1.0 Background of the study:
Doordarshan has started Kalyani programme on National channel. This programme has covered all aspects of health. But then they felt need of the women and children of the community and bifurcate Kalyani programme in two parts Kalyani I and Kalyani II. Kalyani II has complete focus on reproductive and child health needs of the community. The objective of the programme was to high light & create awareness of focused interventions of Reproductive & Child Health (RCH) in EAG/ North East States. This weekly programme for half an hour on any of the RCH theme relating to women’s empowerment, population stabiization relating to girl child and reproductive behavior of men and women was telecast on DD channels from DDK Lucknow, DDK Patna, DDK Jaipur, DDK Ranchi, DDK Raipur, DDK Guwahati, DDK Dehradun, DDK Bhopal, DDK Bhubaneshwar. This study is to evaluate the impact of these programmes designed and telecast on TV channels (9). The programme had been successful in creating a brand out of Kalyani. Doordarshan with the help of Panchayats, Mahila Mandals and Nehru Yuvak Kendras. It had established over 1,200 Doordarshan Kalyani Health Clubs with over 24,000 members. These clubs help improve awareness among the people in the community. This programme brand has created a niche for itself achieving the No.1 position in some of the regions surpassing the popularity of all-time winner, the Regional News.
The campaign employed music, dance and song to broadcast information on RCH as well as comedy sketches, health tips, quizzes, news stories, phone-ins, letters from the audience, competitions, success stories and clubs. Kalyani is different from the usual run-of-the-mill educative programmes and has large viewer ship. It has been conceptualized as an entertaining, participatory, need-based, multi-segmented interactive programme that aims at behaviour change and social action.
2.0 Objectives of the study:
This study aims at:
a- To assess the impact of the programme on the target audience and to assess how Kalyani-II is different from other similar programmes in taking up the issues in terms of contents, presentation, language, instant reactions, timing duration etc.
b- To assess extent of awareness/watching of programme.
c- To assess knowledge gained about the issues taken up in the programme.
d- To identify source of knowledge gained.
e- To assess extent of change in attitude and behaviour relating to issues (as per audience)
f- To identify source of motivation for change in attitude and behaviour.
g- To assess reach of programme, recall of information/massages given opinion about the programme etc.
h- To assess the awareness about RCH & F.W. issues.
3.0 Methodology:
Kalyani programme is telecast only in 9 EAG states thus the study was limited to only networking area of DDK Lucknow, DDK Patna, DDK Jaipur, DDK Ranchi, DDK Raipur, DDK Guwahati, DDK Dehradun, DDK Bhopal and DDK Bhubaneshwar. The target audience was the entire population in the EAG States-UP, Bihar, Rajasthan, Jharkhand, Chattisgarh, Assam, Uttranchal, Madhya Pradesh and Orissa.
The study was conducted in following 8 steps.
Step I: Finalization of the objectives of the study and Desk research:
Step II : Deciding indicators/attributes for evaluation
Step_III : Design the Data Collection Instruments:
The main research tools were:
Quantitative Tools:
a- Target Audience Schedule
b- Health Service Provider Schedule (like ANM/MPW, MO)
c- Health Media Officer Schedule
d- Check list for designers, programme producers and anchors of Door Darshan Kendras
Qualitative Tools:
a- FGD with Community/target audience
b- Observation Study.
Step_IV : Developing an outline for the Study report:
Step_V: Development of Sampling Procedures:
The multistage sampling criteria was used.
Stage – I (Sampling of District in EAG States): In each state 2 districts were selected on the basis of having number kalyani clubs established.
Stage II. Selection of wards & Villages in the sampled District:
In each district at district town 100 households were selected for study. Five wards were selected randomly. In each ward 20 households were selected for study on random basis. In each of the district 30 villages were selected.
Stage-III: Selection of respondents:
In these selected villages 20 interviewers watching Kalyani programme were selected for impact evaluation of the Kalyani programme. In each village 5 interviews, with those who were not watching Kalyani programme, were also interviewed to analyse barriers in reach of the programme. Thus total 700 respondents were scheduled in a district.
Selection of FGD Groups:
In each district atleast 3 FGDs were conducted out of them 2 were women groups & 1 for male members separately.
Step_VI: Training of Investigators & Collecting the data.
Step-VII: Verification and entry of data collected from the field
Step-VIII: Report Writing:
Analyze, interpret and report the findings.
The qualitative data & the tabulated data were analyzed and interpreted. The quantitative data were analyzed by using SPSS package to prepare the report.
4.0 Observation of the study:
For this study initially it was decided that the respondents were married male and female of reproductive age between 15 to 45 years. But later on senior members of the family were also included because of their hold on family decisions on health issues. For this study total 14685 respondents were interviewed. Among them 12312 were those watching Kalyani programme and remaining 2373 were non viewers of the programme.
While collecting the opinion of the respondents they were interviewed on the subjects which were covered during January 2006 to March 2006 as we started data collection in the month of June 2006 as the recall of old data would have been poor.
4.1 Respondents profile:
At the country level almost equal proportion of male (50.2%) and female (49-8%) were the respondents. The study was focused on 15-45 yrs, but the age profile of respondents was skewed to higher age groups 21-35 years (56.9%) and 35-45 years (27.2%). More number of persons interviewed were from joint family structure (56.5%) compared to unitary family (43.5%). A low proportion of the respondents (15.1%) were Scheduled Tribes. Majority (89.6%) of the respondents were Hindu followed by Muslim (7.4%). In viewers group more than one fourth (25.8%) of the respondents were housewives followed by (20.1%) land owning farmers. Majority (53.2%) of the respondents were from lower middle income group, followed by (26.4%) in low income group. Only 0.8% respondents were from high income group. The majority (81.6%) of respondents in almost all states were watching TV at their own home only, followed by viewing TV at friend/neighour’s house (16.0%). A very small percent of respondents were found viewing TV at community centres (2.1%).
4.2 Programme related observations:
The question were asked about the knowledge gained on the theme telecast in Kalyani Programme to know the impact on increase in knowledge and then to what extent they practices that knowledge. The findings are given in this para.
87.1% respondents could recall the Kalyani logo and associated that with pipal tree leaf. Only 6.0% respondents were unable to recall the name of base leaf of Kalyani logo. Only 16.6% Kalyani-viewers regularly watch the programme where as more than 50.0% are not regular. 75% viewers know the correct time of telecast. 65.1% respondents opined that they share the knowledge gained from the programme with others. 62.0% of them discuss with their spouse. More than 75% respondents found Kalyani title song as good. 85.2% respondents were able to recall that they saw episodes on RCH issues. In each state more than 75% respondents were found correct in recalling the RCH issues telecast on DD-1 as Kalyani Programme.
About half (47.2%) of respondents opined that the duration of the programme was short and it should be increased. Only 9.3% respondents felt that the duration of the programme was long. The advertisements were liked by viewers as is evident from high recall level barring a few cases. For example in Assam advertisement on PNDT was not effective one. Highest recalled advertisement was on immunization and lowest on sex determination. In Assam 37.8% respondents were aware of the existence of a Kalyani club in their villages/wards whereas in UP only 14.5% were aware. Status of membership of Kalyani clubs was poor. Willingness for opting membership of Kalyani clubs was found more than 50% in all the states. A majority (60.6%) revealed that they did not know how they can become member of these clubs. But only 61.7% respondents were aware of the format of this programme. Majority of them (92.7%) were found satisfied with the answers provided at phone in programme.
Nearly fifty percent (49.6%) respondents ever heard of ASHA. 96.8% had correct knowledge of right age at marriage. 90.6% respondents were aware of risk factors of old age pregnancy. Only 37.7% respondents could respond to correct answer for diet to pregnant women by responding that a pregnant woman needs one and half times of a normal diet. 88.7% respondents had knowledge about prevention of anaemia and out of them 94.9% respondents were practicing consumption of 100 tablets of iron during pregnancy in the family. Majority (81.1%) of respondents were aware of ANC checkup atleast 3 times during pregnancy (Table 4.4). Only 3.8% respondents do not know about the recommended frequency of ANC checkups. More than 90% of the respondents had practice of 3 or more ANC checkups during pregnancy. A majority (73.4%) of respondents had knowledge of TT immunization to pregnant mothers. Only 1.0% respondents said that no extra care was necessary during pregnancy. A majority of respondents (91.0%) were aware of anemia/unconsciousness/breathing troubles as symptoms of risk pregnancy and 90.1% were aware of edema as symptom of risk factor. Only 42.3% respondents said that the source about their knowledge of risk pregnancy was Kalyani Programme. “Bitiya ne Janam Liya” is a most common tele film telecast in Kalyani Programme. 66.3% of respondents have watched this film. 54.0% respondents informed that Kalyani Programme was source of their information on sex determination. 75.8% respondents were aware that the sex determination of foetus is a legal crime.
After telecast of the Programme very little rise (2%) was seen in Institutional deliveries. Kalyani programme was the source of knowledge for only 16.6% respondents. Higher proportion (26.6%) of respondents ware found in Uttar Pradesh. A good proportion of (78.3%) respondents have knowledge of feeding colostrums to newborn and out of them appreciable proportion (97.0%) of respondents have been practicing the same. 86.5% respondents have knowledge of exclusive breast feeding upto 6 months age of the baby and out of them 95.4% were practicing as well. 98.4% respondents had knowledge about immunization and 97.2% respondents have got their children immunized also. Rest of the respondents which did not have knowledge and also did not get their children immunized. They had some reasons for that. Out of them 63.7 % said infants get fever after immunization so they do not opt for immunization Therefore communication strategy is to be designed to address the myths related to immunization among the large group audience. 62.3% said infants get weak, 64.9% said infants keep crying. Above 75 % respondents had knowledge of diseases being immunized. Knowledge of immunization against diphtheria (39.7), TB (49.7) and Pertusis (35.1) was lower in Orrissa. 69.0 % respondents had knowledge of right time for measles immunization. 82.1 % respondents had seen and could recall Shahrukh Khan’s Ad on immunization (Table 7.5). It seems Ad had good impact. Majority (81.9%) of respondents were aware of role of the Vitamin A in preventing night blindness. Only 28.1% respondents were able to tell the right span of bathing a newborn. At the time of managing sickness of an infant 89.5% respondents told that they take the infant to health care institution immediately. If a child was suffering from diarrhoea then majority (87.8%) of respondents said that they feed ORS to the child, 63.5% said that feeding of pulse soup or dal ka pani is done.
Majority (88.1%) of respondents were able to recall an episode on child care which was telecast on TV. In all 76.6% of the respondents were aware about HIV/AIDS. In all the states more than 90% respondents were aware about the reasons of contracting HIV/AIDS. Overall 52.3% respondents got knowledge about HIV/AIDS by watching Kalyani episode. Only 5.1% received knowledge through Kalyani clubs. About 90 percent respondents said that they can live with HIV/AIDS patients happily and even motivate them for treatment.
About 60 percent (58.8%) have opted any of contraceptive measures either temporary or permanent. In temporary methods contraceptive pill and condoms were commonly used (43.1% and 45.4% respectively). Main reasons for not opting any temporary method was that they were not aware of these methods (24.7%), not easily available (19.9%) and due to religious reasons (19.6%).
In all 25.9% respondents received knowledge of family planning methods from Kalyani Programme. About 25.4% respondents opted contraceptive methods in consultation with their spouse whereas only 6.6% opted on the advice of elders of the family. A majority (63.1%) of respondents knew correct span of spacing. A majority (67.6%) of respondents knew that NSV is a method of male contraception. 23.6% respondents confirmed that themselves or any one of their relative/acquaintance adopted NSV. On inquiring about reasons for not opting NSV, 23.4% said that it developed physical weakness and 19.6% revealed that sterilization should be adopted by women only. In 4.4% cases wife did not allow her husband to adopt NSV.
5.0 Findings from Focus Group Discussions
Some of the groups found the present timings suitable but a large majority wanted the timings for the programme between 7.30 to 8.00 PM. Even the duration of the programme should be increased as per them.
The programmes should focus on encouraging NSV so that male sterilization be increased. The male community is scared of NSV, the focus to reduce their fear be given on Kalyani episodes.
They opined that because of the Kalyani programme influence there was increase in institutional deliveries.
Because of the influence of the programme people were than more prompt towards ANC & New Born care compared to past.
The awareness programmes on the diseases which were of recent origin and not known to community should also be telecast. So that community could be made aware about them & take precautionary measures.
The traditional & home based treatment methods should also be included in the Kalyani programme. Even AYUSH should be included in the programmes as per them.
The Kalyani Programme should be produced in the format of a serial.
The dialogic mode of discussions with the doctors should also be in the drama format.
· Kalyani be included in DTH telecast.
· The CDs of the Kalyani be made available in the market.
The details given through Kalyani were different some times form the information given in health messages of the department. Therefore there was a need to integrate the contents with health messages released through other channels.
The efforts to ensure electricity supply during Kalyani Time be made by the government.
Where ever there is no access of TV, there the programme be disseminated through radio.
Where there is no electricity, the programme contents be disseminated through street plays.
Opinions of anchors and producers of Door Darshan Kendras:
Most of the respondents found the programme OK but a few found the topics are excessively congested i.e. highly condensed with contents.
They suggested that the script be written considering the local culture & constraints of the TV Transmission.
· Most of the producers found the artists performing very well excepting Lucknow & Patna where they found only normal.
· The producers found them successful in communicating the desired messages effectively.
· There should be workshops to identify the issues making the community participate more actively.
· The Government department should support for the popularity of the programme.
· There should be freedom to select the local topics in stead of rigid run sheet.
· PGFs be actively involved in providing the local issues.
· There be Kalyani Rath as is done in Hath Se Hath Mila.
· The programmes be shooted in the remote locations for which the budgets & required manpower does not permit.
· Incorporation of programmes like Uljhan-Suljhan, Ab-Tab, Kalyani Workshops’
· Nautanki based on regional popularity was incorporated in Bihar.
· Connected more with the local situation & field based.
· A large proportion of the respondents said they do not get adequate time & facilities for regional research.
· For increasing the participation in phone-in prgramme they suggested-
a- Local experts should respond in local language
b- The programme be included on DTH
c- Duration of Phone-in be increased.
d- A few forward audiences should be encouraged for more phone-in calls.
· The Kalyani Rath be sent to each district with prior advertisement through local media & local administration.
· The copy of the programme through CDs be sent for dissemination as a large area of the country is media dark
· It should be screened through cables also.
· The hoardings of Kalyani be displayed at Public Places.
· Power supply be ensured or the telecast be matched with supply timings.
· Periodic surveys be conducted.
· New techniques be adopted.
· Too many segments not to be included in one episode.
Opinions of Media Officers of District Health Systems
The opinions of Media Officers of District Health Systems were as follows:
· Most of the media officers interviewed had watched the programme. Which was informative, more useful for rural folks. As per them it helped in increasing immunization.
· Most of the media officers interviewed were dissatisfied because of not using local language.
· The media officers interviewed found their performance good on a varied scale of measurement.
· The programme is successful but it should show more of field realities rather than studio setting.
· It has better impact because of involvement of local artists.
· Puppet show by local artists, local dancers, street plays be included in the programme.
· The information about the programme be given through health workers as well.
· Most of the media officers interviewed found very good synchronism in the programme.
· It should also telecast the latest government health schemes & create awareness before launch.
· A majority was found satisfied with the level of innovations but a few of them wanted more innovative ways to reach to the community.
6.0 Recommendations:
Community watching of the programme had been only in 3.5% cases which needs strengthening as Kalyani was designed to enhance community viewing and their active involvement. The awareness about Kalyani was not among 24.9% cases. Therefore the efforts are needed to advertise about the programme timing through other media and other channels. The concept of Kalyani clubs be strengthened. It may also enhance the audience involvement. The audience does not share this knowledge with health workers (2.7% only). The health workers need to be involved in the programme. Even the copies of the Kalyani episodes be given to block level & district level media personnel to disseminate in their media activities. The efforts are needed to strengthen this component with the help of health service providers. Rather it may be linked with ongoing health schemes and existing community organizations. The awareness about formation of Kalyani health clubs itself has been poor. This again necessitates linking this component with existing health systems.
Only a small proportion 37.7% of the audience was aware of right quantity of food intake during pregnancy. The contents and the formats of communication need modification so that high proportion of audience could get the knowledge of the food intake during pregnancy. The awareness generation on MTP & PNDT was less than adequate. It needs to be given more attention with appropriate strategy. The impact on practices in immunization was good but the myths against immunization still requires communication strategy to achieve 100% immunization in the states like UP & Rajasthan. Kalyani was effective only upto 27% for creating awareness on FP methods. This component of NRHM now need focus for next programmes. GOI wishes to promote adoption of NSV method but 32.4% still need to know about this method. Therefore this subject needs adequate attention on the contents and programme focus areas. A good proportion of community (37.5%) got knowledge about ASHA from Kalyani but this is a low proportion because it was asked from Kalyani ever viewers. There is a need to modify the format so that it can give knowledge to a wider group of viewers.
The programme needs focus on adolescent group as their representations among respondents had been poor. The programme requires to chalk out strategies to involve highly educated class as in the respondents group only 11.3% were graduate & above. The people from higher income group also to be towards the programme as their representation is also poor.
The music like title song was appreciated by a large proportion of audience (75%). This indicates that music like title song should be used even in other components of the programme to keep the audience involved and learn more from the programme. The programme be disseminated through AIR wherever possible as there is demand for the programme but electricity supply is irregular. Though a high proportion of audience was found satisfied with the answers of phone in programme but at the same time a large group could not get line. This requires modification in approach.
The flexibility to producers for promoting the programme, deciding the format of the programme and selection of the team be increased. The state health authorities be asked to contribute technically in the design of contents and they should incorporate the communication in their regular health programmes.
