2013 Articles

Increasing the Availability of Skilled Birth Attendance in Rural India

Bajpai, Nirupam; Dholakia, Ravindra; Towle, Megan

Key considerations in the availability of skilled birth attendance will be a critical component in national efforts towards ensuring universal health coverage in India. This paper aims to examine opportunities for strengthening skilled birth attendance at the primary level by (a) exploring relevant models of rural primary and community-level skilled attendance, both India and internationally, that have achieved positive health outcomes; (b) assessing the current skilled birth attendance coverage in India and means to achieving greater coverage of skilled attendance and enhanced linkages in the continuum of care; and (c) recommending opportunities and required investment for scaling-up skilled attendance within NRHM. Our primary research highlights immediate requirements for more targeted systems strengthening, particularly for sub-centres that can provide intranatal care, and for PHCs depending on their delivery caseload and accessibility to other referral facilities. This requires significantly more strategic planning at the district level, and creating or reinforcing full-time support structures that can focus on quality assurance of care, including training and skills development, facility quality management, and linkages between care providers