To help villages battling high matenal mortality rate (MMR), physicians should be trained to carry out caesarean sections and nurses should be taught to administer anaesthesia. The idea has been mooted in a recent study by the Indian Institute of Management, Ahmedabad, and the Public Health Foundation of India (PHFI).

The study said that the county, with the MMR of 181, will not achieve the dream of ensuring safe motherhood until it starts providing emergency obstetric care (EmOC) in rural areas.

"One of the ways to extend EmOC to rural settings would require trained general doctors and other health workers," said the study, conducted by IIM-A Professor Sunil Kumar Maheshwari, and Dileep Mavlankar, the director of PHFI, Gandhinagar. It has been suggested that induction training be given to ANMs (Auxiliary Nurse Midwife) to provide limited EmOC.

"The training of general practitioners in life-saving skills and basic surgical and obstetrical skills is relied upon by many developing countries to provide EmOC," the study says. "Prioritising these modules in in-service training for general practitioners may be a key matenal mortality reduction strategy."

The study also calls for review of health policies and recommends cooperation between public and private health systems. "Public expenditure on health in India is less than 1% of the GDP. It is one of the lowest in the world," the study says. "There is a shortage of equipments and drugs in the health sector in India. Simultaneously, available equipments are not adequately used in some of the states for the want of technical people."

The health sector in India has been corporatized over the past decade. Large speciality hospitals in big cities get many concessions in the form of cheap land, tax exemptions, and import tariff waiver on equipments, the study says.

This practice indirectly transfers funds from primary health sector to corporate hospitals that are driven by profit and the interests of influential urban middle-class. Hence, strengthening of EmOC requires a review of current policies on primary healthcare expenditure.

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