NRHM Programmes and maternal and child health care service utilization: a study on Kannur District of Kerala Abstract M. Lijina M.Phil. Scholar, Department of Economics, Gandhigram Rural Institute-Deemed University, Dindigul, Tamil Nadu, India. lijinam123@gmail.com Background/Objectives: The specific objective of the study is to examine the various services provided through NRHM to maternal and child healthcare and also to check the effectiveness in the provision of these services. Methods/Statistical analysis: The present study is based upon the collection of primary and secondary data. The primary data will be collected through the structural questionnaire by applying random sampling method. The sample size of 25 households will be collected randomly from Kannur district of Kerala. The secondary data will be collected from various data sources related to NRHM. The statistical tools like correlation, regression, simple average, etc. will be used for analyzing the identified variables. Findings: This study concentrates on service delivery and utilization in the maternal and child healthcare level. By approaching the selected samples, it is clear that only some of the NRHM services are familiar to the people and some are not yet reached them. The available services are utilized by them most efficiently. NRHM bridges the gap between demand and supply of healthcare services to women and children and there by enable to attain the target related to maternal and child health in Kerala. Improvements/Applications: Include all people under NRHM, provide proper awareness to people about NRHM, and also provide awareness about ANC and PNC, provide proper incentives to ASHA. Keywords: NRHM, Maternal health, child health, ANC, PNC, ASHA 1. Introduction Generally the concept of health implies a sound mind in a sound body in sound family in a sound environment. At the time of the creation of the World Health Organization (WHO) 1948, health was defined as a state of complete physical, mental, and social well being and not merely the absence of diseases or infirmity [1]. The health status of an individual is depends mainly the physical environment that he exist. This includes factors such as clean water & air, safe houses, communities and roads all contribute to good health. Moreover, the WHO lists a wide range of other factors that can influence the well being of a person. The gender, social support networks and health services in terms of both quality and access to them are to be considered as health determinants, access to health care is one of the large issues of nowadays society, may be even greater than the quality of services [2]. Individuals in developing countries are more prone to suffer from different health conditions because their access to health system is restricted mostly from financial reasons. The health of women and children are mainly taking in to account by every country because they are considered as the most vulnerable section of the society. Since independence, India has become a world leader in medical advancement due to its incredible medical education system and state-of-the-art private medical facilities. Quality health care, however, remains inaccessible for many undeveloped Indian regions. For example, in rural communities it is estimated that only 18 hospital beds are available per 100,000 people. Even when medical treatment is available, public hospitals are frequently understaffed and undersupplied. Despite the higher growth rate, the problem of malnutrition, anemia and iodine deficiency are common among children in India over the years. Approximately 94 percent of children in the age of 6 to 9 are mildly, moderately or severely underweight [3]. So to enhance the public participation in health care system the Centre and State government introduced special programs. Among them The National Rural Health Mission has its own significance. The National Rural Health Mission (NRHM) is an initiative undertaken by the government of India to address the health needs of underserved rural areas [4]. The NRHM was initially tasked with addressing the health needs of 18 states that had been identified as having weak public health indicators. Economic welfare can be measured in terms of various indicators. Wealth and health of a country is 1 www.iseeadyar.org
to be considered as a prominent indicator, i.e. only one of these should not complete the concept of economic welfare fully, and there must be an equal composition of both of these two. The wealth or the aggregate output and percapita output is expected to increase the economic welfare of the individuals. So it is a not an accurate measure to evaluate the welfare of the economy. For measuring the overall welfare of the country we must take in to account the health status of the individual also. So the health status is one of the important indicators of welfare of the people. An increase in the percapita income of the people, if accompanied with an improvement in the health status of people can be stated as a real increase in the welfare of the people, there by the country as a whole. Health is defined by World Health Organization (WHO) as a complete state of physical, mental and social wellbeing and not merely an absence of diseases or infirmity. A nation s health is determined by the well-being or the health status of the people and state of economic and social development. All developed and developing nations faced the problem of health; so that is why each country paying its attention in the investment on public health. Such types of investment have a greater role in the provision of public health care services to the people. In India, the responsibility of provision of public care system is shared by the central, state and local government, although it is effectively a state responsibility in terms of service delivery. The most of the public health investment in India is diverted through different programs, missions and organizations, which are considered as a bridge between the Government and public/people. Among various programs implemented by government of India, National Rural Health Mission (NRHM) has played a vital role. The National Rural Health Mission was launched by the honorable Prime Minister on 12 th April 2005. The NRHM vision envisaged provision of effective healthcare to rural