India Birth Network driven evidence based peripartum care.

Efficient, safe, and evidence-based peripartum care is of paramount importance in any well-functioning maternity and labor unit.  The challenge in developing countries has always been the large numbers and balancing the coverage of healthcare with quality.  The WHO has stated that despite the fact that most births occur in health facilities, the reductions in maternal and perinatal mortality remain slow. 

The effect of improving the quality of care during labor and delivery is eventually reflected in health indicators like maternal mortality, perinatal mortality, and birth asphyxia rates.  The maternal mortality rates in India range from 100-200 per 100,000 births compared to 10-20 per 100,000 births in developed countries.  The global estimate of the perinatal mortality rate in India is 32/1000, as compared to 5/1000 in high-income countries, and the birth asphyxia rate is 30/1000 as compared to 5/1000 in India in developed countries respectively.  Additionally maintaining the correct cesarean section rates is the other challenge in all settings.

The birthing facilities in our sub-continent range from small, medium, and large to very large that deliver approximately 1000, 2500, 5000, and 10000 or more women respectively, annually. Most of the births in India are conducted in public and not-for-profit organizations and would fall into the later three sizes.

 These birthing units all over the country face common challenges, of being overcrowded, short-staffed, struggling to retain experienced and trained staff to cover the facility 24 hours of the day, fighting market forces and Brain drain along with the existing shortage of all resources.  These facilities often contrive novel strategies to overcome these difficulties to ensure that maternal and perinatal outcomes are optimal and therefore there is a need to support these strategies with a rational policy that should evolve from this discussion.

There is no doubt that the performance of most facilities in  India is not satisfactory as the reduction in maternal and neonatal mortality continues to be slow.

 The function of these facilities in India can be discussed under the following heading.

• 1. Human Resources and  2. Clinical care and audits

 1. Human Resources:

The birthing units in the country are led by an obstetrician and gynecologist who is often overwhelmed with other commitments such as obtaining skills and excellence in managing labor, perinatal medicine, laparoscopy, infertility, gynae cancer, and medical education to say the least, and often have very little time to be involved with research and policy development. Sometimes these responsibilities of research and policy development are outsourced to epidemiologists who are more competent in research execution but are unable to fathom or assess the on–the–ground hardships of managing a busy labor ward.

The medical staff is primarily held responsible for the birth outcomes of the mother and the neonate and therefore should continue to play a leadership role. They should be responsible for optimal performance, auditing outcomes of the facility, and highlighting obstetric and non-obstetric causes for poor birth outcomes, thereby facilitating pre-emptive measures. Currently in India nurses play a supportive role for the woman in labor.  Unlike the well-established midwifery-led care in several developed countries, nurse midwife obstetric care in India is in its early stages of establishment and has not been optimally used. The main reason for this is the lack of a legal and regulatory framework supporting their contribution to intrapartum care. 

Several district hospitals are manned by competent nurses who are often unnoticed. They have been managing and monitoring labor under challenging circumstances with inadequate resources that are familiar to low-resourced centers. Maintaining the correct patient-health provider ratio is a distant reality in our settings. However, there are successful models of nurse midwife facilitated care with close supervision by the medical fraternity as seen in several military command hospitals in the country that can be developed as pragmatic robust models for use in the district hospitals of the country.

2. Clinical care and audits:

Overcrowded health facilities with a shortage of beds are not an uncommon situation in our setting.  Labour management may often need to be tailored to circumvent these hurdles.  The methods of monitoring the labor of women in these facilities have to be efficient, simple, and not cumbersome.  Therefore, the time is taken by the health provider (doctor/nurse) to document labor progress, and maternal and fetal well-being has to be minimized.

It is imperative that the responsibility for birth outcomes, be shared by medical, nursing, and paramedical staff under the leadership of the medical fraternity for efficient management of the overwhelmed facilities. Audits are not always conducted in our facilities, but the importance of confidentiality and non-punitive actions during discussions has to be reiterated to safeguard the morale of the grassroots health providers. The discussions should cover medical and non-medical causes along with obstetric and non-obstetric causes to understand the reasons for poor birth outcomes.

