Tribal communities in the Pune district of India have 25% low birth weight and ~17% preterm babies. Although the government programs have been successful in increasing number of antenatal registrations, visits and institutional deliveries, effective identification and management of high-risk pregnancies in tribal communities continue to pose a challenge. The Government of India has recently launched `Pradhan-Mantri-Surakshit-Matritva-Abhiyan' (PMSMA), wherein clinical practice guidelines are provided to categorize pregnant women according to risk and provide intensive care to high-risk pregnant women until delivery.
This study aimed to identify barriers, challenges and supporting mechanisms to implementing the PMSMA program for the management of high-risk pregnancies and further report recommendations in adapting the PMSMA guidelines.
We used the Consolidated Framework for Implementation Research (CFIR), to guide the qualitative assessment of the implementation context and identify factors that could influence intervention implementation and effectiveness. We used quantitative methods to record health system uses and outcomes from public health system records. Due to COVID-19 pandemic-induced delays in the study implementation, we conducted a rapid qualitative analysis of 20 IDIs and 2 FGDs.
Our study found that the challenges in accessing private sonography centers, untimely services of the ambulance, connectivity issues, out-of-pocket expenditure for sonography, diagnostics and transport by beneficiaries are some serious problems resulting in severe consequences to high-risk mothers. The unavailability of diagnostics at the primary centres adds a layer to these problems. Further, the community education for appropriate nutritional behaviour was important. Culturally a pregnancy is kept secret until first 12 weeks which results in delayed intimation of pregnancy to the healthcare staff resulting in loss of crucial days for providing health care to pregnant women. The tribal community perceived the big babies as a risk to the mothers during delivery, hence depriving the pregnant women of healthy food and iron supplements. Health systems need to leverage the food supplementation program by another department of the government and need to coordinate between the departments for better implementation. In summary, our study recommends community awareness, training to health staff based on our findings, and coordination of the health staff with the local government for implementation.