IN BORN UNIT
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BORN UNI
MADHYA PRADESH
Winning applauses by setting
FORWORD
It gives me great pleasure to document publication a few innovative health
schemes and interventions of M.R These are some of our eager efforts to
bring our State in line with national health indicators and MDGs. This
process of health reform will, I hope, be strengthened and improved with
your valuable suggestions.
M.. R has hitherto being a high focus state due to its health indicators. With
limited resources and rising expectations, we have constantly innovated to
improve our health delivery system. The Government of M.R has in recent
years mead health one of the priority sectors. As a result our critical
indicators are showing constant improvements.
I seek your valuable suggestions on the schemes outlined in this publication.
Mr. S.R. Mohanty
Secretary, Department of Public Health and Family Welfare,
Mantralaya. Vallabh Bhawan, Bhopal (M.R)
Department of
Public Health & Family Welfare
Madhya Pradesh
ROGI KALYAN SAMITI
Launched in 1995-96 ROGI KALYAN SAMITls (RKS) are patient welfare societies. These are registered societies under the
Madhya Pradesh societies registration act -1973- It is a local decentralized management mechanism for the patient
Background
In the State of Madhya Pradesh, traditionally the delivery of health care has been within the domain of public sector. RKS
was successfully experimented at the MaharajaYashwant Rao Hospital (MYH) at Indore in the financial year 1995-96; the
state initiated a scheme for citizen involvement in the management of state hospitals and health centres. The MYH was
projects. In the first year, a handftil of districts, especially those close to medical colleges adopted the scheme. By 1997-
recognition when it was awarded the Global networkaward of U.S. dollars 1,25,000/- atjapan on 13-2-2000.
GOI directed all states to follow Madhya Pradesh in RKS formation. In Madhya Pradesh RKS have been formed in all 50
District Hospitals, 53 Civil Hospitals and 228 Community Health Centres. RKS are also functioning in 870 of the total
1194 Primary Health Centres in the State.
Budget Details for RKS (2010-11)
fromRCH/NRHM
District Hospital Rs. 5.00 lakhs per DHx 50 DHs
Civil Hospitals Rs. 1.00 lakh per Civil Hospital
Rs. 1.00 lakh perC.H.C
Rs. 1.00 lakh per PHC
(Rs. In lakhs)
250.00
54.00
333.00
882.00
Total
1519-00
In the financial year 2010-11 the income of RKS up to 31-05-2010 is two crores thirty eight lakhs & expenditure is thirty
per the guidelines of the state Govt, ensures strengthening the financial condition of Rogi Kalyan Samiti. Special facilities
like ambulance, Operation Theatre, Labour Room, Intensive Cardiac Care Unit (ICCU), NICCU are maintained by RKS
funds. RKS Provides free treatment to patients below poverty line, handicapped, freedom-fighters, labourers & slums
taken care by the society. Drinking water facilites, shade to rest & chair, bench to seat make the ambience patient friendly
STRENGTHENING OF SUB HEALTH CENTERS
FOR 24 X 7 SAFE DELIVERIES
Background:
for Institutional delivery but it also raised challenges for institutions to keep pace with increasing delivery load. Then there
timely access to BEmONCS for safe deliveries in spite of financial incentives provided byJ SY. This was resulting in pockets
oflow institutional delivery with in the district leading to stagnation of institutional delivery gains after the initial rise.
In addition to this therewas increasing load of normal deliveries coming to First referral units making it difficult for them
to keeppacewith increasing load resulting in deterioration in quality of Care.
Thus an urgent need was felt to improve access of women from remote areas to 24 x 7 safe delivery services as well as
reduce congestion at First referral units. An attempt in this direction was first made in the year 2007-08 in Guna District
where District health society Guna with support from UNICEF and Government ofM.R piloted operationalization of Sub
Centers for 24x7 delivery services in remote villages. Looking at the success of this need based innovation it was decided
to scaleitup State wide with necessary provisions made under NRHM plan for 2009-10as well as 2010-11. As of date more
than 450 Sub Centers have been accredited in the State for 24 x 7 safe deliveryservices.
Expected Outcome:
Improved accessofexcluded communities to institutional deliveries.