Obstetric care comprises the majority of the workload in any secondary-level hospital of a rural setup. Recruiting a competent specialist obstetrician in a secondary-level hospital in rural India has always been a challenge because of existing market forces, personal commitments, and compulsions. Often the medical officers employed in these rural facilities are trained in specialties that have low demand and are unable to contribute optimally to the facility. The nurses and paramedics employed in the facility usually speak only the vernacular language and live close to the facility and are less likely to move and leave the facility.   The big challenge faced by the administrators in the country is the lack of standardized care and training in maternity care.  Several large academic institutions in the country have very high cesarean section rates. The primary cesarean section rates range from 60-80% to 2% in some district hospitals.  Revamping the curriculum or creating established midwifery care may delay improvement and encourage the functioning of midwives as an independent stream which is inefficient in the Indian setting or will set in motion market forces. Therefore, there is an urgent need to contrive a feasible strategy to empower health facility providing a centralized support system within the ambit of the clinical establishment law that exists in many states of our country.

The centralized support system should get together academics among the medical and nursing fraternity of our country to do research that is relevant and targeted towards improved peripartum care. This research could influence the government of India guidelines ensuring, they remain simple and practical.

Our solution is a self-sustaining multipronged strategy for health facility empowerment of low- and middle-income countries which can be described under four major headings.

1. Human Resources

2. Digitalized Data capture to drive the Audit training cycle.

3. Obstetric Reorganization for our setting that is driven by new evidence generated by the India Birth Network (IBN).

4. Pragmatic Obstetric infrastructure.

1. Human resource:

The most important component of a facility is its staffing.  It is most likely that the base of the health worker pyramid stays locally and hence is least likely to leave town.  Empowering these staff with proven pragmatic management principles is most likely to provide substantial returns. The training will emphasize the need for the prevention of complications rather than just the treatment of complications.

The intervention will include: -

• Fostering doctors, nurses, midwives, and paramedic teams by integrating and synchronizing their functions in the facility.
• Training this team in the facility with a simple and practical evidence-based pragmatic obstetric regimen that is continuously updated on a digital platform thereby ensuring standardized care.
• Strengthening the facility with a preventive strategy to avoid unnecessary complications and referrals.

The facility will be empowered to tide over intervals between recruitment of a specialist or a period when a fresh graduate is employed.

 2. Digitalized Data capture to drive the Audit training cycle. 

Good data collection from the facility will play a pivotal role in creating new evidence. This realization has already galvanized the national health authority to work on health informatics. Using the services of the existing IT team in the facility, we will capture relevant and realistic data. The incorporation of the simple “Ten Group Classification System” to assess performance and find solutions to difficulties faced by the facility would be a leap forward in its empowerment.

There are several international world authorities that formulate guidelines and the guidelines from WHO are often followed by Govt of India.  These guidelines  are unable to address the concerns peculiar to our setting. The good research on intrapartum care that will result from our robust network will help the government of India make  simple and practical guidelines that can be easily implemented in our poorly resourced settings.

3. Obstetric Reorganization for our setting is driven by new evidence.

Data from audits may identify obstetric and non-obstetric causes for poor outcomes. An example of obstetric reorganization is while VBAC is mooted in most developed countries where 1:1 monitoring is the norm, it can be dangerous in our busy settings. Rational indications for induction of labor and elective and emergency cesarean section for our setting can be described by the IBN, based on evidence. Finding the right dose of misoprostol, an inexpensive and heat stable inducing agent, for safe and effective induction of labor in India is another area that needs urgent attention .  The National and international partnership developed with the formation of the India Birth Network will help formulate practical guidelines specific to our settings.

4. Pragmatic Obstetric infrastructure.

Facilities often need to manage with a 1:6 health worker–patient ratio and therefore should be provided with equipment that will decrease the time taken to monitor women and also improves the reliability and accountability of the monitoring. Consequently, electronic fetal monitoring systems prevent healthcare workers from being overwhelmed by the large patient number of LMICs. Data capture of intrapartum events similarly should be quick and simple.

