Interdistrict variations in child health status and health services utilization: lessons for health sector priority setting and planning from a cross-sectional survey in rural India.

BACKGROUND: There are limited data on interdistrict variations in child health status and health services utilization within the states of India. We conducted this study to identify and understand district-wise variations in child morbidity, mortality, healthcare seeking, and the status of health facilities in India. METHODS: A cross-sectional population-based cluster survey was conducted from April to July 2007 in 16 districts of eight states in India. Two districts with similar demographic profile and health criteria were selected from each study state. RESULTS: A total of 216 794 households and 24 812 under-5 children were surveyed. There were wide interdistrict variations in the health status of children within the same state and between different states across India. Interdistrict difference of >5 points/1000 live-births was found for infant mortality rate and under-5 mortality rate in all eight study states, while in six out of eight states this difference was >10 points/1000 live-births. Four states had a difference of >10 points/1000 live-births between respective districts for neonatal mortality rate. The interdistrict differences were also noted in childhood morbidity and health-seeking behaviour. Analysis of proportion of health facilities conforming to Indian public health standards revealed that the difference was m10% for availability of vaccines in five states, emergency services in three, laboratory services and logistics in four each, and referral facility in three of the eight study states. CONCLUSION: This study underscores an important information gap in the country where planners seem to rely heavily on a few selected national-level databases that may not be adequate at the micro level. The current process of sporadic health surveys also appears inadequate and inappropriate. There is a need for district-specific data for planning, improving quality of service and generating demand for health service utilization to improve child survival in India. The findings of this study may prove useful for child health programme planning in India.

A study of interface of ASHA with the community and the service providers in Eastern Uttar Pradesh.

OBJECTIVE: To study the functioning of ASHA in the community with special focus on interface with community and service providers in Eastern Uttar Pradesh. METHODS: This was a descriptive cross-sectional study conducted in two blocks each in Gorakhpur and Maharajganj districts of Eastern Uttar Pradesh during October-December 2008. A multi stage sampling design was used. The study subjects included 120 mothers, 60 ASHAs, 20 AWWs, 20 ANMs, 4 Medical Officers in charge, 2 Chief Medical Officers (CMOs) and PRI members. Data was collected through pre-designed and pre-tested structured interview schedules and through checklists for FGDs. RESULTS: Most (95%) of the ASHAs were 8th Pass or above. The residential status and marital status was as per guidelines. Induction training was received by all. Major motivating factor for ASHAs were either money (81.66%) or getting a government job (66.66%). Most of the ASHAs (86.66%) got the support from their supervisors in solving their problem and majority of them (95%) were satisfied with their supervisors. All the ASHAs have been accepted very well in the community and are acting a good link between community and health providers. The faith and confidence of community on ASHAs are reflected by the demand of additional jobs like help in getting widow pension and ration card etc. CONCLUSION: Though accepted by the community, ASHAs need regular training, support and cooperation from other functionaries.

Status of birth preparedness & complication readiness in Rewa District of Madhya Pradesh.

OBJECTIVE: To assess status of birth preparedness & complication readiness among recently delivered and pregnant mothers in Rewa district of Madhya Pradesh. METHODS: A cross-sectional descriptive study was conducted during September-November 2008 among a sample of 2022 study subjects (pregnant women in second/third trimester and/or mothers who have delivered within one year) selected through 30 cluster sampling technique. Investigators collected data using pre-designed schedule by house to house visit. 7 indicators were derived from elements of birth preparedness (BP)/complication readiness (CR). Mean of 7 indicators was taken as BP/CR Index. RESULTS: Among 2022 women, 632 were pregnant and 1390 were recently delivered. BP/CR index was found to be 47.5. BP/CR index was significantly high in above poverty line families (50.9), higher educational level (63.6) and in service and business group (59.3). BP/CR were significantly higher in primi-para (50.9) as compared to multipara (40.1). Some indicators for example knowledge of danger sign (18.6%), about transportation facilities (18.6%) and 1st trimester ANC (24.1%) was very low.

Indigenous system of medicine lady doctors and general nurse midwives in operationalization of 24 x 7 services under NRHM in selected districts of Uttar Pradesh.

OBJECTIVES: To find out the status of utilization of MCH services after the induction of the indigenous system of medicine (ISM) lady doctors and CNMs for 24 x 7 services and the acceptance of this innovation by the health system and the community. METHODS: This was a cross-sectional descriptive study conducted during October to November 2008 in 10 blocks of 5 selected districts in Uttar Pradesh. Study subjects (CMO, MO I/C, ISM lady doctors, GNMs, PRI members) were interviewed and FGDs were also conducted. RESULTS: Shortages of medical and paramedical staff as well as facilities for institutional delivery at the district and block level were revealed. Only 6 out of 16 ISMs were trained. Knowledge of the ISMs/GNMs was lacking in many essential components of MCH including identifying high-risk pregnancy, high-risk newborn for urgent and timely referral. 36% could identify high-risk pregnancy and only 18% used partograph during labour. About 68% of the ISMs/GNMs were dissatisfied regarding honorarium, 59% with work conditions and 55% with delivery instrument. Induction of ISMs/GNMs were welcomed and accepted by medical officers and panchayets. Delay in payment of honorarium and pay disparity between MBBS doctors and ISM lady doctors and lack of proper logistic support were some of the problems facing the ISMs/GNMs. CONCLUSION: For sustenance, in service training, provision of transport and accommodation, logistic support, well equipped labour room, timely monitoring and supervision, removal of pay disparities need to be ensured. The contractual appointment should also be made permanent and lucrative.