CHAPTER: 4 HEALTH STATUS IN GUJARAT AND SURAT DISTRICT

Transcription

1 CHAPTER: 4 HEALTH STATUS IN GUJARAT AND SURAT DISTRICT 4.1 INTRODUCTION 4.2 INTER-STATE HEALTH DISPARITIES 4.3 INTER-REGIONAL DISPARITIES OF HEALTH INDICATORS IN GUJARAT 4.4 INTER-DISTRICT DISPARITIES IN HEALTH INDICATORS IN GUJARAT 4.5 INTER-TALUKA DISPARITIES OF HEALTH INDICATORS IN SURAT DISTRICT: WITH SPECIAL REFERENCE TO OLPAD TALUKA 56 P a g e

2 4.1 INTRODUCTION In this chapter we present the health outline of India and Gujarat with a special stress on certain important aspects concerning Surat District. In this outline, we shall be discussing the data obtained from NFH surveys. The following paragraphs will be broadly divided into three. All-India status in section I., Gujarat Status in section- II and in section III about Olpad this chapter we shall discuss the health status of India visà-vis the world status. From Table No we can gather the health status among the major group of countries. These countries are divided into low, medium and high income countries. The details pertain the GDP, expenditure on health, and health outcome indicators. From the table we also get an idea about the effect of GDP on health status. In the case of high income countries the Infant Mortality rate and the maternal morality rate are low, and in the case where the public expenditure and income are low, these indicators are high. This indicates a relation between per capita health expenditure and the indicators. From the table we observe that the average percapita income of high income countries (HIC) is dollars. In these countries the average CMR and MMR is 6.2 and percent. Similarly, for the Medium income countries, whose average per capita income dollars the CMR and MMR is and respectively. Whereas, the least income countries (LIC) the respective figures are 81.0 and The respective figures for these three categories of countries for IMR are 5.0., , and , indicating a similar relationship as mentioned above. Detailed observation of the table indicates that with regards to infant mortality, births attended by skilled professionals, access to improved sanitation and immunization figures for HIC are 5.0., 99.2., (99.8 and 97.0 rural and urban) and The similar figures for MIC , 88.9., (87.75 and rural and Urban) and In the case of LIC the figures observed from the table indicate as follows , (74 and rural and urban) and This denotes that the health indictors are heavily dependent on the incomes of the countries. From the table we also come to know that high income countries spend more than six times the lower income countries. 57 P a g e

3 4.2 INTER-STATE HEALTH DISPARITIES After this brief review of health indicators for the world level, we now try to find out the status of health indicators at the all-india level. To analyse the status the researcher has used the NFH survey data. Wherever possible a comparison of the particular indicator has been made for all the three surveys. Is there any improvement over the surveys in all the indicators, would be found out from the survey data compiled by the researcher. The indicators chosen for the comparison are those which have been focused in the field work. Table no we get the details about the core indicators for all the three surveys. The indicators included are (a) ANC., (b) Visits for ANC Care for three times, (c) visits during the first three months., (d) delivery under health systems (e) delivery by trained midwife. Indicators related to ANC depict that the percentage of antenatal care under the NFHS-I was 64.6 percent which went up to 65.8 percent under NFHS-II. Subsequently under the NFHS III the figure rose to However, there persists a serious rural-urban gap in the amount of care between the rural and urban areas. The percentage of minimum three visits has gone up from a total of 43.9 percent in NFHS I to 44.2 in the second survey and 50.7 in the third. Indicating an awareness among the women. However, in last two surveys the gap between the rural urban areas has been over 30 percent. This is a case for correcting the rural urban disparities. With regards to births assisted by trained midwife the percentage has gone up from 35.1 percent in the NFHS I to 48.8 percent in the NFHS III. The average rural-urban gap in this case has been to the extent of 38 percent. In all these cases though the performance of the indicators in total may have improved but there are persistent gaps in the ruralurban gap. 58 P a g e