Examples of electronic monitoring systems are the innovative Janitri system that compromises The Keyar fetal monitor and the Daksh electronic partograph. The Keyar fetal monitoring system is a patch-based and wearable device allowing for ambulation. It automatically tracks the fetal heart rate, uterine contractions, and maternal heart rate and records it on the Daksh electronic partograph. Daksh is an intelligent intrapartum monitoring mobile application for a digital partograph generation. The partograph has a ‘nag and alert’ feature to prompt the health worker to monitor the patient at regular intervals. It also has provisions to enter the components of the TGCS (Robson’s criteria), which plays an integral part in optimizing the audit training cycle. Thus, this innovative system will provide a support system for improving monitoring in rural facilities. Electronic partograph developed by Jhpiego And Johns Hopkins Centre for Bioengineering Innovation and Design (JHU-CBII) incorporated best practices and algorithms from paper partograph and facilitated automatic plotting of observation.  It indicated complications and limited retroactive data entry, which would be ideal to ensure accountability.  Other innovators have used software applications to assist and facilitate labor monitoring. Inexpensive fetal and maternal monitoring systems incorporated into the electronic partograph would be the ideal solution to the labor monitoring difficulties peculiar to our busy labor wards.

 The Guardian (K2 Medical system Plymouth, UK) an electronic information capture system used in the UK with the INFANT (K2 Medical systems) a decision support software developed to run on the Guardian systems may have potential for use as a universal digital monitoring system in our settings. Since our health system is unable to retain and recruit trained clinicians, a software system like INFANT may have a supportive role in patient monitoring. Relevant primary health care data to be collected by existing staff.

There is a need for obstetric academics to engage with innovators to find solutions to the challenge faced by intrapartum caregivers to foster respectful maternity care.

This solution will eventually benefit women seeking intrapartum care in the district hospitals where the majority of the births in the country take place.

Since we have the support of world-renowned researchers, the initiative in its intermediate stage will help academics in the field of obstetrics all over the country to focus on relevant research questions that will be helpful to society.

This solution will provide a platform for members of IBN to exchange ideas and engage with each other, debate their differences and find a common ground. An opportunity to engage with health innovators who are working tirelessly to produce inexpensive gadgets and software companies that are working on artificial intelligence.

Thus, the benefits will target

1.  Women seeking optimum intrapartum care in the unreached parts of the country.
2.  Academics in obstetrics in different medical colleges of the country.
3. Software companies engaging in health informatics and artificial intelligence.
4. Innovators that are engaged in inventing inexpensive labor monitoring and management tool.
5. Established researchers in the field of obstetrics to focus on making a difference in society.

The India Birth Network formed through a successful “British Council ICMR Newton Bhabha Fund Researcher Link workshop grant” in 2020, brought together several imminent international and national researchers on a common platform to address the improvement of intrapartum care in birthing centers of India. This successful grant initiated two international virtual and hybrid meetings with a target audience that will form the India Birth Network (Attachment 1). The constitution and the steering committee of the IBN were formed with the national and international partners (Attachment 2). The short-term and long-term objectives of the network were described (Attachment 3). The steering committee has been meeting monthly since its inception. The main international members are Prof Andrew Weeks with wide-ranging research in developing countries with a special interest in Misoprostol, and Prof Michael Robson world renowned for the Ten Group Classification Systems. Dame Tina Lavender with considerable experience in research pertaining to midwifery. The senior Indian partners are Prof Suchita Mundle, Brig (retd) Aruna Menon, Prof Jiji Mathews, Prof Santosh Benjamin, and Prof Swati Rathore with considerable research and interest in intrapartum care.  The department of obstetrics at Christian medical college (CMC) has published an eighteen-year experience that showed improved perinatal statistics despite a substantial increase in patient load. The intrapartum initiative that showed improved perinatal outcomes won CMC the Skoch gold award a prestigious national award that aims at encouraging such initiatives. (Attachment 4)

The faculty from CMC deputed to health district hospitals and NGO hospitals in the unreached parts of the country were exposed to the abysmal state of the settings. Thus, they were keen to use their expertise alongside the national and international partners to impact care in district hospitals of India.

Prof. Shuchita Mundle has already been working with Prof Andrew Weeks on several projects pertaining to Misoprostol. Brigadier Aruna Menon brings with her the rich experience of working in several command hospitals and the Armed Forces Medical College. She is well versed with the potential of nurse-midwife facilitated intrapartum care that is followed in most command hospitals.

Attachment 1:

https://www.youtube.com/watch?...

https://www.youtube.com/watch?...