Reduced congestion at District hospital and FRUs.
Operationalizing Sub Health Centres for safe delivery- Guna Experience:
In Guna District till 2006 -07 delivery centers were concentrated along the main highway making it difficult for pregnant
. women from peripheral villages to access safe delivery centers in time as a result institutional delivery in the district was
just 29.8 %.(J)LHS-2).'Ibimprove access ofthese remotevillages to 24x7 safe delivery centers following steps were taken;
1)
EstablishmentEmergencyTransportsystem’connectedto24x7 Call centre
2)
Operationalizing24X7 delivery centers at PHC and Sub centre level.
3)
TrainingofStaffat Health centers. (SBAandessentialNewbomcare)
24 x7 safe delivery centers. Out of these eight were sub centers which were upgraded to provide the above services. The
time leading to increased service utilization. Solar power back up, running water supply, SBA trained staff, essential
Mapping of Delivery Centres in Guna District
Rajasthan border. The nearest safe delivery point was nearly 40 Km away with very poor connectivity resulting in 10 %
institutional delivery rate till 2006. To address this it was decided to start delivery services at Fatehgarh Sub centre in 2007
by providing SBA training to the staff and upgrading infrastructure to provide delivery services and essential new bom
care. A total of2963 deliveries have been conducted till date safely at Fatehgarh Sub Health Centre by SBA trained ANMs
not only to Fatehgarh village but also to neighboring 30 villages. Learning from Fatehgarh experience District health
del iveries per year are being conducted successfully at these 8 Sub centers.
SHC, Fatehgarh
Total Deliveries at all SHC in Guna in 2008-09 and 09-10
This need based innovation to operationalize delivery services in remotely located poorly connected sub centers has gone
'along way in promotingANC and skilled birth attendance for the rural women of Madhya Pradesh. In addition with nearly
13 % of the institutional deliveries in the district being conducted at SHC and another 20 % at PHC there has been a 10 %
reduction In cumulative load of Deliveries at District hospital leading to decongestion.
Decongestion at Guna District Hospital
Secretary Health GOI at Jhagar SHC, Guna
Scaling up
for 24 x 7 safe delivery services with technical support of UNICEF. A State level committee was constituted to develop
filling the below mentioned criteria. The accredited sub health centers are providing cash incentive to women and
Unavailability ofdelivery point within 20 km radius
Telephone connectivity and Availability of referral transport(Janani Express)
Two residential ANMs trained in skilled birth attendance & ENBC
MonitoringofLabor through Partographs.
Essential drugs likeMisoprostol andMagnesium sulphate.
centrewasprovidedunderNRHMplansince 2008-09.
24 x 7 SHC, Shivpuri
24x7, SHCMandsaur
Labour Room 24 x 7 SHC Anuppur
At present45O Sub Health Centers have been upgraded in the State to provide 24x7 delivery services. Bytheendof2010
total of500 Sub centers would be made functional for the same. Such need based initiatives to reach the unreached have
resulted in maximizingbenefits ofopportunity provided byJSYscheme to bringwomen from remote villages and excluded
(DLHS-3:47%JSYConcurrent Evaluation Report 2009:72.8%)
SAVING LIFE ON WHEELS -JANANI EXPRESS
24x7 Cali Centre for Referral Transport of Pregnant Women & Sick Children
Background: High Maternal and infant mortality rate is the challenging issue for the state. Considering the WHO concept
of all pregnancies to be considered at risk the state is moving forward with the approach of making EmONC facili ties easily
available and accessible along with referral transport facilities. Lack of availability of transport has been identified as one
access of rural community to safe institutional delivery centers, Government ofMP decided to establish referral transport
system linked to 24 x 7 Call Centre for coordinated contact. The vision is to have a Comprehensive, functional, adequately
successful contraception are the two reproductive health services not designed to treat complications but to avert them
Concept and Operationalization of the scheme
Janani Express Yojna is offering 24 hrs free referral transport facility to urban and rural beneficiaries APL and BPL. It
is operational in 298 block of the state and nearly40% of the beneficiaries ofJSYare availing benefitof the scheme.
lb optimize utilization of the vehicles contracted underJanani Express and ensuring better monitoring of service fleet of
Janani Express has been linked to 24 x7 Call centre situated at district level.First two Call Centres were established at Guna
and Shivpuri with UNICEF technical support To ensure timely availability of vehicle to all pregnant women and also
monitoring ofjanani Express Vehicle the concept of call centrehas been adopted at each district head quarter.
