Can PHC system in India deliver emergency obstetric Care? a management perspective on safe motherhood programme

Abstract

India has an extensive network of hospitals and health centers with a large field staff in the government sector which has been providing primary health care. Of late this infrastructure has been effective in delivering immunization services to the community. The Child Survival and Safe Motherhood (CSSM) programme envisages strengthening these infrastructures to provide Emergency Obstetric services (EOC) which is the heart of the Safe Motherhood initiative. This paper reviews the state of the PHC system in India from a management perspective to assess its capability to deliver effective EOC. We analyze the Strengths and Weaknesses of the PHC system and the Threats and Opportunities that the environment offers with regards to the development of an EOC facility. Following the strategic management frame work we analyze the safe motherhood program as it is currently planned. Analysis of CSSM program based on strategic management frame work shows that the programme has not planned to achieve congruence between Environment, Structure, Strategy and Processes. It is following a blueprint approach. This is likely to lead to sub-optimal performance. Major inputs are focusing on orientation training and supply of consumable only. Training mainly focuses on technical aspects neglecting the organizational and human aspects. The key management systems such as referral, supportive supervision, problem solving, skill-based training, participation, motivating and rewarding as well as monitoring are very weak in the government PHC system, which will hamper the effective implementation of safe motherhood programme. We suggest some management interventions based on strategic management framework which will support the Safe motherhood programme strategy and make it more effective.