It is a unique programme because it is telecast from regional kendras helped in focusing localized issues, Phone-In Programme is another innovation of audience participation, community involvement by way of Kalyani Clubs is its uniqueness and connected more with the local situation & field based.
Timings from 6.30-7.00 be changed to another slot later when most people can access. It should also be disseminated through AIR and DTH also. Use of folk media and traditional art be made effective. Animation should also be incorporated in the telecast. CDs of the Kalyani episodes be made available in the market and local cable operators be asked to telecast them. The use of local dialects and regional languages is to be increased.
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Wednesday, September 17, 2008
Status of Protection of Child Rights in India against HIV/AIDS
Introduction
As per the UN Resolution the children have Right to Education, Right to Food, Right to Health, Right to Shelter, Right to be Heard and Participation. The SOS Villages carry out activities pertaining to Child Rights in the area of Health, Education, Psychosocial Support, Legal Support and Culture, Youth Development and Community Training, Entrepreneurship and Food Security (Livelihood). Government Organizations such as Ministry of Health, Ministry of Education, Ministry of Commerce & Industries, Department of Social Welfare, Ministry of Women & Child Development, Department of Home Affairs, Ministry of Youth Affairs and Ministry of Social Justice & Empowerment are also concerned with these functions. The status of these child rights was assessed in India with an objective of analyzing the status of Child Rights externally as well as internally (with in SOS Children’s Villages) to help conceptualizing the Policy Document for protecting the children against prevalence of HIV / AIDS in SOS Children’s Villages. IIDM carried out this study with the following research methodology. The main focus on this study had been to provide data on the National Child Right’s Situation Analysis.
In the External Situation Analysis the focus was on:
- Identifying what rights are not realized.
- Identifying why they are not realized – immediate & root causes
- Identifying who/which institution bears responsibility. What are they and other actors are doing.
- Identifying the constraints & obstacles to meeting responsibilities (Capacity, legislative, resources, attitudes etc.). What may help or hinder the realization of children’s rights.
- Identifying how best to support change towards the realization of the UN CRC. What strengths can be reinforced, what needs to be done additionally, or done differently, and with whom? What good practice exists, what brings about the most effective changes?
The main purpose of the consultation with other main stakeholders was to get an overview on the opinions, strategies & programmes of the main public institutions, NGOs & individuals active in the child rights field with regard to the Child Rights Policy. In particular root causes of child rights violations were identified & capacity gaps analyzed jointly through stakeholders consultation.
In case of Internal Strengths & weaknesses it was to assess the SOS Children’s villages own current capacity in India in terms of its knowledge & experience, staffing competence, reputation, quality of relationships, structures & systems, resources etc. such as
- Which children are being reached by SOS Programmes? Who is the specific target group (to consider data on relevant issues, e.g. age, gender, type of disability, family situation etc.) ?
- What services are offered in SOS facilities & programmes? What are the over all goals of the programmes? What is their impact?
- What aspects of child rights are focused on through the programme? Does SOS apply the principles of the UN CRC (Survival & Development, Child Participation, best interests, non-discrimination)? Do children have a voice/ are listened to regarding issues that concern them?
- How are the working relationship between the SOS Villages & the government?
- Are there any external positions, advocacy efforts & cooperation with partners on the topic?
- How are the Child Rights are reflected or supported by the organizational structure, existing systems (Working methods, approaches & procedures) and infrastructure?
- What competencies and or competency gaps does SOS Children’s Villages have regarding Child Rights issues?
- What important links are found between the Child Right Issues & the roots and history of SOS Children Villages?
This study has been carried out with the intention to give specific direction & understanding the situation of children in India.
Objective of the Study:
The study aimed at analyzing the status of Child Rights externally as well as internally (With in SOS Children’s Villages).
Research Methodology:
The study was conducted in following steps.
Desk Research
(Internal Analysis)
In the desk research for internal analysis following documents were studied-
SOS Children’s Villages National Action Plan
SOS Facility Action Plan
SOS Progress reports
Partnership agreements (MOUs) with the governments
Other documents/ Policy related to Child Rights (e.g. Work Place Policy, guidelines for children’s admissions
(External Analysis)
In the desk research for external analysis following documents were studied-
· Reports on Internet
· GOI Plan of Action for Child Rights
· Five Year Plan document of Planning Commission of India.
· National Policy on Child Rights
· 2001 census data
The Stakeholder Consultation Workshop:
A group of stakeholders were consulted in a participatory mode in a workshop organized as per following details.
Place – Indian Institute of Development Management
Date- 20-3-07
Time- 2 PM to 5.30 PM
No. of Participants – 11
Name of Participants who attended the workshop-
1) Mr. Manoj Suryawanshi Khajuri Kala SOS village
2) Ms. Archna Sahay Bhopal Aarambh (NGO)
3) Ms Pallavi Bhopal Aarambh (NGO)
4) Ms Saraswati Iyyer Bhopal CARE (Int. NGO)
5) Mr. Ashish Gangarade Itarsi Jeavodaya (NGO)
6) Dr Mahesh Saxena Bhopal MP Child Wel. Council
6) Dr. S.K.Trivedi Bhopal IIDM
7) Ms. Shubhra Goel Bhopal IIDM
8) Dr. R.S.Nirmal Bhopal IIDM
9) Mr. Manoj Vijaywargiya Bhopal IIDM
10) Mr. Vinod Choudhary Bhopal IIDM
11) Ms. Subhra Bhattacharya Bhopal IIDM
SWOT Analysis:
To identify the internal strengths & weaknesses the SWOT analysis was carried out by involving the following stakeholders:
1- SOS Staff members working directly with children such as SOS mothers, SOS Youth leaders, Village Directors , FSP Field Officers, SOS teachers, nurses & doctors working in SOS medical centres.
2- Member of the board of national association.
3- Members of the National Management Team ( National Director, Facility Heads)
4- Local Donor
5- Representatives of children & young people
6- External partners (NGOs, Out of Home, local authorities)
Primary data Collection:
For collecting the primary data the quantitative & qualitative data collection tools were used.
4.1 Quantitative Tools:
1- SOS Children’s Village Institution Schedules
2- SOS Staff Members Schedule
3- National Management Team Members Schedule
4- Child Schedule
4.2 Qualitative Tools:
1- Focus Group Discussions with Staff
2- Focus Group Discussions with Beneficiaries
5.0 Sampling Criteria:
It was not possible to take opinions of all the stakeholders in such a short time. Therefore samples of respondents were drawn as described. However the opinions of all the Village Directors had also been taken and the opinions of a large number SOS Mothers have been collected.
1- Four SOS Villages were selected for study as per the following criteria.
1- One Village among the oldest established villages. ( Faridabad)
2- One Village being among the latest established villages. (Khajuri Kala)
3- One of them being in metropolitan town ( Faridabad)
4- One of them being in small town. (Bhopal)
For interviewing the members of National Management Team we designed a checklist and the HODs at Head Quarter were interviewed.
6.0 Main Steps of the Study:
The IIDM designed the data collection formats & check lists in consultation with the Director SOS Khajuri Kala who was coordinating the study. We pre-tested those instruments before undertaking the study. Thus the study was conducted in following main steps.
Step-I: Finalising the objectives of the study & scope of work by detailed discussions with the client. At this stage we discussed with the client organization & clarified the objectives of the study & their requirements from the study.
Step-II: Desk Research: Studying the similar studies in other organizations & relevant literature including surfing internet.
Step-III: Design of Data Collection Tools:
The data collection formats & checklists (Tools) were designed by IIDM & were finalized in consultation with SOS Coordinator.
Step-IV: Field Testing:
The formats & checklists were tested in SOS Bhopal & then were finalized.
Step-VI: Collection of data:
The investigators collected the data from the SOS HQ & sampled SOS Villages..
Step-VII: Analysis of data was carried out & the report was prepared.
7.0 Limitations of the Study:
1- The duration of the study assigned was very short.
2- The substantial number of AIDS/ HIV cases were not there in the organization. Therefore the information obtained was based more on opinions than the reality.
3- Because of time constraints the sample size for data collection was small.
4- The literature available in the internal issues was not easily available.
5- Time for study was so short that in-depth analysis of all the collected data could not be done.
As per the UN Resolution the children have Right to Education, Right to Food, Right to Health, Right to Shelter, Right to be Heard and Participation. The SOS Villages carry out activities pertaining to Child Rights in the area of Health, Education, Psychosocial Support, Legal Support and Culture, Youth Development and Community Training, Entrepreneurship and Food Security (Livelihood). Government Organizations such as Ministry of Health, Ministry of Education, Ministry of Commerce & Industries, Department of Social Welfare, Ministry of Women & Child Development, Department of Home Affairs, Ministry of Youth Affairs and Ministry of Social Justice & Empowerment are also concerned with these functions. The status of these child rights was assessed in India with an objective of analyzing the status of Child Rights externally as well as internally (with in SOS Children’s Villages) to help conceptualizing the Policy Document for protecting the children against prevalence of HIV / AIDS in SOS Children’s Villages. IIDM carried out this study with the following research methodology. The main focus on this study had been to provide data on the National Child Right’s Situation Analysis.
In the External Situation Analysis the focus was on:
- Identifying what rights are not realized.
- Identifying why they are not realized – immediate & root causes
- Identifying who/which institution bears responsibility. What are they and other actors are doing.
- Identifying the constraints & obstacles to meeting responsibilities (Capacity, legislative, resources, attitudes etc.). What may help or hinder the realization of children’s rights.
- Identifying how best to support change towards the realization of the UN CRC. What strengths can be reinforced, what needs to be done additionally, or done differently, and with whom? What good practice exists, what brings about the most effective changes?
The main purpose of the consultation with other main stakeholders was to get an overview on the opinions, strategies & programmes of the main public institutions, NGOs & individuals active in the child rights field with regard to the Child Rights Policy. In particular root causes of child rights violations were identified & capacity gaps analyzed jointly through stakeholders consultation.
In case of Internal Strengths & weaknesses it was to assess the SOS Children’s villages own current capacity in India in terms of its knowledge & experience, staffing competence, reputation, quality of relationships, structures & systems, resources etc. such as
- Which children are being reached by SOS Programmes? Who is the specific target group (to consider data on relevant issues, e.g. age, gender, type of disability, family situation etc.) ?
- What services are offered in SOS facilities & programmes? What are the over all goals of the programmes? What is their impact?
- What aspects of child rights are focused on through the programme? Does SOS apply the principles of the UN CRC (Survival & Development, Child Participation, best interests, non-discrimination)? Do children have a voice/ are listened to regarding issues that concern them?
- How are the working relationship between the SOS Villages & the government?
- Are there any external positions, advocacy efforts & cooperation with partners on the topic?
- How are the Child Rights are reflected or supported by the organizational structure, existing systems (Working methods, approaches & procedures) and infrastructure?
- What competencies and or competency gaps does SOS Children’s Villages have regarding Child Rights issues?
- What important links are found between the Child Right Issues & the roots and history of SOS Children Villages?
This study has been carried out with the intention to give specific direction & understanding the situation of children in India.
Objective of the Study:
The study aimed at analyzing the status of Child Rights externally as well as internally (With in SOS Children’s Villages).
Research Methodology:
The study was conducted in following steps.
Desk Research
(Internal Analysis)
In the desk research for internal analysis following documents were studied-
SOS Children’s Villages National Action Plan
SOS Facility Action Plan
SOS Progress reports
Partnership agreements (MOUs) with the governments
Other documents/ Policy related to Child Rights (e.g. Work Place Policy, guidelines for children’s admissions
(External Analysis)
In the desk research for external analysis following documents were studied-
· Reports on Internet
· GOI Plan of Action for Child Rights
· Five Year Plan document of Planning Commission of India.
· National Policy on Child Rights
· 2001 census data
The Stakeholder Consultation Workshop:
A group of stakeholders were consulted in a participatory mode in a workshop organized as per following details.
Place – Indian Institute of Development Management
Date- 20-3-07
Time- 2 PM to 5.30 PM
No. of Participants – 11
Name of Participants who attended the workshop-
1) Mr. Manoj Suryawanshi Khajuri Kala SOS village
2) Ms. Archna Sahay Bhopal Aarambh (NGO)
3) Ms Pallavi Bhopal Aarambh (NGO)
4) Ms Saraswati Iyyer Bhopal CARE (Int. NGO)
5) Mr. Ashish Gangarade Itarsi Jeavodaya (NGO)
6) Dr Mahesh Saxena Bhopal MP Child Wel. Council
6) Dr. S.K.Trivedi Bhopal IIDM
7) Ms. Shubhra Goel Bhopal IIDM
8) Dr. R.S.Nirmal Bhopal IIDM
9) Mr. Manoj Vijaywargiya Bhopal IIDM
10) Mr. Vinod Choudhary Bhopal IIDM
11) Ms. Subhra Bhattacharya Bhopal IIDM
SWOT Analysis:
To identify the internal strengths & weaknesses the SWOT analysis was carried out by involving the following stakeholders:
1- SOS Staff members working directly with children such as SOS mothers, SOS Youth leaders, Village Directors , FSP Field Officers, SOS teachers, nurses & doctors working in SOS medical centres.
2- Member of the board of national association.
3- Members of the National Management Team ( National Director, Facility Heads)
4- Local Donor
5- Representatives of children & young people
6- External partners (NGOs, Out of Home, local authorities)
Primary data Collection:
For collecting the primary data the quantitative & qualitative data collection tools were used.
4.1 Quantitative Tools:
1- SOS Children’s Village Institution Schedules
2- SOS Staff Members Schedule
3- National Management Team Members Schedule
4- Child Schedule
4.2 Qualitative Tools:
1- Focus Group Discussions with Staff
2- Focus Group Discussions with Beneficiaries
5.0 Sampling Criteria:
It was not possible to take opinions of all the stakeholders in such a short time. Therefore samples of respondents were drawn as described. However the opinions of all the Village Directors had also been taken and the opinions of a large number SOS Mothers have been collected.
1- Four SOS Villages were selected for study as per the following criteria.
1- One Village among the oldest established villages. ( Faridabad)
2- One Village being among the latest established villages. (Khajuri Kala)
3- One of them being in metropolitan town ( Faridabad)
4- One of them being in small town. (Bhopal)
For interviewing the members of National Management Team we designed a checklist and the HODs at Head Quarter were interviewed.
6.0 Main Steps of the Study:
The IIDM designed the data collection formats & check lists in consultation with the Director SOS Khajuri Kala who was coordinating the study. We pre-tested those instruments before undertaking the study. Thus the study was conducted in following main steps.
Step-I: Finalising the objectives of the study & scope of work by detailed discussions with the client. At this stage we discussed with the client organization & clarified the objectives of the study & their requirements from the study.
Step-II: Desk Research: Studying the similar studies in other organizations & relevant literature including surfing internet.
Step-III: Design of Data Collection Tools:
The data collection formats & checklists (Tools) were designed by IIDM & were finalized in consultation with SOS Coordinator.
Step-IV: Field Testing:
The formats & checklists were tested in SOS Bhopal & then were finalized.
Step-VI: Collection of data:
The investigators collected the data from the SOS HQ & sampled SOS Villages..
Step-VII: Analysis of data was carried out & the report was prepared.
7.0 Limitations of the Study:
1- The duration of the study assigned was very short.
2- The substantial number of AIDS/ HIV cases were not there in the organization. Therefore the information obtained was based more on opinions than the reality.
3- Because of time constraints the sample size for data collection was small.
4- The literature available in the internal issues was not easily available.
5- Time for study was so short that in-depth analysis of all the collected data could not be done.
Endline Evaluation of ICDS-II in Chattisgarh
Introduction
The Integrated Child Development Services (ICDS) were launched in India to enhance the welfare and development of children and women. This programme was launched on 2nd Oct. 1975 with an objective of promoting the overall development of children under 6 years by strengthening the capacity of caretakers in the family and community. This was to be achieved by improving their access to the basic services needed for improvement of health and nutrition.
The main objectives, of ICDS programme are:
1. Improve the nutritional and health status of children below the age of 6 years.
2. Lay the foundation for proper psychological, physical and social development of child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school dropouts.
4. Achieve effective co-ordination of policy and implementation among various departments to promote child development.
5. Enhance the capability of the mothers to look after health and nutritional needs of the child, through proper health and nutrition education, and,
6. Care of essential needs of pregnant women and lactating mothers of weaker sections of the society.
In old Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi (now in M.P) and Tokapal, a tribal development block of Bastar district (now in Chhattisgarh). Later this programme was further extended to Susner block of Shajapur district, Nagod block of Satna district and urban areas of Jabalpur. Till 1986 ICDS programme in old M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS programme was shifted to Women and Child Development Department in 1986, which was created for this purpose. The Directorate of Women and Child Development under Govt. of Chhattisgarh is looking after this programme since its formation.
The ICDS programme in the state is implemented through team approach. At block /project level, the team is headed by a Child Development Project Officer (CDPO) and Supervisors at sector level and Anganwadi Workers (AWWs) at village / AWC level.
The ICDS II Project in C.G.
The ICDS II project in C.G. is covering 152 blocks of 16 districts in the state. Out of these project 61 projects were being operated in rural areas, 6 in urban areas and 85 in tribal areas. These were further grouped as 83 World Bank New, 40 World Bank Old and 29 ICDS General projects.
The main focus of the study was to assess the existing level of ante and postnatal care (i.e. early registration, T.T. injections, IFA tablets etc.), breast feeding practices, child care practices, awareness about anganwadi centres, nutrition status of children and growth monitoring, training of anganwadi workers, and their awareness about child feeding, maternal care etc. The findings of the study may serve as indicators for measuring the progress and planning for future.
