Buddy-Buddy Model of EMOC-LSAS

Problem Statement

Though Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in Uttar Pradesh has declined over the years, state still accounts for second highest MMR and thirst highest IMR in the country. Majority of these deaths could be averted by ensuring comprehensive obstetric care services through First Referral Units (FRUs). However, out of 305 designated FRUs in UP, only 98 are functional. Also 64% of Specialists posts are vacant. As per National Family Health Survey (NFHS) data, the proportion of C-section reported in public facilities has declined from 11.1% to 4.7% in past 10 years.

Programme Description

The state is focusing on operationalization of 291 FRU  by 2020. To initiate, a detailed gap assessment was conducted to identify non-functional FRUs (without a pair of Anaesthetist & Gynaecologist or those not performing adequate C-sections). A “Buddy-Buddy Counselling Session” was conducted wherein all Life Saving Anaesthesia Skills (LSAS) and Emergency Obstetric Care (EmONC) trained doctors in UP were brought together and were asked to choose their preferred FRUs. Priority was given to doctors choose from the list based on seniority. During the first round of counselling, 47 buddy-doctors were identified, and transfer orders were released within 15 days. The LSAS and EmONC trained buddy-doctors were posted at DH for 6months under mentorship of specialists (Anaesthetist-Gynaecologist). During this period, they assisted the specialists in C-section cases and were expected to conduct minimum 5 C-sections independently per month under supervision. At the end of 6 months, the doctors were posted back to their respective FRUs. The performance of the buddy doctors was also linked to incentives:

• Incentives during Mentoring Period: Rs 1000 per buddy-doctor and specialists (mentors) for maximum of 5 C-section per month.
• Team Incentives post-mentoring period at Inactive FRUs: Rs 1200 per doctor, Rs 600 for MBBS Doctor supporting in Post-op, Rs 600 per staff nurse and Rs 400 per OT Technician for all C-sections performed in the FRU.
• Incentives for visiting FRUs by Specialist Mentors after Mentoring Period: Rs 2500 per specialist per visit. 
• Required equipment was made available to provide suitable work environment to the doctors.

Programme Outcomes

The state plans to make 31 FRUs functional by December 2019. Another 100 FRUs are aimed at making functional through by 2020 which would potentially activate 130 out of 153 nonfunctional FRUs.

Scalability

The model is scalable and can be implemented in other states, specially those not having specialist cadre.

Implementation Partner

UP-TSU

Financial Implications

Provision of incentive in NHM PIP

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019