To improve the health of mother and child in the country, the health ministry is expected to initiate implementing a programme called Accelerating Mother and child Health-1,000 Day Plus by August this year.

The programme was earlier called maternity allowance and later breastfeeding allowance.

The programme’s main objective is to safeguard the health of vulnerable pregnant women and mothers who have recently given birth or are breastfeeding, as well as that of the infants through the coverage of quality maternal and child health services.

Its immediate objective is to increase the uptake of maternal and child health services; and to accelerate the improvements in maternal and child health services.

Health Minister Dechen Wangmo said that today when a mother goes to a Basic Health Unit (BHU) for antenatal check-ups (ANC), she doesn’t know where she would deliver the baby. ANCs are done in different health facilities, which make it difficult for a medical officer to understand her medical history.

With the programme in place, pregnant women will go to the health facility that is the nearest BHU where they will get registered. The mother and child health (MCH) system will then be activated.

The MCH clinics will be the main delivery platform to implement the programme.

The MCH tracking system, which is already in place with the health ministry will constantly monitor the activities. The system will send a notification to the bank stating that a pregnant mother has registered and the bank will then disburse her first installment of allowance through conditional cash transfer (CCT).

While the system would be applicable to all pregnant women, the target for CCT will include only those mothers who are not entitled to six months paid maternity leave. Mothers in private and corporate organisations who do not get six months paid maternity leave are eligible for CCT.

Lyonpo said that 1000 golden days is a beautiful concept. There is strong evidence suggesting that this is the period to intervene in the life of a child but not a single country has done this at a national level.

“We are doing it as a nation and we are going to set an example,” she said. “The moment people say allowance, people think that with democracy, it is like a freebie a political party is giving. We are not giving away money just like that. We are putting in some conditions and there is a responsibility attached to that money.”

The uptake of MCH services will be used as a basis to determine if a woman is eligible to receive the CCT. Health workers would identify the key target beneficiary population during the first registration of pregnancy in MCH clinics.

Lyonpo said that a validation document would have to be endorsed by the health facility to ensure that the criteria detailed for eligibility of CCT have been met before the fund is disbursed.

They would be paid the national minimum wage. Lyonpo said that the government is going with the minimum wage rate because as a mother, her job is to take care of the baby, which cannot be compared to a full-time job. “The idea is shared responsibility; as a mother you have the responsibility and so does the government.”

The CCT would be disbursed in four disbursement periods after the fulfillment of the defined criteria. The CCT shall be considered as income and be taxable in line with the taxation legislations in place.

After completion of four ANC visits, which comprise of the registration and completion of first three ANC (30 weeks after conception), the first installment would be disbursed.

By then, the health worker would inform the mother her tentative due date and ask her which district hospital she would like to deliver her baby at. Accordingly, the health worker would inform the hospital. This will ensure the mother that she would get a bed in the hospital during her delivery.

Lyonpo said this would also help the health ministry strategise human resources in the hospitals. “We have few gynecologists in the country and if we learn that there is a big caseload in a certain hospital, we can deploy doctors during that period,” she said.

Lyonpo said  there have been cases at the national referral hospital where mothers deliver in corridors and some in taxis on their way back home because of lack of bed in the birthing centre and maternity wards.

Currently, she said that expecting mothers from across the country come to deliver at the national referral hospital if they have relatives in Thimphu. “If we don’t have such a system in place, in future there will be a huge gap between the haves and have-nots. The best will only be accessible to the rich and the affluent.”

The second installment would be deposited into the mother’s saving account after she completes the eighth ANC visit and the child is delivered in the institution or birth attended by a trained health worker.

The third installment would be transferred after the mother and the child completes all four post-natal check-ups, which is six weeks after delivery. The last installment would be disbursed at six months after delivery. This would be after completing all immunisation schedules for the period and the baby has been exclusively breastfed for six months.

Lyonpo said only 26 percent of pregnant women report completing the recommended eight ANC visits, and about half the pregnant women in the country do not register their pregnancies until after the first trimester. “This results in women missing out some critical services in the early phase of their pregnancies.”

Administrative data maintained at the health ministry also indicate a high proportion of mothers not completing the crucial post-natal care services.

Lyonpo said it is well known that underutilisation of maternal health services during pregnancy, for delivery and at the post-natal period are important contributors for high maternal and neonatal mortality rates.

Currently, the Infant mortality rate (IMR) and Children under-five mortality rate in the country stands at 15.1 and 34.1 per 1000 live births.

“This is a cause of concern as Bhutan accords high priority in ensuring the survivability of every fetus and newborn especially in light of reducing Total Fertility Rates (TFR),” Lyonpo said.

The clinics will also monitor the status and services availed by the mothers and child. In order to accelerate the improvements in maternal and child health, Lyonpo said that optimum utilisation of health services has been identified as one of the key strategies. “If we cannot invest in our children, if we cannot make them physically fit and cognitively smart then we have failed as a nation and as a government.”

The success indicators of the programme in the 12th Plan are

Complete eight ANC visits increased from 26 percent to 40 percent 

 Institutional delivery maintained at >90 percent 

Complete PNC visits increased from 75 percent to 90 percent 

Reduce newborn deaths from 21 per 1000 live births to 13.2 by 2023 

Immunization coverage to be maintained at >95 percent 

Exclusive Breastfeeding rate increased from 51 percent to 56 percent 

 Reduce stillbirth rate from 16 per 1,000 live births to 12.1 per 1,000 live births by 2023

Dechen Tshomo