Student Dissertation

Agency : Maternal Healthcare Utilization; High Priority Block Tribal District; Supply Side Factor

Objective : To analyze the association of supply side factors and utilization of maternal health in terms of number of ANCs registered, number of deliveries conducted, and number of PNCs visited at SC of high priority block of tribal district Valsad, Gujarat.

Background : Valsad district is one of the 33 districts and one of the 8 HPDs in Indian state of Gujarat. In the public sector, a Sub-center is the most peripheral and first point of contact between the primary health care system and the community. Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. Many factors that affects utilization and provision of health care. These factors operate on both the demand and supply side. The framework identifies three levels of barriers: the community, household level and the health service delivery level.

Methodology : • STUDY DESIGN: A descriptive, Cross-Sectional study design • STUDY AREA: The study was conducted in subcenters of high priority blocks of Valsad District, Gujarat. Two high priority blocks in Valsad namely Kaparada and Dharampur having 86 and 64 sub-centers respectively. • DURATION OF STUDY: The study was conducted over a period of three months start from 8th Feb 2017 to 7th May 2017. • SAMPLE SIZE: As this study was facility survey, sample size was taken as 20 percent of total health facilities in the survey. There are 150 Sub-centers in mentioned high priority blocks. 20 percent of 150 is 30. Total 30 Sub-centers were taken up for the study. • SAMPLING TECHNIQUE: Simple random sampling • DATA COLLECTION PROCEDURE: Face to face interview of FHW/ANM at Sub-Center and use of secondary data from facility register. • DATA COLLECTION INSTRUMENT: Questionnaire of DLHS-3 Facility Survey under Reproductive and Child Health Project for Sub center modified as per requirements. • DATA ANALYSIS PROCEDURE: SPSS software version 20. Univariate and bivariate analysis was carried out.

Findings : Supply side factors for the study were selected from the factsheet of DLHS-3(facility survey) and previous studies done using DLHS-3 data in different state, which were: Health personnel, Drug availability, Equipment, Quality variable, Infrastructure, Quarter for residence and Geographical. There was no association found between no. of ANC registered and independent variables, no. of delivery conducted association with some variables like Instrument sterilizer, hub cutter and hemoglobinometer shows association under equipment and under quality variables integrated skill development training and SBA training show association.

Recommendations :Supply side factors were not acting as barriers or hurdles in maternal healthcare utilization except a few that was instrument sterilizer. This result shows that to establish this fact further study needs to be carried out because the sample size of study may affect the overall result. Supply side factors that were considered in this study, it can be said that only these factors were not taken to know the utilization of maternal health, there may be chances of other factors that may influence the maternal healthcare utilization and to establish this fact further study is needed.