MCH Student:

Karthik Srinivasan

Date of Defense:

August 20, 2009

Abstract:

Background: The Tamil Nadu Health Systems Project (TNHSP) is one of the key programs devised under this health policy and will support implementation of this strategy various interventions. The TNHSP is an externally aided project with funding from World Bank, implemented by the Tamil Nadu government through the Ministry of Health and Welfare.

Methods: This internal evaluation of the TNHSP project was conducted to identify best practices, gaps in delivery of emergency obstetric services and areas for improvement within the program. The evaluation was conducted by a secondary data analysis of routine monitoring data for March 2007 – March 2008 in 47 program managed CEmON centers with comparisons to state and national level data. Analysis was conducted on aggregated data of hospital beds, maternal and neonatal services available; number of patients receiving services and the nature of the services were obtained.

Results: Analysis of maternal services indicated high rates of episiotomies for normal deliveries (mean 58%), high rates of caesarean birth (mean 25 % of all deliveries) with a strong positive association with complicated maternal admissions. The MMR for the program at 80 per 100000, while lower than the national average is still high with a 50 % of deaths due to bleeding complications. Among neonatal services the prevalence of low birth weight, respiratory distress syndrome and birth asphyxia were high with an association to maternal complications and caesarean births.

Conclusion: There is a need to improve reporting practices within the program, improve standardization and perform caesarean audits for each center on a regular basis.