Assessment of Maternal and Child Health Under the NRHM Framework A Study of four Districts of UP: Bahraich, Balrampur Varanasi and Lucknow

Transcription

1 Assessment of Maternal and Child Health Under the NRHM Framework A Study of four Districts of UP: Bahraich, Balrampur Varanasi and Lucknow THESIS SUBMITTED TO THE UNIVERSITY OF LUCKNOW FOR THE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY IN WOMEN S STUDIES Under the Supervision of Prof. Rakesh Chandra By Pravesh Dwivedi Institute Of Women s studies Faculty of Arts University Of Lucknow Lucknow 2013

2 Certificate This is to certify that the thesis entitled Assessment of Maternal and Child Health under the NRHM frame work - A Study of four Districts of UP: Bahraich, Balrampur, Varanasi and Lucknow submitted by Mr. Pravesh Dwivedi in fulfillment of the degree of Doctor of Philosophy under Institute of Women s Studies, University of Lucknow, Lucknow.The thesis is an original record of bonafide research work. I recommend his thesis for evaluation and for Ph.D. degree in Women s studies. Date: Place: Prof. Rakesh Chandra

3 Preface Reproductive health or maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for many women, it is associated with suffering, ill-health, gender discrimination and sometimes death also. The major direct causes of maternal morbidity and mortality include hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor. Globally, every minute, at least one woman dies from complications related to pregnancy or childbirth that means women a year. More than three million babies are stillborn, more than four million newborns die within the first days or weeks of life, and altogether 10.6 million children a year die before their fifth birthday, according to WHO's latest figures. Uttar Pradesh is the largest state in India in terms of its population which has become a cause of concern in many quarters. It is evident that state health care services, particularly relating with maternal and child health interventions are being labeled as inadequate to the extent. Performance of these services have to be improved a lot to catch up the race with other states. The indices of human development relating with rural areas and socially disadvantaged groups such as levels of literacy, gender disparity, provision of basic needs like health care and drinking water show in general, poor performance. Village health infrastructure is also in very bad shape and every stakeholder is keeping themselves away from ground reality. Inefficient administration and wrong policies are going to take long time for a positive change but rural people can be made aware about their entitlements and rights so that they can demand timely fulfillment of these entitlements and rights. Development of maternal health services rural areas is possible only when masses will come forward and protest against ongoing irregularities. A dedicated response is needed to stimulate delivery of maternal health services in rural areas as well as mobilize marginalized sections of the society. Panchayati Raj Institutions also have greater role & responsibilities towards healthy motherhood and childhood but they have failed in delivering their duties and achieving

4 their goals as mandated in constitution of India. Prevailing condition of maternal health and child health in rural India is not so good and millions of Indians are living in frustrated environment. In this research the focus has been centered upon the Community base intervention under NRHM. ASHA and ANM are key players in generating awareness among rural people. Many researches have already shown that better results can be obtained by only spreading awareness on maternal and child health care among rural people. This research is focused on four districts of UP; two districts out of these four districts are High performing districts Lucknow and Varansi and two low performing remote districts Bahraich and Balrampur. This comparative study has been conducted to find out the basic cause of slow progress in low performing districts and to search the best practices of high performing districts. Chapter Scheme of the study has been devised to provide overall picture of National level intervention and State specific plan to access maternal and child health status of Uttar Pradesh with the relevant analysis of different aspects. Detailed introduction about national and state level maternal health services and their present status have been presented in the first chapter of this thesis. Policy and programmes related with maternal child health issues have been discussed in chapter II. In this chapter programs related with maternal health under NRHM have been described in detail. Maternal health policy framework of India, Need of NRHM mission and perspective of NRHM mission, Vision of the mission, goals strategies and expected outcomes of the mission at every level have been covered extensively in chapter two to have an fare idea about holistic approach of the NRHM. Also, a discussion is there about broad framework of implementation, Management of NRHM activities at State / District / Sub district level, Institutional Arrangements and proposed institutional mechanisms of the Mission local to national level. Attempts have been made to show the picture of NRHM mission the way it has been designed and its holistic approach for strengthening MCH services in our country.

