Transforming Maternal and Newborn Healthcare in India Through Midwifery: The Fernandez Foundation Initiative
The case explores the promises and challenges of Public-Private Partnerships (PPPs) in the Indian Healthcare system. India has a high maternal mortality rate, poor doctor-to-patient ratio, rising C-section rates, absence of last-mile access to quality maternal healthcare. In this context, Dr. Fernandez, a veteran in maternal healthcare, believes that midwifery is a workable solution to these widespread problems. However, to have an impact both in terms of and financial sustainability, government support is essential. Dr. Fernandez thinks that a PPP may be the best way to create many well-trained and professional midwives in the country. However, given India's complex healthcare structure, it is not easy to get acceptance and commitment from all the states for government schemes. Problems such as frequent changes in the bureaucratic leadership often disrupt the implementation of schemes. Another challenge is the mindset of birthing mothers, the obstetric community, and family members who view the medicalization of birthing as acceptable. Dr. Fernandez has to overcome multiple challenges. She has to address obstetricians' pushback while changing birthing mothers' mindsets and continually motivate the midwives her team had trained. Regarding the PPP, she has to evolve a plan to fast-track the rollout of the PPP model, ensure that the complex PPP involving multiple stakeholders works effectively, she has to address the roadblocks to the implementation of the PPP initiative, and design mechanisms to monitor progress.