Reducing maternal mortality has been a long standing global health priority, and India is no exception to this agenda. 45000 women die every year during childbirth in India, contributing to nearly 15% of global maternal deaths.
One of the key reasons for losing these lives is most often due to sub-standard and inconsistent quality of care. Cognizant of this scenario, the Government of India, in recent years, has made considerable efforts towards improving the quality of maternal care in public health facilities. However, in a country where private providers account for close to 48% of institutional deliveries, there is an unprecedented need to focus on private facilities.
Recognising this gap in maternal health systems in India, MSD for Mothers, with FOGSI (Federation of Obstetrics and Gynaecologists of India) and Jhpiego, saw a compelling reason to institutionalise a program that standardizes the unregulated private maternal health sector in the country. Together developing a quality improvement and assurance program – Manyata, in 2013. The program was designed with a vision to provide quality maternal care to women in low and middle-income regions in India.
In the current times, a program like Manyata gains further relevance as increasingly, national and international governments are committing to reach the goal of Universal Health Coverage (UHC), a mainstay of the Sustainable Development Goals (SDGs). However, government’s efforts towards UHC tend to focus almost exclusively on the public health sector, neglecting private care and its potential to increase access of vital health care services. Following the United Nations mandate on SDGs, Manyata is a critical initiative towards SDG3.1 goal thatindicates global action for reducing maternal mortality ratio to less than 70 per 100,000 live births, by 2030.
Manyata: An Innovative model to standardise maternal quality care within the private sector
The program entails skilling of health staff in private maternity homes to implement the 16 quality care standards defined by WHO to ensure better maternal and neonatal outcomes. The program uses innovative methods that combine classroom sessions, on site mentoring, drills, and simulation to train, equip and certify private healthcare providers on essential WHO recommended standards. The providers are then assessed by trained and qualified assessors from FOGSI. If they pass the assessment, the facility is ‘Manyata Certified’. By attaining this certification, the enrolled hospital is recognized for its excellence in maternity care for a specific time period.
Program Presence in 3 states, expanding to others
Manyata is currently spread across 3 states (Jharkhand, Maharashtra and Uttar Pradesh) and 26 districts, with presence in 9 out of the 19 aspirational districts listed in the Prime Minister’s ‘Aspirational Districts Program’ for priority intervention. In 2018, we also expanded the program’s reach to Rajasthan, under a development impact bond, called the Utkrisht Impact Bond. The Utkrisht Impact Bond (UIB), is the first of its kind, outcome based financing model to improve the quality of maternal and newborn health services in 440 private health facilities in Rajasthan.Further, in 2019, we established our presence in Karnataka and are soon expanding in other geographies like Assam and Gujarat. In the span of five years, the program has witnessed an increased level of demand from private maternal care providers -From 146 facilities in phase 1, today, 400 facilities are either in process of seeking Manyata certification or have received it.Taken together, we have trained 3083 providers, reached 217,339 deliveries and touched 14 million lives.
Leveraging professional associations & technology for program scale and sustainability
Having played a pivotal role in benchmarking quality standards for private providers, who cater to women in low and middle-income areas, the future trajectory of Manyatais to focus on scale and sustainability. In that context, with the program being led by one of the largest professional associations such as FOGSI, that represents over 33000 practitioners of obstetrics and gynaecology in India, it is well positioned to harness FOGSI’s wide network to expand Manyata’s reach. Partnership with FOGSI also ensures the program the necessary support to conceptualise and build along term sustainability model for the program. In addition to this, the program is currently digitizing all its processes, which is a critical initiative to sustain and scale the efforts of Manyata. Leveraging information systems for the program will not just help in streamlining administrative tasks such as paperless registration, maintenance of a central database, but is also expected to enhance the program’s capacity to analyze and measure outcomes.
Manyata, complements national maternal health priorities and Universal Health Coverage scheme – by improving the quality of private maternity care services and strengthening the quality maternity care movement in India.The program has also been lauded for its efforts to effectively converge public and private partnerships to make affordable maternal care solution accessible to low income communities, and for contributing towards improving maternal health outcomes in the country.
What lies ahead of Manyata is ambitious, but the work we do will change the futureof Maternal Health in India. Together with our partners we are building an ecosystem where women are empowered enough to demand a certain standard of services and the provider is equipped enough to provide it. The program custodians, and the growing number of Manyata champions across geographies, tirelessly drive the program with one vision – India, a nation, where birth of a child isnever the reason for the death of a mother.
Pompy Sridhar is India Director, MSD for Mothers