Research methodology and coverage of study
A combination of research techniques, such as quantitative, qualitative, and desk research have been used in the study. The information related to this study has been collected from heads of households, mothers of children aged 0-3 years and 3-6 years, pregnant women, lactating women, adolescent girls and anganwadi workers. Besides the interviews among above categories group discussions and case studies were also conducted.
Sampling criteria
The present study has been conducted in 11 ICDS projects. Total number of anganwadi centres covered were 66. The study has been conducted in two phases. In the first phase an enlistment of households was carried out and in second phase detailed interviews of the sampled beneficiaries, group discussions and case studies were carried out. The sample size for different categories was household 8699, pregnant women 314, lactating women 321, children 0-3 yrs. 2962, children 3-6 yrs.1654, adolescent girls 877 and AWWs 59.
Data analysis
After data collection the exercise of field editing of data was conducted at field level. After field level editing the data was brought to headquarters and second phase of office editing of data was performed. Then the data was entered into computer through software and was again rechecked. The analysis of data was performed by using SPSS. 9.0 version & EPI Info 6-0.
Salient findings of the study
The summary of findings of the study are given for different category of respondents as under:
Household characteristics
Basic information, related with household, was collected from 8699 heads of households. The socio-economic profile of the households is given below: -
1. 93 percent of the heads of households were males. Nearly 45 percent of them were illiterate. The percentage of illiterate heads of households was highest (55 percent) in tribal projects. Out of them 96 percent of heads of households were Hindus and only 2 percent were Muslims. Out of them 16 percent were scheduled castes, 33 percent scheduled tribes and 39 percent were OBCs. The main occupations of the heads of households were either wage labour (32 percent) or agriculture (51 percent). In urban areas 48 percent were wage labours, 9 percent were agriculturists, 27 percent were salaried people and 12 percent were traders/business men.
2. Overall 31 percent heads of households had monthly income below Rs. 750. In tribal projects 41 percent, in urban projects 8 percent and in rural projects 33 percent had monthly income below Rs. 750. In urban (new) projects 8 percent, in rural (new) projects 3 percent and in tribal (old) projects nearly 5 percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (62 percent), well water (22 percent) and tap water (13 percent). The main source of drinking water in urban projects was tap water (50 percent) in rural projects, hand pumps (89 percent) and in tribal projects hand pump/ borewell (47 percent). Out of the total households surveyed nearly 92 percent had no toilet facility in their houses. In tribal projects 93 percent, in rural projects 97 percent and in urban projects 76 percent had no toilet facility.
The economic condition of households was poor particularly in tribal and rural projects. In general people were at low subsistence level of livelihood.
Pregnant women’s health and nutrition
ICDS programme provides specific interventions for pregnant women by enhancing their capacity to care for themselves and their infants. For gathering information on the issues related with pregnant women. 314 pregnant women were interviewed in sample projects. More than three fourth (78 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 23.8 years. 47 percent of pregnant women were illiterate and 18 percent were educated till middle school. Whereas 4 percent in urban (new) and 4 percent in tribal (old) projects were graduates as well. The salient outcome of the study was as follows: -
1. Only 69 percent pregnant women were administered T.T. injections. Of these only 64 percent were administered at least two injections. Only 45 percent had gone through ANC check-up by doctors. About 47 percent pregnant women were not aware of the benefits of ANC check ups. Most of the pregnant women (89 percent) were aware about the existence of AWC in their village and 71 percent were registered in AWCs. Only 6 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 14 percent pregnant women was recorded every month in the AWCs.
2. Maximum advice on breast-feeding, childcare and nutrition was given by elderly women (64 percent). Nearly 33 percent pregnant women received advice on these issues from AWWs and ANMs.
Lactating women
The ICDS programme reaches lactating women with an objective of enhancing their capacity to care for themselves and their children during lactating period. The data was collected from 321 lactating women on their present health and nutritional status as well as their awareness about the programme. The mean age of lactating women interviewed was 24.6 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (53 percent), followed by 25-29 years (25 percent) and 30-34 years (10 percent) only. The proportion of illiterate women was found high (51 percent). This proportion was found higher in tribal projects (67 percent) compared to rural (55 percent) and urban (30 percent) projects. The salient findings of the study are given below: -
1. More than one third of lactating women had not taken IFA tablets (38 percent) and only 11 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (89 percent). Among lactating women who took at least two injections during their pregnancy was 85 percent.
2. During delivery 87 percent of lactating women faced no complications. The major complications faced were extended labour pain (7 percent) and caesarean delivery (2 percent). Home was the most preferred place of delivery among 86 percent lactating women interviewed. Highest percentage (97 percent) of home deliveries was found in rural projects followed by tribal projects (94 percent) and urban projects (59 percent). The second highest choice for place of delivery (14 percent) was the Govt. Hospital and Pvt. Hospitals.
3. According to lactating mothers maximum number (72 percent) of newborn children were not weighed at birth. Among those children who were weighed 58 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 17 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 45 percent of lactating mothers. In tribal projects it was reported by 60 percent lactating women, in urban projects by 37 percent and in rural projects by 36 percent. Nearly 51 percent lactating women reported that they squeezed out milk prior to breast feeding the child. Majority of them said that this was done either on the advice of elders (52 percent) or because of local customs (28 percent).
5. Nearly 89 percent of lactating women reported the nutritional status of their child as normal. 16 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (73 percent), diarrhoea (29 percent) and cough (22 percent). None of the mothers reported that they have given vitamin A rich food to their children within last 3 days and use of deworming tablets was found very low (6 percent).
6. Nearly 52 percent of lactating women were collecting supplementary food from AWCs 34 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (30 percent), nutrition (25 percent), childcare (22 percent) were found the major issues on which AWW had discussed with the lactating women. Only 18 percent of lactating mothers stated that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 73 percent said that they had been advised by elderly women in the family on these issues.
Adolescent girls
ICDS programme defines adolescent girls as unmarried girls between the age of 11 to 18 years. Specific programmes have been launched for their optimal development in health and family life. These programmes include health checks ups, supplementation of IFA, and health and family life education.
877 adolescent girls were interviewed in the study to know about their access to information and services in health and nutrition. The maximum number of girls interviewed was in the age group 13-14 years (31 percent). The mean age was 14 years. About 19 percent of girls interviewed were illiterate, 26 percent had primary education and 42 percent had middle level education. Only 4 percent were found above 10th class. The findings of the study are given below: -
1. Intake of vitamins, IFA tablets and supplementary nutrition was 31, 4 and 3 percent respectively among the girls. Most of the girls took IFA tablets (50 percent) only for less than1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 80 percent of total girls interviewed had never undergone blood tests.
2. Their access to health/nutrition and family life education was found to be poor (only 25 percent). Whatever information, they had on these issues, was mostly provided by school teachers (31 percent), friend/relatives/neighbours (21 percent) and AWWs (13 percent). Ninteen percent of the girls were aware about AIDS and their major source of information was mass media (57 percent) and their participation in any women’s group activities was very low (8 percent).
3. The data on food consumption pattern indicates that cereals (100 percent), pulses (55 percent) and vegetables (82 percent) are taken daily by maximum numbers of girls. But consumption of fruits (2 percent), milk and milk products (4 percent) and non-veg items (1 percent) are very low in their daily diet.
Children’s health and nutrition
The early childhood care of children below six years of age is focal point of ICDS programme. Therefore, this programme includes schemes like immunisation, health check ups, growth monitoring, supplementary feeding, referral services and counselling to mothers for promoting better health and nutritional practices. The data on children of 0-6 years have been collected from 4616 mothers. Among the children studied 55 percent were male and 45 percent were female. Out of them 11 percent were below six months of age and 37 percent were between 36 to 72 months of age. The major findings for this category are given below: -
1. Nearly 72 percent of the total children were not weighed at birth. Among those who were weighed, only in 52 percent cases, birth weight was recorded at AWCs and in 17 percent cases birth weight was found below 2.5 Kgs. In 44 percent cases breast-feeding was done within two hours of birth and 54 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breastfed 8 times a day before the interview. This was almost similar in tribal, rural and urban projects. The median number of months a child was breast fed was 18 in all areas and was 15 in tribal projects, 20 in rural projects and 14 in urban projects. Nearly 89 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 7 months in all projects (in tribal 6.8, in rural 7.2 and in urban 6.9 months). The main items consumed by children during last 48 hours (2 days) were plain water (99 percent), solid/mushy food (88 percent), tea (45 percent) and fresh milk (23 percent), Tinned/powder milk was given in 5 percent children of urban (new) project. Doses of vitamin A was provided to 41 percent children. Around 65 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the two weeks proceeding survey almost 21 percent children were found sick. Of these 77 percent suffered from cough, 27 percent from fever and 29 percent from diarrhoea. Nearly 21 percent of children surveyed were given de-worming tablets.
4. Nearly 99 percent mothers of children reported presence of AWC in the village and 83 percent reported registration of their children in the AWC. 58 percent of children were found receiving supplementary food from AWCs. In 44 percent cases, mothers confirmed that food for children was being shared by other members of family and nearly 51 percent of children (3-6 years) were found attending pre-school education in AWCs.
Anganwadi workers (AWW)
It was decided to interview all the anganwadi workers of sampled AWCs (66) but only 59 AWWs could be interviewed. Most of the AWWs were in the age group 21 to 30 years. Out of them 25 percent were in the age group of 21-25 and 32 percent in the age group of 26-30 years. The mean age was 31.6 years. Nearly one third of AWWs were above High school (34 percent). The major findings of the study were as below.
1. 76 percent AWWs received both the training and only 2 percent could not get any training at all.
2. Overall 49 percent of AWCs were functioning in Govt. buildings and 41 percent in rented buildings where as in urban areas 82 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWC consisted of 37 children of 0-3 years, 33 children of 3-6 years, 4 adolescent girls, 8 pregnant women and 9 lactating women.
4. Under Kishori Shakti Yojana on an average 2-3 adolescent girls were enrolled in AWCs. In about 3 percent AWCs weighing machines were not found where as nearly in 73 percent AWCs weighing machines were found in working condition. Nearly 88 percent of children below 3 years of age are weighed once a month. The wall charts were available in 76 percent AWCs and growth charts were available in 71 percent AWCs. In about 27 percent AWC no food stock was found and in 20 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.7 in all AWCs, 5.9 in tribal as well as in rural projects and 5 in urban projects. Adequate number of pre school kits were found only in 32 percent AWCs, whereas 27 percent AWCs belonging to urban project had adequate number of kits 86 percent of AWCs had no medicine kits. In 69 percent AWCs kits were out of stock but not replaced and in 31 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 44 percent AWCs. Immunisation register and survey register were maintained in 90 percent and 95 percent centres respectively.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 86 percent were advised to get TT injections, 75 percent were advised to eat green vegetables, 70 percent advised to take IFA tablets, 64 percent were advised to get registered at AWCs and 58 percent were advised to take care of food. The main advice given to lactating women included, providing colostrum (by 81 percent AWWs), timely Immunisation (by 68 percent AWWs), exclusive breast-feeding (by 66 percent AWWs) and keeping child clothed (by 41 percent AWWs). Seventy three percent of AWWs advised the mothers for breast-feeding to new-born child within one hour after birth. 97 percent of AWWs were aware about providing colostrum to new-born child. 95 percent of AWWs had correct knowledge about exclusive breast-feeding period.
The Integrated Child Development Services (ICDS) were launched in India to enhance the welfare and development of children and women. This programme was launched on 2nd Oct. 1975 with an objective of promoting the overall development of children under 6 years by strengthening the capacity of caretakers in the family and community. This was to be achieved by improving their access to the basic services needed for improvement of health and nutrition.
The main objectives, of ICDS programme are:
1. Improve the nutritional and health status of children below the age of 6 years.
2. Lay the foundation for proper psychological, physical and social development of child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school dropouts.
4. Achieve effective co-ordination of policy and implementation among various departments to promote child development.
5. Enhance the capability of the mothers to look after health and nutritional needs of the child, through proper health and nutrition education, and,
6. Care of essential needs of pregnant women and lactating mothers of weaker sections of the society.
In old Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi (now in M.P) and Tokapal, a tribal development block of Bastar district (now in Chhattisgarh). Later this programme was further extended to Susner block of Shajapur district, Nagod block of Satna district and urban areas of Jabalpur. Till 1986 ICDS programme in old M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS programme was shifted to Women and Child Development Department in 1986, which was created for this purpose. The Directorate of Women and Child Development under Govt. of Chhattisgarh is looking after this programme since its formation.
The ICDS programme in the state is implemented through team approach. At block /project level, the team is headed by a Child Development Project Officer (CDPO) and Supervisors at sector level and Anganwadi Workers (AWWs) at village / AWC level.
The ICDS II Project in C.G.
The ICDS II project in C.G. is covering 152 blocks of 16 districts in the state. Out of these project 61 projects were being operated in rural areas, 6 in urban areas and 85 in tribal areas. These were further grouped as 83 World Bank New, 40 World Bank Old and 29 ICDS General projects.
The main focus of the study was to assess the existing level of ante and postnatal care (i.e. early registration, T.T. injections, IFA tablets etc.), breast feeding practices, child care practices, awareness about anganwadi centres, nutrition status of children and growth monitoring, training of anganwadi workers, and their awareness about child feeding, maternal care etc. The findings of the study may serve as indicators for measuring the progress and planning for future.
Research methodology and coverage of study
A combination of research techniques, such as quantitative, qualitative, and desk research have been used in the study. The information related to this study has been collected from heads of households, mothers of children aged 0-3 years and 3-6 years, pregnant women, lactating women, adolescent girls and anganwadi workers. Besides the interviews among above categories group discussions and case studies were also conducted.
Sampling criteria
The present study has been conducted in 11 ICDS projects. Total number of anganwadi centres covered were 66. The study has been conducted in two phases. In the first phase an enlistment of households was carried out and in second phase detailed interviews of the sampled beneficiaries, group discussions and case studies were carried out. The sample size for different categories was household 8699, pregnant women 314, lactating women 321, children 0-3 yrs. 2962, children 3-6 yrs.1654, adolescent girls 877 and AWWs 59.
Data analysis
After data collection the exercise of field editing of data was conducted at field level. After field level editing the data was brought to headquarters and second phase of office editing of data was performed. Then the data was entered into computer through software and was again rechecked. The analysis of data was performed by using SPSS. 9.0 version & EPI Info 6-0.
Salient findings of the study
The summary of findings of the study are given for different category of respondents as under:
Household characteristics
Basic information, related with household, was collected from 8699 heads of households. The socio-economic profile of the households is given below: -
1. 93 percent of the heads of households were males. Nearly 45 percent of them were illiterate. The percentage of illiterate heads of households was highest (55 percent) in tribal projects. Out of them 96 percent of heads of households were Hindus and only 2 percent were Muslims. Out of them 16 percent were scheduled castes, 33 percent scheduled tribes and 39 percent were OBCs. The main occupations of the heads of households were either wage labour (32 percent) or agriculture (51 percent). In urban areas 48 percent were wage labours, 9 percent were agriculturists, 27 percent were salaried people and 12 percent were traders/business men.
2. Overall 31 percent heads of households had monthly income below Rs. 750. In tribal projects 41 percent, in urban projects 8 percent and in rural projects 33 percent had monthly income below Rs. 750. In urban (new) projects 8 percent, in rural (new) projects 3 percent and in tribal (old) projects nearly 5 percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (62 percent), well water (22 percent) and tap water (13 percent). The main source of drinking water in urban projects was tap water (50 percent) in rural projects, hand pumps (89 percent) and in tribal projects hand pump/ borewell (47 percent). Out of the total households surveyed nearly 92 percent had no toilet facility in their houses. In tribal projects 93 percent, in rural projects 97 percent and in urban projects 76 percent had no toilet facility.
The economic condition of households was poor particularly in tribal and rural projects. In general people were at low subsistence level of livelihood.
Pregnant women’s health and nutrition
ICDS programme provides specific interventions for pregnant women by enhancing their capacity to care for themselves and their infants. For gathering information on the issues related with pregnant women. 314 pregnant women were interviewed in sample projects. More than three fourth (78 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 23.8 years. 47 percent of pregnant women were illiterate and 18 percent were educated till middle school. Whereas 4 percent in urban (new) and 4 percent in tribal (old) projects were graduates as well. The salient outcome of the study was as follows: -
1. Only 69 percent pregnant women were administered T.T. injections. Of these only 64 percent were administered at least two injections. Only 45 percent had gone through ANC check-up by doctors. About 47 percent pregnant women were not aware of the benefits of ANC check ups. Most of the pregnant women (89 percent) were aware about the existence of AWC in their village and 71 percent were registered in AWCs. Only 6 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 14 percent pregnant women was recorded every month in the AWCs.
2. Maximum advice on breast-feeding, childcare and nutrition was given by elderly women (64 percent). Nearly 33 percent pregnant women received advice on these issues from AWWs and ANMs.
Lactating women
The ICDS programme reaches lactating women with an objective of enhancing their capacity to care for themselves and their children during lactating period. The data was collected from 321 lactating women on their present health and nutritional status as well as their awareness about the programme. The mean age of lactating women interviewed was 24.6 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (53 percent), followed by 25-29 years (25 percent) and 30-34 years (10 percent) only. The proportion of illiterate women was found high (51 percent). This proportion was found higher in tribal projects (67 percent) compared to rural (55 percent) and urban (30 percent) projects. The salient findings of the study are given below: -
1. More than one third of lactating women had not taken IFA tablets (38 percent) and only 11 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (89 percent). Among lactating women who took at least two injections during their pregnancy was 85 percent.
