Abstract

ABSTRACT Background: Till 2008, Jharkhand had only 12 designated first referral units (FRUs) at the district level and none of them were fully functional. Aims &
Objective: This paper focuses on the processes, experiences and health system challenges in operationalizing FRUs in Jharkhand.
Materials and Methods: In an operations research, a pre and post assessment of designated FRUs in the study area was undertaken using standardized tool during March 2009 and February 2011.
Results: There was 33 % (04) increase in availability of obstetricians, surgeons and pathologists across the facilities. The availability of pediatrician was improved in 26% (02) facilities, while there were only 14 % (01) of anaesthetists across all the seven facilities. There was significant improvement (P= 0.017) in availability of skilled human resource post intervention. This can be attributed to increased manpower recruitment and reallocation of specialists to designated FRUs post intervention. Only 29 % (02) of the facilities operated with a blood bank or blood storage unit. Magnesium-sulphate availability had improved by 29 % across the facilities. There was rise in availability of Misoprostol in four (57%) facilities and dip in availability of Nifedepine in six (86 %) and lignocaine- hydrochloride in one (14 %). About four (58 %) of the facilities did not have maternal-newborn care equipments. At the end of the project, only three out of seven designated FRUs achieved operational status. Conclusion: This piece of work on small scale generated evidence from Jharkhand made to think strategically to scale-up operationalization of FRUs. Lack of leadership, management, skilled human resources, infrastructure and medical supplies impeded operationalization of FRUs in Jharkhand. Access to comprehensive emergency obstetric and new-born care services (CEmONC) is remaining as a major issue.