4 Information regarding can be obtained from Table no the immunization among the children under the NFHS I was 35.4 percent this figure came down to 43.5 percent during the NFHS III. While the Urban immunization percentage of 50.7 percent went up 57.6 the rise was not enough from rural areas which went up from 30.9 to 38.6 percent. There have been gaps between the rural and urban areas here too. In the following paragraphs, we deal with the similar aspects concerning infrastructure in Gujarat and India. (Table no ) For this aspect we have taken the data on rural health statistics from India, Government of (2008) The table depicts the shortfall in the health force and some infrastructure related to the three tier health centers in India, Gujarat and Tribal areas of Gujarat. With regards to health manpower the maximum shortage observed was in the case of physicians at 72.5 and 100 percent respectively for India and Gujarat. In the case of tribal areas the respective figures were 83.3 and 100 percent respectively. Total shortage for specialists as a whole was 68 and 93.2 percent respectively for India and Gujarat. This signifies that at the all India level the shortage of all specialists taken together was lower compared to Gujarat. In the case of tribal areas the corresponding figures were still higher at 70.3 and 96.5 percent respectively. Here too the all-india shortage was far less than the Gujarat. The shortfalls in other categories of manpower, which too are significant enough for the sake of analysis, have not be taken up here for reasons of space. From the table we also observe that in the case Sub centers in position there was a shortfall of 12.9 percent at all India level, while in the case of Gujarat the number of required sub-centers is higher than that of the requirement. Similarly in the case of PHC and CHC in position, the shortfall was 17.3 and 32.9 percent respectively in the case of All-India status taken together, where as the respective figures for Gujarat were 7.5 and 4.1. This signifies that in the case of fulfilling the number of health centers Gujarat is in a better position. In case of the shortfall of the SCs., PHCs., and CHCs in tribal areas is concerned, the respective figures for the all India level are 21.4., 63.6., and 31.9 percent.. Whereas the respective figures for Gujarat are , and Signifying a better ranking for Gujarat in this case 59 P a g e

5 ANC Care Gujarat The details of this aspect are given in table no Indicators related to ANC in Gujarat depict that the percentage of antenatal care under the NFHS-I was 77.5 percent which went up to 87.2 percent under NFHS-II. Subsequently under the NFHS III the figure came down to to 87.0 However, there persist a serious rural-urban gap in the amount of care between the rural and urban areas. The average gap during the three surveys has been around 11 percent. This is a better performance compared to the national scenario mentioned in the earlier paragraphs. The percentage of minimum three visits has gone up from a total of 61.3 percent in NFHS I to 61.2 in the second survey and 64.9 in the third. Indicating awareness among the women. However, in last two surveys the gap between the rural urban areas has been averaging over percent. Though the performance of Gujarat is better than the national scenario there is a case for correcting the rural urban disparities. With regards to births assisted by trained midwife the percentage has gone up from 44.1 percent in the NFHS I to 64.7 percent in the NFHS III. The average rural-urban gap in this case has been to the extent of 37 percent. In all these cases though the performance of the indicators in total may have improved but there are persistent gaps in the ruralurban gap. With regards to delivering births in health facility, the rural urban disparities in percentage points has come down from 39.3 under NFHS I to 35.8 under NFHS 3. However it is worth noting hiere that that total births in the health facility went up from 36.8 percent (rural-urban combined) to 54.6 under the NFHS 3. This is not reflected in the reduction of rural urban disparities. 60 P a g e

6 61 P a g e

7 Chart Interstate Disparities in Health Indicators Family Planning Unmet need for family planning Mother who had three ANC visit for last birth Children fullyimmunisation Knowledge of HIV/AIDS among maried women Knowledge of HIV/AIDS among married men All India Gujarat 61 P a g e

8 Chart Interstate Disparities in Health Indicators (Highest and Lowest Value) Highest Lowest Meghalaya (24.3) Bihar (16.9) Nagaland (21) Zarkhand (28.9) Zarkhand (52.7) Himachal Pradesh (72.6) AP (4.7) Tamil Nadu (96.5) Tamil Nadu (80.9) Manipur (98.5) Manipur (99.3) Nagaland (26.1) Family Planning Unmet need for family planning Mother who had three ANC visit for last birth Children fullyimmunisation Knowledge of HIV/AIDS Knowledge of HIV/AIDS among maried women among married men 62 P a g e

9 This can be observed in table no The indictors specified in the table are as follows.. (a)using any method for family planning. (b) Unmet need for Family Planning., (c) Mother who had three ANC visits for last birth., (d) Full Immunization and Vitamin A Supplementation., and (e) Knowledge of HIVAIDS among married men and Women. The highest percentage of population using any of the family planning method as per NFHS 3 was observed in the state of Himachal Pradesh (72.6 percent) and the lowest was observed in Meghalaya (24.3). The all India figure in this case is 56.3 percent with Gujarat being percent. Unmet need for family planning was highest in Nagaland (26.1 percent) while the lowest percentage of population with unmet need was 4.7 in the case of Andhra Pradesh. The national percentage was 12.8 and in the case of Gujarat it was 8.0 percent. It is necessary for the mothers to have at least three ANC visits prior to the birth of the child. Which state had the highest percentage in this indicator? we observe from the table that the 96.5 percent of mothers in Tamil Nadu had three ANC visits whereas the least was in the case of Bihar (16.9). the national average was 50.7 and Gujarat it was In the case of immunization status among the states, 80.9 percent of the children were fully immunized and in the case of the lowest percentage, the same was observed for Nagaland (21.0). The all India average was 43.5 whereas for Gujarat it was The average awareness about HIV/AIDS among the married men and women was 72.6 as far as all India average was concerned. As far as the states are concerned the highest awareness was observed in the case of Manipur (98.9) whereas the lowest was in Jharkhand (40.8 percent). The similar average in the case of Gujarat was 64.6 Due to lack of time and space, the researcher has not gone into the comparative status vis-à-vis NFHS 1 and P a g e

