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Public Systems Partnership

Strengthening Public Health Systems to deliver quality healthcare services in urban informal settlements


Mumbai, Kalyan, Thane, Vasai-Virar, Mira-Bhayandar, Ulhasnagar, Kalyan-Dombivali and Bhiwandi-Nizampur

The Problem


In India, about 35,000 women die from pregnancy and childbirth-related complications each year.Nearly all of these deaths are preventable with adequate prenatal care and education.


women in Mumbai had four
or more Antenatal Care visits

infant mortality rate in urban
Maharashtra (per 1,000 live births)

State-run primary health care centres, maternity homes and tertiary hospitals offer maternal health services, but often experience capacity constraints. These constraints affect delivery of critical health services to vulnerable pregnant women and newborns. Many target beneficiaries in urban informal settlements are unaware these services exist, and also demonstrate limited understanding of best practices that can enhance the wellbeing of mothers and newborns.

Source: National Health Family Survey 5 (NHFS 5) 2019-21

How can we better equip families, communities and government health systems to ensure safe pregnancies and healthy newborns?

Our Work


We believe that strengthening delivery of public health services and raising community awareness of these services can improve health outcomes among pregnant women and their newborns.

Establishing and facilitating a maternity referral network


We have partnered with seven municipal corporations in and around Mumbai to strengthen maternal and newborn referral processes. The referral system works to improve coordination and documentation across various municipal health facilities. These improvements aim to reduce the load on overburdened health facilities and ensure that high risk pregnancies receive timely, critical care.

Strengthening primary care


In urban India, health posts are local clinics that provide free primary health services to communities. We work with health post staff to develop effective processes, track efficiency, and facilitate community awareness building.

Mahila Arogya Samiti (MAS)


Mahila Arogya Samitis (MAS) are women’s groups of 8-12 locally resident women, formed for every 100 households for neighbourhood health planning, action on social determinants of health and for monitoring all local services. The municipal Accredited Social Health Activists (ASHA), or health outreach worker is a member Secretary of the MAS and a member is elected as Chair. The MAS is expected to create awareness on Government health services and refer community members on a timely basis to the appropriate service provider.

Reach


48,608

Pregnant women with potential complications
assisted through referral networks
(2016-2022)

1213

Health facility staff trained on
maternal and neonatal care (2016-2022)

2080

Outreach workers trained to address
maternal and neonatal health (2016-2022)

176

Public health facilities strengthened to
quality healthcare services (2016-2022)

Impact



84%

Cases referred appropriately
(2021-2022)

66%

Women referred reached the
tertiary or peripheral hospitals
(2021-2022)

81%

Complete documentation of referrals
(2021-2022)

Notes from the field
Referrals for a safe delivery


Women in our communities are often hesitant to deliver babies in hospitals due to misconceptions and lack of awareness around hospital services. By facilitating hospital visits and referrals, we try to ensure that each woman is aware of the benefits of hospital deliveries.

Twenty-four year old Seema* was easily convinced and proactive about opting for an institutional delivery. She had enrolled herself at the health post for antenatal care, even before she met a SNEHA Community Organiser. During a routine visit, the CO found that Seema was preparing for a home delivery. Seema had misplaced her antenatal card and test reports, and was worried about going to the hospital without them.

Seema was encouraged to go to the hospital, despite not having the documents. On admission, doctors found that there were complications due to the position of the baby. The hospital assisted her with an ambulance and rushed her to a tertiary hospital.

Seema underwent a Cesarean section, a procedure she would not have had access to in a home delivery, or even at a maternity home.

*Name changed

Scaling Our Model


Our partnerships help us scale our models and exchange best practices with other organizations in maternal and newborn health.

Learn more about how we work.


We documented our maternal referral system to three other municipalities near Mumbai through a grant from WHO in 2013. The system now covers a total of 7 municipalities across the Mumbai metropolitan region resulting in more optimal utilisation of health facilities.


In 2017, child rights organisation Save the Children (STC) adopted our referral model for safe pregnancies and uptake of primary care throughout the Pune Municipal Corporation. We provided technical support and capacity building in order to support the STC team in strengthening delivery of health services at municipal health facilities. We worked with STC to customize clinical protocols, and facilitated workshops with public and private health system workers towards the adoption of best practices.

Partners


Kalyan- Dombivali Municipal Corporation

Thane Municipal Corporation

Vasai Virar Municipal Corporation

Brihanmumbai Municipal Corporation

Mira-Bhayandar Municipal Corporation

Bhiwandi Nizampur Municipal Corporation

Ulhas Nagar Municipal Corporation

CIPLA Foundation

F

Family Welfare Bureau

Directorate of Health Service (DHS) Maharashtra