ABSTRACT
Background: In India, as in many other countries, postpartum family planning is usually initiated after 6 weeks postpartum. Early resumption of sexual activity coupled with early and unpredictable ovulation leads to many unwanted pregnancies in the first year postpartum. Increase in hospital deliveries provides an excellent opportunity to sensitize women and provide effective contraception. Hence the present study was done at our tertiary care centre to assess the knowledge, attitude, practice regarding contraception and to find out the relationship between knowledge and attitude regarding contraception among breast feeding mothers.Methods: A hospital based observational study. The patients admitted at our tertiary care centre in the Department of Obstetrics and Gynecology.Results: Majority of the participants (72%) were in the age group of 21-25 years. 21.2% of the study group was educated up to primary level while 33.2% and 18.4% of the participants studied till SSC and HSC respectively. Majority of participants were from middle class (50%) followed by lower class (36.4%) and upper class (13.6%). 69.6% participants resided in rural areas while 30.4% participants were from urban areas. It was observed that age, education and mode of delivery were the significant factors.Conclusions: As the government gives incentives to couples who opt for permanent sterilization, which is an effective drive, it should also give incentives to couples who follow temporary methods and delay pregnancies. Couples who adopt one child norm or 2 children norm should be encouraged by benefits either in the form of children’s education or health insurance.
ABSTRACT
Janani Suraksha Yojana (JSY) is a centrally sponsored scheme which is being implemented with the objective of re-ducing maternal and infant mortality by promoting institutional delivery among pregnant women. The Government of India introduced the JSY (safe motherhood program) based on the principles of CCT. Under JSY, cash assistance was given to pregnant women receiving at least three antenatal check-ups (ANCs) and delivering at institutions. The study is undertaken to establish if there is any co-relation of level of awareness about the scheme and its impact on ANC and institutional deliveries in the rural, urban and tribal area of Ahmednagar district. Method: The JSY beneficiaries were asked demographic characteristics, area of residency, educational levels, Category and place of delivery were noted. A set of question (self-designed and pretested) and their responses were noted. Result: Out of 825 JSY beneficiaries, there were total 781 (94.7%) Hindu, Muslim 23(2.8%) and Christian 21 (2.5%) beneficiaries. Majority of Hindu reli-gion JSY beneficiaries. Only few member from BPL JSY beneficiaries have opted for delivery at private hospital. Maximum deliveries taking place in civil hospital are from BPL category. It was observed that the awareness level about JSY is low in tribal area compared to the rural and urban area. It was also seen that 648 (78.54%) JSY benefi-ciaries availed free transport facility out of which 358 (55.24%) fall in high level of awareness category. There is a positive relation between age group and awareness about JSY. Conclusion: 46.8% women with high awareness about JSY scheme, it is a programme for pregnant women which aims at safe institutional delivery. Other factors such as education of mother, religion, culture, area of residence, family type played important role in utilization of available maternal health scheme.
ABSTRACT
Background: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. Objective: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013–2014. Methods: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. Results: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. Conclusion: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.
ABSTRACT
Country‑ and state‑wise maternal mortality shows the highest disparity among health statistics. The erstwhile National Rural Health Mission (NRHM) in India aimed reduction in maternal mortality ratio (MMR) to <100 per lakh live births. Accordingly, many new initiatives were planned and started. This analysis was carried out using data from the Sample Registration System. The data from 1997 to 1998 are available which dates 8 years prior to the launching of NRHM. Hence, comparison period was considered as 8 years of implementation of NRHM. The overall decline in MMR prior to NRHM was 36% and after NRHM implementation 30%. The difference is not significant. The best states and lowest states had changed, but the disparity also has remained almost at the ratio of 1:5. The pace of decline has not increased after NRHM. As well disparity ratio has not reduced indicating the differentially better treatment to the vulnerable states was not adequate.
ABSTRACT
Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM) launched the Chhattisgarh Rural Medical Corps (CRMC) in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG) level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs), and rural medical assistants (RMAs) in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI) interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12), though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff.
