Rapid Assessment of Child Health and Service Delivery Status in UNICEF Focused 5 Districts of Rajasthan
Agency : UNICEF; MCHN; Child Health; NRHM
Objective : On the spot observations to understand the skills and quality of service implementation at MCHN session site, AWCs and sub-centres. In depth surveys and verification of health facilities; In-depth interviews of eligible mothers to understand community behaviors and practices for utilization of MCHN service.
Background : The IMNCI package has been developed by experts including the Child Health Researchers, academicians the Indian Academy of Pediatrics (IAP) and the National Neonatology Forum (NNF) to adapt it for the specific requirements of children in India. Since newborn care is an important issue for bringing down the infant mortality rate in India, this aspect has been included in the package adapted by India. IIHMR on the behest of UNICEF, Rajasthan conducted a rapid assessment of MCHN services in UNICEF focused districts of Rajasthan.
Methodology : EPI 30 cluster technique was used for identifying the villages. The clusters were identified from villages with population less than 1,000 in order to assess the situation in small villages, which are more likely to be excluded and left out by service providers. In each identified village, Anganwadi center of that village was studied. A sample of 10 sub-centers serving the 30 identified villages was studied. Similarly, from the 10 identified sub-centers, PHCs and FRUs related to these sub-centres were included in the sample frame. In addition, 10 MCHN session sites were studied covering under the identified Sub-centers.
Findings : The facility survey revealed that the facilities were lacking many basic supplies and equipments. There was an acute shortage of manpower which was most severe with specialists. Although immunization supplies were there, but other modes of newborn and infant care were lacking. The knowledge and skills of village health functionaries was below any acceptable levels and none of them had the complete knowledge about the package of child care, they basically knew about their most basic roles and IPC was highly ignored. The community survey to describe the health status and understand the community’s perspective on these services revealed that a large number of children were not receiving care as per the national standards and this was largely attributable to lack of knowledge and belief about health services coupled with incompetence of workers and lack of supplies.
Recommendations : Although the public health sector in India has seen a lot of improvements, particularly in recent years; there is still a long way to go. The health needs of people in rural areas are largely unmet and traditional treatments are widely practiced still. The need of the hour is the overall improvement of the system with focus not only on the provider side but also on the beneficiaries. Community mobilization and behaviour change communication are as important as ensuring regular supplies at healthcare facilities. From the study certain conclusions/ suggestions emerge, which are albeit stated time and again but still hold high importance.
the spot observations to understand the skills and quality of service implementation at MCHN session site