Student Dissertation

Agency : Three Delay Model; Tribe; Maternal Death; Referral System; Perception

Objective : 1. To explore the facility based referral mechanism of pregnant women in Kandhamal district of Odisha. 10 2. To assess the institutional preparedness for assured basic obstetric care services in Kandhamal district of Odisha. 3. To study the perception of pregnant women for service availability and it quality in Kandhamal district of Odisha.

Background : Kandhamal District, home to Kutia kondh tribe, is a hilly district in Odisha. With figure of MMR 245, one of the highest amongst the entire district in Odisha. Most of the deaths are attributed to direct obstetrics cause. Based on the three-delay model of maternal death, an effort has been made to understand the perception of patient, referral system mechanism and preparedness of the facilities for obstetrics care.

Methodology : A descriptive retrospective study was carried out for a period of three months in Kandhamal district of Odisha, which is home to the scheduled tribe, ‘Kutia-Kondh’. This district has been categorized in the list of high-focused districts and tops all for its maternal and Under-five mortality. Based on the secondary data of total delivery in last two months, available from hospital record, three top blocks with maximum delivery at district hospital were selected. 61 cases of these blocks were randomly selected and trace back to their residence with the help of ASHA and ANM for personal interview & data collection using semi-structured questionnaire, designed for qualitative and quantitative data. Further, facility assessment of all the delivery points was done using a separate checklist. Analysis was done with SPSS and MS-excel.

Findings : HR: 35% of available staff is BmoC, NSSK & SBA trained. LR:70% of the required infrastructure is available but 12% is still lying unused Non-availability of Systemic documentation of referred cases. Cause of referral of 7 cases out of 31 referred was documented. Only 47% of the patients received the ambulance service. 43% called but could not get the service in time Time lost: 28% of patients required 2 or more than 2 hours to reach DHH. In addition, 44% of patient received treatment in 30 and more than 30 minutes. 18% of patient received the services within 30 or more than 30 minutes. 51 respondents of the total respondents (61) preferred to advice other to go to DHH at the time of delivery

Recommendations : Kandhamal district is an HPD therefore efforts should be made to provide required infrastructure and manpower. Training of newly recruited staff and refresher trainings of old staff should be focused. Implementation of MNH Tool kit is still not meet in Kandhamal. Reporting of referral cases, details and documentation is not present in any of the primary level delivery facilities. Measures to improve accountability of the health system to provide quality care should be strengthened.


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