1. Call Centre Model
Components ofModel: The model has two key components
2) Centrally located 24 x 7 Call Centre: This is required to control the fleet of vehicles and ensure Coordinated
Contact. The call centre is located in district hospital campus in a room of roughly 80-150 sq. feet size. It has
minimum 3 dedicated operators on 8 hourly duty shift (One in each shift) .Additional 4th operator can also be kept
to adjust weekly offandfield coordination with drivers andASHAworkers.
The call centre are provided with 2 dedicated telephone lines with both incoming and outgoing facility. Both the
numbers are beingpublicized in community through radio, TV scrolls, posters, banners andASHA workers.The Call
delivery centre about incoming patient The software (provided by UNICEF) uses the information stored to generate
Cost Analysis:
1) Cost of Establishment of Call Centre is undertaken in RCH
• Cost ofSetting up ofCall Centre: Approx. Rs. 200,000
Computer with Printer and UPS: Approx. Rs. 35,000.
AirConditionner 1.5 tonsplit: Approx. Rs. 25,000
Furniture: 2 computer table and 4 visitor chairs: Approx. Rs. 10,000
TWo telephone connectionswith out going facility: Approx. Rs. 5,000
Civil work: Approx 125,000 (allocate room ofabout 100 sq. feet for call centre)
Fleet ofVehicles:
On an average vehicles are being hired @ Rs. 15-20 thousand per month which is inclusive of fuel cost, hiring of
drivers, maintenance ofvehicles fromJSY transport cost
Running Cost: Rs.24,000 per month: Met under RCH
Salaryof4 Computer operators: Rs. 4000 per month x 4 = Rs. 16,000 per month
Electricity and telephone bills: Rs. 4,000 per month.
Contingency: Rs.4,000 per month.
Output ofreferral transport system and Call Center:
Example Guna: In theyear 2007-08 total 5026 pregnant women were transported free of charge from villages of Guna to
accounts for nearly 40 % ofinstitutional delivery taking place in rural area. In addition majority of beneficiaries were from
Combined data of all Call centers in Madhya Pradesh
MODEL MATERNITY WING:
ADDRESSING QUALITY AMIDST QUANTITY
Madhya Pradesh has shown significant gains in terms of Institutional deliveries with DLHS-3 showing institutional
delivery figures of 47.1 % and concurrent assessment ofJSY 2009 reflecting: 72.8% in 2009. The main catalyst for this'
spurt in institutional deliveries has been success ofJanani Suraksha andJanani Express scheme. This rapid rise has also
put a challenge before our health institutions to keep pace with increasing delivery load and provide quality care to the
beneficiaries. The main bottlenecks currently are inadequate infrastructure especially number of Labour beds, Small
Commission grant of Rs 75 crore. The construction of model maternity wings is being taken in a phased manner and by
Model maternity wing will have following section:
1- Labour room
3- Maternityward(ANC,PNCforND)
5- Obstetric ICU
Observation Room
MATERNITY WING TO BE ESTABLISHED IN CLOSE PROXIMITY TO SNCU.
Design ofmaternitywing will be district specific depending upon delivery load, available space and existing infrastructure.
In year 2010-11 upgradation/ establishment of maternity wing will be done in 10 District Hospitals based on Guna
Efforts have been made to address and establish a model maternity wing under NRHM with the technical support of
UNICEF. The focus is on following areas:
District Hospital at Guna has nearly8,000 deliveries peryear. Labour room size was increased to handle 8-10 deliveries at a
square feet area has been marked as patient waiting area for the attendants of women in labou r. 8 Labou r tables have been
In addition following modifications have been made:
Air conditioning: lb improve air circulation, temperature regulation and microbial reduction.
Flooringwith Vitrified Tiles of Isqmtr by 1 sq. mtr to reduce joints.