ABSTRACT
Health care delivery in India has been envisaged at three levels namely primary, secondary and tertiary. The secondary level of health care essentially includes Community Health Centres (CHCs), constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The CHCs were designed to provide referral health care for cases from the Primary Health Centres level and for cases in need of specialist care approaching the centre directly. CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and Gynaecology, Surgery, Paediatrics, Dental and AYUSH. These centres are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the National Rural Health Mission (NRHM) gives the opportunity to have a fresh look at their functioning. For the first time under National Rural Health Mission, an effort had been made to develop Indian Public Health Standards (IPHS) for a vast network of peripheral public health institutions in the country to provide optimal specialized care to the community and achieve and maintain an acceptable standard of quality of care.
ABSTRACT
Background: The role of RHTC set up under MCI requirement of medical colleges is rising in implementation of NRHM phase 2 programme (2012 onwards); as private medical colleges are expanding in India and they can be an important supporter in public-private partnership for national health programmes. Objective of current study was to assess the role of rural health training centre as a supporting component to a primary health care system for NRHM programme. Methods: The present study was carried out by comparative evaluation of the rural health and training centre of a private medical college with a sub-centre (Muzaffarnagar) on key RCH services of NRHM: a) Family planning materials distribution, b) ANC services and c) Immunization services. Inclusion criteria: Proper ethical approval from both primary health care system and private medical college authorities were obtained for the study. Study design: Prospective evaluation based study on ANM in SC & SN in RHTC in NRHM programme for 1 year duration from 1st January 2013 to 31st December 2013. Data analysis: The statistical data was analysed by Epi-info version 7.1.3. Results: The ANC services, family planning services and immunization services delivered under NRHM programme was found to statistically significantly contributed (P <0.05) by SN of RHTC as compared to ANM of SC in area of Bilaspur, Muzaffarnagar (Uttar Pradesh). Conclusion: RHTC of a private medical college in Muzaffarnagar (UP) is significantly contributing and supporting in RCH services of NRHM programme for primary health care system. RHTC of medical colleges can be an asset for public private partnership in NRHM programme.
ABSTRACT
This study compares the implementation of community-based monitoring (CBM) in 45 primary health centers (PHCs) in the pilot phase in Maharashtra with the equal number of randomly selected PHCs not implementing CBM (non- CBM) from the same districts. Information was collected by teams from Community Medicine Departments by visiting selected PHCs. Establishment of monitoring committees and training of medical offi cers (MOs) had been completed as required but only 36.36% MOs were trained. Only 43.18% MOs received the facility report card. Most of the MOs (90.90%) attended Jansunwai and opined that it had increased community awareness and the barriers between the people and PHC staff were broken. There was no difference in fund utilization and meetings of Rugna Kalyan Samittees. Percentage of Institutional deliveries and women receiving Janani Suraksha Yojana benefi ts among home deliveries was more in the non-CBM group of PHCs.
ABSTRACT
Meeting the needs of HIV‑positive pregnant women and their offspring is critical to India’s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent‑to‑child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT‑RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.
ABSTRACT
Background : Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. Material and Methods: A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Results: Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Conclusions: Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future.
ABSTRACT
The Primary Health Care (PHC) has been globally promoted as a comprehensive approach to achieve optimal health status and ‘Health for all’. The PHC approach, although, initially received the attention but failed to meet the expectations of the people in India. The child health programs in India had been started for long as verticals programs, which later on integrated and had been planned in a way to deliver the services through the PHC systems. Nevertheless, the last decade has witnessed many new initiatives for improving child health, specially; a number of strategies under National Rural Health Mission have been implemented to improve child survival- Skilled Birth Attendant and Emergency Obstetric Care, Home Based Newborn Care, Sick newborn care units, Integrated Management of Neonatal and Childhood Illnesses, strengthening Immunization services, setting up Nutritional rehabilitation centers etc. However, for a large proportion of rural population, an effective and efficient PHC system is the only way for service delivery, which still needs more attention. The authors note that although there have been improvements in infrastructure, community level health workers, and availability of the funding etc., the areas like community participation, district level health planning, data for action, inter-sectoral coordination, political commitment, public private partnership, accountability, and the improving health work force and need immediate attention, to strengthen the PHC system in the country, making it more child friendly and contributory in child survival, in India.