10 4.3 INTER-REGIONAL DISPARITIES OF HEALTH INDICATORS IN GUJARAT Based on Table No the researcher has attempted to view of the position of these indicators in terms of regions in Gujarat. This can be observed from Table nos to For the sake of convenience, we have divided Gujarat as whole into four regions. These are (a) South Gujarat., (b) Central Gujarat., (c) North Gujarat and (d) Saurashtra region. In the following paragraphs we analyse the above mentioned indicators in terms of the regions Chart Inter-Regional Health Disparities ANC TT Injection Contreceptive Dilevery Fully Immunization Family Planning South Gujarat Central Gujarat North Gujarat Saurashtra Region Antenatal Care The highest percentage of the cohort having taken benefit of the antenatal care was in central Gujarat (64.0) where as the lowest performance was in the North Gujarat region (51.9) under DLHS 2, while under the DLHS -3 best performance was under the 64 P a g e

11 Saurashtra region (66.6) where as the lowest was in North Gujarat (46.6). Though the poorest performance was by North Gujarat region under both the surveys it is observed that the performance had deteriorated between the two surveys. TT Injection. The highest percentage of the cohort having taken benefit of the facility of TT Injection was in Saurashtra region (86.5) where as the lowest performance was in the North Gujarat region (75.3) under DLHS 2, while under the DLHS -3 best performance was under the Saurashtra region (80.1) where as the lowest was in North Gujarat (60.8). Though the best and worst performance was by maintained by both the regions, it is worth noting that in the case of these two regions the performance showed a serious deterioration, especially the North Gujarat region between the two surveys. Contraception The highest percentage of the people adopting some form of contraception was found in South Gujarat (64.6) where as the lowest performance was in the North Gujarat region (52.6) under DLHS 2, while under the DLHS -3 best performance was under the South Gujarat region (67.36) where as the lowest was in North Gujarat (60.4). We thus find that not only the respective positions are maintained in between both the surveys, the adoption percentage of any form of contraception by the people has also gone up. This welcome trend for a progressive society. Institutional Delivery The highest percentage of women going in for institutional delivery in central Gujarat (57.10) where as the lowest performance was in the Saurashtra region (45.1) under DLHS 2, while under the DLHS -3 best performance was under the Central region (67.4) where as the lowest was in South Gujarat (50.6). It can also be observed from the table that the poorest performer in DLHS -2 performed better in the DLHS P a g e

12 Full Immunisation The highest percentage of the cohort having taken benefit of the facility of Immunisation was in Saurashtra region (62.1) where as the lowest performance was in the North Gujarat region (45.2) under DLHS 2, while under the DLHS -3 best performance was under the Saurashtra region (62.7) where as the lowest was in Central Gujarat (54.2). There was a marginal improvement by the topper in DLHS 2 in DLHS 3. Adoption of Family Planning The highest percentage of the population having adopted family planning in North Gujarat region (20.4) where as the lowest performance was in the South Gujarat region (16.6) under DLHS 2, while under the DLHS -3 best performance was under the Central Gujarat region (20.3) where as the lowest was in Saurashtra (17.7). 4.4 INTER-DISTRICT DISPARITIES IN HEALTH INDICATORS IN GUJARAT The data for this section of analysis has been procured form District level Health Surveys 2 and three. Gujarat comprises of twenty five districts. The purpose of this section is not only get the overall picture of Gujarat but also compare the same with Surat district in particular. We have tried to select those indicators which have been common to both these surveys. However, not all the indicators are those covered in the survey. This analysis helps the reader to have some idea about the prevalent disparities.. These indicators are (a) Antenatal care., (b) TT Injection., (c) Contraceptive prevalence., (d) Delivery., (e) Full Immunization., (f) Family Planning. The details about these can be seen from table No P a g e

