**4. Knowledge and skills of ground level workers regarding identification and management of high risk complications**

In case of India, every five women die every hour, and nearly 45,000 mothers die due to causes related to Postpartum and Postnatal period every year in India which accounts for 17 per cent of such deaths globally" [21].

National Family Health Survey-4, recommended the strategy for the quality facility and service that is confirming the mandatory postnatal care to be imparted within first twenty four hours of delivery followed by the on 3rd, 7th, 14th and 42nd day home visit subsequently to identify and manage the emergent complications which occurs in the occurring postnatal period. Therefore Auxiliary nurse midwives, Lady Health Visitors, and other cadre of nurses working in the first referral units and PHCs are meant to be focused on and proficient for handling these conditions in the respective home visits [22].

Women's death with Post-Partum Haemorrhage is an important indicator for the maternal health which helps anyone to reflect upon the kind of care been imparted to the mothers during the intrapartum and postpartum period. Many of this kind of negligence are preventable. In many situations, deaths due to high rates of postpartum haemorrhage complications are associated with the gap in the health care system, along with the factors like inadequate information and skills of health care workers in the prevention of PPH and its quick management, lack of decision making ability of health workers at appropriate time and which leads to delays in further referral system [23].

Another problem is that be that many postpartum infections emerges 24 after the delivery and the discharge from the hospital. Consequently, in the lack proper knowledge and skills regarding identification of postnatal complications like secondary PPH and Puerperal Infection during postnatal follow-up, many cases of identification of High risk mothers can go undiagnosed and unreported. This will add on to the burden of increased maternal Mortality rate, where on the other side these can be easily detectable and managed if appropriate knowledge and skills are used.

A study conducted at in North-East district of Delhi among 55 ASHA workers on their Knowledge and practice for maternal healthcare delivery in Delhi. The results showed that ASHAs workers possess substantially good knowledge but the practices are not up to the level. The reason identified as various problems challenged by them which require immediate addressing by skill based trainings including decent communication and ability to solve the problems. Over and above vigilant supervision should be considered a primary fragment of work practice during the practice to safeguard that imparted knowledge is appropriately giving the required results in the form of good practices [24].

*Identification and Management of High Risk Complications during Postnatal Period… DOI: http://dx.doi.org/10.5772/intechopen.97533*

The identification and initial management of High risk mother during the post-natal period is totally depends upon the knowledge and skills of these ground level workers, otherwise they will remain un-notified and unreported. The question arise is how far the health task force is skilled and possess accurate information. Government is nowhere less than any other by providing extreme measures and resources to train them. Still the gaps in the knowledge and skills are there. It also depends on the mode of learning and training they got which is one of the biggest reasons for inadequate training. The hands on live demonstration training sessions in these cases are highly recommended.
