Cost of Salary Total

blocks CHC/ HSC Bike Bike mainten for (In Rs)
PHC ambula ambula ance drivers
nces to nce (Anually (Anually
be (In Rs) In Rs) In Rs)
procure
d
6 6 121 12 (2 for 2700000 144000 120000 2964000
each
CHCs)
Intended Impact

This will lead towards following intended outcomes:

 Direct reduction in the IMR and MMR.
 Increase the reach of health department to every corner of the district.
 Provide life support to other patients with critical conditions.
 Will help reach Skilled birth attendants to reach with require equiipments.
 Challenges

 Delay in the overall process.

 High quality purchase during procurement.
 Monitoring mechanism to strictly followed.
 Regular reviews and maintenance.
THANK YOU