13 Antenatal Care The percentage of the cohort having taken benefit of the antenatal care was 60.3 percent under DLHS 2, while under the DLHS -3 the figure had come down to Though the highest percentage of those availing the ANC was by Navasari District under DLHS 2 the same had come down from 86.9 to 81.1 under the respective survey. Thus, losing its position to Surat Distict (87.8) a highest in the DLHS 3. Similar was the case of Dangs district. While it maintained the lowest position in terms percentage of women taking the ANC, the same came down drastically from 37.3 under DLHS-2 to 19.3 under DLHS-3. In the case of Surat District as a whole the percentage of women taking the benefit of antenatal care was 51.9 under DLHS-2 while under DLHS-3 the same was 87.8 highest under DLHS-3 - Showing that the performance under this category of indicator was better than All Gujarat taken together It can also be seen from the table that the performance for the rural areas had worsened in many of the districts. It can also be seen that there are fifteen districts, which have performed poorly in DLHS 3 compared to DLHS 2. Surat district is one which has performed better in the former to the latter. Thus we observe a positive difference of over 37 percentage points. 67 P a g e

14 Chart Disparities in Health Indicators (Gujarat & Surat) All Gujarat Surat ANC T.T Injection Contraceptive Insitutional Delivery Fully Immunisation Family Planning 68 P a g e

15 Chart Disparities in Health Indicators (Inter District- Gujarat) Lowest 0 Dang (19.3) Vadodara (59.9) Dang (53.2) Dang (9.4) Panch Mahal (32.2) Surat (87.8) Jamnagar(88.2) Surat (85.7) Mahesana (84.2) Navsari (80.4) Amreli (10.7) Dahod (36.5) ANC T.T Injection Contraceptive Insitutional Delivery Fully Immunisation Family Planning 69 P a g e

16 TT Injection Taking TT injection is an important aspect of health services. From the table we observe that a maximum percentage of women availing the TT injection under DLHS 2 was under Amreli district (94.5). While Banaskantha had the lowest percentage (63.0) of women taking the TT injection during the course of pregnancy period. The figure for all Gujarat was 80.9 while in the case of Surat district the same was Comparing these figures with DLHS 3 the respective highest and lowest figures were for the districts of Jamnagar (88.2) and Vadodara (59.9). In the case of Gujarat the figure was 71.2 and that of Surat District it was While in the case of All Gujarat the figure had come down in the case of Surat there was an improvement in the performance. In assessing the overall performance of the districts we observe from the table that out of 25 districts, the performance of nineteen districts came down, while six of the districts could improve their performance. One of them was Surat whose performance improved by 6.69 percent or 4.8 percentage points. In the case of rural population improvement was observed in only three districts, while the performance of the rest of the districts deteriorated. Among the three whose performance had improved Surat District was one of them. That too an improvement by 12.1 percent Contraception The percentage of contraception by the population is an important aspect in a health policy and an important feature of the health system. The percentage of population adopting any methods of contraception in Gujarat as a whole was 59.3 under DLHS 2 while the same was 64.9 under DLHS 3. The highest in the former was in the district of Surat (90.7) while the lowest was in the district of Dahod (38.0). In the case of the latter survey the highest was in the district of Surat (85.7) while the lowest percentage of contraception was observed in Dangs (53.2). We observe from the table that Surat district maintained its top ranking position under both the surveys. 70 P a g e

17 Assessing the overall position of the districts, we observe that twenty districts improved their performance, while five of them could not improve their performance. In the case of rural areas 21 districts could improve their performance under this indicator. In the case of rural Surat the percentage of contraception was more than the total i.e., 94.6 percent. Institutional Delivery Under this category of indicator it is observed from the table that highest percentage of institutional delivery was observed in the district of Mehasana (74.1) while the lowest was in Dangs District (10.7) under the DLHS-2. In the case of DLHS-3 the highest and Lowest figures were maintained by these districts. The respective figures are 84.2 and 9.4. In the case of Dangs the performance had deteriorated, whereas in the case of Mehasana not only the district maintained its top position, but also came up with an improved performance on this count. If we take the case of All-Gujarat we observe that the respective figures for both the surveys are 50.2 and 59.4 percent. Whereas, in the case of Surat District the respective figures are 69.8 and While overall performance of Gujarat improved between the two surveys, the performance deteriorated slightly in the case of Surat District. In terms of all Districts, the performance of twenty two districts improved while in the case of only three the performance had deteriorated. In the case of performance by rural areas twenty one districts saw an improved performance and only four had deteriorated performance. The performance was slightly improved in the case of Surat. Full Immunisation This indicator is very important determinant to understand Child-health in a community or a nation. Under this category of indicator it is observed from the table that highest percentage of immunisation was observed in the district of Navsari (91.4) while the lowest was in Dahod District (17.6) under the DLHS-2. In the case of DLHS-3 while the 71 P a g e

