Authors : D.V.R. Seshadri, Geetika Shah and Swati Sisodia

Synopsis :

The case is about the relentless efforts made by Dr. Evita Fernandez, Chairperson, Fernandez Foundation, (FF), in ameliorating the abysmal state of maternal and neonatal health in the country. Considering the problems of poor doctor to patient ratio, rising C-Section rates, absence of last-mile delivery of quality maternal care for large sections of the population, and higher maternal mortality in India, Dr. Fernandez firmly believes in promoting Midwifery as a workable solution. While FF has been actively training midwives as part of their mission and need, Dr. Fernandez is cognizant of the fact that government support is necessary for a national-level change. Absence of government partnership restricts expansion, both in terms of geography and financial resources, into all areas needing care. With the desired results in mind, she envisaged a Public Private Partnership Model (PPP) to create a large number of well-trained midwives in the country. With an agreement with the Government in place, the PPP model is rolled out with six training centers recognized to run institutes of midwifery training. FF would play the role of a mentor at a national level while also taking the direct responsibility for two centers. Since the inception of this program, the performance of half the centers is languishing.

There are several barriers to the adoption of midwifery, both from the perspective of obstetric community as well as from that of birthing mothers. The former perceive it as threat to their profession and the latter fear pain of normal delivery or believe an expensive process (C-Section) would be superior to the economical option of normal delivery. However, in reality midwifery is complementary to obstetrics as midwives can optimize the traffic of patients at secondary and tertiary level. Midwives are trained to take care of normal delivery and low-risk cases and can refer the complex cases to the next level of care

Dr. Fernandez was aware that this PPP initiative was one of strategic importance for the country in order to reach the last mile population and reduce C-section rates. However, given the complex structure of healthcare in India, where the central government frames the health policies and the state government implements it, uniform acceptance of the initiative and commitment from all the states could not be expected. Besides, the frequently changing bureaucrats, both in the state governments and the central government, often disrupted the execution.

FF has a small but motivated team who are committed to the cause. Students working on the case need to come up with a plan to fastrack the performance of all the six training centers and keep the midwives motivated to work at their peak levels in rural hinterland. This needs to be done by overcoming the pushback from the obstetric community, increasing the acceptance of midwives among birthing mothers, and putting in place robust systems for monitoring the performance of the PPP.