Attachment 2:

The India Birth Network

The Indian Birth Network (IBN) is a new, multidisciplinary international maternal health partnership set up in 2021 by Christian Medical College Vellore (India) and the University of Liverpool (UK) following the award of a Newton Bhabha Fund Researcher Link Workshop Grant.

Aims

Our aim is to create sustainable research links between nurses, doctors, and midwives in India and the UK and promote accessible evidence-based practice to improve maternity care for mothers and babies across India in government maternity units.

The IBN has already successfully identified and unified early-career researchers across India and the UK to provide a platform for maternal health-related mentorship, networking, and knowledge exchange. The future directions include ensuring sustainability, identifying key research priorities, and research capacity building.

Steering Group

A steering group was formed in 2021 and terms of reference were agreed upon (see Appendix 1).

Work to date

Although multiple steering group meetings have been held, there have only been two meetings of the whole network. We recruited early-career multidisciplinary researchers from public hospitals in India (including government, military, and network hospitals) and the UK to attend through an open advertising call.

The first meeting was a two-day online meeting in October 2021 at which the core group concepts were introduced to 40 attendees from the UK and India. The 3 concepts were cesarean section audit, misoprostol, and the use of nurse-midwives. The minutes were captured in graphic form (Appendix 2).

The second 2-day meeting in January 2022 was a hybrid meeting with in-person attendees in Vellore Medical College in India and at a Lancashire hotel in the UK. This gave an opportunity to expand on the themes above as well as review cesarean audit data from the participating hospitals in the UK and India. Sessions were also held on research methodology and fund-raising for the network. The in-person sessions also allowed members to interact informally and learn about the research and development work that each of the attendees was engaged in. The minutes of the 2 days were again captured visually (Appendix 3).

To date, participants from over 40 maternity centers across 11 Indian states and 20 centers in the UK have attended. An IBN web presence has also been developed: Indian Birth Network and an initial free ‘Slack’ group for the steering committee.

IBN Objectives

The steering group committee has agreed on a list of short- and long-term objectives including:

• participating in meaningful data collection to inform obstetric care such as through the ‘Ten Group Classification System’ (TGCS, or ‘Robson criteria’).
• improving knowledge exchange across Indian states to improve outcomes in low-resource areas
• promoting doctor-nurse-midwife teams to foster integrated care in birthing units
• framing research questions based on identified gaps in clinical research, especially using misoprostol

Feedback and future directions:

Qualitative participant feedback from the meetings highlighted an appreciation of the diverse healthcare needs within the Indian maternal population, the need for a regular forum to continue knowledge exchange, and a continued enthusiasm to keep developing India-UK research partnerships.

Attendees supported the overall aims and direction of the IBN. In addition, they also identified other potential actions for the network including:

• An annual meeting to share experiences and drive collaborative research
• A research prioritization exercise to understand the needs of the participating facilities
• The formation of an accessible digital repository to collate evidence-based guidelines and local audit data
• Capacity building via research skills training for nursing staff
• Promoting evidence-based medicine with practical application in India

The steering group committee has agreed that the immediate next steps are to organize an online platform for information-sharing, coordinate a research prioritization exercise across the maternity centers in India, and hire two administrators (in the UK and India) to develop the network and facilitate an annual conference.

               Indian Birth Network (IBN) Steering Committee

                                 TERMS OF REFERENCE 2021

Constitution:

The IBN Steering Committee is a non-affiliated committee set up in 2021 to oversee the running of the network.

IBN Mission:

The Indian Birth Network (IBN) seeks to achieve high-quality care in Indian maternity units.

IBN Aims:

The IBN aims to:

• Bring together academics and clinicians working in maternal and newborn health from India, the UK, and Ireland to share expertise and resources.
• Encourage and support early career academics working in this field by providing opportunities for education, networking, presentations, and feedback.
• Develop appropriate and meaningful research outputs.
• To develop high-quality guidelines for maternal and newborn care
• Enhance networking between academics working across all relevant disciplines in India, the UK, Ireland, and beyond.

Finances:

The India Birth Network will have no independent bank account. Any funds held by IBN in India will be held by the Department of Obstetrics and Gynaecology in Christian Medical College Vellore, whilst any in the UK or Ireland will be held by the University of Liverpool Sanyu Research Unit. A treasurer will be appointed in Vellore and Liverpool to keep a record of transactions and oversee the accounts.