18 the highest percentage of immunisation was maintained by Navsari District (80.4) the lowest figures came under the district of Panchamahal (32.2). In the case of Navsari, though it maintained the top position in the subsequent survey, its overall performance deteriorated by eleven percentage points or 13.7 percent. If we take the case of All-Gujarat we observe that the respective figures for both the surveys are 55.9 and 57.9 percent. Whereas, in the case of Surat District the respective figures are 56.5 and We can see that the performance of Guajrat and Surat showed marked improvement between the two surveys. In terms of all Districts, thirteen districts showed and improved performance over the earlier survey, while in the case of twelve the same showed a deteriorated performance In the case of rural areas, seventeen districts showed an improved performance whereas the rest showed a deteriorated performance. Adoption of Family Planning This indicator is very important determinant to understand the reception to the various family planning methods by the citizens of a nation. Under this category of indicator it is observed from the table that highest percentage of people adopting any of the family planning method was observed in the district of Rajkot (41.4) while the lowest was in Amreli District (9.1) under the DLHS-2. In the case of DLHS-3 while the highest percentage of adoption of any family planning method was under the district of District of Dahod (36.5) the lowest figures came under the district of Amreli (10.7). If we take the case of All-Gujarat we observe that the respective figures for both the surveys are 18.3 and 19.1 percent. Whereas, in the case of Surat District the respective figures are 12.4 and We can see that the performance of Gujarat and Surat showed marked improvement between the two surveys. 72 P a g e

19 In terms of all Districts, seventeen districts showed and improved performance over the earlier survey, while in the case of eight districts the same showed a deteriorated performance In the case of rural areas, similar performance was observed 4.5 INTER-TALUKA DISPARITIES OF HEALTH INDICATORS IN SURAT DISTRICT: WITH SPECIAL REFERENCE TO OLPAD TALUKA After taking up the All-India and interstate health disparities, followed by Inter-district Health Disparities in Gujarat, in the following sections we shall deal with the inter-taluka health disparities under the Surat District. Since Olpad taluka is the focus of this study, we shall discuss it vis-à-vis its position in Surat district. There are fourteen talukas (Sub-districts) under Surat district this is inclusive of talukas covered under the recently bifurcated Vyara taluka. The indicators covered here are (a) Early ANC Registration., (b)institutional deliveries (Government/Private)., (c)home Delivery (d) Immunisation status. From Table No we find details about important health indicators pertaining to Surat district. The data is taken from the report brought out by the government of Gujarat s Surat Action Plan. 73 P a g e

20 4.1.4 Disparities in Health Indicators (Surat District and Olpad) Surat Olpad Block wise early registered Institutional Delivery in (Govt) Institutional Dilivery in (Private) Home delivery Fully Immunisation Institutional Delivery in (Govt) 74 P a g e

21 4.1.5 Disparities in Health Indicators (Inter Taluka- Surat District) Highest Lowest Bardoli (80) Choryasi (50) Choryasi (20) Umarpada (5) Nizar (142) Umarpada (10) Vyara (84) Umarpada (5) Choryasi (70) Umarpada (90) Choryasi (80) Songadh (21) Block wise early registered Institutional Delivery in (Govt) Institutional Dilivery in (Private) Home delivery Fully Immunisation Institutional Delivery in (Govt) 75 P a g e

22 Early ANC Registrations Early Antenatal registrations play an important role in improving the health of the expectant mothers and child. This helps the state to tract the health status of the expectant mothers with regards to timely immunisation, nutrient supplements, handling emergencies, pregnancy related complications etc. Further an important measure of safe mother hood. From the table we observe that the district average of early registrations in the year was 69.4 while in the year the same was 69.9, showing a marginal increase, The highest early antenatal registrations in the year was registered in Vyara Taluka (81.0 percent) whereas in Choriyasi it was 49.0 percent. The similar figures for the year in the year were 84.0 percent - jointly by Vyara and Valod, while the lowest was Choriyasi. Of the fourteen talukas five of them showed a decline in early antenatal registrations. In the case of Olpad Taluka there was a Marginal increase in the same, which went up from 60 to 61 percent in the reference period. Institutional deliveries (Government/Private) It is a well established fact that giving birth in a medical institution under the care and supervision of trained health care providers promote child survival and reduces the risk of maternal mortality. In India both the child mortality (especially neonatal mortality) and maternal mortality are vey high. To prevent this the institutional deliveries need to go up. From the table we observe that the institutional deliveries as whole in the district was averaging 53.5 in the year This came down to 51.6 in the year Thus, showing a decline at the district level. The highest institutional delivery percentage in the reference years of and were 88.0 and 80.0, both in the Choriyasi Taluka. While the respective lowest institutional deliveries were found the Umarpada Taluka (14.0 and 10.0 percent). In the case of Olpad Taluka the respective figures for both the years 65.0 and Thus we observe that while the district level percentages showed a decline, the case of Olpad taluka is better because the percentage of institutional deliveries went up during the reference period. 76 P a g e

