Student Dissertation

Agency : RMNCH+A Intervention, NRHM, Gap Analysis

Objective : The objective of this study was to identify the gaps in RMNCH+A interventions at District level Dahod District. The study area was all the PHCs and CHCs of Dahod district and respondents were medical officers and female health supervisors of the respective PHC.

Background : The Reproductive, Maternal, Neonatal, Child and Adolescent Health programme is at the heart of flagship programme National Rural Health Mission (NRHM). Central tenets guiding this programme have been equity, universal care, entitlement and accountability. The aim is to protect the lives and safeguard the health of women, adolescents and children and this has been the driving force for reaching out to the maximum numbers, in the remotest corners of the country through constant innovation and calibration of interventions. The strategies have yielded rich and quick dividends, evident in improved IMR and MMR. However there is much that needs to be done – the extension of the Mission into a new phase of five years is a strategic opportunity that must be seized to make the most of it in terms of taking forward the agenda of health for all.

Methodology : A structured standardized questionnaire was used as a data collection tool. The study was a questionnaire based survey. That aimed to collect the data with closed ended questions divided into different Sections. The questionnaire used was in English Language. 35 The data was analysed in three categories: 1. Gaps identified from facility Subcenters for RMNCH+A intervention. 2. Gaps identified from facility CHC/Non FRU and PHCs for RMNCH+A intervention. 3. Gaps identified from Household for RMNCH+A intervention.

Findings : The situational analysis was based on intensive review of available data, (documents and reports), data collected from the facilities, analysis of data of PCTS and MIS. The analysis was broadly divided into two service delivery components: facility based and community based. This was a descriptive cross sectional study including the 65 Primary Health Centers, 11 CHCs and 332 Subcentres of Dahod District. The study projects the functional gaps in the facility for infrastructure, equipments and essential drugs for Sub centres and PHCs/Non FRU and CHC. The Subcentre analysis shows three major shortfalls; lack of functional newborn care corner (9%) at SC infrastructure, lack of neonatal ambu bags(19%) in SCs, equipments and minimal availability of Vit K(4%), Gentamycin (6%) and Magnesium sulphate(9%) at Sub centres. The PHCs and Non FRU CHCs analysis shows three major shortfalls: Only 58% of the PHC/Non FRU and CHC infrastructure have 24*7 water supply in its infrastructure, 21% PHC/Non FRU and CHC dohave MVA/EVA functional equipments and 34% availability of mefipristone tablet at the facility. The Household analysis shows (87%) of the adolescents have received the IFA tables, (82%) of the women are aware of antenatal services and have received the services. Only 24% of total 73% JSY have received the payment before the discharge of the women. Ninety Five Percent women are aware of exclusive breastfeeding and (95%) of the ASHAs are aware of ORS+ Zinc.

Recommendations :

After analysis it was found that the prerequisite conditions available at facility related RMNCH+A is not sufficient at SCs, PHC/CHC/Non FRU facility. Some of the important components of RMNCH+A like 5*5 matrix were not focused which effects the overall productivity of the RMNCH+A program. Correct implementation and minimization of the existing gaps is essential as Dahod is in high priority district category with all high priority talukas. With current status of the prerequisite resources available in Dahod District about RMNCH+A intervention it can be concluded that the strong advocacy of guideline and protocol follow up is required along with resource provision in the limited timeframe with comprehensive strategy addressing all issues.