2. During delivery 87 percent of lactating women faced no complications. The major complications faced were extended labour pain (7 percent) and caesarean delivery (2 percent). Home was the most preferred place of delivery among 86 percent lactating women interviewed. Highest percentage (97 percent) of home deliveries was found in rural projects followed by tribal projects (94 percent) and urban projects (59 percent). The second highest choice for place of delivery (14 percent) was the Govt. Hospital and Pvt. Hospitals.
3. According to lactating mothers maximum number (72 percent) of newborn children were not weighed at birth. Among those children who were weighed 58 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 17 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 45 percent of lactating mothers. In tribal projects it was reported by 60 percent lactating women, in urban projects by 37 percent and in rural projects by 36 percent. Nearly 51 percent lactating women reported that they squeezed out milk prior to breast feeding the child. Majority of them said that this was done either on the advice of elders (52 percent) or because of local customs (28 percent).
5. Nearly 89 percent of lactating women reported the nutritional status of their child as normal. 16 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (73 percent), diarrhoea (29 percent) and cough (22 percent). None of the mothers reported that they have given vitamin A rich food to their children within last 3 days and use of deworming tablets was found very low (6 percent).
6. Nearly 52 percent of lactating women were collecting supplementary food from AWCs 34 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (30 percent), nutrition (25 percent), childcare (22 percent) were found the major issues on which AWW had discussed with the lactating women. Only 18 percent of lactating mothers stated that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 73 percent said that they had been advised by elderly women in the family on these issues.
Adolescent girls
ICDS programme defines adolescent girls as unmarried girls between the age of 11 to 18 years. Specific programmes have been launched for their optimal development in health and family life. These programmes include health checks ups, supplementation of IFA, and health and family life education.
877 adolescent girls were interviewed in the study to know about their access to information and services in health and nutrition. The maximum number of girls interviewed was in the age group 13-14 years (31 percent). The mean age was 14 years. About 19 percent of girls interviewed were illiterate, 26 percent had primary education and 42 percent had middle level education. Only 4 percent were found above 10th class. The findings of the study are given below: -
1. Intake of vitamins, IFA tablets and supplementary nutrition was 31, 4 and 3 percent respectively among the girls. Most of the girls took IFA tablets (50 percent) only for less than1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 80 percent of total girls interviewed had never undergone blood tests.
2. Their access to health/nutrition and family life education was found to be poor (only 25 percent). Whatever information, they had on these issues, was mostly provided by school teachers (31 percent), friend/relatives/neighbours (21 percent) and AWWs (13 percent). Ninteen percent of the girls were aware about AIDS and their major source of information was mass media (57 percent) and their participation in any women’s group activities was very low (8 percent).
3. The data on food consumption pattern indicates that cereals (100 percent), pulses (55 percent) and vegetables (82 percent) are taken daily by maximum numbers of girls. But consumption of fruits (2 percent), milk and milk products (4 percent) and non-veg items (1 percent) are very low in their daily diet.
Children’s health and nutrition
The early childhood care of children below six years of age is focal point of ICDS programme. Therefore, this programme includes schemes like immunisation, health check ups, growth monitoring, supplementary feeding, referral services and counselling to mothers for promoting better health and nutritional practices. The data on children of 0-6 years have been collected from 4616 mothers. Among the children studied 55 percent were male and 45 percent were female. Out of them 11 percent were below six months of age and 37 percent were between 36 to 72 months of age. The major findings for this category are given below: -
1. Nearly 72 percent of the total children were not weighed at birth. Among those who were weighed, only in 52 percent cases, birth weight was recorded at AWCs and in 17 percent cases birth weight was found below 2.5 Kgs. In 44 percent cases breast-feeding was done within two hours of birth and 54 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breastfed 8 times a day before the interview. This was almost similar in tribal, rural and urban projects. The median number of months a child was breast fed was 18 in all areas and was 15 in tribal projects, 20 in rural projects and 14 in urban projects. Nearly 89 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 7 months in all projects (in tribal 6.8, in rural 7.2 and in urban 6.9 months). The main items consumed by children during last 48 hours (2 days) were plain water (99 percent), solid/mushy food (88 percent), tea (45 percent) and fresh milk (23 percent), Tinned/powder milk was given in 5 percent children of urban (new) project. Doses of vitamin A was provided to 41 percent children. Around 65 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the two weeks proceeding survey almost 21 percent children were found sick. Of these 77 percent suffered from cough, 27 percent from fever and 29 percent from diarrhoea. Nearly 21 percent of children surveyed were given de-worming tablets.
4. Nearly 99 percent mothers of children reported presence of AWC in the village and 83 percent reported registration of their children in the AWC. 58 percent of children were found receiving supplementary food from AWCs. In 44 percent cases, mothers confirmed that food for children was being shared by other members of family and nearly 51 percent of children (3-6 years) were found attending pre-school education in AWCs.
Anganwadi workers (AWW)
It was decided to interview all the anganwadi workers of sampled AWCs (66) but only 59 AWWs could be interviewed. Most of the AWWs were in the age group 21 to 30 years. Out of them 25 percent were in the age group of 21-25 and 32 percent in the age group of 26-30 years. The mean age was 31.6 years. Nearly one third of AWWs were above High school (34 percent). The major findings of the study were as below.
1. 76 percent AWWs received both the training and only 2 percent could not get any training at all.
2. Overall 49 percent of AWCs were functioning in Govt. buildings and 41 percent in rented buildings where as in urban areas 82 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWC consisted of 37 children of 0-3 years, 33 children of 3-6 years, 4 adolescent girls, 8 pregnant women and 9 lactating women.
4. Under Kishori Shakti Yojana on an average 2-3 adolescent girls were enrolled in AWCs. In about 3 percent AWCs weighing machines were not found where as nearly in 73 percent AWCs weighing machines were found in working condition. Nearly 88 percent of children below 3 years of age are weighed once a month. The wall charts were available in 76 percent AWCs and growth charts were available in 71 percent AWCs. In about 27 percent AWC no food stock was found and in 20 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.7 in all AWCs, 5.9 in tribal as well as in rural projects and 5 in urban projects. Adequate number of pre school kits were found only in 32 percent AWCs, whereas 27 percent AWCs belonging to urban project had adequate number of kits 86 percent of AWCs had no medicine kits. In 69 percent AWCs kits were out of stock but not replaced and in 31 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 44 percent AWCs. Immunisation register and survey register were maintained in 90 percent and 95 percent centres respectively.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 86 percent were advised to get TT injections, 75 percent were advised to eat green vegetables, 70 percent advised to take IFA tablets, 64 percent were advised to get registered at AWCs and 58 percent were advised to take care of food. The main advice given to lactating women included, providing colostrum (by 81 percent AWWs), timely Immunisation (by 68 percent AWWs), exclusive breast-feeding (by 66 percent AWWs) and keeping child clothed (by 41 percent AWWs). Seventy three percent of AWWs advised the mothers for breast-feeding to new-born child within one hour after birth. 97 percent of AWWs were aware about providing colostrum to new-born child. 95 percent of AWWs had correct knowledge about exclusive breast-feeding period.
End Line Evaluation of ICDS-II in MP
Introduction
The Integrated Child Development Services (ICDS) was launched in India to enhance the welfare and development of children and women. This programme was launched on 2nd Oct. 1975 with an objective of promoting the overall development of children under 6 years by strengthening the capacity of caretakers in the family and community. This was to be achieved by improving their access to the basic services needed for improvement of health and nutrition.
The main objectives, of ICDS programme are:
1. Improve the nutritional and health status of children below the age of 6 years.
2. Lay the foundation for proper psychological, physical and social development of child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school dropouts.
4. Achieve effective co-ordination of policy and implementation among various departments to promote child development.
5. Enhance the capability of the mothers to look after health and nutritional needs of the child, through proper health and nutrition education, and,
6. Care of essential needs of pregnant women and lactating mothers of weaker sections of the society.
In Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi and Tokapal, a tribal development block of Bastar district. Later this programme was further extended to Susner block of Shajapur district, Nagod block of Satna district and urban areas of Jabalpur. Till 1986 ICDS programme in M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS was shifted to Women and Child Development Department in 1986 formed for this purpose.
The ICDS programme in the state is implemented through team approach. At block /project level, the team is headed by a Child Development Project Officer (CDPO) and Supervisors at sector level and Anganwadi Workers (AWWs) at village / AWC level.
The ICDS II Project in M.P.
The ICDS II project in M.P. was covering 336 blocks of 45 districts in the state. Out of these project 216 projects were being operated in rural areas, 23 in urban areas and 97 in tribal areas. These were further grouped as 185 World Bank New, 65 World Bank Old and 86 ICDS General projects.
The main focus of the study was to assess the existing level of ante and postnatal care (i.e. early registration, T.T. injections, IFA tablets etc.), breast feeding practices, child care practices, awareness about anganwadi centres, nutrition status of children and growth monitoring, training of anganwadi workers, and their awareness about child feeding, maternal care etc. The findings of the study may serve as indicators for measuring the progress and planning for future.
Research methodology and coverage of study
A combination of research techniques, such as quantitative, qualitative, and desk research have been used in the study. The information related to this study has been collected from heads of households, mothers of children aged 0-3 years and 3-6 years, pregnant women, lactating women, adolescent girls and anganwadi workers. Besides the interviews among above categories group discussions and case studies were also conducted.
Sampling criteria
The present study has been conducted in 17 ICDS projects. Total number of anganwadi centres covered were 102. The study has been conducted in two phases. In the first phase an enlistment of households was carried out and in second phase detailed interviews of the sampled beneficiaries, group discussions and case studies were carried out. The sample size for different categories was household 12713, pregnant women 545, lactating women 650, children 0-3 yrs. 4716, children 3-6 yrs.2728, adolescent girls 1323 and AWWs .93.
Data analysis
After data collection the exercise of field editing of data was conducted at field level. After field level editing the data was brought to headquarters and second phase of office editing of data was performed. Then the data was entered into computer though software and was again rechecked. The analysis of data was performed by using SPSS. 9.0 version & EPI Info 6-0.
Salient findings of the study
The summary of findings of the study are given for different category of respondents as under:
Household characteristics
Basic information, related with household, was collected from 12713 heads of households. The socio-economic profile of the households is given below: -
1. 94 percent of the heads of households were males. Nearly 50 percent of them were illiterate. The percentage of illiterate heads of households was highest (63 percent) in tribal projects. Out of them 93 percent of heads of households were Hindus and only 6 percent were Muslims. Out of them 20 percent were scheduled castes, 23 percent scheduled tribes and 42 percent were OBCs. The main occupations of the head of households were either wage labour (42 percent) or agriculture (42 percent). In urban areas 41 percent were wage labours, 4 percent were agriculturists, 25 percent were salaried people and 21 percent were traders/business men.
2. Overall 30 percent heads of households had monthly income below Rs. 750. In tribal projects 40 percent, in urban projects 6 percent and in rural projects 29 percent had monthly income below Rs. 750. In urban general projects 17 percent, in rural general projects 5 percent and in tribal general projects less than one percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (39 percent), well water (36 percent) and tap water (23 percent). The main source of drinking water in urban projects was tap water (70 percent) in rural projects areas, well water (43 percent) and in tribal projects area hand pump/ borewell (54 percent). Out of the total households surveyed nearly 85 percent had no toilet facility in their houses. In tribal projects 94 percent, in rural projects 90 percent and in urban projects 30 percent had no toilet facility.
The economic condition of households was poor particularly in tribal and rural projects. They were at low subsistence level of livelihood.
Pregnant women’s health and nutrition
ICDS programme provides specific interventions for pregnant women by enhancing their capacity to care for themselves and their infants. For gathering information on the issues related with pregnant women. 545 pregnant women were interviewed in sample projects. More than three fourth (79 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 24 years. 65 percent of pregnant women were illiterate and 12 percent were educated till middle school. Whereas 4 percent in urban projects were graduates as well. The salient outcome of the study was as follows: -
1. Only 57 percent pregnant women were administered T.T. injections. Of these only 51 percent were administered atleast two injections. Only 45 percent had gone through ANC check-ups by doctors. About 59 percent pregnant women were not aware of the benefits of ANC check up. Most of the pregnant women (83 percent) were aware about the existence of AWC in their village and 42 percent were registered in AWCs. Only 18 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 12 percent pregnant women was recorded every month in the AWCs.
2. Maximum advice on breast feeding, childcare and nutrition was given by elderly women (81 percent). Only 10 percent pregnant women received advises on these issues from AWWs and ANMs.
Lactating women
The ICDS programme reaches lactating women with an objective of enhancing their capacity to care for themselves and their children during lactating period. The data was collected from 650 lactating women on their present health and nutritional status as well as their awareness about the programme. The mean age of lactating women interviewed was 24.8 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (47 percent) followed by 25-29 years (33 percent) and 30-35 years (13 percent) only. The proportion of illiterate women was found high (64 percent). This proportion was found higher in tribal projects (76 percent) compared to rural (63 percent) and urban (37 percent) projects. The salient findings of the study are given below: -
1. Nearly one third of lactating women had not taken IFA tablets and only 7 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (76 percent). Among lactating women who took at least two injections during their pregnancy was 71 percent.
2. During delivery 83 percent of lactating women faced no complications. The major complications faced were extended labour pain (11 percent) and excessive bleeding (5 percent). Home was the most preferred place of delivery among 81 percent lactating women interviewed. Highest percentage (93 percent) of home deliveries was found in tribal projects followed by rural projects (88 percent) and urban projects (22 percent). The second highest choice for place of delivery (12 percent) was the Govt. Hospital.
3. According to lactating mothers maximum number (77 percent) of new-born children were not weighed at birth. Among those children who were weighed only 42 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 27 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 37 percent of lactating mothers. In urban projects it was reported by 65 percent lactating women, in tribal projects by 33 percent and in rural projects by 32 percent. Nearly 66 percent lactating women reported that they squeezed out milk prior to breast feeding the child. Majority of them said that this was done either on the advice of elders or because of local customs.
5. Nearly 81 percent of lactating women reported the nutritional status of their child was normal. 26 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (72 percent), Diarrhoea (44 percent) and cough (35 percent). Only 3 percent mothers reported that they have given vitamin A rich food to their children within last 3 days and usage of deworming tablets was found very low (5 percent).
6. A little more than 30 percent of lactating women were collecting supplementary food from AWCs 42 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (34 percent), Nutrition (29 percent), childcare (24 percent) were found the major issues on which AWW had discussed with the lactating women. Only 13 percent of lactating mothers opined that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 81 percent said that they had been advised by elder women in the family on these issues.
Adolescent girls
ICDS programme defines adolescent girls as unmarried women between the age of 11 to 18 years. Specific programmes have been launched for their optimal development in health and family life. These programmes include health checks ups, supplementation of IFA, and health and family life education.
1323 adolescent girls were interviewed in the study to know about their access to information and services in health and nutrition. The maximum number of girls interviewed was in the age group 11-12 years (33 percent). The mean age was 13.9 years. About 30 percent of girls interviewed were illiterate, 27 percent had primary education and 26 percent had middle level education. Only 4 percent were found above 10th class. The findings of the study are given below: -
1. Intake of vitamins, IFA tablets and supplementary nutrition was 6, 7 and 2 percent respectively among the girls. Most of the girls took IFA tablets (42 percent) only for 1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 83 percent of total girls interviewed had never undergone blood tests.
2. Their access to health/nutrition and family life education was found to be poor (only 17 percent). Whatever information, they had on these issues, was provided by Friends/ Relatives/ Neighbours (36 percent), schoolteachers (30 percent) and AWWs (23 percent). One fourth of the girls were aware about AIDS and their major source of information was mass media (70 percent) and their participation in any women’s group activities was very low (8 percent).
3. The data on food consumption pattern indicates that cereals (100 percent), pulses (67 percent) and vegetables (69 percent) are taken daily by maximum numbers of girls. But consumption of fruits (7 percent), milk and milk products (21 percent) and non-veg items (2 percent) are very low in their daily food. It has been observed that about 55 percent of girls had correct knowledge of legal age at marriage. The girls in urban areas were more aware (78 percent) than rural (58 percent) and tribal areas (33 percent).
Children’s health and nutrition
The early childhood care of children below six years of age is focal point of ICDS programme. Therefore, this programme includes schemes like immunisation, health check ups, growth monitoring, supplementary feeding, referral services and counselling to mothers for promoting better health and nutritional practices. The data on children of 0-6 years have been collected from 7444 mothers. Among the children studied 56 percent were male and 44 percent were female. Out of them 14 percent were below six months of age and 37 percent were between 36 to 72 months of age. The major findings for this category are given below: -
1. Nearly 73 percent of the total children were not weighed at birth. Among those who were weighed, only in 37 percent cases, birth weight was recorded at AWCs and in 28 percent cases birth weight was found below 2.5 Kgs. In 37 percent cases breast-feeding was done within two hours of birth and 63 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breast fed 7 times a day on the day before the interview. This was almost similar in tribal, rural and urban projects. The median number of months a child was breast fed was 13 in all projects and was 12 in tribal projects, 14 in rural projects and 14 in urban projects. Nearly 90 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 8 months in all projects (in tribal 8.1, in rural 7.9 and in urban 8.4 months). The main items consumed by children during last 48 hours (2 days) were plain water (97 percent), solid/mushy food (84 percent), tea (64 percent) and fresh milk (49 percent), Tinned/powder milk was given in 9 percent children of urban (new) projects. Doses of vitamin A were provided to 42 percent children. Around 42 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the last 2 weeks of survey almost 27 percent children were found sick. Out of these 71 percent suffered from fever, 38 percent from cough and 34 percent from Diarrhoea. Nearly 14 percent of children surveyed were given de-worming tablets.
4. Nearly 96 percent mothers of children reported presence of AWC in the village and 66 percent reported registration of their children in the AWC. 33 percent of children were found receiving supplementary food from AWCs. In 37 percent cases mothers confirmed that food for children was being shared by other members of family and nearly 33 percent of children were found attending pre-school education in AWCs.
