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Stronger Together: Building Capacity and Creating Networks to Improve Maternal Care in India

By Dr. Mahesh Srinivas, Director of Programs, Pathfinder International (India) and Chandrashekhar Joshi, General Manager, World Health Partners

January 19, 2017

When Sunita, a 23-year-old woman from the village of Sajethi in Uttar Pradesh, India, became pregnant with her third child, she went to the nearest public health center. She was registered and asked to return during her second trimester when she would receive immunizations.

For pregnant women, diagnostic testing, including checking blood pressure and measuring body weight, and discussions about warning signs during pregnancy and birth preparedness, are an integral part of prenatal care and key to preventing maternal and newborn deaths. Yet, too often, providers in local communities do not have the capacity to offer these services.

For millions of women in rural, low-income settings around the world, Sunita's experience is all too common. In 2013, nearly 50,000 women in India died from complications during pregnancy and childbirth.

This number was shocking to us. At Pathfinder International and World Health Partners (WHP), our work is driven by a commitment to reducing this number and we understand the importance of partnerships and meaningful collaboration to truly improve outcomes and drive change.

Therefore, in 2013, we joined forces and launched the Matrika program, with support from MSD, through its MSD for Mothers initiative. Through Matrika, we sought to leverage the best of our organizations by increasing access to quality care for women, like Sunita, by building the capacity of providers at both public and private health care facilities as well as creating an unprecedented partnership between public and private health systems across three districts in Uttar Pradesh.

Our work and this program really made a difference for Sunita. When she began to feel incredibly weak shortly after her visit to the public health clinic, Sunita turned to her community health worker or "ASHA" for help.

The ASHA, trained by the government and Pathfinder, brought Sunita to a private center (part of World Health Partners' network of providers supported by Matrika) where she was examined and able to consult with a city-based gynecologist through telemedicine technology. While there, Sunita received diagnostic tests that revealed she suffered from low blood hemoglobin and low blood pressure – signs of a potential high risk pregnancy. She was advised to take iron and folic acid supplements and rest. By Sunita's next visit, her health had improved and shortly after she delivered her child.

Through the Matrika program, providers at 58 rural private facilities and approximately 3,000 frontline workers in the public sector were trained to deliver higher quality antenatal care. For many providers in the network, this was the first time they provided maternal care and diagnostic services. Our program also established a referral mechanism between the public and private sectors – which was critical to ensuring women received care.

For Sunita, and many of the 160,000 other women impacted by the Matrika program, the increased quality of care available in the public sector led them to choose a public facility for their delivery, even if they had received antenatal care from a private provider. The ability for women to go between sectors and receive the best care possible is a significant program achievement.

While we're inspired by Sunita's story, challenges still remain for women facing obstetric complications. We know that future projects will need to address the need for a seamless referral system, specifically for managing obstetric emergencies. Our hope is that the Matrika program helped demonstrate the feasibility and benefits of a joint public-private initiative to improve the quality of maternal health care.

With continued focus on improving the network and referral system, we're dedicated to ensuring more women like Sunita receive the care they need for a healthy pregnancy and a safe delivery.

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Dr. Mahesh Srinivas, Director of Programs in India

Dr. Mahesh Srinivas is the Director of Programs for Pathfinder International in India. He is a medical doctor and public health management specialist with more than 15 years of experience. He has worked on a range of public health programs including reproductive and sexual health, child health and nutrition, HIV & AIDS, tuberculosis, comprehensive eye care, and water and sanitation. He joined Pathfinder in 2014.

Chandrashekhar Joshi, General Manager, World Health Partners

Chandrashekhar Joshi began his career with Liam Health Care, a service delivery project of DKT International, targeting the urban poor in New Delhi. He spent over four years with Janani, a rural family planning social franchise affiliate of DKT International in Bihar. In both organizations, his work focused on managing franchised clinics, creating rural outreach networks, and supervising commodity procurement and the supply chain. With his expertise in large scale rural implementation and operations management, he was brought on to help start WHP. Joshi has a postgraduate degree in sociology and a Post Graduate Diploma in computer application from the Excellent Computer Education Program at Haldwani, Nainital.