5 Chapter III attempts to provide overview of maternal and child health under NRHM in State of UP. Details of the information available towards progress made by UP state in Maternal and child health have been presented with key indicators. In this chapter, key strategy for strengthening Mother health status in Uttar Pradesh includes Strengthening outreach and sub center services, Village health and Nutrition days planning and implanting village to state level strategy,monitoring quality assurance and progress of Janani surksha yojna scheme and access to emergency obstetric care service. Child health scheme like Jannani Shishu Suraksha Karyakaram and Immunization program Implementation are given in detail and in the same chapter, review of DLHS and NRHM data with reference of Human development index report Uttar Pradesh is also provided. Chapter IV includes predominant study and papers published in different journals on maternal and child health. In this chapter, the trends of maternal mortality in international arena and its impact of Indian policy framework have been showcased. This chapter also comprises findings of evaluation of NRHM conducted by Ministry of Health and Family welfare GOI. Integrated Management of Neonatal and Childhood Illness (IMNCI) programme for reducing IMR, included in NRHM is given required space of discussion. This chapter also highlights the findings of other researches done on this program. Chapter V is showing overall research design & methodology of this research.this chapter comprises selection of research plan, Hypothesis, objective of the study, scope of the study, primary preparation,research design,selection procedure of district and blocks, sampling plan, collection of data tools and techniques, Interview schedule,observation and data processing etc. Chapter VI provides information on background of research area and respondents on basis of a household survey conducted in four districts stretched over 20 villages. This chapter provides information on background characteristics of districts and respondents. This chapter includes gender and cast pattern, education status type of marriage and age of marriage, monthly income patterns and utilization patterns of basic amenity. Chapter VII comprises analysis of data collected from the respondents. Information base for the analysis in this chapter is the household survey with women having children

6 aged between 1-2 years. This chapter compares the districts in two groups one is high performing districts and second one is low performing districts. It includes obstetric care.antenatal, delivery and postnatal care; children s immunization services. Further, respondent s awareness about NRHM s interventions and major schemes at village level, ASHA, JSY, VHSC and VHND is also provided in this chapter. Chapter VIII provides key findings and information on obstetric care, children immunization services and other key aspects maternal health surveyed at grassroots level. Chapter IX contains final conclusion and suggestions relating with maternal and child health services and interventions in selected Uttar Pradesh Districts. Some key suggestions have been presented to improve maternal and child health services under NRHM. Pravesh Dwivedi

7 Acknowledgement Om shri gurave namah!! God is almighty and every action is possible only with his blessings. But the guidance of Gurudev is also must for correct direction and successful completion of particular action. In this context Prof. Rakesh Chandra provided his invaluable guidance, precious time and shared his rich experience in the capacity of my Research Guide. He always supported and encouraged me throughout the research process. Other learned faculty members also provided significant inputs at different stages. Blessings of my mother Smt. Uma Dwivedi, father Shri Harishchandra Dwivedi and grandfather Shri Sitaram Pandey have been always with me and provided enough strength to complete the research work. My elder brother Dr. Ritesh Dwivedi, Assistant Professor, Amity University UP and sister Mrs Richa Tiwari helped me a lot every time. Kirti Gupta, Jyoti Gupta and Ankita mukharji my friends also provided important suggestions from beginning till the end. Being a social study, contributions of NGOs and other stakeholders of the society are very important. Professional relations with different social sector experts and NGO workers paid rich dividends during the intervention period. Different government departments and their officials took great interest and helped at regular intervals. Also, I want to express my gratitude towards every individual who supported and participated in the survey as well as shared their experiences with me. Pravesh Dwivedi

8 Content Chapters 1. Introduction Policy and programme Related with Maternal child Health: NRHM Status of Maternal & Child Health in UP Review of literature Research methodology Background of research area and respondent Data Analysis Key findings Conclusion and suggestion Annexure 1. Bibliography Questionnaire

9 Abbreviations ANC ANM ASHA AWW BCC CHC CMO DLHS ICDS IEC IFA IPC/C IPHS JSSK JSY MoHFW NFHS NHSRC NRHM ORS PHC PIP PMU PRI RCH RKS TBA VHSC WHO Antenatal Care Auxiliary Nurse Midwife Accredited Social Health Activist Anganwadi Worker Behavior Change Communication Community Health Center Chief Medical Officer District Level Household and Facility Survey Integrated Child Development Services Scheme Information, Education and Communication Iron and Folic Acid Interpersonal Communication/Counseling Indian Public Health Standards Janani Shishu Suraksha Karyakram Janani Suraksha Yojana Ministry of Health and Family Welfare National Family Health Survey National Health Systems Resource Center National Rural Health Mission Oral Rehydration Solution Primary Health Center Program Implementation Plan Program Management Unit Panchayati Raj Institute Reproductive and Child Health Rogi Kalyan Samiti Traditional Birth Attendant Village Health and Sanitation Committee World Health Organization