Mentoring of the Primary Health Centers by Obstetricians: A Novel Public Health Program from Tamil Nadu, India
Rahul Anand Kanakasabapathy, Nandini Annamalai
Antenatal care, First referral unit, Maternal health, Mentoring, Primary health center, Public health program, Rural health, Telemedicine
Citation Information :
Kanakasabapathy RA, Annamalai N. Mentoring of the Primary Health Centers by Obstetricians: A Novel Public Health Program from Tamil Nadu, India. J South Asian Feder Obs Gynae 2022; 14 (5):606-610.
Introduction and objectives: The healthcare system of India, being publicly funded relies on the numerous health programs run by the government. Maternal health is benefitted from many such programs. One such innovation by the National Health Mission, Tamil Nadu is the “mentoring” program, where obstetricians from the first referral units (FRU) mentor the service providers at the primary health care level. Our study aims to examine the efficacy of the program.
Materials and methods: We conducted a prospective, mixed-methods, longitudinal study at Government Kamaraj Hospital, Chidambaram, Tamil Nadu. Two blocks of the taluk and their nine primary health centers (PHC) were included in the study. The two-mentor obstetricians gave virtual mentoring over WhatsApp groups and real-time mentoring by organizing camps twice a month and collecting the data.
Results and discussion: A total of 1,054 antenatal women-kilometers per week were saved due to the reduction of travel from PHC to FRU. Reduction in the waiting time at the outpatient department (OPD) of FRU from 74 ± 31 minutes to 52 ± 19 minutes. Increase in the proportion of elective surgeries by 53%. Reduction in the rate of re-referrals by 5.8 times. The questionnaire-based satisfaction score showed 82% of the PHC team were extremely satisfied with the mentoring program.
Conclusion: Mentoring of the primary health care providers by the obstetricians of the FRU is a novel and innovative concept by the National Health Mission, Tamil Nadu, and has helped bridge the gap between pregnant mothers and obstetricians in the resource-limited setting of the rural public sector.
Black RE, Taylor CE, Arole S, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. Conclusions and recommendations of the Expert Panel. J Glob Health 2017;7(1):010908. DOI: 10.7189/jogh.07.010908.
Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016;387(10017):462–474. DOI: 10.1016/S0140-6736(15)00838-7.
Bhatia M, Dwivedi LK, Banerjee K, et al. Pro-poor policies and improvements in maternal health outcomes in India. BMC Pregnancy Childbirth. 2021;21(1):389. DOI: 10.1186/s12884-021-03839-w.
Kumar JR. Role of public health systems in the present health scenario: Key challenges. Indian J Public Health 2013;57(3):133–137. DOI: 10.4103/0019-557X.119808.
National Health Mission, Ministry of Family and Health Family Welfare, Government of India. LaQshaya – Labour Room Quality Improvement Initiative. 2017. Available at: https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCH_MH_Guidelines/LaQshya-Guidelines.pdf. Accessed date: 12 June 2022.
Johns Hopkins Program for International Education in Gynecology and Obstetrics. Improving Quality of Maternal and Newborn Health in India. 2016. DAKSHATA – Government of India's strategic initiative for Quality Improvement in Labor Rooms. Available at: https://www.jhpiego.org/wp-content/uploads/2016/10/MNH-factsheet_-July-2016_final.pdf. Accessed date: 12 June 2022.
Ministry of Family and Health Family Welfare, Government of India. Surakshit Matritva Aashwasan (SUMAN). Available at: https://suman.nhp.gov.in/. Accessed date: 12 June 2022.
Health and Family Welfare Department, Government of Tamil Nadu. Health Directorates. https://www.tnhealth.tn.gov.in/tngovin/healthdirectorates.php. Accessed date: 12 June 2022.
Wadhawan I, Sarkar A. The unique challenges faced by obstetricians of a lower-middle income country during the COVID-19 pandemic. J South Asian Feder Obs Gynae 2021;13(5):347–348.
Qureshi A, Muzaffar U. Impact of COVID-19 lockdown on admissions to a tertiary maternity hospital in Srinagar. J South Asian Feder Obs Gynae 2021;13(1):55–57. DOI: 10.5005/jp-journals-10006–1857.
The Hindu. National Health Mission selects TN's mentoring concept as best practice. Available at: https://www.thehindu.com/news/national/tamil-nadu/national-health-mission-selects-tns-mentoring-concept-as-best-practice/article33649224.ece. Accessed date: 12 June 2022.