THIRUVANANTHAPURAM:
Kerala’s consistent and concerted efforts to improve its health indices have hit a stellar milestone as it achieved the Infant Mortality Rate (IMR) of 7 per 1,000 live births, which is not only the lowest in India but also meets a Sustainable Development Goal (SDG) of the UN that has set a target of 8 for this vital health parameter.
Kerala also has the distinction of having the lowest Maternal Mortality Ratio (MMR) in the country, which is below 30 per 100,000 live births for the year 2019-20 as per the HMIS compared to 43 in 2016-18. India’s MMR in 2016-18 has been 113 while the SDG target is to reduce the global MMR to less than 70 by 2030.
The state government’s programmes and strategies to further reduce IMR and MMR will be discussed on February 24 at a webinar series, titled ‘Kerala Health: Making the SDG a Reality’.
Chief Minister Pinarayi Vijayan will inaugurate the event, organized by the state’s Department of Health and Family Welfare on Feb 17. The five sessions of the webinar series, each session dealing with a specific health issue, are staggered over this month and early March.
The major components of the state government’s programmes to reduce MMR are maternal death audit, disposable kits, Obstetric Rapid Response Team in major hospitals, and skill lab trainings conducted at the Kerala State Institute of Health and Family Welfare, Kozhikode to train staff nurses on delivery services.
“Kerala is the first state to implement confidential audit of all maternal deaths in the government and private sectors, which are audited by a committee constituted by the District Medical Officer (DMO) and the partners KFOG representatives,” said state Health and Family Welfare Minister K K Shailaja, adding: “Maternal deaths are mostly preventable through quality and skilled care and investments in improving hospital infrastructure.”
The major causes of maternal deaths, as listed by UNICEF, are severe bleeding, infections, high blood pressure during pregnancy, and complications from delivery and unsafe abortions.
The strategies adopted by the state in MMR reduction hinge on prioritizing the policies, strategies and activities based on evidences. Disposable delivery and caesarean kits have been introduced in hospitals to improve the quality of care, reduce hospital infections and measure the blood losses during the delivery.
Further, emergency obstetric care trainings for the gynaecologists and staff working in the labour room are conducted in association with the KFOG.
In 2012, the Kerala government joined with NICE International and KFOG to implement Quality Standards in obstetric care in both public and private hospitals. Five simple steps were recommended to address the problems of post-partum haemorrhage (PPH) and hypertension, the two leading causes of maternal deaths in the state and globally.
In 2014 -15, the Central Government had recommended to start ‘near miss’ reviews, which was started in Kerala. “We started the review as a pilot project involving all major government medical colleges and it is still continuing,” the minister said. “As a result of these activities, Kerala’s MMR has now come down to below 30 for the year 2019 -20”
As for the IMR, the state government’s policies include strengthening public sector for managing newborn and infants requiring intensive critical care by infrastructure development and capacity building; implementing quality standards in government-run and private hospitals through partnerships with professional bodies, and focused intervention on improving survival of all salvageable babies like those with congenital heart disease and low birth weight.
Based on the 2014 Sample Registration System (SRS) report of the Registrar General of India, IMR in Kerala was 12 and there were projections of around 6,000 infant deaths occurring every year. After setting the targets under SDG, the state government’s efforts to improve the figures on IMR and MMR have yielded commendable results.
