TRANSFORMING INDIA

Innovation for Viksit Bharat

"Mission 28 :Transforming Maternal & Child Health in Melghat

  • 1
  • Jan 17th 2025
  • Saurabh Katiyar
  • ( Amravati , Maharashtra )

Introduction 

The Melghat region, situated in the Amravati district, comprises two main talukas: Dharani and Chikhaldara. These areas, characterized by a significant tribal population, are part of the NITI Aayog's Aspirational Block Programme. Melghat is famous for its Tiger Reserve, while Chikhaldara is a renowned hill station and the only coffee-growing region in the state. The area's predominantly hilly terrain offers scenic views but also presents a challenging landscape. This geographical setting greatly impacts the lifestyle and health conditions of the local population.

Problem Statement

Melghat faces significant health challenges, including high infant mortality rate (IMR) and maternal mortality rate (MMR). In 2018-19, the IMR was 36, and the MMR was 87. The region also struggles with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). During the pre-project analysis, a significant concern was identified: nearly 70% of infant mortality in Melghat occurred within the first month of birth, with 60% of these deaths taking place at home. It became evident that institutional delivery, a fundamental aspect of reproductive and child health, was lacking. Annually, approximately 7,000 deliveries occur in Melghat, with 30% of these being premature. This results in a substantial percentage of low birth weight babies and neonatal deaths, primarily due to septicemia, pneumonia, and other diseases. In 2022, of the 7288 total deliveries, 1135 were home-based, contributing to the Higher IMR and MMR in the Melghat region.

Root Cause Analysis

§Most of the Villagers preferred Home deliveries instead of institutional delivery due to their superstations & beliefs.
§Initially, communication was a challenge due to the local tribe's Korku language. To address this, two counselors were stationed at each Primary Health Center to provide counseling in Korku.
§The administration conducted the analysis of last five years of data related to IMR, MMR, Institutional Delivery & Child Deaths.

§From the Analysis we found that the IMR was 31, and the MMR was 114. The region also struggles with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). all these indicators were on the rising side throughout this 5 years.

Indicators

2017-18

2018-19

2019-20

2020-21

2021-22

IMR

31

36

30.49

27.36

20.88

MMR

114

93

124.50

156.79

65.17

Institutional Delivery

74%

77 %

78%

80%

80%

Child death

(0-1 years )

217

245

196

171

149

§During the pre-project analysis, a significant concern was identified nearly 70% of infant mortality in Melghat occurred within the first month of birth, with 60% of these deaths taking place at home. It became evident that institutional delivery, a fundamental aspect of reproductive and child health, was lacking. Annually, approximately 7,000 deliveries occur in Melghat, with 30% of these being premature. This rlow-birth-weightts in a substantial percentage of low birth weight babies and neonatal deaths, primarily due to septicemia, pneumonia, and other diseases.
Introduction of "Mission 28 "
§The administration  organized a comprehensive workshop & demonstrated the Root cause Analysis of the health indicators to all the relevant staffs.
§To effectively address the health challenges an innovative campaign named "Mission 28" for Melghat was launched in 2022. Under Mission 28, a proactive approach was adopted to monitor and support pregnant women and lactating mothers 28 days before delivery and 28 days after delivery. The objectives of Mission 28 include increasing institutional deliveries, reducing infant mortality rates (IMR), maternal mortality rates (MMR), and child deaths
§The campaign takes a proactive approach, closely monitoring pregnant and lactating mothers 28 days before and after delivery. ASHA workers from the Health Department and Anganwadi workers from the ICDS Department were mobilized for this 56-day period.
§Conducted comprehensive training for all employees from the Women and Child Development Department and Health Department. The training was strategically organized, with ASHA workers leading on the first day, Anganwadi workers on the second day, and ASHA workers again on the third day to prevent fatigue.
§Nearly 1,000 high-risk pregnant women are identified and monitored annually by specialized doctors
§Counseled pregnant women to encourage hospital births, provided guidance on breastfeeding techniques to lactating mothers, and ensured prompt medical attention for infants when needed
§Medical infrastructure, including 3 Nutritional Rehabilitation Centers (NRC), Blood Banks, and 62 Child Treatment Centers (CTC) in Primary Health Centers (PHC) were established in Villages.
§Specialized doctors were deputed in critical villages for 15 days each month to support the initiative. also vehicles  for Pregnant Women and 2 Ambulance for neonatal were arranged by the Administration.
Wage loss compensation was provided under the Manav Vikas scheme.
Dedicated Helpline was set up for Pregnant women to seek help from Doctors. 

IMPACT OF “MISSION 28”



 The above Charts shows the significant improvement in the indicators like IMR, MMR, institutional delivery,
ØThere has been a notable reduction in IMR from 36  in 2018-19 to 19.98 in 2023-24,  which is closest to state average.
ØMMR decreased from 93 in 2018-19  to 28.92 in 2024-25.
ØInstitutional delivery rates increased from 77% in 2018-19  to 94% in 2023-24,
ØChild Deaths decreased from 245  in 2018-19  to 128 in 2023-24.

Monitoring & Evaluation

§For effective monitoring, the administration introduced three cards: Yellow (before delivery), Saffron (for postnatal care up to 28 days), and Green (for neonatal care up to 28 days)
§Flying Squad was established for effective Monitoring of the Initiative & Helpline numbers were established to facilitate convenient communication.
§Monthly reviews were conducted to assess the progress of awareness programs led by Sevikas and ASHA Workers. This ongoing monitoring ensured that the campaign remained on track and responsive to community needs.

§Recognized and encouraged outstanding employees to boost morale.

Fund Mobilization

Mission 28's sustainability is rooted in its innovative and inclusive approach, tailored to the unique challenges of Melghat's tough terrain and hilly areas. Unlike other projects, Mission 28 was designed with long-term viability in mind, ensuring that its impact would endure beyond its initial implementation. Financially the Mission Melghat 28 incurred minimal expenditure. Training expenses were limited to arrangements made at Primary Health Centers. No additional costs were required for the helpline numbers, as they were managed by Taluka Medical Officers. The expense for printing home visit cards, used during home visits, was covered by the office expenses of the health departments. Consequently, Mission 28 did not necessitate separate financial allocations. 


Video: 
https://drive.google.com/file/d/1q8MEBsWcm-vKSzzx-mY6IL7ZIWd3xYNy/view?usp=sharing 

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Authored By Saurabh Katiyar

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