PICME or Pregnancy and Infant Cohort Monitoring and Evaluation is an initiative taken by the Tamil Nadu State Government to track all pregnant women in the state. It was launched in the year 2008 to collect data on antenatal, delivery and post-partum care in pregnant women and infant health. In its inception year, registration in the PICME database was not mandatory, however it was made mandatory in the year 2018 and a result of the same, The Greater Chennai Corporation has asked all pregnant women to register their maternity period particulars on the state health department’s Pregnancy and Infant Cohort Monitoring and Evaluation database by visiting nearest health centre or government and medical college hospitals.
Tamil Nadu has always been a model worldwide for successfully reducing the maternal mortality rate from 450 deaths per 100,000 live births in 1980 to 90 per 100,000 in the year 2006. As a matter of fact, Tamil Nadu is amongst few in India having specialized public health cadre in charge of primary and first referral level of health care and has always implemented one or the other platform to have effective monitoring system. It was in the year 1998 when state has implemented monitoring report system, which has put an effective emphasis on registration of pregnancy, as early as by the third month. To ensure a healthy monitoring system of expectant women in the state and to achieve a remarkable decline in the maternal mortality rate takes consistent political commitment and consistent senior policy makers and officials who are getting changed too often and thus helped in making continuity in policy and programme management and innovative schemes such as maternal death audits etc.
Pregnancy And Infant Cohort Monitoring And Evaluation (PICME) Benefits
PICME is an initiative launched as a part of Reproductive and Child Health Scheme, which was launched in October 1997. The main aim of the scheme was to reduce the infant and maternity mortality rates and some of the key objectives of the scheme are as below:
As an extension of RCH campaign, PICME registration also aims at bringing down the maternal mortality ratio by providing an interface to the government for monitoring health of pregnant women registered on the PICME database. In order to get yourself registered in the PICME database, you need to follow the below mentioned steps:
- Visit the https://picme.tn.gov.in
- You need to register on the website right from the inception of your pregnancy till you get the birth certificate for your newborn.
- On successful registration, you will be provided with 12 digits RCH ID, which has to be used in further correspondence.
- The 12 digit RCH ID is also used to track every aspects of the pregnancy by the Public Health Department.
- The easiest way to get registered in the PICME database is through the nearest health care centers, hospitals and primary health care centers.
- You can also collect your 12 digit RCH code by contacting local nurses or Aanganwadi center workers.
- Registration with PICME is beneficial for the expecting mothers in more than one way. Apart from having a regular monitoring of your health during the pregnancy, it also gives you the benefits under the RCH scheme such as Maternity Benefit Scheme, which provides pregnant women a total of Rs 12,000 in three installments – First installment once they have availed all required health services, second installment after they have delivered in a government hospital or health center and third installment after the immunization schedule of infant is completed.
- Expectant mothers are monitored by local nurses during the ante-natal stage. Local nurses can also help you to upload your documents on the official software of PICME.
Registration with PICME is not only important from health point of view but it is also important to get the birth certificate of your newborn i.e. women who haven’t registered their pregnancies with the PICME, will not be able to register childbirth and hence cannot get birth certificates. Tamil Nadu has taken a stern but thoughtful step by making PICME registration mandatory and as per health secretary J Radhakrishnan – “It is an ambitious project that attempts to bring down maternal and infant mortality rates by keeping a tab on every pregnant woman in the state”.
Developed by the National Informatics Centre, PICME consists of four modules for the pregnancy cohort and five modules for the infant cohort i.e.
- Four capsules for pregnancy cohort: General demographics, antenatal check-ups and scans, antenatal referral and delivery, and post-partum details.
- Five capsules for infant cohort: General; referral; immunization; growth monitoring; infant death.
Data collected is saved in the PICME database and gives following information for analytical purpose:
- From the collected database, doctors can have information on the kinds and extent of pregnancy related risk factors amongst pregnant women.
- It helps to generate reports on expectant women who would need a regular follow-up such as those having high risk factors. It also helps in generating reports with details such as estimated date of delivery and immunization requirements.
- It helps to generate reminder to the health workers to keep a check on their catchment population and also to generate automatic SMS texts to remind pregnant women regarding their antenatal tests and other mandatory health checkups during the pregnancy.
PICME, a special pilot platform launched by the Tamil Nadu government, is a positive step towards reducing female foeticides and infanticides because before PICME was made mandatory in the year 2018, the government has no way to track approximately 40 percent of the deliveries happening either at the private hospitals or at homes. Also most of the women in rural areas were apprehensive to come forward to register their third and consecutive pregnancies, because doing so would not make them eligible for the welfare schemes offered by the government. Going by the statistics, the mortality rate of Tamil Nadu has been on an ever high, standing at 79 for the year 2016-17 and total number of maternal deaths 26 in the Coimbatore district itself.
Idea of PICME is based on facts such as high maternal mortality rates and low awareness regarding antenatal check-ups, but it is also based on certain assumptions, such as:
However, like every other thing is life, every good or innovative step comes with its own challenge and PICME is no exception. With the introduction of PICME, government has to account for the complications and issues it brings along, such as doctors not being sensitized about single women pregnancy. Also the onus of implementing the task falls on the local nurses, who are also women and thus in a way takes them away from doing their basic and primary tasks which is to visit communities and interact with people. It is given fact that the health system is a rigid system with internal hierarchies and power differentials and for this very fact, the government must ensure that PICME does not become more of a supervisory and monitoring tool than a progressive health system tool.
Government must also deal with another and critique perspective of PICME which is implementation of PICME may lead or set up a victim-blaming approach where rural women are being blamed for missing their antenatal visits rather than making it a health system which is working towards finding ways to improve maternal and infant health. In order to have an effective implementation of PICME across each and every village of Tamil Nadu, its government must find ways to use the platform and the data to handle the broader social determinants of health with women, health workers, local nurses and communities as partners in the process. Also where use of information technology and creation of database has resulted in creation of databases with large amount of information, it has also increased pressure both on the pregnant women and peripheral health workers.