Anganwadi workers (AWW)
It was decided to interview all the anganwadi workers of sampled AWCs (102) but only 93 AWWs could be interviewed. Most of the AWWs were in the age group 26 to 35 years. Where as 31 percent was in the age group of 26-30 years and 26 percent in the age group of 31 to 35 years. The mean age was 32.3 years. A large number of AWWs were above High school (43 percent). The major findings of the study were as below.
1. 47 percent AWWs received both the trainings and only 2 percent could not get any training at all.
2. Overall 27 percent of AWCs were functioning in Govt. buildings and 44 percent in rented buildings where as in urban areas 92 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWCs consisted of 39 children of 0-3 years, 34 children of 3-6 years,6 adolescent girls, 9 pregnant women and 10 lactating women.
4. Under Kishori Shakti Yojana on an average 5-6 adolescent girls were enrolled in AWCs. In about 7 percent AWCs weighing machines were not found where as nearly in 95 percent AWCs weighing machines were found in working condition. Nearly 81 percent of children below 3 years of age are weighed once a month. The wall charts were available in 81 percent AWCs and growth charts were available in 83 percent AWCs. In about 30 percent AWC no food stock was found and in 16 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.6 in all AWCs, 5.5 in tribal as well as in rural projects and 6 in urban projects. Adequate number of pre school kits were found only in 40 percent AWCs, whereas 92 percent AWCs belonging to urban project had adequate number of kits 71 percent of AWCs had no medicine kits. The reasons were in 64 percent AWCs kits were out of stock but not replenished and in 33 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 48 percent AWCs. Immunisation register and survey register were maintained in 95 percent AWCs.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 82 percent were advised to eat green vegetables, 79 percent were advised to get TT injections, 74 percent were advised to take care of food, 57 percent were advised to take IFA tablets and 34 percent were advised to get registered in AWCs. The main advice given to lactating mothers included providing colostrum (by 77 percent AWWs), timely Immunisation (by 48 percent AWWs), exclusive breast-feeding (by 44 percent AWWs) and keeping child clothed (by 27 percent AWWs). Seventy five percent of AWWs advised the mothers for breast-feeding to newborn child within one hour after birth. 96 percent of AWWs were aware about providing colostrum to newborn child and 58 percent of AWWs had correct knowledge about exclusive breast-feeding period.
The data were compared with the base line data (1997) and an improvement has been found in the situation.
The Integrated Child Development Services (ICDS) was launched in India to enhance the welfare and development of children and women. This programme was launched on 2nd Oct. 1975 with an objective of promoting the overall development of children under 6 years by strengthening the capacity of caretakers in the family and community. This was to be achieved by improving their access to the basic services needed for improvement of health and nutrition.
The main objectives, of ICDS programme are:
1. Improve the nutritional and health status of children below the age of 6 years.
2. Lay the foundation for proper psychological, physical and social development of child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school dropouts.
4. Achieve effective co-ordination of policy and implementation among various departments to promote child development.
5. Enhance the capability of the mothers to look after health and nutritional needs of the child, through proper health and nutrition education, and,
6. Care of essential needs of pregnant women and lactating mothers of weaker sections of the society.
In Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi and Tokapal, a tribal development block of Bastar district. Later this programme was further extended to Susner block of Shajapur district, Nagod block of Satna district and urban areas of Jabalpur. Till 1986 ICDS programme in M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS was shifted to Women and Child Development Department in 1986 formed for this purpose.
The ICDS programme in the state is implemented through team approach. At block /project level, the team is headed by a Child Development Project Officer (CDPO) and Supervisors at sector level and Anganwadi Workers (AWWs) at village / AWC level.
The ICDS II Project in M.P.
The ICDS II project in M.P. was covering 336 blocks of 45 districts in the state. Out of these project 216 projects were being operated in rural areas, 23 in urban areas and 97 in tribal areas. These were further grouped as 185 World Bank New, 65 World Bank Old and 86 ICDS General projects.
The main focus of the study was to assess the existing level of ante and postnatal care (i.e. early registration, T.T. injections, IFA tablets etc.), breast feeding practices, child care practices, awareness about anganwadi centres, nutrition status of children and growth monitoring, training of anganwadi workers, and their awareness about child feeding, maternal care etc. The findings of the study may serve as indicators for measuring the progress and planning for future.
Research methodology and coverage of study
A combination of research techniques, such as quantitative, qualitative, and desk research have been used in the study. The information related to this study has been collected from heads of households, mothers of children aged 0-3 years and 3-6 years, pregnant women, lactating women, adolescent girls and anganwadi workers. Besides the interviews among above categories group discussions and case studies were also conducted.
Sampling criteria
The present study has been conducted in 17 ICDS projects. Total number of anganwadi centres covered were 102. The study has been conducted in two phases. In the first phase an enlistment of households was carried out and in second phase detailed interviews of the sampled beneficiaries, group discussions and case studies were carried out. The sample size for different categories was household 12713, pregnant women 545, lactating women 650, children 0-3 yrs. 4716, children 3-6 yrs.2728, adolescent girls 1323 and AWWs .93.
Data analysis
After data collection the exercise of field editing of data was conducted at field level. After field level editing the data was brought to headquarters and second phase of office editing of data was performed. Then the data was entered into computer though software and was again rechecked. The analysis of data was performed by using SPSS. 9.0 version & EPI Info 6-0.
Salient findings of the study
The summary of findings of the study are given for different category of respondents as under:
Household characteristics
Basic information, related with household, was collected from 12713 heads of households. The socio-economic profile of the households is given below: -
1. 94 percent of the heads of households were males. Nearly 50 percent of them were illiterate. The percentage of illiterate heads of households was highest (63 percent) in tribal projects. Out of them 93 percent of heads of households were Hindus and only 6 percent were Muslims. Out of them 20 percent were scheduled castes, 23 percent scheduled tribes and 42 percent were OBCs. The main occupations of the head of households were either wage labour (42 percent) or agriculture (42 percent). In urban areas 41 percent were wage labours, 4 percent were agriculturists, 25 percent were salaried people and 21 percent were traders/business men.
2. Overall 30 percent heads of households had monthly income below Rs. 750. In tribal projects 40 percent, in urban projects 6 percent and in rural projects 29 percent had monthly income below Rs. 750. In urban general projects 17 percent, in rural general projects 5 percent and in tribal general projects less than one percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (39 percent), well water (36 percent) and tap water (23 percent). The main source of drinking water in urban projects was tap water (70 percent) in rural projects areas, well water (43 percent) and in tribal projects area hand pump/ borewell (54 percent). Out of the total households surveyed nearly 85 percent had no toilet facility in their houses. In tribal projects 94 percent, in rural projects 90 percent and in urban projects 30 percent had no toilet facility.
The economic condition of households was poor particularly in tribal and rural projects. They were at low subsistence level of livelihood.
Pregnant women’s health and nutrition
ICDS programme provides specific interventions for pregnant women by enhancing their capacity to care for themselves and their infants. For gathering information on the issues related with pregnant women. 545 pregnant women were interviewed in sample projects. More than three fourth (79 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 24 years. 65 percent of pregnant women were illiterate and 12 percent were educated till middle school. Whereas 4 percent in urban projects were graduates as well. The salient outcome of the study was as follows: -
1. Only 57 percent pregnant women were administered T.T. injections. Of these only 51 percent were administered atleast two injections. Only 45 percent had gone through ANC check-ups by doctors. About 59 percent pregnant women were not aware of the benefits of ANC check up. Most of the pregnant women (83 percent) were aware about the existence of AWC in their village and 42 percent were registered in AWCs. Only 18 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 12 percent pregnant women was recorded every month in the AWCs.
2. Maximum advice on breast feeding, childcare and nutrition was given by elderly women (81 percent). Only 10 percent pregnant women received advises on these issues from AWWs and ANMs.
Lactating women
The ICDS programme reaches lactating women with an objective of enhancing their capacity to care for themselves and their children during lactating period. The data was collected from 650 lactating women on their present health and nutritional status as well as their awareness about the programme. The mean age of lactating women interviewed was 24.8 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (47 percent) followed by 25-29 years (33 percent) and 30-35 years (13 percent) only. The proportion of illiterate women was found high (64 percent). This proportion was found higher in tribal projects (76 percent) compared to rural (63 percent) and urban (37 percent) projects. The salient findings of the study are given below: -
1. Nearly one third of lactating women had not taken IFA tablets and only 7 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (76 percent). Among lactating women who took at least two injections during their pregnancy was 71 percent.
2. During delivery 83 percent of lactating women faced no complications. The major complications faced were extended labour pain (11 percent) and excessive bleeding (5 percent). Home was the most preferred place of delivery among 81 percent lactating women interviewed. Highest percentage (93 percent) of home deliveries was found in tribal projects followed by rural projects (88 percent) and urban projects (22 percent). The second highest choice for place of delivery (12 percent) was the Govt. Hospital.
3. According to lactating mothers maximum number (77 percent) of new-born children were not weighed at birth. Among those children who were weighed only 42 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 27 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 37 percent of lactating mothers. In urban projects it was reported by 65 percent lactating women, in tribal projects by 33 percent and in rural projects by 32 percent. Nearly 66 percent lactating women reported that they squeezed out milk prior to breast feeding the child. Majority of them said that this was done either on the advice of elders or because of local customs.
5. Nearly 81 percent of lactating women reported the nutritional status of their child was normal. 26 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (72 percent), Diarrhoea (44 percent) and cough (35 percent). Only 3 percent mothers reported that they have given vitamin A rich food to their children within last 3 days and usage of deworming tablets was found very low (5 percent).
6. A little more than 30 percent of lactating women were collecting supplementary food from AWCs 42 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (34 percent), Nutrition (29 percent), childcare (24 percent) were found the major issues on which AWW had discussed with the lactating women. Only 13 percent of lactating mothers opined that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 81 percent said that they had been advised by elder women in the family on these issues.
Adolescent girls
ICDS programme defines adolescent girls as unmarried women between the age of 11 to 18 years. Specific programmes have been launched for their optimal development in health and family life. These programmes include health checks ups, supplementation of IFA, and health and family life education.
1323 adolescent girls were interviewed in the study to know about their access to information and services in health and nutrition. The maximum number of girls interviewed was in the age group 11-12 years (33 percent). The mean age was 13.9 years. About 30 percent of girls interviewed were illiterate, 27 percent had primary education and 26 percent had middle level education. Only 4 percent were found above 10th class. The findings of the study are given below: -
1. Intake of vitamins, IFA tablets and supplementary nutrition was 6, 7 and 2 percent respectively among the girls. Most of the girls took IFA tablets (42 percent) only for 1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 83 percent of total girls interviewed had never undergone blood tests.
2. Their access to health/nutrition and family life education was found to be poor (only 17 percent). Whatever information, they had on these issues, was provided by Friends/ Relatives/ Neighbours (36 percent), schoolteachers (30 percent) and AWWs (23 percent). One fourth of the girls were aware about AIDS and their major source of information was mass media (70 percent) and their participation in any women’s group activities was very low (8 percent).
3. The data on food consumption pattern indicates that cereals (100 percent), pulses (67 percent) and vegetables (69 percent) are taken daily by maximum numbers of girls. But consumption of fruits (7 percent), milk and milk products (21 percent) and non-veg items (2 percent) are very low in their daily food. It has been observed that about 55 percent of girls had correct knowledge of legal age at marriage. The girls in urban areas were more aware (78 percent) than rural (58 percent) and tribal areas (33 percent).
Children’s health and nutrition
The early childhood care of children below six years of age is focal point of ICDS programme. Therefore, this programme includes schemes like immunisation, health check ups, growth monitoring, supplementary feeding, referral services and counselling to mothers for promoting better health and nutritional practices. The data on children of 0-6 years have been collected from 7444 mothers. Among the children studied 56 percent were male and 44 percent were female. Out of them 14 percent were below six months of age and 37 percent were between 36 to 72 months of age. The major findings for this category are given below: -
1. Nearly 73 percent of the total children were not weighed at birth. Among those who were weighed, only in 37 percent cases, birth weight was recorded at AWCs and in 28 percent cases birth weight was found below 2.5 Kgs. In 37 percent cases breast-feeding was done within two hours of birth and 63 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breast fed 7 times a day on the day before the interview. This was almost similar in tribal, rural and urban projects. The median number of months a child was breast fed was 13 in all projects and was 12 in tribal projects, 14 in rural projects and 14 in urban projects. Nearly 90 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 8 months in all projects (in tribal 8.1, in rural 7.9 and in urban 8.4 months). The main items consumed by children during last 48 hours (2 days) were plain water (97 percent), solid/mushy food (84 percent), tea (64 percent) and fresh milk (49 percent), Tinned/powder milk was given in 9 percent children of urban (new) projects. Doses of vitamin A were provided to 42 percent children. Around 42 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the last 2 weeks of survey almost 27 percent children were found sick. Out of these 71 percent suffered from fever, 38 percent from cough and 34 percent from Diarrhoea. Nearly 14 percent of children surveyed were given de-worming tablets.
4. Nearly 96 percent mothers of children reported presence of AWC in the village and 66 percent reported registration of their children in the AWC. 33 percent of children were found receiving supplementary food from AWCs. In 37 percent cases mothers confirmed that food for children was being shared by other members of family and nearly 33 percent of children were found attending pre-school education in AWCs.
Anganwadi workers (AWW)
It was decided to interview all the anganwadi workers of sampled AWCs (102) but only 93 AWWs could be interviewed. Most of the AWWs were in the age group 26 to 35 years. Where as 31 percent was in the age group of 26-30 years and 26 percent in the age group of 31 to 35 years. The mean age was 32.3 years. A large number of AWWs were above High school (43 percent). The major findings of the study were as below.
1. 47 percent AWWs received both the trainings and only 2 percent could not get any training at all.
2. Overall 27 percent of AWCs were functioning in Govt. buildings and 44 percent in rented buildings where as in urban areas 92 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWCs consisted of 39 children of 0-3 years, 34 children of 3-6 years,6 adolescent girls, 9 pregnant women and 10 lactating women.
4. Under Kishori Shakti Yojana on an average 5-6 adolescent girls were enrolled in AWCs. In about 7 percent AWCs weighing machines were not found where as nearly in 95 percent AWCs weighing machines were found in working condition. Nearly 81 percent of children below 3 years of age are weighed once a month. The wall charts were available in 81 percent AWCs and growth charts were available in 83 percent AWCs. In about 30 percent AWC no food stock was found and in 16 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.6 in all AWCs, 5.5 in tribal as well as in rural projects and 6 in urban projects. Adequate number of pre school kits were found only in 40 percent AWCs, whereas 92 percent AWCs belonging to urban project had adequate number of kits 71 percent of AWCs had no medicine kits. The reasons were in 64 percent AWCs kits were out of stock but not replenished and in 33 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 48 percent AWCs. Immunisation register and survey register were maintained in 95 percent AWCs.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 82 percent were advised to eat green vegetables, 79 percent were advised to get TT injections, 74 percent were advised to take care of food, 57 percent were advised to take IFA tablets and 34 percent were advised to get registered in AWCs. The main advice given to lactating mothers included providing colostrum (by 77 percent AWWs), timely Immunisation (by 48 percent AWWs), exclusive breast-feeding (by 44 percent AWWs) and keeping child clothed (by 27 percent AWWs). Seventy five percent of AWWs advised the mothers for breast-feeding to newborn child within one hour after birth. 96 percent of AWWs were aware about providing colostrum to newborn child and 58 percent of AWWs had correct knowledge about exclusive breast-feeding period.
The data were compared with the base line data (1997) and an improvement has been found in the situation.
Infrastructure Assessment Study in IPD Districts in MP India
Introduction
Department of Public Health and Family Welfare, Govt. of M.P. is implementing Integrated Population and Development (IPD) Project sponsored by UNFPA in five districts of M.P. These districts are Chhatarpur, Panna, Satna, Rewa, and Sidhi. They were selected based on the criteria on Crude Birth Rate, Female literacy, hospital based deliveries, antenatal registration and deliveries by untrained hands.
The objectives of IPD project are:
¨ To enable individuals and couples to achieve their personal reproductive intentions and to ensure the survival and development of their infants and children’s.
¨ To eliminate discrimination against girls and to improve their health, nutrition and educational status.
¨ To achieve gender equity and equality between men and women and to enable women to achieve their full potential.
IPD Project is headed by Director, Public Health and Family Welfare. In state IPD has one State Project Officer and at each district it has one District Project Officer.
Research methodology and sampling criteria:
The study focused on Sub Health Centers, sector PHCs & CHCs. It has been limited to the equipments & infrastructure required for NSV, Laproscopy, RTI, STI & conducting delivery. It studied the issues whether the equipments & infrastructure were in working conditions or were requiring repair & maintenance. It also obtained data on caseload & placement of adequately trained manpower for the job.
This study aimed at:
§ Assess the community need for health interventions. (limited to IPD project goals)
§ Assess the status of health infrastructure & health facilities at health institutions in the project districts at Sub Heath Center. Sector Primary Health Center, Community Health Center / Block Primary Health Center level.
The designed instruments had been sent to all project districts and were distributed to all CHC/BPHC, sector PHC and SHC. The filled instrument would constitute as secondary data. Institute's research team collected the primary data at the sampled institutions.
In each IPD districts 2 CHC/BPHC were selected randomly. In each selected CHC/BPHC 3 sector PHCs were selected. In each selected sector PHC 3 SHCs were selected on random basis. In PHC's having only three or less than three SHCs, all were covered.
Focus group discussions (FGD) were organized in all selected Sub Health Center villages by research team. These focus group discussions were focussed on community need regarding reproductive health and to get the opinion from the community in the village about the functioning of ANM and SHC.
