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New Delhi: Difficult terrains, inaccessible areas, weak public health system, limited availability of medicines and diagnostics, and lack of healthcare personnel, nothing could daunt Assam.

The northeastern state has speedily improved its health indicators, especially on maternal mortality. Call it increased community awareness or government's genuine efforts, the battle to conquer is on.

Bearing testimony to the latest Sample Registration System (SRS) Bulletin that noted the most significant decline in maternal mortality ratio (MMR) in Assam, state finance minister Himanta Biswa Sarma, while presenting the state's annual budget 2020-21 on Friday, pointed out the fast pace in improvement of healthcare landscape of the state, especially regarding MMR.

“The overall sea change in the health sector is exemplified by the steep increase in the percentage of institutional deliveries (child birth in hospital) which has gone up from 70.6% (2015-16) to 91% in 2019-20. This, in turn, has been one of the contributing factors for a steep decline in MMR (23.67%) and Infant Mortality Rate IMR (6.38%)," Sarma said.

The latest SRS, released last year, had highlighted that the MMR of the country has declined from 130 in 2014-2016 to 122 in 2015-17 and the decline has been most significant in empowered action group (EAG) states and Assam from 188 to 175. MMR is derived as the proportion of maternal deaths per 100,000 live births reported under the SRS.

According to the NITI Aayog's health index, Assam was categorised in the “achievers" in terms of the overall and incremental performance.

The state has remarkably worked hard to tackle the problem of maternal mortality and improve on healthcare indices. “ Assam has the slow pace when it comes to comparing other states in India but if we see the improvement in its own state of health, it is going on at a very fast pace. In minimal possible resources, the state has improved immensely. But there is a long way to go, said Alok Kumar, advisor health, Niti Aayog.

According to Niti Aayog, for every 100,000 live births, 130 women die in India due to pregnancy-related complications.

“Assam’s current MMR status might overshadow the strides the state has made in maternal healthcare. In just over a decade, Assam has reduced its MMR from 480 to 237--that is a greater than 50% reduction. The drastic reduction in Assam's MMR is mostly attributed to an increase in institutional deliveries, said Bhavna Mukhopadhyay, Chief Executive, Voluntary Health Association of India (VHAI).

In 2018, the Assam government launched the Wage Compensation Scheme for pregnant women in tea gardens. Under this cash transfer programme, pregnant women working in the tea gardens are provided with 12,000 by the government. NGOs such as VHAI in collaboration with civic engagement Alliance is also working on equitable access to adequate food and nutrition by pregnant and lactating mothers and children below 5 years of age in six districts of Assam.

“Investing in nutrition is fundamental to achieving maternal and child survival goals and reducing MMR," said Mukhopadhyay.

Public health policy experts believe that with about 3.4 crore population, Assam is poised in a unique context both demographically and topographically and is the largest state with 68.4% population of the country’s northeastern region. In this context, Assam’s healthcare delivery system has improved to have accessibility, quality of services and affordability etc.

“Delivering healthcare services in north-east has always been a challenge due to difficult terrain and other issues. To cover the hard to reach areas and areas where healthcare facility is inadequate, the Assam government has deployed 130 Mobile Medical Units (MMUs) of which 80 are deployed in the tea garden areas. At present 414 tea gardens are covered by these MMUs every month. MMUs are basically “hospital on wheel" manned with doctor, nurse, paramedical staff equipped with basic free diagnostic services and free medicines. More than 20.31 lakh patients have been treated in 47,020 camps organised by these MMUs from June 2017 to January 2019," said Chandrakant Pandav, member, National Council on India Nutrition Challenges, POSHAN Abhiyan.

“To provide healthcare services in the riverine and char areas, one-of-its kind boat clinics have been deployed with 15 Boat Clinics operating across 13 districts from 2008. These are basically 'floating hospitals' manned with doctor, nurse, paramedical staff equipped with basic free diagnostic services and free medicines. A total 20,72,880 patients are treated in 27,959 camps organised by boat clinics," he said.

Assam National Health Mission has also entered public private partnership with 150 tea garden management and provides financial support for tea garden hospitals and with various charitable hospitals across the state. The boat clinics providing essential health services in farthest riverine islands of Assam are exemplary PPP initiatives.

Assam also has 104 sarathi, a round-the-clock free of cost helpline and grievance redressal system in PPP mode. The technology and the mobile applications have been extensively used for effective implementation of flagship programs and intensive monitoring and supportive supervision of the programs.

“Drugs availability status is being constantly monitored through Drugs Stock Monitoring System and it is also made available in the public domain to increase transparency in the system. Assam is one among the few states in the country to use android mobile application for conducting district gap analysis using Indian public health standards results are utilised for strengthening health infrastructure and service availability," Pandav said.

“Decreasing MMR occurs because of good antenatal care. In fact, care should begin before conception and the mother should receive folic acid tablets and adequate diet regular antenatal check-up, correction of anaemia," said Mrudula Phadke, senior advisor, National Rural Health Mission (NRHM), UNICEF.

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