Chair:

The chair(s) of the committee is/are chosen by agreement (or simple majority vote) from the steering committee membership at the first meeting of the steering committee each year.

Duties of Chair:

1. Organize the date, time, location,        and agenda of each meeting
2. Chair committee meetings
3. Ensure that a member is appointed to write the minutes and circulate them following each meeting

Duties of committee:

1. To fundraise for the organization, and oversee the IBN finances to ensure that there are adequate funds to pay for any costs
2. To convene an organizing committee to oversee local arrangements for any IBN meetings
3. To organize network events to promote the aims of the organization
4. To liaise with stakeholder organizations.

Membership:

The voting membership will consist of 17 ordinary members from India, Ireland, and the UK. Membership will seek to be inclusive between the constituent groupings.

The tenure of the members will usually be 4 years, renewable once with the agreement of the committee for a total of 8 years. These 17 (with a nominal start date for sake of continuity) are currently:

India

Jiji Matthews (co-Chair)

Santosh Benjamin

Aruna menon

Shuchita Mundle

Hilda Yenuberi

Richa Sasmita Tirkey

Swati Rathore

UK

Andrew Weeks (co-Chair)

Tina Lavender

Kirtana Vallabhaneni

Kate Lightly

Teesta Dey

Mira Ebringer

Tracey Mills

Stuart Baird

Mike Robson (Eire)

Ordinary members will be ineligible to re-join the committee for 4 years after the end of their membership.

The secretariat to the meeting will be provided by the current chair.

Quorum:

A quorum shall be 5 members including the Chair (or nominated deputy)

Voting:

Each member will have one vote with the Chair collecting votes in absentia from members unable to attend if required.  Should a vote be necessary, a decision will be determined by a simple majority with the chair having a second casting vote in the event of a tie.

Attendance:

Members will be encouraged to attend all meetings, with no minimum attendance requirement stipulated.

Representatives from partner organizations, local organizing committees, or other external bodies may be invited to attend as appropriate.  Such representatives will not have voting rights.

Frequency:

Meetings shall be held at least 6-monthly with the frequency decided by the chair depending on the strength of the local organizing committee.

Code of Conduct for membership:

1. Treat all members with respect and act in a way that does not discriminate against or exclude anyone
2. Listen to and respect the views and experiences of other people contributing
3. Allow others to have equal opportunity and time to share their opinions
4. Challenge ideas, not individuals or their opinions
5. Observe the authority of the chair and support the individual in this role

Review:

These terms of reference will be reviewed on a 5-yearly basis

Authored by

Andrew Weeks

Approved

IBN Steering Committee meeting December 2021

Review date:

Dec 2026

Document owner:

Chair of IBN Steering committee

 Attachment 3:

SHORT TERM OBJECTIVES

1.  To use the help of international experts to find pragmatic solutions for optimal management of birthing units in India.

2. To share and use the expertise of health leaders of under-resourced states in India to improve birth outcomes in overcrowded under-resourced settings.

3. To develop evidence-based, simple pragmatic digital algorithms with regular updates for antepartum, intrapartum, and postpartum care, that can be used by nurse-doctor teams, to optimize birth outcomes.

4. To describe the basic standard of care in birthing units with relevance to our setting.

5. Describe the monitoring of obstetric care, using audit cycles such as the “Ten Group Classification System” (TGCS) and other pragmatic confidential, and non-punitive audits.

6. To identify direct and indirect causes (gaps) for poor outcomes in birthing units.

7. Identifying potential leaders of “doctor–nurse teams” to foster integrated care in birthing units that are followed uniformly in the country.

LONG TERM OBJECTIVES

1. Promoting digital platforms for continuous evidence synthesis and development of pragmatic care for birthing units in India.

2. To identify early career researchers (doctors and nurses) who will help develop the above digital platforms. To ensure a robust support system to embark on well-designed studies on topics relevant to our country that can be published in peer-reviewed journals.

3. Framing research questions based on the identified gaps in clinical research in Indian settings.

4. To establish large research networks among government and not-for-profit organizations in partnership with international experts to conduct well-designed studies on topics relevant to our setting. 