23 In the case of Institutional deliveries in government facilities the average figures for the district as a whole during the respective years were 12.7 and The highest observed institutional deliveries in the government facilities was observed in Uchhal and Songadh Taluka (21.0 percent) in the year , whereas the lowest in the same year was 5.0 percent in Vyara Taluka. In the year the highest institutional deliveries in the government facilities was 21.0 percent in Songarh taluka, whereas the lowest was observed in Umarpada (5.0 ). In the case of Olpad Taluka the respective figures for both the years were 12.0 and 16 percent. Thus, indicating a rise in the usage of government facilities for the same In the case of Institutional deliveries in private facilities the average figures for the district as a whole during the respective years were 39.6 and The highest observed institutional deliveries in the private facilities was observed in Choriyasi (73.0 and 70.0 percent) for both the years in the reference, whereas the lowest in the same year was 5.0 and 5.0 percent in Umarpada Taluka for both the years. In the case of Olpad Taluka the respective figures for both the years were 54.0 and 63.0 percent. Thus, indicating a rise in the usage of private facilities for the same. In the case of home deliveries the average figures for the district as a whole during the respective years were 47.6 and The highest observed home deliveries was observed in for Nizar taluka 77.0 percent in the in the year , whereas the lowest in the same year was 12.0 percent in Choriyasi Taluka. In the year the highest home delivery was observed in Umarpada Taluka ( 90.0 percent), whereas the lowest was observed in Choriyasi Taluka (20.0) In the case of Olpad Taluka the respective figures for both the years were 35.0 and 31.percent. This aspects shows us that while the home deliveries rose at the district level, the performance of the Olpad taluka has improved, signifying a fall in the percentage of home deliveries. 77 P a g e

24 Full Immunisation With regards to immunisation there was a drastic improvement in the efforts. All the talukas have seen commendable increase in this aspect. There was an overall rise in the percentage of immunisation in the district. The percentage of immunisation on average at the district rose from 88.6 to 89.5 during the reference period. However, the percentage of immunisation during the reference period came down from 94.0 in the year for to 92.0 percent in the year Co-Variance in Health Indicators Apart from the above interstate, district and inter-taluka analysis, the researcher has tried to find out co-variance between two surveys. In the case of variance among the states at all India level, coefficient of variance has been for NFHS data, while in the case of interdistrict and taluka variance the results are based on DLHS data. With regards to the indicators that have been used are, (a) Family Planning (with relation to use of any methods) by the population in the states., (b) Unmet need for Family Planning (Total unmet need for family planning among the population in the various states., (c) Percentage of mothers in different states who had three ANC visits for the last birth., (d) Percentage of children who are fully immunized in the states., (e) Percentage of men and women who have the knowledge about HIV/AIDS.The results for these indicators are as follows. (Table No ). The comparative figures of co-variance for the first four indicators could be computed. With regards to HIV/AIDS comparative figures could not be obtained and result based on NFHS 3 data is available. (a) Family Planning. The mean has gone up from in (NFHS 1) to (NFHS 3) and the respective co-variance among the states came down came from.36 to.23 signifying a fair amount of equitious efforts on the part of the states. While the mean in the case of indicator of unmet need for family planning is concerned, the mean of all the states is seen to have come down 13.5 in NFHS 3 over NFHS 1, the co-efficient of variance has gone up from.28 to.50 during the reference period. This shows that inter-state variations have gone up, though the overall need for family planning has gone up among all the 78 P a g e