Salient features:
The primary data were collected from 9 CHC/ BPHC, 24 sector PHCs and 80 SHCs. The details regarding need of repair and renovation were collected from 23 SHCs, 8 PHCs and 9 CHCs/ BPHCs as these data were collected from only those institutions which have Govt. owned buildings.
A. Infrastructure available to health centers:
1. Multipurpose worker male and female each must be posted in a SHC but only SHCs of Chhatarpur dist. has all post of multipurpose worker females and Rewa has all post of multipurpose worker males occupied.
2. In Satna district 100 percent SHCs were situated within village locality where as 50 percent of SHCs buildings were outside the village locality in Chhatarpur. 100 percent PHC buildings in Satna and Sidhi district were located at centre of the village. In total 25.00 percent PHCs were located at one end of village and 25.0 percent were located out of the village. Only one of the sampled CHC building in Sidhi district was located at one end of the locality whereas in rest of all CHC buildings were located at centre of the village.
3. Distance of ILR from SHC plays an important role in maintenance of cold chain for effective immunisation. For 17.4 percent SHCs the ILRs were situated more than 50 Km away. and also for 17.4 percent SHCs the ILRs were situated within 5 Km. Whereas for 26.1 percent cases the ILRs were situated between 30 – 50 Km. away from SHCs villages.
4. Although 5 PHCs and 6 CHCs have operation theatre but none of them were performing caesarian deliveries. Only in Sidhi district the sampled CHCs did not have operation theatre.
5. 47.8 percent SHCs had separate labour room but in Satna no SHC had separate labour room. 4 PHCs also had separate labour rooms, but in Sidhi district no PHC had separate labour room. At 4 CHCs separate labour rooms were found available.
6. 41.7 percent PHCs had no facility for admitting patients. Whereas 45.8 percent PHCs had six to ten bed facility, 25.0 percent PHCs at Rewa district had bed capacity more than 15 beds. 6 CHCs had bed capacity less than 30 whereas 3 CHCs had bed capacity between thirty to fifty beds.
7. 91.3 percent SHCs had pucca building, 33.3 percent SHC in Panna and 20.0 percent SHCs in Rewa had katchcha buildings. None of the PHCs had katchcha building. Only one PHC in Rewa district had semi pucca building. In all 7 PHCs had pucca building whereas all sampled CHCs had pucca buildings.
8. 34.8 percent SHCs building had no cracks. 39.1 percent buildings had cracks in inside walls. Only SHCs at Chhatarpur district did not have any cracks in their walls. 5 sampled PHCs buildings had cracks in walls. Sampled CHC buildings at Chhatarpur, Panna and Rewa district had cracks in the walls, but in Satna and Sidhi district only one CHC building in each districts have cracks.
9. Floor of all SHCs building in Panna, Rewa and Satna district were broken and having pits whereas in total 52.1 percent SHC building floors were properly tiled or plastered suitably. Three PHC building floors were found broken whereas in 6 PHC buildings floors were found plastered suitably. At all sampled CHCs at Chhatarpur, Panna and Satna districts and one at Rewa district the floor was found either properly tiled or plastered suitably.
10. 91.3 percent SHC had no proper wastewater disposal facility whereas only half of the sampled PHC in Sidhi district had open pit. One CHC each at Panna and Sidhi district had open pit available for waste disposal, rest of them had no facility for safe disposal of hospital waste.
11. In 56.5 percent SHCs building inside walls and door & windows were found properly painted/ white washed. Outside walls of 60.9 percent SHC buildings were found properly whitewashed whereas only 40 percent of the existing boundary walls were found properly painted / whitewashed. In 5 PHC buildings inside walls were found properly / white washed. In 4 PHC buildings outside walls, doors and windows found properly painted/ white washed. Four CHC buildings were found properly painted / white washed.
12. 69.5 percent of SHCs were using hand pump water as a main drinking water source. In PHCs also the major source of drinking water was hand pump only (5 PHCs). In CHCs as well the major source of drinking water was hand pump. 5 CHCs were using hand pump water, 3 CHCs were using tap water and 1 CHC was using tube well water as drinking water.
13. 65.2 percent SHCs had flush laterines, 13.0 percent had pit laterines where as 21.8 percent SHCs did not have any type of toilet. 5 PHCs had toilet either type flush or pit. All sampled CHCs at Chhatarpur, Rewa, Panna and Satna and one CHC at Sidhi districts had toilet facility.
14. Only 30.4 percent SHC have electric connection but 47.8 percent SHC have proper electric wiring done. Only 4 PHCs have electric connection whereas all sampled CHCs had electric connection but in 3 CHCs proper electric wiring was not done.
15. For ANC check-ups 65.2 percent SHCs were assuring privacy, 30.4 percent SHCs were assuring privacy for RTI / STD diagnosis, 47.8 percent SHCs were ensuring at the time of delivery and 60.9 percent SHCs were ensuring privacy to female patients for IUD services.
16. All sampled PHC did not have any type of vehicle whereas 8 sampled CHCs had Jeeps out of which 7 were in working order, one CHC at Rewa district and both sampled CHCs at Satna district had ambulance facility available in working order.
17. 91.3 percent SHCs needed finance for repair / renovation. 2 PHCs needed financial assistance of less than Rs. 5,000/-, 3 PHCs needed assistance of Rs. 50,000/- to Rs. 1,00,000/- and 2 PHCs needed more than Rs. 1,00,000/-. 4 sampled CHCs needed financial assistance of Rs. 50,000/- to 1,00,000/-, 2 CHCs needed amount more than Rs. 2,00,000/- in same number CHCs needed amount less than Rs. 50,000/-. Whereas one CHC needed amount between Rs. 1,00,000/- to Rs. 2,00,000/-.
B. Workload, stock position and training status:
1. 67 MPW (F) were trained in conducting deliveries and 65 in IUD insertion. 38 MPW (F) were also trained in child survival and safe motherhood. But only 54 MPW (F) were using the skills in conducting deliveries and 51 in IUD insertion at SHCs. At PHCs 10 M.Os were trained in conducting delivery cases while only 5 were found using the skill. In 9 CHCs sampled only 5 M.O.s were found trained in conducting deliveries and all of them were applying these skills also.
2. Availability of trained dai’s in sub health center areas were less than 5 in 46.2 percent of the SHCs, whereas more than 10 trained dai’s were found in only 7.5 percent of SHCs. Availability of 25-50 trained dai’s in the PHCs were in 45.8 percent whereas 4.2 percent PHCs had trained dais in between 50-75 persons. 16.7 percent PHCs had more than 75 trained dais. In CHC areas less than 100 trained dai’s were found in 2 CHCs whereas 4 CHCs had trained dais in between 100-200 and 3 CHCs had more than 200 trained dais.
3. 30 percent SHCs had less than 5 AWCs, whereas 68.8 percent SHCs had 5-10 AWCs and 1.2 percent SHCs did not have AWC in their field. 61.2 percent SHCs had less than 5 Jan Swasthya Rakshaks in the area and 8.8 SHCs had more than 20 JSRs in area.
4. In 15.0 percent SHCs oral pills were not distributed during October 2002. Whereas 100 packets of pills were distributed in 65.0 percent SHCs. In 7.5 percent SHCs distribution of oral pills were made to more than one thousand eligible women. 45.8 percent PHCs did not distribute oral pills, whereas at 20.8 percent PHCs the distribution made was between 1-250, in 16.7 percent PHCs distribution of oral pills was made between 250-500 and in 4.2 percent PHCs distribution made was more than 1,000. Less than 500 oral pills were distributed in 2 CHC/BPHCs area. Between 500-1,000 pills were distributed in 4 CHCs and more than 1,000 pills were distributed by 3 CHCs.
5. 17.5 percent SHCs did not distribute condoms during the month of October 2002. 38.8 percent of SHCs distributed condoms in between one hundred to five hundred and 5.0 percent SHCs distributed more than one thousand condoms. In 45.8 percent PHCs condoms were not distributed during the month of October 2002 whereas above one thousand condoms distribution were made by 20.8 percent PHCs. 5 CHCs distributed condoms less than 5,000 during the month of October 2002. One CHC each at Rewa and Satna districts were distributed more than 10,000 condoms.
6. 46.3 percent SHCs distributed IFA tablets to one to twenty five pregnant women, 5.6 percent SHCs at Chhatarpur and 6.7 percent SHCs at Sidhi district did not distribute IFA tablets to any pregnant women. 20.0 percent SHCs distributed more than hundred tablets also to pregnant women. In 50.0 percent PHCs no distribution of IFA tablets was made, where as 8.3 percent PHCs distributed IFA tablets to 250-500 pregnant women. 5 CHCs distributed IFA tablets to less than one thousand pregnant women, whereas 1 CHC distributed IFA tablets more than 5,000 pregnant women. 3 CHCs distributed IFA tablets to one thousand to five thousand pregnant women.
7. Total deliveries conducted in all the SHC areas were 1694 and 4 cases were referred to PHC/ CHC. Total deliveries conducted in the PHC areas were 1759 out of which 28 were admitted and 19 were referred to BPHC/ CHC. No. of institutional deliveries were 194 out of which only 2 deliveries were conducted in Satna district. 2 caesarian deliveries were also conducted at Sidhi district. Total deliveries conducted in the area were 6023 out of them 1981 were home deliveries that were attended by ANMs. 635 home deliveries were attended by untrained dais also. Number of institutional deliveries were 227. Highest number of institutional deliveries were 98 conducted at CHCs of Satna district whereas lowest number of Institutional deliveries were 12 which were conducted at Sidhi district. No caesarian delivery was conducted at any CHC/ BPHC.
8. 61.3 percent SHCs had adequate stock of IFA tablets. Disposable delivery kits were found adequate in 61.5 percent SHCs at Panna district. Medicines for RTI/ STD were found adequate in only 23.1 percent SHCs at Panna district. At Satna district PHCs did not have adequate stock of all the essential medicines, vaccines, contraceptives etc. In all districts medicines for RTI/ STD were not available in adequate quantity. The stock of T.T. doses were not kept at PHCs because of unavailability of deep freezer/ ILR. The vaccines were taken from CHC/ BPHC on daily requirement basis. Out of 9 sampled CHC/ BPHCs 7 had adequate stock of disposable delivery kits. Only 2 CHCs had adequate stock of copper T, disposable needles, reusable needles and medicines for RTI/ STD. One sampled CHC at Chhatarpur district did not have adequate quantity of reuasble syringes, needles and medicines for RTI/ STD.
C. Equipment status in health institutions:
a. At SHC:
Only 27 haemoglobinometer were found available at 26 SHCs. Out of them 16 were found in working condition. Only 49 infant weighing scales were found available in 34 SHCs. Out of them only 25 were reported in working condition. 83 adult weighing scales were found available at 54 SHCs. 68 were in working conditions, 5 needed repairing. At 20 SHCs adult weighing scales were needed. Only 8 examination tables and footsteps were found in 7 and 4 SHCs respectively. 1 of them was unserviceable. 26 SHCs had reported about inadequacy of examination tables whereas 21 reported inadequacy for footsteps. 85 vaccine carriers were found in stock at 66 SHCs. Out of them 78 were in working condition. 25 SHCs had reported about the inadequacy of vaccine carriers. 37 steam sterilisers were found available at 34 SHCs. Out of them 6 were unserviceable and 2 needed repair. Cheatle forceps were found available only in 44 SHCs (1 each). Out of them 4 were unserviceable. 18 knife handles were found in working condition. Only 2 SHCs reported about adequacy of knife handles, 86 artery clamps were available at 33 sHCs and only one was unserviceable. 14 SHCs had reported their inadequacy.
b. At PHC:
Only 11 infant weighing scales were found available. Out of them 9 were in working condition. Demand was made for 23 infant weighing scales. 22 adult weighing scales were available. Out of them only 12 were in working condition and 6 needed repairing. 6 weighing scales were needed in various PHCs. Only 4 uterine sound were available in working condition and 8 PHCs needed 12 uterine sound. 3 vulsellum forceps at 2 PHCs, 11 Sim's vaginal double ended speculum at 6 PHCs, 6 Sim's vaginal depresser/ retractor at 3 PHCs, 4 Cusco's bivalve vaginal speculum at 2 PHCs and 10 IUD removal forceps at 7 PHCs were found available. Only 5 ILR at 5 PHCs and 7 deep freezers at 6 PHCs were found available, 2 deep freezers needed repairing.
c. At CHC:
20 ILR were found available at 6 CHCs. Out of them only 6 were in working condition and 3 needed repairing, whereas 12 deep freezers were found in stock at 3 CHCs. Out of them 9 were in working condition and 3 needed repairing. Not a single CHC had catheter either nasal or endotracheal. But required quantities were expressed by 3 CHCs for 102 and 81 respectively. Catheter suction rubber type was found in 5 number at 1 CHC but all were unserviceable. 21 catheters were found in further demand by 2 CHCs. Only 6 complete tubectomy kit were found available in 2 CHCs and all of them were in working condition. One CHC expressed the need for one complete tubectomy kit.
D. COMMUNITY NEEDS ASSESSMENT:
For assessing the need of community regarding reproductive health FGDs were conducted at each sampled SHC village. The persons involved in the discussions were mainly among the following:
§ Local people of the same and adjoining villages.
§ Teachers posted and residing in the village.
§ Elected representatives of PRI, Member of Parliament, Member of Legislative Assembly or local leader.
§ Anganwadi worker of the village.
§ Traditional birth attendant.
§ Members of self help groups and mahila mandals.
§ Shopkeepers.
§ Govt. employee posted or residing in the village.
§ Influential persons of the village.
The major needs of the community are listed below:
1. Health needs before marriage/ Adolescents:
They did not know the reason behind fixing of minimum age at marriage so they marry their children at early age. At some places of Chhatarpur and Panna districts female group members suggested that proper awareness generation programmes should be organized for creating awareness about causes of maternal mortality.
2. Health needs after marriage:
Most of the people did not know the importance of small family and also the measures to be taken in this direction. The reasons for low CPR were told as:
1. Place for getting contraceptives was not known.
2. Contraceptives were not made available at health centers at times.
3. Unaware regarding importance of use of contraceptives.
4. The incentive money was not distributed regularly and money should also be given to motivators.
5. Females did not like taste of oral pills.
6. Oral pills can cause ill effects on their health.
7. At some places in Panna and Chhatarpur district women complained that a few MPW (M) and ANMs asks for fee for LTT operations.
3. Antenatal care need:
Community did not prefer ANC check-ups because ANMs perform these check-ups in the presence of other patients also. A mobile health care unit providing privacy for such check-ups will increase ANC registration. At some places in case of any complication ANMs did not intimate family members regarding steps to be taken at that stage. Because of unawareness of complication family members did not make any arrangements to take pregnant women to higher health institutions and at the last moment due to lack of time and lack of transport facility maternal mortality takes place. Community members were well aware about the advantages of immunization during pregnancy.
4. Need during delivery (Natal care):
A few of them talked of disposable delivery kit but very less in numbers. The VHC should be trained for ensuring cleanliness during home delivery in the village.
At Jawa PHC community wanted training of dais should be done. In case of emergency women feel insecured with untrained dais. In Panna and Chhatarpur districts many villages were inaccessable. People of that region told that in some of the delivery cases they had taken pregnant women to the hospitals on cot. In one of the case women died on the way to the hospital.
5. Need after delivery (Post natal care):
At some places community had misconception regarding side effects of immunisation, i.e., fever etc. They also think that no one can prevent their children from God’s curse. There is a need for proper campaigning of importance of immunisation at such places.
6. Child care:
Almost all the places few women were not aware about the importance of weighing children after birth. Women were also not aware regarding early initiation of breast-feeding in the areas of Chhatrpur, Panna and Sidhi. At all the districts men as well as women were found unaware regarding importance of oral rehydration solution. Community members were also not well aware about early diagnosis of morbidity.
7. Other needs:
Due to lack of medical stores and poverty medicines written by health institutions could not be bought by community. There is a need to increase number of Jan Swasthya Rakshak. Even at few places they suggested the JSR should be a women equipped with more knowledge in ANC and PNC. The TBAs may also be encouraged for JSRs course. At some time in case of emergency health centers were found closed because of lack of staff.
All the villagers of Tingudi PHC expressed about the need of lady doctor at sector PHC. Due to lack of staff 5 mothers and 6 children died there.
At a PHC group members reported that the doctors were posted but attend duty only once a month. At Sinhawal BPHC all the three sampled PHCs doctors were posted but due to not having residential accommodation doctors were not residing in the PHC village. At the places where ANMs were locally posted, due to Parda Pratha and social customs they fail to visit the field and their husbands carry out routine work on their behalf. In Sinhawal block at few places ANM and MPW (M) were carry out private practices and they charge fee for their routine works.
8. Observation by research team of IIDM:
At one place at Panna district research team saw early marriage where bride as well as bridegroom both were of below 10 years. One place in Sinhawal block husband of ANM was conducting immunisation of children. At some places where ANM or MPW (M) were of upper caste they hesitated to check-up lower caste patients and vice versa. Many posts of ANM and MPW (M) were found vacant at the time of data collection which affected proper implementation of health services. There is a need to construct SHC buildings with ANM residence having all basic amenities like toilet facility and electric connection.
At Raipur PHC in Teonthar block community informed that doctors did not want to reside at PHC level and the health services suffered. Wine shop and restaurants were located nearby Chandrapur SHC at Teonthar block. So women were hesitating to come to SHC.
Garhi SHC at Jawa PHC is located other side of river and did not have bridge over river. Area was “Daquiat” affected also, so doctor and other servants did not want to posted there even patients were also not want to go for treatment at this PHC.