Wall tiles till 6 feet to maintain hygiene and facilitate cleaning.
False ceilingwith Central Music and concealedlights.
Wall mounted focus lights with each delivery bed for better visibility.
Provision ofuninterrupted hotwater supply 24x7.
2 Attached toilets
Receiving room, changing room, Nursing station, Duty Doctors room in vicinity.
Present: Model labour Room Guna District Hospital
2) Human Resource Rationalization:
Nurses: Total 6 nurses posted in labour room (2 for each shift and 2 for leave and weekly off) These nurses are trained for
handling different range of obstetric problems and proper obstretic protocols. In addition 4 student nurses in Morning
material and training (Total 4).
3) Equipments: As per standard requirement.
No shoes allowed inside, separate clean slippers provided.
Sterile Gowns for patient andStaff.
Regular Floor and wall moppingwith disinfectant
Restricted entry
JANANI SURAKSHAYOJANA
Janani Suraksha Yojana is safe motherhood intervention under the National Rural Health Mission (NRHM) being
With the implementation ofJSY there is substantial rise in institutional delivery but ANC coverage still needs focused
2006-07 the benefit under the scheme was extended to all pregnant women in Madhya Pradesh which is evident by
threefold rise in institutional delivery.
Evaluation ofJSY
improvement in institutional delivery is remarkable as compared to other maternal health indicators. The total
number institutional deliveries have increased from 28.7% to 47.1% DLHS-I1I. In rural sector this rise is appreciable
rise in just one percent between DLHS-2 and DLHS-3.
Increasing trends in Institutional Deliveries with JSY Beneficiaries
Focus on Equity
Concurrent assessment ofjanani Suraksha Yojana (JSY) scheme in selected states of India, 2008
80.3 % women areaware about 24x7 Govt, facilities
72.8 % institutional deliveries.
67.8 % deliveries in Govt, facilities.
68%JSY beneficiaries.
82.7% ofJSYbeneficiaries received any money after delivery.
91.3% women registered forANC.
64.5% of received at least 3 ANC checkups.
37.1% ofwomen consumed 1001FA tablets.
67.9% of institutional deliveries receivedPNC care.
births in health facilities: an impact evaluation
i, Seatie, WA, USA
Madhya Pradesh has achieved highest level ofparticipation and uptake ofJSY.
MadhyaPradesh acclaimedofmakingspecial efforts to accredit remote health facilities.
Steps taken to keep pace with increased delivery load in terms ofquality of services Up-gradation of infrastructure in Public Health Institutions:
Institutional Deliveryhas increased tremendously. It is proposed to strengthen maternity wings of all districts hospitals for
e and NRHM funds.
Accreditation of Private Institutions- Accreditation of private health institutions to provide the benefit ofJSY to BPL
have been encouraged to join hands with govt for increasing the accessibility of the scheme.
Process of accreditation of sub health centers has been is under processed. 450 Sub Health Centres are accredited out of
which around270 are providing essential obstetric care and have been accredited underJSY.
women benefitted under the scheme has been consistently around 1% of the total deliveries from 2005-06 to 2008-09.
The payments are monitored for home delivery beneficiaries, revised guideline of Janani Suraksha Yojana has been
circulated, in accordance to Hon'ble Supreme Court order, regarding cash incentive to all BPL home deliveries within two
days of delivery through VHSC account by ANM. This fund is reimbursed by fund earmarked forJSY under RCH flexipool.
ANM to conduct all home deliveries is being made mandatory.
Microbirth planning:
To address the issue of low ANC coverage due to inadequate microbirth planning as per the recommendations of Goi
following steps are being taken.
state budget and is made available in AHSA kit. ASHA is being trained on pregnancy test at village level.
2.
Pregnancy tracking of each pregnant woman by HID number will be ensured fromJuly 2010. Training to Geld level
Suraksha Card will be in use shortly.
ANM and LHV with focus on nutritional counseling.