25 states. In the case of the indicator pertaining to mother who had three ANC visits during the last birth. Mean during the reference period has gone up from to and the coefficient of variance among the states too came down from.53 to.35 from NFHS 1 to NFHS 3. Performance by the indicator of full immunisation too saw a progress with mean moving from to and covariance coming down from.54 to.34. In the case of the knowledge about HIV/AIDS, the co-efficient of variance with regards to knowledge about HIV/AIDS among the married males is lower (.15) compared to Females(.30) under the NFHS 3 Table no depicts the inter-district variance among the districts of Gujarat, The data pertains to DLHS 2 and 3. The indicators that could be studied for this section are (a)early ANC Registration., (b) Taking of TT Injections., (c) Contraceptions., (d) Place of Delivery Institutional., (e) Full Immunisation., and (f) Family planning methods. In the case of the first two indicators the co-efficient of variance has gone up, vis-à-vis the two surveys, while in the rest it has comedown signifying equitious performance of the indicators among the district in Gujarat. Table no depicts the inter-taluka variations. There has been a rise in the coefficient of variation in the case literacy rate from.10 to.15, with a decline in mean literacy over the DLHS 2. Encouraging performance of indicator related to ANC registration showed a marginal fall in the co-variance. The mean for home delivery has gone up, with co-efficient of variation marking almost no change. Similarly the mean for full immunisation has registered a growth from to with a marginal decline in the covariance with regards to these indicators among the talukas of the Surat District. 79 P a g e

26 Table No: 4.1.0: HIC Health status Across Major Group of Nations: Some important Indicators EXPENDITURE ON HEALTH Public As% Private As% Total CMR /1000 MMR /10000 HIC IMR /1000 Births Attended by Access to Urban Switzerland NA USA Japan NA NA 98 UK Germany NA NA NA 89 Canada France NA NA NA 84 Australia Italy NA NA NA 70 Avg. HIC MIC Mexico Malasiya NA Brazil South Africa Thailand China Sri Lanka Avg. MIC LIC Indonesia India Pakistan Bangladesh Avg. LIC Source: WHO (2000, 2004) Rural Immun 80 P a g e

27 Table: Information about Maternal care in India No. Indicators of Mortality care NFHS-1 ( ) NFHS-2 ( ) NFHS-3 ( ) U R T U R T U R T 1. ANM care Rural Urban disparities Three visits in pregnancy care (In percentage) Rural Urban disparities First three months pregnancy care (In percentage) Rural Urban disparities Delivery from Health care (in percentage) Rural Urban disparities Delivery by Trainee Dai Rural Urban disparities Sources: NFHS Report-III,Vol-I,Page-222 U=Urban, R=Rural, T= Total 81 P a g e

28 Tabel :4.1.2 Immunization of child over months in India No Immunization NFHS-I( ) NFHS-II( ) NFHS-III ( ) U R T U R T U R T 1 B.C.G D.P.T Polio Ory Full immunization Sources:NFHS Report III. Vol-1 Page-232 U:Urban, R:Rural, T:Total 82 P a g e

29 Table: Health status in Gujarat and India (Figures in Brackets indicate percentage) India No Short Fall Item Gujarat Short Fall Situated Require Sub Centers (12.9) PHC (8.0) (17.2) CHC (7.2) (36.0) 4. Multipurpose Workers(Female) ANM Sub Center (15.5) 5. Heatlh Worker (Male) PMW in Sub Center (38.7) (5.4) Health Helper (Female) in PHC (74.9) (27.6) Health Helper (Male) in PHC (37.6) Doctor in PHC (5.0) (15.0) Health experts and Delivery Expets (62.9) in PHC (97.2) Physician in CHC Pediatric Doctor in CHC Total Experts Radiographer Pharmacist Laboratory Technician Nurse Source: RHS Bulletin march, 2008 M/O Health & F.W.GOI (63.1) 2662 (62.2) (64.5) 2280 (53.3) 7022 (25.3) (50.9) (33.7) 83 P a g e

30 Table No: 4.1.4: Antenatal Care in Gujarat No. Indicators NFHS-I( ) NFHS-II( ) NFHS-III( ) U R T U R T U R T 1. Percentage of who received antenatal care R-U Disparities Percentage of who had at least three antenatal care visits R-U Disparities Percentage of who received antenatal care within the first trimester of pregnancy R-U Disparities Percentage births delivered in a health facility R-U Disparities Percentage of deliveries assisted by health personnel R-U Disparities Sources: NFHS- Report III ( ), page-68 R- rural U-urban T- total 84 P a g e