Department of Public Health and Family Welfare, Govt. of M.P. is implementing Integrated Population and Development (IPD) Project sponsored by UNFPA in five districts of M.P. These districts are Chhatarpur, Panna, Satna, Rewa, and Sidhi. They were selected based on the criteria on Crude Birth Rate, Female literacy, hospital based deliveries, antenatal registration and deliveries by untrained hands.
The objectives of IPD project are:
¨ To enable individuals and couples to achieve their personal reproductive intentions and to ensure the survival and development of their infants and children’s.
¨ To eliminate discrimination against girls and to improve their health, nutrition and educational status.
¨ To achieve gender equity and equality between men and women and to enable women to achieve their full potential.
IPD Project is headed by Director, Public Health and Family Welfare. In state IPD has one State Project Officer and at each district it has one District Project Officer.
Research methodology and sampling criteria:
The study focused on Sub Health Centers, sector PHCs & CHCs. It has been limited to the equipments & infrastructure required for NSV, Laproscopy, RTI, STI & conducting delivery. It studied the issues whether the equipments & infrastructure were in working conditions or were requiring repair & maintenance. It also obtained data on caseload & placement of adequately trained manpower for the job.
This study aimed at:
§ Assess the community need for health interventions. (limited to IPD project goals)
§ Assess the status of health infrastructure & health facilities at health institutions in the project districts at Sub Heath Center. Sector Primary Health Center, Community Health Center / Block Primary Health Center level.
The designed instruments had been sent to all project districts and were distributed to all CHC/BPHC, sector PHC and SHC. The filled instrument would constitute as secondary data. Institute's research team collected the primary data at the sampled institutions.
In each IPD districts 2 CHC/BPHC were selected randomly. In each selected CHC/BPHC 3 sector PHCs were selected. In each selected sector PHC 3 SHCs were selected on random basis. In PHC's having only three or less than three SHCs, all were covered.
Focus group discussions (FGD) were organized in all selected Sub Health Center villages by research team. These focus group discussions were focussed on community need regarding reproductive health and to get the opinion from the community in the village about the functioning of ANM and SHC.
Salient features:
The primary data were collected from 9 CHC/ BPHC, 24 sector PHCs and 80 SHCs. The details regarding need of repair and renovation were collected from 23 SHCs, 8 PHCs and 9 CHCs/ BPHCs as these data were collected from only those institutions which have Govt. owned buildings.
A. Infrastructure available to health centers:
1. Multipurpose worker male and female each must be posted in a SHC but only SHCs of Chhatarpur dist. has all post of multipurpose worker females and Rewa has all post of multipurpose worker males occupied.
2. In Satna district 100 percent SHCs were situated within village locality where as 50 percent of SHCs buildings were outside the village locality in Chhatarpur. 100 percent PHC buildings in Satna and Sidhi district were located at centre of the village. In total 25.00 percent PHCs were located at one end of village and 25.0 percent were located out of the village. Only one of the sampled CHC building in Sidhi district was located at one end of the locality whereas in rest of all CHC buildings were located at centre of the village.
3. Distance of ILR from SHC plays an important role in maintenance of cold chain for effective immunisation. For 17.4 percent SHCs the ILRs were situated more than 50 Km away. and also for 17.4 percent SHCs the ILRs were situated within 5 Km. Whereas for 26.1 percent cases the ILRs were situated between 30 – 50 Km. away from SHCs villages.
4. Although 5 PHCs and 6 CHCs have operation theatre but none of them were performing caesarian deliveries. Only in Sidhi district the sampled CHCs did not have operation theatre.
5. 47.8 percent SHCs had separate labour room but in Satna no SHC had separate labour room. 4 PHCs also had separate labour rooms, but in Sidhi district no PHC had separate labour room. At 4 CHCs separate labour rooms were found available.
6. 41.7 percent PHCs had no facility for admitting patients. Whereas 45.8 percent PHCs had six to ten bed facility, 25.0 percent PHCs at Rewa district had bed capacity more than 15 beds. 6 CHCs had bed capacity less than 30 whereas 3 CHCs had bed capacity between thirty to fifty beds.
7. 91.3 percent SHCs had pucca building, 33.3 percent SHC in Panna and 20.0 percent SHCs in Rewa had katchcha buildings. None of the PHCs had katchcha building. Only one PHC in Rewa district had semi pucca building. In all 7 PHCs had pucca building whereas all sampled CHCs had pucca buildings.
8. 34.8 percent SHCs building had no cracks. 39.1 percent buildings had cracks in inside walls. Only SHCs at Chhatarpur district did not have any cracks in their walls. 5 sampled PHCs buildings had cracks in walls. Sampled CHC buildings at Chhatarpur, Panna and Rewa district had cracks in the walls, but in Satna and Sidhi district only one CHC building in each districts have cracks.
9. Floor of all SHCs building in Panna, Rewa and Satna district were broken and having pits whereas in total 52.1 percent SHC building floors were properly tiled or plastered suitably. Three PHC building floors were found broken whereas in 6 PHC buildings floors were found plastered suitably. At all sampled CHCs at Chhatarpur, Panna and Satna districts and one at Rewa district the floor was found either properly tiled or plastered suitably.
10. 91.3 percent SHC had no proper wastewater disposal facility whereas only half of the sampled PHC in Sidhi district had open pit. One CHC each at Panna and Sidhi district had open pit available for waste disposal, rest of them had no facility for safe disposal of hospital waste.
11. In 56.5 percent SHCs building inside walls and door & windows were found properly painted/ white washed. Outside walls of 60.9 percent SHC buildings were found properly whitewashed whereas only 40 percent of the existing boundary walls were found properly painted / whitewashed. In 5 PHC buildings inside walls were found properly / white washed. In 4 PHC buildings outside walls, doors and windows found properly painted/ white washed. Four CHC buildings were found properly painted / white washed.
12. 69.5 percent of SHCs were using hand pump water as a main drinking water source. In PHCs also the major source of drinking water was hand pump only (5 PHCs). In CHCs as well the major source of drinking water was hand pump. 5 CHCs were using hand pump water, 3 CHCs were using tap water and 1 CHC was using tube well water as drinking water.
13. 65.2 percent SHCs had flush laterines, 13.0 percent had pit laterines where as 21.8 percent SHCs did not have any type of toilet. 5 PHCs had toilet either type flush or pit. All sampled CHCs at Chhatarpur, Rewa, Panna and Satna and one CHC at Sidhi districts had toilet facility.
14. Only 30.4 percent SHC have electric connection but 47.8 percent SHC have proper electric wiring done. Only 4 PHCs have electric connection whereas all sampled CHCs had electric connection but in 3 CHCs proper electric wiring was not done.
15. For ANC check-ups 65.2 percent SHCs were assuring privacy, 30.4 percent SHCs were assuring privacy for RTI / STD diagnosis, 47.8 percent SHCs were ensuring at the time of delivery and 60.9 percent SHCs were ensuring privacy to female patients for IUD services.
16. All sampled PHC did not have any type of vehicle whereas 8 sampled CHCs had Jeeps out of which 7 were in working order, one CHC at Rewa district and both sampled CHCs at Satna district had ambulance facility available in working order.
17. 91.3 percent SHCs needed finance for repair / renovation. 2 PHCs needed financial assistance of less than Rs. 5,000/-, 3 PHCs needed assistance of Rs. 50,000/- to Rs. 1,00,000/- and 2 PHCs needed more than Rs. 1,00,000/-. 4 sampled CHCs needed financial assistance of Rs. 50,000/- to 1,00,000/-, 2 CHCs needed amount more than Rs. 2,00,000/- in same number CHCs needed amount less than Rs. 50,000/-. Whereas one CHC needed amount between Rs. 1,00,000/- to Rs. 2,00,000/-.
B. Workload, stock position and training status:
1. 67 MPW (F) were trained in conducting deliveries and 65 in IUD insertion. 38 MPW (F) were also trained in child survival and safe motherhood. But only 54 MPW (F) were using the skills in conducting deliveries and 51 in IUD insertion at SHCs. At PHCs 10 M.Os were trained in conducting delivery cases while only 5 were found using the skill. In 9 CHCs sampled only 5 M.O.s were found trained in conducting deliveries and all of them were applying these skills also.
2. Availability of trained dai’s in sub health center areas were less than 5 in 46.2 percent of the SHCs, whereas more than 10 trained dai’s were found in only 7.5 percent of SHCs. Availability of 25-50 trained dai’s in the PHCs were in 45.8 percent whereas 4.2 percent PHCs had trained dais in between 50-75 persons. 16.7 percent PHCs had more than 75 trained dais. In CHC areas less than 100 trained dai’s were found in 2 CHCs whereas 4 CHCs had trained dais in between 100-200 and 3 CHCs had more than 200 trained dais.
3. 30 percent SHCs had less than 5 AWCs, whereas 68.8 percent SHCs had 5-10 AWCs and 1.2 percent SHCs did not have AWC in their field. 61.2 percent SHCs had less than 5 Jan Swasthya Rakshaks in the area and 8.8 SHCs had more than 20 JSRs in area.
4. In 15.0 percent SHCs oral pills were not distributed during October 2002. Whereas 100 packets of pills were distributed in 65.0 percent SHCs. In 7.5 percent SHCs distribution of oral pills were made to more than one thousand eligible women. 45.8 percent PHCs did not distribute oral pills, whereas at 20.8 percent PHCs the distribution made was between 1-250, in 16.7 percent PHCs distribution of oral pills was made between 250-500 and in 4.2 percent PHCs distribution made was more than 1,000. Less than 500 oral pills were distributed in 2 CHC/BPHCs area. Between 500-1,000 pills were distributed in 4 CHCs and more than 1,000 pills were distributed by 3 CHCs.
5. 17.5 percent SHCs did not distribute condoms during the month of October 2002. 38.8 percent of SHCs distributed condoms in between one hundred to five hundred and 5.0 percent SHCs distributed more than one thousand condoms. In 45.8 percent PHCs condoms were not distributed during the month of October 2002 whereas above one thousand condoms distribution were made by 20.8 percent PHCs. 5 CHCs distributed condoms less than 5,000 during the month of October 2002. One CHC each at Rewa and Satna districts were distributed more than 10,000 condoms.
6. 46.3 percent SHCs distributed IFA tablets to one to twenty five pregnant women, 5.6 percent SHCs at Chhatarpur and 6.7 percent SHCs at Sidhi district did not distribute IFA tablets to any pregnant women. 20.0 percent SHCs distributed more than hundred tablets also to pregnant women. In 50.0 percent PHCs no distribution of IFA tablets was made, where as 8.3 percent PHCs distributed IFA tablets to 250-500 pregnant women. 5 CHCs distributed IFA tablets to less than one thousand pregnant women, whereas 1 CHC distributed IFA tablets more than 5,000 pregnant women. 3 CHCs distributed IFA tablets to one thousand to five thousand pregnant women.
7. Total deliveries conducted in all the SHC areas were 1694 and 4 cases were referred to PHC/ CHC. Total deliveries conducted in the PHC areas were 1759 out of which 28 were admitted and 19 were referred to BPHC/ CHC. No. of institutional deliveries were 194 out of which only 2 deliveries were conducted in Satna district. 2 caesarian deliveries were also conducted at Sidhi district. Total deliveries conducted in the area were 6023 out of them 1981 were home deliveries that were attended by ANMs. 635 home deliveries were attended by untrained dais also. Number of institutional deliveries were 227. Highest number of institutional deliveries were 98 conducted at CHCs of Satna district whereas lowest number of Institutional deliveries were 12 which were conducted at Sidhi district. No caesarian delivery was conducted at any CHC/ BPHC.
8. 61.3 percent SHCs had adequate stock of IFA tablets. Disposable delivery kits were found adequate in 61.5 percent SHCs at Panna district. Medicines for RTI/ STD were found adequate in only 23.1 percent SHCs at Panna district. At Satna district PHCs did not have adequate stock of all the essential medicines, vaccines, contraceptives etc. In all districts medicines for RTI/ STD were not available in adequate quantity. The stock of T.T. doses were not kept at PHCs because of unavailability of deep freezer/ ILR. The vaccines were taken from CHC/ BPHC on daily requirement basis. Out of 9 sampled CHC/ BPHCs 7 had adequate stock of disposable delivery kits. Only 2 CHCs had adequate stock of copper T, disposable needles, reusable needles and medicines for RTI/ STD. One sampled CHC at Chhatarpur district did not have adequate quantity of reuasble syringes, needles and medicines for RTI/ STD.
C. Equipment status in health institutions:
a. At SHC:
Only 27 haemoglobinometer were found available at 26 SHCs. Out of them 16 were found in working condition. Only 49 infant weighing scales were found available in 34 SHCs. Out of them only 25 were reported in working condition. 83 adult weighing scales were found available at 54 SHCs. 68 were in working conditions, 5 needed repairing. At 20 SHCs adult weighing scales were needed. Only 8 examination tables and footsteps were found in 7 and 4 SHCs respectively. 1 of them was unserviceable. 26 SHCs had reported about inadequacy of examination tables whereas 21 reported inadequacy for footsteps. 85 vaccine carriers were found in stock at 66 SHCs. Out of them 78 were in working condition. 25 SHCs had reported about the inadequacy of vaccine carriers. 37 steam sterilisers were found available at 34 SHCs. Out of them 6 were unserviceable and 2 needed repair. Cheatle forceps were found available only in 44 SHCs (1 each). Out of them 4 were unserviceable. 18 knife handles were found in working condition. Only 2 SHCs reported about adequacy of knife handles, 86 artery clamps were available at 33 sHCs and only one was unserviceable. 14 SHCs had reported their inadequacy.
b. At PHC:
Only 11 infant weighing scales were found available. Out of them 9 were in working condition. Demand was made for 23 infant weighing scales. 22 adult weighing scales were available. Out of them only 12 were in working condition and 6 needed repairing. 6 weighing scales were needed in various PHCs. Only 4 uterine sound were available in working condition and 8 PHCs needed 12 uterine sound. 3 vulsellum forceps at 2 PHCs, 11 Sim's vaginal double ended speculum at 6 PHCs, 6 Sim's vaginal depresser/ retractor at 3 PHCs, 4 Cusco's bivalve vaginal speculum at 2 PHCs and 10 IUD removal forceps at 7 PHCs were found available. Only 5 ILR at 5 PHCs and 7 deep freezers at 6 PHCs were found available, 2 deep freezers needed repairing.
c. At CHC:
20 ILR were found available at 6 CHCs. Out of them only 6 were in working condition and 3 needed repairing, whereas 12 deep freezers were found in stock at 3 CHCs. Out of them 9 were in working condition and 3 needed repairing. Not a single CHC had catheter either nasal or endotracheal. But required quantities were expressed by 3 CHCs for 102 and 81 respectively. Catheter suction rubber type was found in 5 number at 1 CHC but all were unserviceable. 21 catheters were found in further demand by 2 CHCs. Only 6 complete tubectomy kit were found available in 2 CHCs and all of them were in working condition. One CHC expressed the need for one complete tubectomy kit.
D. COMMUNITY NEEDS ASSESSMENT:
For assessing the need of community regarding reproductive health FGDs were conducted at each sampled SHC village. The persons involved in the discussions were mainly among the following:
§ Local people of the same and adjoining villages.
§ Teachers posted and residing in the village.
§ Elected representatives of PRI, Member of Parliament, Member of Legislative Assembly or local leader.
§ Anganwadi worker of the village.
§ Traditional birth attendant.
§ Members of self help groups and mahila mandals.
§ Shopkeepers.
§ Govt. employee posted or residing in the village.
§ Influential persons of the village.
The major needs of the community are listed below:
1. Health needs before marriage/ Adolescents:
They did not know the reason behind fixing of minimum age at marriage so they marry their children at early age. At some places of Chhatarpur and Panna districts female group members suggested that proper awareness generation programmes should be organized for creating awareness about causes of maternal mortality.
2. Health needs after marriage:
Most of the people did not know the importance of small family and also the measures to be taken in this direction. The reasons for low CPR were told as:
1. Place for getting contraceptives was not known.
2. Contraceptives were not made available at health centers at times.
3. Unaware regarding importance of use of contraceptives.
4. The incentive money was not distributed regularly and money should also be given to motivators.
5. Females did not like taste of oral pills.
6. Oral pills can cause ill effects on their health.
7. At some places in Panna and Chhatarpur district women complained that a few MPW (M) and ANMs asks for fee for LTT operations.
3. Antenatal care need:
Community did not prefer ANC check-ups because ANMs perform these check-ups in the presence of other patients also. A mobile health care unit providing privacy for such check-ups will increase ANC registration. At some places in case of any complication ANMs did not intimate family members regarding steps to be taken at that stage. Because of unawareness of complication family members did not make any arrangements to take pregnant women to higher health institutions and at the last moment due to lack of time and lack of transport facility maternal mortality takes place. Community members were well aware about the advantages of immunization during pregnancy.
4. Need during delivery (Natal care):
A few of them talked of disposable delivery kit but very less in numbers. The VHC should be trained for ensuring cleanliness during home delivery in the village.
At Jawa PHC community wanted training of dais should be done. In case of emergency women feel insecured with untrained dais. In Panna and Chhatarpur districts many villages were inaccessable. People of that region told that in some of the delivery cases they had taken pregnant women to the hospitals on cot. In one of the case women died on the way to the hospital.
5. Need after delivery (Post natal care):
At some places community had misconception regarding side effects of immunisation, i.e., fever etc. They also think that no one can prevent their children from God’s curse. There is a need for proper campaigning of importance of immunisation at such places.
6. Child care:
Almost all the places few women were not aware about the importance of weighing children after birth. Women were also not aware regarding early initiation of breast-feeding in the areas of Chhatrpur, Panna and Sidhi. At all the districts men as well as women were found unaware regarding importance of oral rehydration solution. Community members were also not well aware about early diagnosis of morbidity.
