The Yogi Adityanath government is planning its own annual survey, starting with interviewing around three lakh women who delivered a child in Uttar Pradesh in the last one year, in an effort to bring down its high maternal and infant mortality rates, News18 has learnt.
The burden of maternal mortality, neonatal and infant mortality of Uttar Pradesh is disproportionately higher than the rest of the country, the UP government said in a proposal document accessed by News18.
As per the Sample Registration System (SRS) estimates, 2018, UP’s Maternal Mortality Ratio (MMR) has been 197 maternal deaths per 100,000 live births, while Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) estimate for UP were 43 and 32 per 1,000 live births, respectively, much higher than the national average.
The state now wants to analyse its health data “more granularly” than that offered by various central data sources such as the Health Management Information System (HMIS), SRS and National Family Health Survey (NFHS).
“An annual quantitative survey is proposed, which can be used to monitor the government’s investments and help track the state’s progress on critical health indicators. We expect that a coverage of about 2.8 lakh women delivered in last one year across rural and urban UP will be required to provide the district-level representative estimate of Neonatal Mortality Rate (NMR) and Infant Mortality Rate (IMR). This sample would be sufficient to provide the regional estimate of Maternal Mortality Rate (MMR) as well. The same group of women can also be interviewed,” the document states.
UP’S FIGHT AGAINST MOTHER-CHILD MORTALITY
The SRS Bulletin for 2020 released last month had said that UP’s infant mortality rate was down to 38 in 2020, from 43 in 2018, and 61 almost a decade ago. The latest figure was, however, still much higher than the national average of 28. A recent NITI Aayog report also said UP is one of the progressive states in the improvement in various health outcomes.
The 2018 estimates, however, still suggested that given the projected population, around 12,000 mothers and 2.5 lakh children aged below one year are expected to die annually in UP. Further, the Global Burden of Disease Study, published in 2017, showed a considerable variation in IMR across the 75 districts, with the lowest of 36 in Deoria and highest of 76 in UPs Badaun district.
“Such variations also call for geography-specific interventions (district or cluster of districts) to increase the pace of reduction in mortality. The Government of UP is committed to achieving the Sustainable Development Goal (SDG) by reducing MMR to below 70 and NMR to 12 by 2030 through strengthening the health infrastructure, promoting public-private partnerships, and addressing the complication management by training providers and strengthening referral mechanisms,” the UP government proposal says.
THE NEW SURVEY
Critical health indicators will be covered in the new survey covering domains such as reproductive health, maternal, newborn and child health, risk factors, mental health, treatment-seeking pattern, exposure to telemedicine, out-of-pocket health expenditure, exposure to Ayushman Bharat Yojna, substance use, tuberculosis and multidimensional poverty.
“In addition, this survey is expected to provide a robust estimate on infant and neonatal mortality at the district level, while maternal mortality at the regional level,” the state says.
The study would also attempt to provide MMR for five broader regions of the state — East, West, Central, Bundelkhand and Tarai region. The state wants its own survey as its feels that HMIS provides aggregate level data and does not allow for deeper individual level analysis, while survey data such as that of NFHS provides estimates at an interval of three-five years. Similar is the issue with SRS, where the mortality data has limitation in in-depth exploration, the document says.
“Considering these drawbacks with the existing data sources, the state is planning to develop an internal system to arrange disaggregated representative data periodically, which can be used to monitor and provide insights on persisting gaps for needful action. Moreover, considering a wide variation in the coverage of health services, outcomes, as well as the differential in the rate of change in mortality indicators, it would be most crucial to identify the geography and socio-economic strata having poor coverage indicators and the reasons behind it,” the state government has said.
The survey is expected to help the state understand and prioritise the geographic and programme-related areas for maternal and childcare interventions, understand key socio-demographic, contextual and factors associated with maternal, neonatal and infant deaths and come up with the strategies for improved provisioning of services in the health care facilities through action plans, protocols and policies.
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