Facility Identification and referral transport:
issued to establish call centre in all districts with technical support from UNICEF. Nearly 40% of the rural beneficiaries
Improving the Quality ofService:
2. Quality of EmOC and BEmONC training of MOs and SBA training of SN.LHV and ANM are being strictly monitored
from UNFPA at State & Divisional Head Quarter
will be taken carewith this fund. Additional manpowerwill be managed through RCH.
ensures atleast 2 checkups during post natal period.
Steps taken to Increase PNC checkup as per protocol
Nutritional and family planning counseling.
In NIPI supported 3 districts Yashodas are hired in district hospitals to provide support to women during labour
ensuring 5 postnatal checkups as per protocols, in 3 districts supported by NIPI.
PNCofwomen.
PhysicafcVerifteHion — Physk^’verift:atioh-ofJSi'beBeficiari#s>is donebydie cSsfrict nodal.officer. the institutions
providirigdeiiveryiacility are also inspected. 5% ofthe total women benefited-at district’and 2% at divisional level during
MIS - Records ofJSY are maintained in standard formats in all facilities. Data Entry Operators have been provided in all
district hospitals and civil hospitals with bed strength of 100 or more. Monthly reports on physical and financial progress
are sent from the delivery institution to the block, district and state level.
Grievance Redressal Cell - Grievance redressal cells have been set up in the offices of Block Medical Officers, Civil
Surgeons, ChiefMedical and Health Officers and Directorate of Health Services.
Help Desk-All hospital with high delivery load have help desk for assisting the target beneficiaries ofJSY and Deendayal
Antyoday Yojana and also to maintain records and display of list of beneficiaries .3% administrative cost is being utilized
for this purpose.
CONTINUUM OF CARE OF
SEVERE ACUTE MALNUTRITION IN M.P.
2006 - 2010
Evidence based interventions to address under nutrition in the State
1. Due care ofAdolescent girls and maternal nutrition to help shape the baby's tomorrow
2. Early Initiation ofBreast feeding& Promotion of Exclusive breast feeding up to first 6 months oflife
3.
Improvedaccess to locally available lowcost nutritive foods
4.
Enhanced Knowledge, Attitude and Practices regarding complementary feedingin under privileged populations.
5.
Ensuringavailabilityofmicronutrients-Zinc, VitaminA, IFA, Iodine
NRC conceptualized and set up in Shivpuri district in January 2006
IAP guidelines adapted
Admission criteria - W/A (Grade III & IV)
Locally made F-75 & F-100, and mixed Diets
Discharged from NRC after 14 days
NRC Strengthened - 2007
47 NRCs established till mid 2007 across the State
IAP 2006guidelines followed
• Appropriate infrastructure and Staff recruitment
-Treatmentcost-Rs. 3375/Child
- AWs to refer SAM children to NRC
Residential Trainings ofNRC Support Staffstarted
- Standardized preparations as per IAP of F-75 & F-100 taught
-MUAC&W/H measurement introduced butadmission criteria remainedW/A
- Support ensured by UNICEF - W/H wall charts, MUAC tapes
More than 100 NRCs functional by 2008
■Way Forward in-2009
196 NRCs functional
Appetite test formulated and standardizedwith local available food
- Locally made F-75 and F-100 as per IAP/WHO protocol along with
Admission criteria
-MUAC<11.5cm&/or
-Bilateral pitting Oedema
-4 Followups at 15 days intervals for 2 months
Appropriate MIS system
Present NRC Scenario-2010
210NRCS functional
- Locally made Therapeutic Feed introduced across the State
Discharge criteria from Program
-15% weightgain over the Admissionweight
Introduction of Multi-charts for recording feeding and treatment of
Supplementary suckling technique (SST) unit in NRC for
managementdf <6mSAM child
manner, and in year 2010-11,45 NRCs are proposed to be established to
cover the high risk blocks.
In the year 2009-10,33645 children were
followed. All the functional NRCs have one
Financial Guidelines for Bal Shakti Yojna
Certain evidence based studies have showed that majority (>75%) of the SAM cases who are not medically complicated
can be treated in the community itself with an outpatient program, while only 15-20% cases who are diagnosed with
medical complications, require treatment in facility based care (NRC). Hence, both DoPH&F\V and DoWCD in
severe acute malnutrition. It has been recommended by AIIMS, New Delhi, and IaR that therapeutic feed is required for
optimum treatment ofSAM both at Facility level as well as Community level.
