Battling maternal deaths, Assam upgrades health workers' skills

Guwahati, April 22 (IANS) Assam, which has the highest maternal mortality rate (MMR) in the country at 390 per 1,000 live births, also faces a serious crunch of doctors. So the state is now rolling out rural health workers, upgrading skills and making it mandatory for medical students to practise in villages.

Prateek Hajela, mission director of the National Rural Health Mission (NRHM), Assam, said the state has been adopting a host of initiatives to tackle the issue.

"Lack of doctors and trained specialists, even nurses, is a huge problem in Assam. I don't think lack of infrastructure is that big a problem. I mean, we have first referral units (FRUs) which are non-functional because of dearth of manpower," Hajela told IANS.

Admitting to the seriousness of the issue - of lack of manpower - in the face of an already critical problem of high MMR, Assam has thus been designing new courses and implementing new laws to retain its human resources and upgrade the skills of existing health workers.

"The Assam government's own health university, the Srimanta Sankardeva University of Health Sciences, which was established in 2009, offers a three and a half year training programme, at the end of which, one can practise as a rural health practitioner," Hajela said.

"It is a diploma programme and one can enrol right after Class 12. These rural health practioners are posted in the sub centres and health facilities in the village level, and are capable of handling complicated deliveries, but not a C-section. That can only be conducted by a specialist," he added.

Hajela said these health workers can largely fill the void left behind by doctors. Three batches, constituting 300 students, are already enrolled in this course.

Then again, considering that a number of medical students from Assam go outside the state for specialisation, and then stay back to work in bigger hospitals, the state decided to upgrade the skills of existing doctors in government hospitals.

"We have created our own course which aims at skill upgradation of doctors. It's a two-year diploma programme and will help enhance his or her skills to deal with more complicated cases in a better manner," Hajela said.

The course is approved by the Medical Council of India (MCI) and will be on offer from this year.

According to Hajela, despite the course not giving doctors the tag to practise as a gynaecologist, government hospital doctors "are willing" to enroll.

To address the issue of dearth of nurses, the government has also introduced a six-month course for Auxillary Nurse Midwife (ANM), after which one will reach the same level as a General Nurse Midwife (GNM).

"There is a dearth of doctors, paediatricians and nurses; and the government knows that it cannot compete with the market when it comes to luring these professionals. So we have to come up with innovative techniques to either retain them or somehow plug the hole," he said.

For instance, the government was in a dilemma when doctors did not respond to its call to work in the river island Majuli in Assam which desperately needed good health services. The health minister even tweeted saying that monetary incentives were failing to do the trick.

"The problem got sorted out after we offered Rs.75,000 per month to specialists to work in the island," Hajela told IANS.

The state has, however, now made it mandatory for its medical students to practise in a rural area for a year in order to be eligible to do post-graduation in Assam. This has brought a fresh lease of life to the primary health facilities in villages.

Tying up with medical colleges to spread awareness on various issues, and giving them the role of mentoring is yet another initiative. For a paediatric conference in the Karimganj district for instance, the health department roped in the Silchar Medical College.

Although Assam improved its MMR from 480 (2004-06) to 390, it is still way above the national average of 212 - which, in itself, is still far off from the Millennium Development Goal of bringing down the MMR to 109 by the year 2015.

(Azera Parveen Rahman can be contacted at azera.rahman@gmail.com)