Abstract of Dissertation

Keyword : Rural Health; Gap Analysis; Village Health; Child Health and Nutrition; Nutrition Day

Objective : Village Health and Nutrition Day is an initiative taken under NRHM, with a prime motto to deliver basic health services to the last person in the community. The data shows that health service provision has fairly improved but the aim of the program is yet to be achieved. This signifies that there are gaps in the service delivery at VHNDs. Research Question: * What are the gaps at the Village Health Nutrition Day at every village level? Research Objective: * To identify the gaps at the Village Health and Nutrition Day held at village level.

Background : Village Health and Nutrition Days (VHNDs) are a major initiative under the National Rural Health Mission (NRHM) to improve access to maternal, new-born, child health and nutrition (MNCHN) services at the village level. Across the country, VHNDs are intended to occur in every village level. This would provide the first point of contact for essential primary health care and would work as the common platform for convergence amongst service providers of Health, ICDS and the community. Strategically, trainings would be given at State, regional district and sector level to various categories of functionaries. Under the programme, the primary clients are pregnant women, lactating mothers, children below five years and adolescent girls. Basic components of primary healthcare services, including early registration, deworming, counselling on early breastfeeding, identification and referral of high risk cases of children and pregnant women, as well as basic ANC and PNC care will be provided at community level in order to address the essential requirements of pregnancy, delivery, referral, childhood illnesses and adolescent health. The programme would be organized for once a month in every Anganwadi Centre on a fixed day basis (either Wednesday or Saturday) with joint efforts of ANM, AWW and ASHA. On an average, there are six to eight AWCs under the operational jurisdiction of one Sub Centre and thus there would be about eight fixed days in a month per Sub Centre. There should be an advanced fixation of the day with all AWCs for the entire month, so that the service providers and the community are aware of it much in advance.

Methodology : Research Methodology:  Study Type- cross sectional study  Study Area- The study is conducted at Kaimganj block of Farrukhabad district (Uttar Pradesh) with a sample size of 20 VHND sites.  Study Period- 3 month  Study Respondents-The respondents for the following were front line workers (ANM, ASHA and AWW) at the various VHND site.  Sample Method- The method followed for the study is simple random sampling. From every PHC area, 2 sub centres will be selected and 4 VHND sessions will be selected from each sub centre area. The sample will be decided from the micro plan available at block. Simple random sampling method will be applied for selecting the VHND sites from the micro plan.  Sample Size- A sample size of 20 is taken. VHND is conducted on Wednesday and Saturdays of every week. If 1 VHND site are visited every Tuesday and 1 site every Friday, then total 8 VHND sites can be assessed in a month. In a time period of 3 month, 24 VHND sites can be visited. Leaving public holidays aside a sample size of 20 can be taken.  Data Collection Technique- Face to face interview and direct observation.  Data Collection Tool- Structured questionnaire  Data Analysis- The data analysis done in MS Excel  Ethical Consideration- ï‚· Data confidentiality will be maintained throughout the study. ï‚· The will be shared for the dissertation purpose only.

Findings : It is very clearly evident from the results that the services available at VHNDs are very poor and needs immediate attention. The infrastructure is very poor and almost 90 percent of sites do not have basic facilities like electricity, toilet, and drinking water. Counselling is rarely done. The drugs and equipment’s are not sufficiently available at many VHND sites and if available then the utilization is very poor. The frontline workers do not have proper skills to deliver the services. Services relate to immunization are in focus and other services are kept aside. Overall there is a huge gap in the service delivery at VHNDs as 70 percent of the VHND sites fall under poor performing zone (red zone), 30 percent fall under satisfactory performing category and zero percent fall under the good performing category.

Recommendations : There is a need to fill the gaps presents at the VHND sites and for the following steps need to be taken: ï‚· Supportive supervision and on the spot training at VHND sessions. ï‚· Capacity building of frontline workers and frequent training of the same. ï‚· Proper planning and implementation of VHNDs. ï‚· Strengthening monitoring and supervision of VHNDs. ï‚· Community awareness and proper IEC should also be done to encourage health seeking behaviour among the masses. ï‚· Mobile VHND concept. ï‚· Motivate the workers to perform better by introducing an award for the best VHND site (Model VHND) ï‚· Cluster meetings should be properly arranging ï‚· AAA meeting platform should be properly utilize, it will help to develop the coordination between ASHA, Anganwadi worker and ANM. So, main motto behind VHND will be fulfilled.

Scope of the Study: Facilities available at VHND sites, Presence of frontline workers, Counselling services available at VHND sites, availability of food and THR at the VHND site, availability of equipment’s at the VHND sites, utilization of equipment’s, availability of drugs at VHND sites, availability of vaccines at VHND sites, availability of records and registers at VHND sites. Use of the study: After the study if results are satisfactory in those particular areas then no further changes are required. If it is not, then we need to be focus on the following aspects like, Supportive supervision at VHND sessions, capacity building of frontline workers, strengthening monitoring and motivate the workers to perform better by introducing an award for best VHND site.