URGENCY OF IMPROVING
NEW BORN SURVIVAL IN MADHYA PRADESH
STRENGTHENING FACILITY BASED
NEW BORN CARE THROUGH SCNU
Background: The Millennium Development Goal (MDG) 4 of the United Nations Millennium Declaration calls for a two
thirds reduction of the under five mortality rate between 1990 and 2015. The National Population Policy of India has set a
goal of achieving an IMR of 30 and NMR < 20 by 2010. In Madhya Pradesh, as per SRS 2008 Infant Mortality rate at 70 per
1000 live births is highest in the country with a high Neonatal mortality rate of 48 per 1000 accounting for 69% of Infant
deaths and 52% of under five deaths. Not only is the Neonatal mortality in the State high but has only reduced by three
points during 2002 to 2008 as against the fail of 15 points in the IMR during the same period. As a result proportion of
neonatal deaths ofall infant deaths has increased from 60% in 2002 to 69% in 2008. (Data Source: SRS)
Thus if reduction in IMR has to be expedited and MDG for child survival is to be
met, priority must be given to prevent Neonatal deaths.
institutional delivery rate leading to increased load of new bom at delivery centers, 10% ofwhich require specialized care
hospitals was
the biggest
Program Strategies to Improve New Born Survival:
To address high Infant and Neonatal mortality in the State, Continuum ofCare from Community to Health facility has been
through emergency transport system connected to 24 x 7 Call centre. This approach was first piloted with UNICEF support
in Guna in the year 2007 and is nowbeingscaled up State wide under NRHM.
lb meet the need of providing specialized care to increasing load of new bom in line with rise of institutional delivery
and referrals under IMNCI, Sick New Bom Units are beingset up at District and Blocklevel. First two such units were set
up by Government ofM.P with support from UNICEF in Guna and Shiipuri districts.
Salient Features of Each Unit:
• 20 bedded unitwith nearly 2000 sq feet area
• FourPediatrician.TWelvestaffnursesandTWolabtechnicians
• Separate section for inborn and Out bom babies
• Breastfeedingroomineachunit
• Central oxygen supply with Power back up
• Establishment cost of each unit Rs. 45 Lakhs.
(Civil work Rs.25 lakh, Equipments 20 lakh)
• Runningcostofpilotunitsandscaleupentirely throughNRHM
• Eachunithasapotentialtosave 1200 New bom every year.
These units in addition to inborn deliveries also cater to sick babies born
saved in last two years. Scale up to all
50 districts by December 2010.
Newborns identified through home visits and referred under IMNCI. The
District hospital units are level-11 unit and are linked to smaller
stabilization units at block level and level III unit at medical college.
Scale up Plan: Government of Madhya Pradesh is committed to scale up these units in all 50 districts of the State in the
year 2010-11. As of now 16 district level units are functional and another 20 are in final stages of construction.
Necessary budgetary provisions have been provided under NRHM plan for 2010-11 to support scale up. In addition, the
State has made necessary HR policy changes to meet the human resource demand to operate these units
Status of Sick New Born Units
(29
Salient Features of Each Unit:
• 20beddedunitwithnearly2000sqfeetarea
■ EstablishmentcostofeachunitRs. 45 Lakhs.
(Civil workRs.25 lakh, Equipments 20 lakh)
■ Runningcostofpilotunitsandscaleupentirely throughNRHM
• Eachunithasapotentialtosave 1200Newbomeveryyear.
50 districts by December2010.
These units in addition to inborn deliveries also cater to sick babies born
at peripheral health centers as well as serve as a referral unit for Sick
Newborns identified through home visits and referred under IMNCI. The
stabilization units at block level and level III unit at medical college.
2§)
Scale up Plan: Government of Madhya Pradesh is committed to scale up these units in all 50 districts of the State in the
year 2010-11. As of now 16 district level units are functional and another 20 are in final stages of construction.
State has made necessary HR policy changes to meet the human resource demand to operate these units
Survival at One Year ofAge: Guna SCNU Data
Future Plans:
(Currently in two blocks to be scaled up to six districts this year).
