Transcript Are functioning Village Health and Sanitation Committees

Are functioning Village Health and
Sanitation Committees associated
with regular fixed-day visits of
Auxiliary Nurse Midwives and
performance of their stipulated
duties under NRHM
Jiban Krushna Behera
Dr Sudharani Acharya
Society for Developmental Action (SODA)
Odisha
with support from Sunita Singh (CHSJ)
The Argument
According to National Rural Health
Mission guideline
• There should be one Village Health and
Sanitation Committee (VHSC) in every revenue
village
• VHSC role is to plan and monitor the activities
under NRHM at the village level
• VHSCs are prime contributors for the success
of NRHM
• The VHSCs focuses on functioning and
activities to ensure service delivery of
Auxiliary Nursing Midwifes (ANM)
• The VHSCs ensure stipulated duties of the ANM
related to maternal health on Fixed Health
Days & service delivery.
Geographical Area
•
•
•
•
Bangriposi block in Mayurbhanj
district of Odisha
Mostly inhabited by tribals 67.8 %
Literacy rate is 38%.
One of the districts for Community
Monitoring – First phase
Selection Procedure
•
•
7 villages with functioning
VHSCs ( using scoring system)
7 villages are selected randomly from
the rest 81 villages where there is no
VHSC.
Note : Care was taken to select villages
where the ANM is
not common with
community
monitoring
villages.
Parameters of VHSC Functioning
• The VHSCs 3 months old
• Adequate representation as per NRHM guideline
• Members were sensitized
• Meeting at least once in a month.
• The ANM/ASHA/AWW are present in the meeting.
• Prepared village Health Register
Data collection Methods & Tools
Method: Observation and Interview
•
•
Observation of 28 Fixed Health day in 14 villages (
7 X 2 X 2 months)
Individual interview with 40 mothers who have
delivered in last 3 months ( 20 X2 )
Tools :
1 VHSC scoring
2 Fixed health day scoring
3 Maternal health scoring
Data Analysis
The data was entered in excel sheet and analyzed
FINDINGS:
Fixed Health Day Comparison
FDH attendees - system
16
14
12
10
8
6
4
2
0
VHSC
C
A
H
S
SH
S
H
G
/P
R
I/V
A
W
W
A
N
M
A
U
P
_S
IC
D
S
PO
C
D
M
O
NVHSC
Note: Participation of village level functionaries
are uniform but presence of PRI, SHG & VHSC
members are more in VHSC villages
ANC service at FHD camps
compared
16
14
12
10
8
6
4
2
0
VHSC
Sc
_1
L
UN
SE
CO
CQ
_G
IV
EN
A
IF
TT
K
_C
H
AB
D
W
EI
BP
C
G
HT
NVHSC
HE
K
No of Camps
ANC Services at camps
Service
VHSC – 28 women checked; N_VHSC – 39 women
checked
PNC services at FHD compared
16
14
12
10
8
6
4
2
0
VHSC - CMP
SERVICE
_C
O
H
IV
TI
_R
TI
-C
O
FE
ED
AR
N
C
BO
R
S
IG
_C
O
E
O
_C
SERVICE
N
W
N
TR
A
C
O
H
Y
TC
O
S
R
E
D
IE
G
IN
_c
o
NVHSC-CMP
TC
O
No of camps
PNC services
Services available
Note : PNC services were available at 14/14 VHSC village FHD and 9/14 non
VHSC village FHD.
VHSC – 30 women received services- ave. 4.8/8 services/woman; N_VHSC – 16
women-1 woman received 3 services in one FHD out of 9 FHD.
Maternal Health
VHSC
villages
Non-VHSC
villages
PREG_REG 12 WEEKS
70%
0%
PREG_REG 12-14 WEEKS
10%
65%
PREG_REG BY AWW
95%
95%
IFA BY ANM
95%
95%
INSTITUTIONAL DELIVERY
60%
60%
ANM ASST. HOME DEL
15%
0%
ASHA ACCOMPANY
65%
60%
ADVICE ON COMMON
PROBLEM
90%
0%
Services
More…..
VHSC
villages
Non-VHSC
villages
Referral by ANM for immediate
medical attention
50%
0%
Check up after delivery
65%
20%
Advice for early breast
feeding
95%
0%
Advice for diet
95%
0%
Personal Hygiene
75%
5%
Neo Natal Care
95%
10%
Maternal Health Services Score
• The number of services received by each woman was
converted into a score with base 10.
• ANC score – Registration, ANM checkup, Wt check, BP
check, Abdomen, TT 2, IFA, ANM advice
• INC score – Inst. Deliv., Deliv advice, ASHA accomp, risk
related counselling, ANM advice.
• PNC score – PNC check, No of checks, ANM counsel, Diet
counsel, rest counsel, Hygiene counsel, Contraceptive
counsel
• NNC score – Temp related, Breast feeding related
counseling and BCG, Polio and DPT vaccine received
Services received by Women
MATERNAL HEALTH
AVE. SCORE/10
10
8
6
VHSC
4
NVHSC
2
0
ANC
INC
PNC
NNC
SERVICE
Difference – 1.4 times for ANC; 2.1 times for INC,
20 times for PNC and 5.6 times for NNC between
mothers in VHSC and Non VHSC villages.
Limitation of the study
•The study is done in one block.
•Situation may be different in other blocks.
•Assessment study was done by the same
NGO that was responsible for implementing
VHSC formation and training
Conclusion
1. In all the fixed health day ANM, AWW and ASHA
were present; but in in VHSC villages PRI, SHG and
VHSC members were also present
2. In both VHSC and non VHSC village Fixed health
day, IFA distribution and TT injection is being done
but check-ups of abdomen, BP and measurement of
weight is being done primarily in VHSC villages
3. Most mothers received counseling in VHSC villages
but not so in non VHSC villages
4. Women from VHSC villages received more ANC,
INC, PNC and Neo-natal care services compared to
Non VHSC villages.
5. Non VHSC villages hardly received any PNC or Neo
Natal Care services
Some Positive Indications…
• Formation of VHSC in the village is promoting the
presence of SHG, PRI and VHSC members during
Fixed Health Day
• Presence of trained VHSC members improved the
range of services being provided during the FHD
• Women from villages with trained VHSC receive
substantially more services – especially with
regard to PNC and neo-natal care
• PNC and neo Natal care are known to be low
compared to ANC and Institutional delivery
• PNC and neo Natal Care are important to reduce
MMR and NMR which are persistent problems.
Recommendation
1 Formation of VHSC under Community Monitoring
should be done as soon as possible in other villages
2 There is need to ensure proper composition of VHSC
members
3 Attendance in VHSC meetings of PRI, ANM and SHG
members should be ensured
4 More rounds of VHSC member training is required in
order to ensure their roles and responsibility
5 The Community Monitoring should be upscale in all
the villages of this country
THANKS