Private Sector Integration: Key To Reducing Maternal Mortality In India

India struggles with high maternal mortality due to significant inter- and intra-state inequities in maternal health services. However, the current SRS data suggests that India's Maternal Mortality Ratio (MMR) has improved to 103 in 2017-19, from 113 in 2016-181, highlighting improvements in our health systems. While this may seem an encouraging sign that the country may well be on its way to achieving the SDG target of a Maternal Mortality Ratio (MMR) of 70 lakh live births by 2030, we still have much ground to cover, especially when it comes to ensuring quality care, equity, and dignity for mothers. While as a country we have leapfrogged in making health care accessible and affordable for mothers, quality remains the missing link. Quality and quantity of care need to be integrated for better outcomes.

India accounts for 12 per cent of all maternal deaths globally, according to the World Health Organization. Most of these are preventable and linked to issues like severe bleeding, high blood pressure, post-childbirth infections and birth complications. Moreover, the health system's disruptions caused by the pandemic have exposed its frailties worldwide, impacting maternal health care immensely. As per a review by The Lancet, global maternal and fetal outcomes worsened during the COVID-19 pandemic, increasing maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. One way to help reduce fatalities is to intensify the support from the private sector as it can be an essential part of improving women's reproductive and maternal health. The private sector's expertise and market-based solutions can augment innovations in delivering solutions and creating advanced technologies to bolster health systems globally.

How accreditation can be a game-changer in integrating the private sector

In India, over 30 per cent of mothers choose to deliver in private sector facilities and the number has only been growing in every survey conducted over the last few decades. Therefore, to reduce maternal and neonatal mortality and optimise service delivery, it is essential to include the private sector which is already providing a significant quantum of care. Private facilities are empanelled by the country’s ambitious universal health care scheme- Ayushman Bharat which targets the not-so-literate or affluent India. The Government and the development community have mainly focused on strengthening the public health system, but the country needs efficient solutions from the private sector as well to fully address the gaps in maternal care to realise Prime Minister Modi’s vision of "One Nation, One Standard".

There have been ambitious initiatives towards improving the quality of maternal and neonatal care in public facilities through accreditation programs such as LaQshya, a flagship program of the Government of India which focuses on reducing maternal and newborn morbidity and mortality. When adopted by private facilities, accreditation can help accelerate decline in maternal and infant mortality and improve outcomes, as evidence suggests that by improving facility-based care, complications can be drastically lessened. Not just that– local private providers are often the first line of response for families needing health care and when complications arise in ill-equipped set ups. A woman deserves the best provision of care per WHO recommended guidelines wherever she chooses to seek care.

In their call to action towards 2030, the SDGs emphasize intersectoral coordination and cooperation between governments, civil society and businesses to achieve its goals. This would translate to strengthening the countries' capacity to manage the private sector and mixed health systems for the health sector, so that providers can more effectively contribute to the Universal Health Coverage (UHC) goal. To this end, public-private partnerships are increasingly seen as a vital avenue for tackling health challenges. One of the best examples in India is FOGSI's partnership with the Public Health Department, Government of Maharashtra under LaQshya-Manyata, aimed at improving the quality of care in private maternity facilities.

FOGSI’s recent collaboration with the National Accreditation Board for Hospitals and Healthcare Providers (NABH)/Quality Council of India (QCI), India’s apex body for accreditation and quality promotion, to advance the Government’s vision to improve the quality of maternity services in the country. This collaboration is intended to reinforce ‘One Nation One Standard’ where clinical standards of hospitals and nursing homes having maternal care facilities, will be jointly assessed by NABH and FOGSI, to achieve consistent, safe, and respectful care for mothers during and after childbirth. Envisioned to improve and standardise quality across all maternal and child health facilities in the country, the collaboration is a landmark step in our evolving health system.

The role of professional associations in making India a safer place for childbirth

Private sector integration extends much beyond hospitals and healthcare staff. It means. mobilising professional associations to work jointly in addressing public health challenges can serve as a link between the Government and the private sector, keeping communities safe.

To illustrate, the Federation of Obstetric and Gynecological Societies of India's (FOGSI) flagship initiative, Manyata, involves the public and the private sector at the foundational level. It equips health care staff with essential clinical and patient care protocols to deliver a safe and respectful birthing experience to mothers through quality improvement and certification. Manyata, a quality certification program for private facilities spread across 22 states, not only helps improve quality but also equity. The endeavor skills teams in private facilities including in India's remote, hard-to-reach, and underserved areas, particularly the Aspirational Districts, and is trying to usher in a “Quality Culture” across private facilities, so that that every mother receives standardised care.

Our Prime Minister, Narendra Modi, has also heralded a focus on strengthening the public-private partnerships in the quest for making India self-reliant. As he expressed that "To keep India ready for any eventuality, it is critical to strengthen the health sector." Therefore, strong partnerships are imperative to revolutionise the health ecosystem. These need to be guided by science in this case evidence gathered on what can better population level outcomes.

Public Private Collaboration is Promising

India is known as a crucible of ingenuity in global health, and such initiatives are testimony to that. We hope that the private-public sector consociation will bring changes to accelerate universal coverage, improve quality and help achieve a standardized quality of healthcare and increase the resilience and preparedness of the health system. By fostering growth in the private sector, these innovations and collaborations will help create a self-sustaining model to reduce maternal mortality and take the country closer to its vision of providing every woman with a safe and healthy childbirth experience.

India is leading by example under an inspirational leadership powering inclusive growth. Let’s ensure no woman is left behind.

The author is India Director, MSD for Mothers

Pompy Sridhar

Guest Author