population throughout the country, to begin with special focus on 18 states in 2005, which had weak health indicators and weak infrastructure. Through this mission there are so many policies and programs are implemented to strengthen the public health management and service delivery in the country. The mission also intended to adopt synergetic approach by relating health to determinants of good health via nutrition, sanitation, hygiene and safe drinking water. The mission seeks to provide accessible, affordable and quality healthcare to rural population especially the vulnerable and underserved population in the country [4]. Kerala has achieved international recognition for its outstanding achievement in the health sector. The main characteristics of Kerala s health gains are low Infant Mortality& child mortality, high life expectancy at birth, virtual elimination of many communicable diseases and replacement level birth rate in many districts. Even though the state is advanced as compared to the other state of India. The essences of NRHM implementation in Kerala are; Promoting preventive and promotive aspect of primary healthcare in the community. Establishing health management information system. Strengthening nursing education department etc. The important programs under NRHM are; JananiSurakshaYojana(JSY) Child Immunization program AYUSH The National Disease Control Program(NDCP) Pre natal, delivery care, ante natal care(maternal Healthcare) Family planning program Introduction of ASHA etc. As we stated above the NRHM has different visions. It mainly concentrates on the children and women who are the most vulnerable section of the society. The proposed study try to analyze the different programs provided through NRHM and how it helps to bridge the gap between the demand and supply of health services to women and children in Kerala and how far it was helpful to improve their health care lot. As such the NRHM services addressed women s and children s health and universal immunization. The accessibility of the NRHM programs and services provided to women and children is the core of the investigation. How these services are reached to them and the extent to which it is beneficial to them? The basic limitation which creates hurdles in the way of effective implementation etc. are very relevant in this context to assess and investigate. So the study is an attempt to answer these basic research questions. 2 www.iseeadyar.org
The specific objectives of the study are; To examine the role of NRHM in the provision of effective health care services particularly Maternal and child health services in the rural segments of Kerala To evaluate the progress achieved in maternal and child health segment through the provision of NRHM services in Kerala towards the attainment of MDGs To examine whether decentralized governance improved the working and service delivery mechanism of NRHM scheme in Kerala by providing needed infrastructure and health manpower? To examine the role of NRHM in bridging the gap between the demand and supply of health care services in the rural segments of Kerala 2. Background of the study Lack of national care has produced severe health issues in maternal and child health care throughout the nation. This lack of national healthcare infrastructure is having severe and lasting effects on the livelihoods of Indian citizens. In Rajasthan, about half the children suffer from malnutrition, 49 percent of women are anemic, and about one-third of children are born with a low birth weight [5]. Additionally, only 14 percent of children between 12 and 23 months receive the necessary vaccinations to prevent diseases such as small pox and polio. Public hospitals have insufficient funds to support their communities, and since only 15 percent of Indian citizens have health insurance, quality health care remains unattainable for millions in dire need. In these circumstances the government of India introduced NRHM as a means to meet the basic health needs of the people. They mainly target the most deprived section of the society. The present study is proposed in the light of the completion of NRHM scheme which has a time period from 2005-2012. Now it is the apt time to analyze and evaluate the different NRHM programs provided to maternal and child health care and its utilization. So the present study is attempt to examine the progress of maternal and child health services utilization under the ambit of NRHM in Kerala. 3. Materials and Methods The present study is based upon the collection of primary and secondary data. The primary data will be collected through the structural questionnaire by applying random sampling method. The sample size of 25 households will be selected randomly from Kannur district of Kerala. Among this the opinion is collected from 25 recently delivered women and 25 children below age 3 on random sampling basis by using an interview schedule.data will also be collected from important PHCs, CHCs and Sub centers in rural areas related to their infrastructure and health man power availability to ensure the efficiency of delivery mechanism.the secondary data will be collected from various data sources related to NRHM. The statistical tools like correlation, regression, simple average, etc. willbe used for analyzing the identified variables. 4. Relevance of the study Health has its own significance over the entire world. A healthy environment and a healthy population is an integral part in the development of every country. Countries are now being ranked not in terms of digital economic growth but based on human development. In this regard to attain better human development the role of heath care facilities and healthcare development and its utilization is very significant. So to achieve overall growth and development, a country must take in to consider the health status of its population also. The NRHM program is an initiative in this direction and a research work of evaluating the effectiveness of the program is very important and relevant and will be a useful to the policy makers at the regional, national and international level to chalk out specific policies to improvethe hurdles and limitations of the program at the rock bottom level. 5. Result and discussion The present study related to the NRHM Programs and maternal and child health care service utilization a case study on Kannur district of Kerala is conducted by collecting the opinion from 25 recently delivered women and 25 children below age 3 on a random sampling basis by using an interview schedule. Among these, one family consists of one mother and one child, 64% are engaged in manual works (agriculture labors, domestic workers) and 36% are NRIs. 3 www.iseeadyar.org
