Strategies to improve the performance of female health workers in West Bengal: A cross-sectional survey.

Background. Female health workers in India face an increasing workload that affects their performance. We did a study in 2 districts of West Bengal, India, to quantify their workload and identify determinants of good performance. Methods. We randomly sampled female health workers from the health department’s list. First, we quantified the time allocated to tasks through observations of work sessions. Second, we estimated the prevalence ratio (PR) of aboveaverage performance for three indicators (DPT-booster coverage, antenatal check-up coverage and family planning performance) according to selected potential determinants. Results. Female health workers spent 26% of their time in documentation. We recruited 42 female health workers (average population covered: 6495). Larger floor space (PR 2.5; 95% CI 1.2–5.3), use of simplified documentation procedures (PR 2.5; 95% CI 1.2–5.2) and monthly supervision (PR 3.0; 95% CI 1.1–8.5) were associated with above-average DPT-booster coverage. Availability of a private space was associated with above-average coverage in antenatal check-up (PR 1.9; 95% CI 1.0–3.5) and family planning (PR 2.5; 95% CI 1.2–5.2). Workers who used existing resources to cope with multi-tasking performed better. Conclusion. Female health workers spent excessive time in documentation which left less time for service delivery. Infrastructure, planning and supervision affected performance and these areas must be strengthened to improve primary healthcare services.

An evaluation of diarrheal diseases and acute respiratory infections control programmes in a Delhi slum.

OBJECTIVE: Effective early management at home level and health seeking behavior in case of appearance of danger signs are key strategies in Acute respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) where majority of episodes are self-limiting and viral in origin. Integrated Management of Childhood illnesses (IMNCI) also envisages that family and community health practices especially health care seeking behaviors are to be improved to reduce childhood morbidity, mortality and cost of admissions to hospitals. Thus, a study was undertaken at an urban slum area--'Gokul Puri' in Delhi, among under-5 children with the aim to assess the magnitudes of ARI and ADD. METHODS: A Cross-sectional survey was conducted in this urban slum of Trans-Yamuna, covering 1307 under-5 children for five days starting from 9th of August, 2004. Survey team consisted of 14 FETP Participants (WHO Fellows) from India, Nepal, Myanmar, Bhutan and Sri Lanka. A pre-tested, house-hold tally marking form was used to interview the caretakers/mothers. History of episodes of ARI and/or ADD in the last two weeks was asked. Health care practices including use of ORS &home available fluids in diarrhea, continued feeding during diarrhea, awareness of danger signs of ARI &ADD and medical advice sought were asked of those mothers whose children had such an episode. RESULTS: 191 (14.6 %) of 1307 children surveyed, had an attack of ARI in the preceding two wk. The common symptoms of ARI cases were mild running nose (78%), cough (76.4%) and/or fever (45.5%). Only 8 (4%) had fast breathing. One or more danger signs were known to 80% (152/191) of mothers and an equal number (80%) of mothers had sought treatment. ARIs are mostly mild or self limiting but only 16% of caretakers perceived so and doctors also prescribed medicines. The attack rate of Acute Diarrheal Diseases was 7.73% in the study and ADD's annual adjusted morbidity rate was 1.69 episodes per child per year. Though nearly three-fourth of mothers (71.3%) had reported to be seeking medical advice (which is not needed in mild episodes of diarrhea) the ORS use was 38.6%, use of Home available fluids (HAF) was 42% and continued feeding was 50% during the ADD episode and awareness of at least two danger signs was present in 34%. CONCLUSION: Though aware of danger signs of ARI, care takers were still seeking medical advice for mild cases of ARI and doctors were prescribing drugs. Correct home based management e.g. use of ORS, continued feeding etc. was deficient in the community. Knowledge of danger symptoms was low and medical advice was being sought and drugs were being prescribed for ADD, too.