Rural Jharkhand

Earlier this week, I spent some time in rural Jharkahnd, in the eastern part of India. LifeSpring had been invited by KGVK to provide recommendations on how to improve their two hospitals, called Shalini, which had both been built in the 1980s with USAID funding. They are looking to see how best practices at LifeSpring related to quality and efficiency can be applied to Shalini.

For me, it was an eye-opening experience. The context of both of our hospital chains are vastly different. LifeSpring, based in urban Hyderabad, serves a city with an institutional delivery rate approaching 90% (Andhra Pradesh as a whole has an institutional delivery rate of 69%, based on the latest National Family Health Survey in 2006). In terms of institutional delivery, Andhra is fourth from the top, after Kerela (100%), Goa (93%), and Tamil Nadu (90%).

Jharkhand, on the other hand, is third from the bottom in terms of institutional delivery. For the state as a whole, institutional delivery is 19%, and I'm told it's much less in rural Jharkhand -- somewhere between 10-15%. The only states lower than Jharkhand in institutional delivery are Nagaland (12%) and Chattisgarh (16%).

The reasons, I learn, are of course multi-faceted. First, there's the poverty and lack of infrastructure. Accessibility is a huge challenge; the hospital cited that some women travel over 40 kilometers to deliver there. There are cultural reasons as well, with tribal communities distrusting hospitals and preferring traditional birth attendants. Of course, nothing is inherently "bad" about home deliveries. But it is about quality and health of the mother prior to delivery. In Jharkhand-- a relatively newly-formed state-- maternal mortality is 371 per 100,000 births, as compared with the national average of 301 per 100,000 births.

There are some great initiatives happening to improve the quality of care happening at the community level, such as MANSI, the Maternal and Newborn Survival Initiative.

At the same time, there is also much more than can be done to integrate community programs with hospitals themselves, which is where KGVK comes in. Through their Total Village Management approach, they target key villages to provide holistic services -- not only in health, but in education and livelihood as well.

It's an incredible opportunity to both share learnings of our hospital to a region much in need of innovations in maternal health, as well as learn more about the multi-faceted challenge of converting need into demand, in the most challenging of settings.