31 Table No Inter-State Disparities in Health Indicators No. STATE Family Planning (Current Married Women) Currant Use Any Method Unmet Need For Family Planning. (Total Unmet Need %) Mother Who Had Three ANC Visit For Last Birth (%) NFHS-1 NFHS-2 NFHS-3 NFHS-1 NFHS-2 NFHS-3 NFHS-1 NFHS-2 NFHS-3 1 A.P Assam Chaatishghad N.A N.A N.A Goa Gujarat Hariyana Jarkhand N.A N.A N.A Kerala Maharstra Meghlaya Nagaland Punjab Sikkim N.A N.A N.A Tripura Uttankhand N.A N.A N.A Arunachal Paradesh Bihar N.A N.A N.A Delhi Himachal Pradesh Jammu and Kasmir N.A N.A N.A Karnataka M.P N.A N.A N.A Manipur Mizoram Orissa Rajasthan Tamil Nadu U.P N.A N.A N.A W. Bangal All India P a g e

32 Table No Inter-State Disparities in Health Indicators (Contd.) No. State Child Fully Immunization And Vitamin A Supplementation Knowledge Of HIV/AIDS Among Married Women Knowledge Of HIV/AIDS Among Married Men NFHS-1 NFHS-2 NFHS-3 NFHS-1 NFHS-2 NFHS-3 NFHS-1 NFHS-2 NFHS-3 1 Andra Pradesh N.A N.A Assam N.A N.A Chhatisgarh N.A N.A N.A N.A Goa N.A N.A N.A 5 Gujarat N.A N.A Hariyana N.A N.A N.A Jharkhand N.A N.A N.A N.A Kerala N.A N.A N.A Maharshtra N.A N.A Meghlaya N.A N.A Nagaland N.A N.A Punjab N.A N.A N.A Sikkim N.A N.A N.A N.A Tripura N.A N.A Uttarakhand N.A N.A N.A N.A Arunachal Pradesh N.A N.A Bihar N.A N.A N.A N.A Delhi N.A N.A Himachal Pradesh N.A N.A N.A Jammu & Kashmir N.A N.A N.A N.A Karnataka N.A N.A N.A Madhya Pradesh N.A N.A N.A N.A Manipur N.A N.A Mizoram N.A N.A Orissa N.A N.A N.A Rajasthan N.A N.A N.A Tamil Nadu N.A N.A Uttar Pradesh N.A N.A N.A N.A West Bengal N.A N.A All India N.A N.A N.A 80 Source: Compiled from NFHS-3 Sheets. 86 P a g e

33 Table No Inter-District Disparities of Health Indicators in Gujarat DISTRICT ANC TT INJECTION CONTRESPTIVE DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Porbander Sabarkantha Vadodara Anand Dahod Kachchha Panchmahal Valsad Bharuch Dangs Jamnagar Mehasana Patan Rajkot Suredranagar Ahmedabad Banaskatha Junagadh Narmada Bhavnagar surat Amreli Gandhinagar Kheda Navsari Gujarat P a g e

34 Table No Inter-District Disparities of Health Indicators in Gujarat (Contd.) DISTRICT DELIVERY FULLY IMMUNIZATION FAMILY PLANNING DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Porbander Sabarkantha Vado'ra Anand Dahod Kachchha Panch mahal Valsad Bharuch Dangs Jamnagar Mehasana Patan Rajkot Suredranagar Ahmedabad Banaskatha Junagadh Narmada Bhavnagar surat Amreli Gandhinagar Kheda Navsari Gujarat Source: Compiled from NFHS-3 Sheets. 88 P a g e

35 Table No Inter-Regional Disparities of Health Indicators in Gujarat - Districts of South Gujarat Region DISTRICT ANC TT INJECTION CONTRESPTIVE DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Valsad Bharuch Dangs Narmada Surat Navsari Average (Cont ) Table No Inter-Regional Disparities of Health Indicators in Gujarat - Districts of South Gujarat Region DISTRICT DELIVERY FULLY IMMUNIZATION FAMILY PLANNING DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Valsad Bharuch Dangs Narmada Surat Navsari Average Source: Compiled from NFHS-3 Sheets. 89 P a g e

36 Table No Inter-Regional Disparities of Health Indicators in Gujarat - Districts of Central Gujarat Region DISTRICT ANC TT INJECTION CONTRESPTIVE DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Vadodara Dahod Panchmahal Ahmedabad Kheda Gandh'ar Anand AVERAGE Table No Inter-Regional Disparities of Health Indicators in Gujarat - Districts of Central Gujarat Region (Contd ) DISTRICT DELIVERY FULLY IMMUNIZATION FAMILY PLANNING DLHF-2 DLHF-3 DLHF-2 DLHF-3 DLHF-2 DLHF-3 TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL TOTAL RURAL Vadodara Dahod Panchmahal Ahmedabad Kheda Gandhinagar Anand AVERAGE Source: Compiled from NFHS-3 Sheets. 90 P a g e