Student Dissertation

Agency : Gap Analysis; Healthcare Infrastructure; delivery of RMNCH+A; Healthcare Delivery System

Objective : 1. To assess the availability of drugs and equipment’s coverage for RMNCH+A 2. To identify gaps in services delivery of RMNCH+A

Background : Health (RCH), healthcare infrastructure and workforce as also the expansion of programme management capacity since the launch of NRHM in 2005 provide an important opportunity to consolidate all our efforts. As we inch closer to 2015, there is an opportunity to further accelerate progress towards MDG and redefine the national agenda to come up with a coordinated approach to maternal and child health in the next five years. The most common direct medical causes of maternal death as per SRS (2001–03) are haemorrhage, mainly postpartum (37%), sepsis because of infection during pregnancy, labour and postpartum period (11%), unsafe abortions (8%), hypertensive disorders (5%) and obstructed labour (5%). These conditions are largely preventable and once detected, they are treatable. Among children who die before their fifth birthday, almost one third of them die of infectious causes, nearly all of which are preventable.

Methodology : A Descriptive cross sectional study was carried out in Barabanki district of Uttar Pradesh from February2016 to May 2016.Random sampling was done for PHCs and SC and one district women hospital. The sample design was Quota study design and sample size was 21 health facilities. In the data collection tools Government of India Supportive supervision was used. The data or information is compiled using MS Excel. Data is entering manually into the application and analyzed. Graphs and charts are being made using MS Excel package.

Findings : Average referral among all facilities was 213 it shows that there was not proper handling of cases is being done. Quarterly IPD average load was 2208 and OPD average load was 220603.Availability of drugs at maternal care basically if we talk about injectable MgSO4 is only available was 60%. The availability of drugs and essentials of new born health, the bag and mask is only present is 61% which is very low indicator for managing the Asphyxia in new born. If we see in Adolescent health Dicyclomine availability is very poor at facility only 32%. The vaccine supplies at L1 facility HEPB supply is only 45% followed by 27% vitamin syrup and Measles Vaccine is 36%. At L2 also Hep B availability is only 60% followed by in L3 HEP B, Measles and Syrup Vitamin supply is 80% only. If we see the overall availability HEP B is 67%, syrup Vitamin 71% is available only. For the infection prevention, quarterly data shows that color coded bins are only 43% which shows very poor facility of Bio medical waste management apart from this bleaching powder availability is only 57%. In TSU blocks Fetal Heart Rate recorded at time of admission is 100%, partograph is filled is 100%, uterotonic drugs use is 100%. The basic difference is that mother temperature recorded at time of admission is 77% in L1 and in L2 and L3 IS 100%. But in non TSU block it is not recorded in L1 and L2 only in one FRU which is L3 it is done. Antenatal Corticosteroids used at all level L1 was 50%, L2 was 67% and in L3 100% But in non TSU block L1 is 14%, L2 (50%). Essential New Born care and new born Resuscitation equipped NBCC is available at L2 facility (57%). The services delivery at community level by ASHA and ANM. The status of menstrual hygiene is only 52%. The referral at NRC was done only 76% because they are unaware to detect the SAM child.