5.1. Age of recently delivered mother Table 1. Age of recently delivered mother Age No. of persons Below 20 4 (16%) 20-25 12(48%) 25-30 7(28%) Above 30 2(8%) total 25(100%) Table 1 shows that the age of recently delivered mothers. 48% of the recently delivered mothers are belongs to the age group 20-25. The age group of 25-30 comes in the second position (28%). Only 8% of them are come under the age group of above 30. And 16% are belongs from the age group below 20%. 5.2. Registration of pregnancy Pregnancy is a normal process. There are so many problems arises during pregnancy that may cause even the death of the mother. These can be reduced only by taking good care. For this registration of pregnancy and regular checkup is needed. So it is necessary for every pregnant woman to register under the Anganwadi centers or ASHA workers. The ASHA worker visits the pregnant women frequently and delivers proper information about pregnancy care. And they also keep a record which consists of all the details about them. This will helps to prevent critical problems during pregnancy. Table 2. Registration of pregnancy Registered with No. of responds Government doctor - Private doctor - ASHA worker 25 Anganwadi center 25 Table 2 reveals that all respondents are register their pregnancy with Anganwadi centers and ASHA workers. The doctors and hospitals keep only the record of pregnancy during consultation. 5.3. Beneficiaries of NRHM services The major programs provided through NRHM consists the services of ASHA, JananiSurakshaYojana (JSY), JananiShishuSurakshaYojana (JSSY), RashtriyaBalSwasthyaKaryakram (RBSK), Mother Child Health Wing (MCH), National Iron Initiatives and Immunization Program. Janani Suraksha Yojana (JSY) was launched in April 2005 to enable women especially from the vulnerable sections of the society to access institutional delivery and thereby effect reductions in maternal and neonatal mortality. The scheme provides conditional cash assistance to pregnant women for giving birth in a government health facility by providing access to skilled birth attendance and emergency obstetric care [6]. Table3 shows the number of respondent utilizing these services. Table 3. Beneficiaries of NRHM services Types of services Yes No ASHA 25 (100%) - JSY 12 (48%) 13 (52%) JSSY - 25 (100%) RBSK - 25 (100%) MCH 9 (36%) 16 (64%) Iron initiatives 18 (72%) 7 (28%) Immunization program 25 (100%) - From Table 3 one can identify that all respondents receive benefit from the service of ASHA. Only 12 women availed benefit through the JSY program. The reason is that JSY program cover pregnant women who belongs from the Below Poverty Line (BPL) category. 36% of respondents are members of Mother Child Health wing. All are get benefit from the immunization program. The respondents are not aware about the JSY and RBSK program. 4 www.iseeadyar.org
5.4. Ante natal care utilization Table 4. Ante Natal Care Utilization Type of services Utilized Not utilized Weight 25 (100%) - Nutritional status 7 (28%) 18 (72%) Anemia 5 (20%) 20 (80%) HIV status 8 (32%) 17 (68%) TT injection 25 (100%) - IFA tablets 25 (100%) - Check position of the child in the womb 6 (24%) 19 (76%) Table 4 reveals that recently delivered mothers are getting different antenatal care services like checking of weight, nutritional status, anemia, HIV test, TT injection, IFA tablets, etc. all women (25) availed the services such as checking of weight, TT injection, and IFA tablets. Only 32% of women utilize the service of HIV status. 76% of women are not utilized the service of check the position of child in the womb. This data shows that women are not much aware about the antenatal care during pregnancy; this may be due to the lack of availability and accessibility of the services. 5.5. Place where vaccination taken from Table 5 lists the places where vaccination sought by the respondents. It reveals that PHC was the most preferred destination for vaccination for the new born. Table 5. Place where vaccination taken from Place No. of respondents Govt: hospital 1 (4%) Private hospital 3 (12%) Anganwadi centers 2 (8%) Primary Health Centers (PHC) 19 (76%) Total 25 (100%) 6. Conclusion The National Rural Health Mission (as2005-2012) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. So NRHM has a significant role in the health sector of India as well as Kerala. Delivery assistance to women through ASHA, immunization program for children are the two important programs implemented in Kerala. The study reveals that all the BPL families receive JSY incentives. And 100% families are cooperated for immunization program. ASHA act as a link between the community and health care services. But people are not much satisfied with the services of ASHA because the services of them are not reached to the people who resides long distance from the ASHA workers. At the same time ASHA workers faces some problems related with their work. They do not get proper incentives to their work. So to reach the household in long distance there incur more expenses. And some people are not cooperated with ASHA. 7. References 1. WHO definition of Health. http://www.who.int/about/definition/en/print.html. Date accessed: 20/06/2015. 2. The Impact of Social and Cultural Environment on Health. http://www.ncbi.nlm.nih.gov/books/nbk44249/. Date accessed: 20/06/2015. 3. P. Maneesh. Mid day meals and food security among children: Assuring nutritional security of Tamil Nadu. Indian Journal of Economics and Development. 2015; 3(9), 1-5. 4. National Health Mission, Ministry of Health & Family Welfare, Government of India. http://nrhm.gov.in. Date accessed: 29/06/2015. 5. National Family Health Survey (NFHS-3) INDIA 2005-06. http://www.icmr.nic.in/annual/nirrh/j%20chapter%204%2095%20-%2098.pdf. Date accessed: 25/06/2015 6. Maternal health programme, Annual report 2013-14. http://www.mohfw.nic.in/writereaddata/l892s/chapter415.pdf. Date accessed: 28/06/2015. 5 www.iseeadyar.org