Extending Continuum of Care Back to Conununity to ensure survival ofNew born after discharge from SCNGs
(Piloted in Guna and Shivpun).
EMERGENCY AMBULANCE SERVICE
Emergency is a sudden unplanned occurrence of an event that poses immediate risk to life, health, property, daily life and
demands immediate action. Most emergencies require urgent intervention to prevent a worsening of the situation or at
least offer palliative care for the aftermath. Medical services andMedical care are one of the essential services that would
be required at this stage to reduce the levels of risk on Life and Health. The Department of Public Health and Family
Welfare, Government of Madhya Pradesh, has labeled this issue as a top priority of concern and invited Emergency
Management & Research Institute (EMRI), Hyderabad a Hot for profit' organization to develop and operationalise
emergency response units in the entire state and signed a Memorandum of Understanding (MoU), with EMRI on 25th
esidents ofState.
Bhopal Launch
Indore Launch
^ice(EMS).system is beingdeveloped to provide pre-hospital acute care and
transport to definitive care, to patients with illnesses and injuries which constitute a medical emergency. The aim of EMS is
to provide treatment to those in need of urgent medical care, with the goal of either satisfactorily treating the malady, or
arrangingfor timely removal of the patient to the next point ofdefinitive care. The framework is being developed including
a call center and supported activities of emergency handling as medical assistance to critical patients, ambulance
management and equipment management The major institutions and infrastructure setups like hospitals, police
stations, and fire brigades are being identified and a system of networking is also being established between these
institutions and the Emergency Management Service system. Well equipped vehicles, with GPS, GIS maps, Automatic
Vehicle Location Tracking and Mobile Communication systems and adequately equipped with manpower & other
resources to taddewith a various possible medical emergencies alongwith providing appropriate support for other forms
ofemergencies occurringslmultaneously are being developed.
At present the status of the project is that 55 ambulances are running in four districts- Bhopal, Indore, Gwalior&Jabalpur
and it is expected that byMarch/April 2010, another 45 ambulanceswill be added to the project. These ambulances are
the Health Facility for necessary medical care.
A State level call centre has been established at Bhopal to receive and segregate/ dispatch the calls received for any
emergencies. The uniform number is “108” (Toll free) which can be accessed from landline as well as mobile telephone.
Emergency Medical Service system provides pre-hospital acute care and transport which covers definitive care to
such system in the State linking and providing the complete Sense, Reach and Care.
These would be first ambulances in the state with GPS, GIS Maps, Automatic Vehicle Location Tracking and Mobile
b) Ambulance Management
Pre-Hospital Care of Injured
districts presently. This would also help reduce the IMR and MMR along with road side accident death cases in the State.
ambulances in these 4 districts with 15 ambulances in Indore, 14 ambulances in Bhopal &Jabalpur and 12 ambulances
Following table shows the total number ofemergencies transported till 20thJanuary, 2010 and breakup also:
Emergency Type
Acute Abdomen
Animal Bite
Cardiac
Diabetes
Others** Poisoning/
Drug Overdose
Pregnancy Related
Respiratory
Suicide
Trauma (Non Vehicular)
Trauma (Vehicular)
Total
Bhopal
618
64
442
61
2475
84
3214
. 355
6
404
2684
10407
Indore
210
26
162
20
883
84
1075
114
6
184
1375
4139
Gwalior
419
109
146
28
1784
106
2685
209
10
353
1774
7623
Jabalpur
1345
179
508
44
3088
230
4007
384
7
301
1490
11583
Total
2592
378
1258
153
8230
504
10981
1062
29
1242
7323
33752
(a)
Costofnew45vehicles®Rs. 10.501akhsperunit
(b)
Operational costofold 55 vehicles @ Rs. 12.00 lakhs per unit peryear.
(c)
Operationalcostofnew45vehides@Rs. 12.00 lakhs perunitperyear.
Operational cost for old 55 vehicles is proposed 60% of the total requirement and for new 45 vehicles is proposed 80% of
the total requirement as per guidelines issued by Ministry ofHeal th and Family Welfare, Government of India.
Department of
Public Health & Family Welfare
Madhya Pradesh
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