Abstract of Dissertation

Keyword : Integration; Community Health Workers; Co-ordination; AAA Model; ANM; ASHA

Objective : To identify the gaps at the AAA platform at SC level of 4 block of farrukhabad district

Background : A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched RMNCH+A in2005 to revamp India’s rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. There is a need to coordinate front-line workers at the village level. The AAA platform provides this opportunity of coordination. This study discusses community health workers’ integrated service delivery through village level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers firmly believe in – is in constant tension with the limitations of narrow indicators of health system performance. Our study shows how effectively this platform performs to improve the health and nutrition issues in the community. ANM, ASHA and AWW are three pillars of health and nutrition and are at the core of the AAA platform. This is an important effort towards the establishment of a sustainable and integrated health system.

Methodology : ï‚· Study Type- Descriptive, Cross Sectional study. ï‚· Study Area- The study was conducted in 4 administrative blocks (Badhpur, Kaimganj, Kamalganj, Shamashabad) of Farrukhabad district in Uttar Pradesh with a sample size of 50 respondents. ï‚· Study Period- 3 month (Feb-2016 to April-2016) ï‚· Study Respondents-The respondents were front line workers ANM at the 50 AAA site. ï‚· Data Collection Technique- Face to face interview and direct observation. ï‚· Data Collection Tool- Structured questionnaire.

Findings : In the AAA platform, out of four meetings that were planned, three meeting were conducted. Half of the AWW were present in the platform. Supportive supervision visits were done only in half of the Platform. Ninety percent of AAA done Village Health and Nutrition Day (VHND) activities of due list for Routine immunization, Antenatal Care, Antenatal Check-up, Postnatal Care, Nutrition support, Family planning Services were prepared. Ninety five percent of AAA prepared the action plan to motivate resistant families, population hard to reach and address absentees in AAA platform was achieved. Nearby Ninety five percent AAA Activity for the Village Health Index Register like reviewing and updating, poor performing indicator discussion, poor performing ASHA area were done. For AAA strengthening, it was observed that activities like next meeting date was communicated and meeting minutes was documented in the entire platform.

Recommendations : AAA should be conducted as per micro plan; Block level manager should focus to prepare micro plan and share it with CDPO and other departments in advance. Block level MO/IC should coordinate with CDPO and ensure that every meeting can be supervised by MO, HV, ICDS supervisor, BCPM etc. ANM should take the responsibility for capacity building of ASHA and AWW, for that they can use Mobile kunji and ASHA academy facility .AAA meeting platform should be properly utilize, it will help to develop the coordination between ASHA, Anganwadi worker and ANM.

What are the gaps at the AAA platform at SC level of 4 block of farrukhabad district?