5. Formalizing research partnerships, fostering grant application, and research publication through a Memorandum of understanding. (MOU)

6. Developing a process of guideline development relevant to India.

Attachment 4:

A) SKOCH GOLD AWARD (For Intrapartum initiative to improve patient and newborn safety)

Ebenezer, ED, Londhe, V, Rathore, S, Benjamin, S, Ross, B, Jeyaseelan, L, Mathews, JE. Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study. BJOG 2019; 126 ( S4): 21– 26.

We want the simple successful initiatives in our department scaled up to help district hospitals with the help of a robust” India Birth Network” (IBN). The formation of a robust IBN will need seed funding to develop and maintain interactions. Maintaining this international and national network will be the immediate goal of this grant. There is also an urgent need to develop interphase with software companies interested in labor care, artificial intelligence, and innovators of birth monitoring equipment.

This solution will eventually benefit women seeking intrapartum care in the district hospitals where the majority of the births in the country take place since we have the support of world-renowned researchers. The initiative in its intermediate stage will help mentor academics in the field of obstetrics all over the country to focus on relevant research questions that will be useful to society.

This solution will provide a platform for members of IBN to exchange ideas and engage with each other to debate their differences and find a common ground. It will enable us to foster the integration of nurse midwife-facilitated care. An opportunity to engage with health innovators who are working tirelessly to produce inexpensive labor monitoring gadgets and software companies that are working on artificial intelligence.

World famous academics have been able to come together on one platform to address relevant intrapartum managerial challenges faced in our country, through the “India Birth Network”. This is an opportunity to study the potential and efficacy of innovations that can make maternal and fetal intrapartum monitoring with automatic digital capture reliable and easy. Academics from around the country will be galvanized to address the challenges faced by busy birthing units of the country through this network.

The IBN now has representation from the obstetric units of several important academic centers in the country. These representatives will be encouraged to find a district hospital that has a minimum of 300 deliveries a month, to mentor.  The initial data collections from these centers and training of staff in the facility will need some training which will require seed funding.

Impact Goals for the first year:

• The ability of the steering committee of the IBN to engage with members of the IBN and   communicate their short- and long-term goals and maintain the fervor
• The ability of IBN to find target district hospitals to mentor.
• Description of synchrony of the integrated work of Doctor, Nurse -midwife, and paramedic to be followed by a facility.
• Describe the TGCS in the chosen target hospitals to find optimal cesarean rates in these settings.
• Finding the most inexpensive effective health informatics company that is keen on engaging in artificial intelligence and data capture.
• Describing the minimum  mandatory data collection for the audit training cycle.
• Demystifying the new ECG-based foetal monitoring systems that have not been validated.
• Describing research priorities for our setting and finding an inexpensive design to find quick answers.
• Engaging with innovators

Impact Goals for five years :

• Finding more academic leaders from different states.
• Mapping of all district hospitals in the country with help of academic leaders in different states.
• Ensuring academics engage in relevant research that will have a significant impact on birthing units.
• Developing a digital platform for pragmatic but evidence based guidelines
• Facilitating multicentric studies to improve intrapartum care.

Our Impact goals will address UN Sustainable Development Goals 3, 4, 16, and 17.

The specific measures that we are monitoring are the progress made by the partnership of IBN  towards fulfilling its short-term and long-term objectives.

We plan to capture baseline data that will provide us with indicators of facility empowerment.

Measurement of indicators during the 5-year period of the rollout of initiatives after identifying target district hospitals are as follows:-

• Maternal Mortality.
• Significant Maternal Morbidity
• Perinatal Mortality
• Significant Perinatal Morbidity
• Preventing transfer to another center during labor
• Cesarean Sections rates using the “Ten Group Classifications System”

Our solution will comply with the theory of change. We are suggesting a solution that is simple and standardized evidence-based targeting the grassroots.

We will circumvent the hard task of ensuring evidence-based and good intrapartum practices are taught in the different academic centers of our country, through the pragmatic guidelines developed by the IBN  to address challenges faced by the district hospitals and large busy academic centers.

Our solution is powered by world-famous researchers working to solve the concerns of intrapartum care. We are hoping to use artificial intelligence and technology to address the major challenges of busy labor rooms by engaging with soft ware companies that work on data collection of peripartum care. 