7. Other needs:
Due to lack of medical stores and poverty medicines written by health institutions could not be bought by community. There is a need to increase number of Jan Swasthya Rakshak. Even at few places they suggested the JSR should be a women equipped with more knowledge in ANC and PNC. The TBAs may also be encouraged for JSRs course. At some time in case of emergency health centers were found closed because of lack of staff.
All the villagers of Tingudi PHC expressed about the need of lady doctor at sector PHC. Due to lack of staff 5 mothers and 6 children died there.
At a PHC group members reported that the doctors were posted but attend duty only once a month. At Sinhawal BPHC all the three sampled PHCs doctors were posted but due to not having residential accommodation doctors were not residing in the PHC village. At the places where ANMs were locally posted, due to Parda Pratha and social customs they fail to visit the field and their husbands carry out routine work on their behalf. In Sinhawal block at few places ANM and MPW (M) were carry out private practices and they charge fee for their routine works.
8. Observation by research team of IIDM:
At one place at Panna district research team saw early marriage where bride as well as bridegroom both were of below 10 years. One place in Sinhawal block husband of ANM was conducting immunisation of children. At some places where ANM or MPW (M) were of upper caste they hesitated to check-up lower caste patients and vice versa. Many posts of ANM and MPW (M) were found vacant at the time of data collection which affected proper implementation of health services. There is a need to construct SHC buildings with ANM residence having all basic amenities like toilet facility and electric connection.
At Raipur PHC in Teonthar block community informed that doctors did not want to reside at PHC level and the health services suffered. Wine shop and restaurants were located nearby Chandrapur SHC at Teonthar block. So women were hesitating to come to SHC.
Garhi SHC at Jawa PHC is located other side of river and did not have bridge over river. Area was “Daquiat” affected also, so doctor and other servants did not want to posted there even patients were also not want to go for treatment at this PHC.
End Line Evaluation of Sub District RCH II Interventions in Mizoram
Introduction
The Endline Evaluation survey was sponsored as part of Sub District Reproductive and Child Health Project by Government of India and Government of Mizoram with the financial assistance from World Bank. In Mizoram, Indian Institute of Development Management Bhopal carried out this endline evaluation survey during April to June, 2004 at districts of Aizawl, Champhai, Kolasib and Saiha as sample districts in the endline survey. The main focus of the endline survey was on the following aspects:
1. Coverage of ANC and Immunization services.
2. Proportion of safe deliveries.
3. Contraceptives prevalence rate.
4. Unmet need for family planning.
5. Awareness about RTI, STI and HIV (AIDS).
6. Utilization of Health Services and User’s satisfaction.
7. Management of Project.
8. Efficacy of strategies adopted in the Sub District Project.
The survey was carried out in 1595 households from rural areas. The total population covered in the survey was 9488 out of which 4680 were males and 4808 were females. The sex ratio of the population covered was1027 females per 1000 males. The state was mostly inhabited by Christians with 99.4 percent population. Similarly population of Scheduled Tribes (99.1 percent) was also highest in the state in the sampled population.
Out of total 1595 households 480 eligible women were selected randomly of whom 478 women were interviewed. These eligible women were usual resident, currently married in the age group of 15 to 45 years. Age at consummation of marriage below 18 years was 9.8 percent where as for 18 years and above it was 90.2 percent. The mean age at marriage for boys and girls who married since 1 January, 2001 was 23.5 and 21.3 respectively. The mean number of children ever born to women age 15 to 45 years was 2.8.
Among the 478 interviewed women only 3.2 percent were illiterate whereas 69.0 percent attended schools for 9 years and 27.8 percent attended school for 10 years or more. The mean children ever born and surviving to women age 15-45 years was 2.8 and 2.6 respectively.
The ANC coverage of women in Mizoram was 76.4 per cent. Of those who received ANC, 92.9 per cent had it from Government health facility and only 6.3 per cent had it from Private Health Facility. 20.2 per cent of women had minimum three ANC visits and 14.7 percent had first ANC visit in the first trimester. 69.9 percent and 51.3 percent of women had daily doses of one or two IFA tablets and 45.6 per cent had 2 TT injections. 50.6 per cent and 52.3 per cent had check up of blood pressure and weight respectively during pregnancy and 49.3 per cent had 3 or more abdominal check up. A full ANC package of at least one TT, daily consumption of IFA tablets and 3 ANC visits was received by 47.5 per cent of the pregnant women.
Institutional deliveries were of the order of 40.1 per cent of the total deliveries and 96 per cent of the institutional deliveries were in Government health facilities. Nurse/ANM and Trained Dais conducted 22.8 per cent and 21.5 percent of the home deliveries. On the whole in this state, 86.5 per cent were safe deliveries. Delivery related complications were experienced by 14.0 per cent of the women. Out of the total women who had delivery complications 38.5 per cent had obstructed labors and 21.5 percent had Prolonged Labors (12 + hours) during delivery and 36.4 per cent had post delivery complications.
The Vaccination coverage of Children in this state was 75.3, 64.9, 58.9 and 61.3 per cent respectively for BCG, three doses of DPT, three doses of polio and measles. 39.1 per cent of the children were fully protected against six vaccine preventable diseases.
64.7 per cent of children were breast fed within two hours of birth and 16.7 percent were given colostrums. 92.9 percent of women exclusively breastfed their children for at least 4 months. 91.0 per cent of the women were aware of diarrhea management and 25.9 per cent of danger signs of pneumonia.
Knowledge of family planning was widely spread in Mizoram state with 95.2 per cent women knowing at least one modern method. Contraceptive prevalence rate in this state was 72.8 per cent with 67.6 per cent CPR due to modern methods and 5.2 per cent due to traditional method. Among the methods adopted Condom/Nirodh (33.1%) and IUD/Loop (26.5%) predominated. A total of 10.7 per cent of women had unmet need for family planning out of which 2.5% was for Limiting and 8.2 % for Spacing.
42.7 per cent of eligible women reported that the ANM visited their houses during three months prior to the survey. The counseling by ANM to unmarried adolescent girls was done only in 6.5 per cent of households. IFA tablets were distributed to adolescent girls in 15.4 percent families. During the last three months only 16.1 per cent of the women visited Government health facility and 15.3 per cent of them expressed center good enough for recommending to others.
The awareness of RTI among females was 15.5 per cent. The corresponding figures for STI was 28.2 percent and for HIV (AIDS) 87.9 per cent. 4.2 percent of women reported at least one symptom of RTI. Newspapers (66.1 percent) and Electronic media (45.8 percent) contributed mostly in spreading the awareness of HIV (AIDS). Only 2.1 per cent of females were ignorant of the mode of transmission of HIV (AIDS) while 84.7 percent and 72.4 percent told that it spreads by Sexual intercourse and Needles/Blades/Skin Puncture. 14.4 percent of women believed that (AIDS) could be cured. Nearly 73 per cent of female respondents were aware of preventing HIV (AIDS) by practicing safe sex.
In about 97 percent Sub Centers male Health Workers and in 85 percent Sub Centers female Health Workers were found posted. The longest distance to be covered by Health Workers for reaching 7 villages was 16 Kms. and above. 87 percent of Sub Centers were located in Government buildings. The status of 47 percent buildings of sub centers was reported poor and in 25 percent it was reported in good condition. Water supply and Electricity supply in 33 percent and 31 percent sub centers was reported continuous. Sufficient stock of vaccines, ORS, and Cotrimaxazole was reported sufficient in only 31 percent, 36 percent and 26 percent sub centers respectively. Records and Registers in 90 percent SHCs were found complete and in 87 percent SHCs accurately maintained.
Posts of Medical Officer was found vacant in only 3 Primary Health Centers out of 10 Centers studied and Lady Doctor/Gynecologist was available in only 3 PHCs. All the PHCs were located in Government buildings but condition of only 3 buildings was reported good. Condition of water supply and electricity supply was found continuous in 2 and 5 buildings only. Sufficient stock of Vaccines, Cotrimaxazole, and General Medicines was reported sufficient in 4, 4 and 1 PHC only. Records and Registers of 8 PHCs were found complete and accurate.
Presence of Village Health Workers/Village Health Guide was reported by 75 percent of Village Heads in Mizoram state and 67 percent of them reported that VHGs of their villages have visited the house of village heads. Among the 40 villages studied 23 Village Heads reported that they do not have Village Health Committees in their villages. 32 out of 40 village heads intimated that in their villages N.G.O.s have also contributed for village health interventions. Almost all the village heads were aware about the RCH Project and its contribution in village health programme.
Team approach, positive attitude of service providers towards the community and the senior officer’s supportive leadership were the strengths of the project. But at the same time planning, monitoring and controlling mechanism were in want of improvement. The political environment, the community and NGOs had been quite supportive to the project interventions; but the resource availability was sometimes irregular which hampered the project progress.
The facility survey was needed for planning and allocating the budget properly but this survey could not be under taken. The budgets along with action plans were prepared. In this project OTs & Laboratories at PHCs were constructed and about 246 sub centers were upgraded. The diagnostic equipments for RTI/STI and facilities for MTP were procured but facilities for emergency obstetric care were not established or strengthened. Under this project the medicines were not procured at state level. They were supplied directly by GOI to PHCs. Therefore state Government was facing difficulty in sending correct status in time to GOI.
The training needs were assessed and training courses were designed for health personals of different cadres. The project management has developed its own IEC material in Mizo language. Though the written communication was adequate, but department could not think of producing video films for IEC purpose. Department has organized healthy baby shows at village and PHC level. The department could not organize orientation programs for village councils and neither the department could organize any inter-village exchange program as envisaged earlier.
The micro level planning has not been attempted in the state. The project management has developed its own MIS by incorporating the main issues of MIS formats supplied by GOI for RCH. The project management has designed project specific MIS; but MIS was not effective as the feed back to the senders was rarely made during later part of the interventions.
The Endline Evaluation survey was sponsored as part of Sub District Reproductive and Child Health Project by Government of India and Government of Mizoram with the financial assistance from World Bank. In Mizoram, Indian Institute of Development Management Bhopal carried out this endline evaluation survey during April to June, 2004 at districts of Aizawl, Champhai, Kolasib and Saiha as sample districts in the endline survey. The main focus of the endline survey was on the following aspects:
1. Coverage of ANC and Immunization services.
2. Proportion of safe deliveries.
3. Contraceptives prevalence rate.
4. Unmet need for family planning.
5. Awareness about RTI, STI and HIV (AIDS).
6. Utilization of Health Services and User’s satisfaction.
7. Management of Project.
8. Efficacy of strategies adopted in the Sub District Project.
The survey was carried out in 1595 households from rural areas. The total population covered in the survey was 9488 out of which 4680 were males and 4808 were females. The sex ratio of the population covered was1027 females per 1000 males. The state was mostly inhabited by Christians with 99.4 percent population. Similarly population of Scheduled Tribes (99.1 percent) was also highest in the state in the sampled population.
Out of total 1595 households 480 eligible women were selected randomly of whom 478 women were interviewed. These eligible women were usual resident, currently married in the age group of 15 to 45 years. Age at consummation of marriage below 18 years was 9.8 percent where as for 18 years and above it was 90.2 percent. The mean age at marriage for boys and girls who married since 1 January, 2001 was 23.5 and 21.3 respectively. The mean number of children ever born to women age 15 to 45 years was 2.8.
Among the 478 interviewed women only 3.2 percent were illiterate whereas 69.0 percent attended schools for 9 years and 27.8 percent attended school for 10 years or more. The mean children ever born and surviving to women age 15-45 years was 2.8 and 2.6 respectively.
The ANC coverage of women in Mizoram was 76.4 per cent. Of those who received ANC, 92.9 per cent had it from Government health facility and only 6.3 per cent had it from Private Health Facility. 20.2 per cent of women had minimum three ANC visits and 14.7 percent had first ANC visit in the first trimester. 69.9 percent and 51.3 percent of women had daily doses of one or two IFA tablets and 45.6 per cent had 2 TT injections. 50.6 per cent and 52.3 per cent had check up of blood pressure and weight respectively during pregnancy and 49.3 per cent had 3 or more abdominal check up. A full ANC package of at least one TT, daily consumption of IFA tablets and 3 ANC visits was received by 47.5 per cent of the pregnant women.
Institutional deliveries were of the order of 40.1 per cent of the total deliveries and 96 per cent of the institutional deliveries were in Government health facilities. Nurse/ANM and Trained Dais conducted 22.8 per cent and 21.5 percent of the home deliveries. On the whole in this state, 86.5 per cent were safe deliveries. Delivery related complications were experienced by 14.0 per cent of the women. Out of the total women who had delivery complications 38.5 per cent had obstructed labors and 21.5 percent had Prolonged Labors (12 + hours) during delivery and 36.4 per cent had post delivery complications.
The Vaccination coverage of Children in this state was 75.3, 64.9, 58.9 and 61.3 per cent respectively for BCG, three doses of DPT, three doses of polio and measles. 39.1 per cent of the children were fully protected against six vaccine preventable diseases.
64.7 per cent of children were breast fed within two hours of birth and 16.7 percent were given colostrums. 92.9 percent of women exclusively breastfed their children for at least 4 months. 91.0 per cent of the women were aware of diarrhea management and 25.9 per cent of danger signs of pneumonia.
Knowledge of family planning was widely spread in Mizoram state with 95.2 per cent women knowing at least one modern method. Contraceptive prevalence rate in this state was 72.8 per cent with 67.6 per cent CPR due to modern methods and 5.2 per cent due to traditional method. Among the methods adopted Condom/Nirodh (33.1%) and IUD/Loop (26.5%) predominated. A total of 10.7 per cent of women had unmet need for family planning out of which 2.5% was for Limiting and 8.2 % for Spacing.
42.7 per cent of eligible women reported that the ANM visited their houses during three months prior to the survey. The counseling by ANM to unmarried adolescent girls was done only in 6.5 per cent of households. IFA tablets were distributed to adolescent girls in 15.4 percent families. During the last three months only 16.1 per cent of the women visited Government health facility and 15.3 per cent of them expressed center good enough for recommending to others.
The awareness of RTI among females was 15.5 per cent. The corresponding figures for STI was 28.2 percent and for HIV (AIDS) 87.9 per cent. 4.2 percent of women reported at least one symptom of RTI. Newspapers (66.1 percent) and Electronic media (45.8 percent) contributed mostly in spreading the awareness of HIV (AIDS). Only 2.1 per cent of females were ignorant of the mode of transmission of HIV (AIDS) while 84.7 percent and 72.4 percent told that it spreads by Sexual intercourse and Needles/Blades/Skin Puncture. 14.4 percent of women believed that (AIDS) could be cured. Nearly 73 per cent of female respondents were aware of preventing HIV (AIDS) by practicing safe sex.
In about 97 percent Sub Centers male Health Workers and in 85 percent Sub Centers female Health Workers were found posted. The longest distance to be covered by Health Workers for reaching 7 villages was 16 Kms. and above. 87 percent of Sub Centers were located in Government buildings. The status of 47 percent buildings of sub centers was reported poor and in 25 percent it was reported in good condition. Water supply and Electricity supply in 33 percent and 31 percent sub centers was reported continuous. Sufficient stock of vaccines, ORS, and Cotrimaxazole was reported sufficient in only 31 percent, 36 percent and 26 percent sub centers respectively. Records and Registers in 90 percent SHCs were found complete and in 87 percent SHCs accurately maintained.
Posts of Medical Officer was found vacant in only 3 Primary Health Centers out of 10 Centers studied and Lady Doctor/Gynecologist was available in only 3 PHCs. All the PHCs were located in Government buildings but condition of only 3 buildings was reported good. Condition of water supply and electricity supply was found continuous in 2 and 5 buildings only. Sufficient stock of Vaccines, Cotrimaxazole, and General Medicines was reported sufficient in 4, 4 and 1 PHC only. Records and Registers of 8 PHCs were found complete and accurate.
Presence of Village Health Workers/Village Health Guide was reported by 75 percent of Village Heads in Mizoram state and 67 percent of them reported that VHGs of their villages have visited the house of village heads. Among the 40 villages studied 23 Village Heads reported that they do not have Village Health Committees in their villages. 32 out of 40 village heads intimated that in their villages N.G.O.s have also contributed for village health interventions. Almost all the village heads were aware about the RCH Project and its contribution in village health programme.
Team approach, positive attitude of service providers towards the community and the senior officer’s supportive leadership were the strengths of the project. But at the same time planning, monitoring and controlling mechanism were in want of improvement. The political environment, the community and NGOs had been quite supportive to the project interventions; but the resource availability was sometimes irregular which hampered the project progress.
The facility survey was needed for planning and allocating the budget properly but this survey could not be under taken. The budgets along with action plans were prepared. In this project OTs & Laboratories at PHCs were constructed and about 246 sub centers were upgraded. The diagnostic equipments for RTI/STI and facilities for MTP were procured but facilities for emergency obstetric care were not established or strengthened. Under this project the medicines were not procured at state level. They were supplied directly by GOI to PHCs. Therefore state Government was facing difficulty in sending correct status in time to GOI.
The training needs were assessed and training courses were designed for health personals of different cadres. The project management has developed its own IEC material in Mizo language. Though the written communication was adequate, but department could not think of producing video films for IEC purpose. Department has organized healthy baby shows at village and PHC level. The department could not organize orientation programs for village councils and neither the department could organize any inter-village exchange program as envisaged earlier.
The micro level planning has not been attempted in the state. The project management has developed its own MIS by incorporating the main issues of MIS formats supplied by GOI for RCH. The project management has designed project specific MIS; but MIS was not effective as the feed back to the senders was rarely made during later part of the interventions.
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