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.