There is an urgent need to engage with innovators and validate their innovations for accuracy reliability and feasibility

Primary health care data will be collected by the existing IT team in the district hospitals. However, we will need to support this team for at least a period of 5 years.

We will liaise with the existing govt organizations such as the "Ayushmaan Bharat program",NITI AAYOG under the National health authority and ensure the effect is complimentary.

The IBN has ensured representations from government and not-for-profit hospitals from all over the country. The India Birth Network has representatives from the Medical, Nursing, and Midwifery domains. We will be engaging with software companies, Innovators, and government agencies 

Steering Committee Members:

India

Prof. Jiji Matthews (co-Chair)

Prof. Santosh Benjamin

Prof. Shuchita Mundle

Prof Brig (retd) Aruna Menon

Prof. Swati Rathore

Associate Prof. Hilda Yenuberi

Assistant Prof. Richa Sasmita Tirkey

UK:

Prof. Andrew Weeks (co-Chair)

Prof. Tina Lavender

Kirtana Vallabhaneni

Kate Lightly

Teesta Dey

Mira Ebringer

Tracey Mills

Stuart Baird

 Ireland:

Prof. Mike Robson (Eire)

IBN Members: 

1          Col Sanjay Sharma, Lt col S . Sreedevi

             (ARMED FORCES MEDICAL COLLEGE-PUNE-MAHARASTRA)

2          Prof. JB Sharma, Dr. Anubhuti Rana

             (AIIMS DELHI) 

3          Dr. Mishu Mangla, Dr Naina Kumar

             (AIIMS BIBINAGAR-TELENGANA) 

4          Dr. Sharmila Babu (AIIMS MANGALAGIRI-ANDRA PRADESH) 

5          Dr. Seema Yadav (AIIMS-ANDAMANS & NICOBAR ISLANDS) 

6          Dr Anita Yadav (AIIMS NAGPUR-MAHARASTRA) 

7          Dr. Charu Sharma (AIIMS JODHPUR -RAJASTHAN)

8          Dr. Saubhagya Jena, Dr Jasmina Begum

              (AIIMS BHUBANESWAR-ODISHA) 

9          Dr. Asmita Rathore, Dr. Shakun Tyagi

              (MAULANA AZAD MEDICAL COLLEGE-DELHI ) 

10       Dr. Dilip Kumar  (JIPMER-PONDICHERRY)

11        Dr. Wansa Shullai  (NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL    SCIENCES -SHILLONG -MEGHALAYA)

12        Dr. Poonam ( MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCE-WARDHA-MAHARASTRA) 

13        Dr. Veronica Jalaja,  Dr Jayasri

             (KING KOTI GOVT HOSPITAL-TELENGANA)

14        Dr. Joslin

            (NGO HOSPITAL-BROADWELL CHRISTIAN HOSPITAL- FATHEPUR)

15        Dr. Sarin

             (NGO HOSPITAL -DUNCAN CHRISTIAN HOSPITAL-RAXUAL) 

16        Dr. Paul

             (NGO HOSPITAL- CHRISTIAN FELLOWSHIP HOSPITAL-ODDANCHATRAM)

17.        Dr. Vijaya Anand, Dr. Ann

             (NGO HOSPITAL- CHRISTIAN HOSPITAL MAKUNDA)

18.        Dr. Bendang  Jamir, Sr. Christy Simpson

         (NGO HOSPITAL-CHRISTIAN INSTITUTE OF HEALTH SCIENCES AND           RESEARCH-NAGALAND)

19.       Dr. Anne George, Dr. Toby Ann Marcus, Dr. Kavitha Abraham, Dr. Annie  Prashanti, Dr.  Shiny Nirupama, (CMC VELLORE-TAMIL NADU)

20.       Sr. Anne Jarone, Sr. Diana David, Sr. Mary Jennifer

             (COLLEGE OF NURSING, CMC-TAMIL NADU)

This is not a business model. It is a strategic health initiative.

We are suggesting a strategy that is inexpensive and can be achieved within the budget allocated to the facility by simple initiatives that empower it as was done in the labor ward of Christian Medical College Vellore. 

The initiatives described in the labor ward of Christian Medical College Vellore were inexpensive and can easily be followed in other birthing units.