*Y.C.* Making medical Interns as maternal care service providers

Making medical interns as maternal care service providers at the remote or the rural locations to overcome the global health care workforce crisis. As a public health specialist, I firmly believe that one of the cause of the high rates of the maternal mortality and morbidity is the lack of the health care providers, inadequate maternal health policies and lack of access to quality maternal care.
Pregnancy is not a disease and pregnancy related mortality is almost always preventable. Yet more
than half a million women die annually worldwide, due to pregnancy related complications. About
90-95% of these come from developing countries. Maternal Mortality Ratio (MMR) in developing countries ranges from 300 to 1000 in contrast with 2.9 in the industrialised world. This is the only Public Health Statistic with such a huge difference. In Pakistan alone, an estimated 30,000 maternal deaths occur each year, due to pregnancy related complications
.
This figure is indicative of the need of quick attention about the maternal health intervention especially in the developing nations. Maternal Health is directly related to the maternal and neonatal mortality and morbidity. The conceptual framework for maternal and neonatal mortality and morbidity presented by UNICEF explains that there are various determinant of the maternal health responsible for the maternal and neonatal morbidity and morbidity.
There are direct factors such as obstetric risks including complications of abortion, disease and infections, inadequate dietary intake. The framework also explains about the underlying causes at the household/ community and district levels such as Insufficient access to the maternity services- including emergency obstetric and newborn care, inadequate maternal and new born health practices and care seeking. As a health planner, the basic causes at the societal level concerns me the most that is the quality and the quantity of the actual resources for the maternal health- human, economic and organizational- and the way they are controlled.
The global health workforce crisis is one of the challenge which makes the delivery of the desired quality of the maternal health care to the remote locations where it is required the most. The problem is worse in the developing countries due to migration of skilled health workforce to the developing countries.
The solution is to use the available resource in a sustainable and feasible framework. This idea proposes utilising the community medicines departments of the medical colleges in the various countries for the delivery of the maternal health care for the pregnant females. Every medical college has a team of medical staff and medical interns appointed to work in the community medicines. This staff can be utilised to impart the maternal check-up and assist the lady health workers.I propose to shift the duties of these interns from the hospital to the village based centres or kiosk to reach maximum people especially females in the developing countries who are dependant on the male members for travelling to the hospitals also.
I don't think it should involve much of the change in the curricullum but yes strong policy by the public health department to make such intern-ship at the rural centre mandatory.Also, it will increase the exposure of the interns which is the main idea of the intern-ship.
A network can be developed engaging the skills of the medical interns, the Lady Health Workers (LHW)and the traditional birth attendants (TBAs). The capacity building and mentoring of the of the LHW & TBA can be done by the interns for the basic Ante Natal Check-ups of the pregnant females, the deliveries and post natal check ups . The services such as delivery by the TBAs can be charged from the beneficiaries whereas the interns can screen the complication of the females and refer the pregnancies to the hospitals for the management of the complications at the right time.
The following can be the advantages of the proposed idea:
1)Increased maternal health care workforce- The team of medical interns can replace the need of locating the gynaecologist at the peripheral locations. The valued human resource can be located at a central location where they can be accessed by larger population.
2)Low cost and sustainable set-up – The cost of locating an intern to a rural or remote locations is much lower than the gynaecologist. The Lady Health Workers (LHW) and the attached TBAs can work on the basis of user fee. This will also ensure higher motivation levels of the among the LHW and TBAs
3) Higher accountable maternal health care force- If the postings of the medical interns are part of their curriculum they will be more responsible towards the duties assigned to them.
Lastly, if the interns can not be utilised in delivering the care as a professional then at-least they can be the first point of contact for the pregnant females or other patients in screening the complications and establishing timely referrals.