With a population of 200 million, Uttar Pradesh is India’s fourth largest and most populous state. If Uttar Pradesh were a country, it would be the fifth largest in the world in terms of population. More than three-quarters of people live in rural areas, and almost a third of live below the poverty line.
Despite recent improvements, maternal mortality remains high in Uttar Pradesh, with most recent estimates of MMR at 345 deaths per 100,000 live births. Maternal mortality is largely associated with preventable causes that require emergency obstetric care, such as postpartum hemorrhage, high blood pressure, sepsis and obstructed labour.
In Uttar Pradesh, several obstacles stand in the way of progress in reducing maternal mortality, including poor health infrastructure, oversubscribed clinics, scarcity of specialists trained in emergency obstetric care and limited transportation services. The public sector is weak, and rural communities often depend on a complex network of informal and formal private providers, with the former serving as the first point of contact due to availability within the village, and the latter being accessed for more complicated services. These providers lack training in maternal health services and, particularly, in emergency care.
The Matrika project is implemented by two NGOs, Pathfinder International and World Health Partners, working in three districts of Uttar Pradesh – Kannauj, Kanpur Nagar and Kanpur Dehat. The districts have a combined population of 8.1 million and vary considerably in terms of demographic and health indicators.
The idea behind the Matrika project is to leverage the private sector to improve maternal health. The aim is to increase access to and use of basic obstetric care, emergency obstetric care and family planning services. The three-year project works towards three main objectives: (1) establish the Sky social franchise network of private health providers and functional referral centres offering affordable antenatal care, emergency obstetric care and family planning services; (2) strengthen capacity of and linkages between rural private and public sector health providers to offer high quality services; and (3) improve community awareness, demand and linkages with maternal health services among rural populations.
The Sky franchise network includes private providers at various levels offering a range of services under the Sky brand, including antenatal care, emergency obstetric care and family planning. The programme also delivers clinical training to private and public sector health providers.