Reproductive and child health programme pdf
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- Reproductive and Child Health (RCH) care and its implementation by IMA
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- Reproductive and Child Health under National Rural Health Mission
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Reproductive and Child Health (RCH) care and its implementation by IMA
Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana. METHODS: A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life.
Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. RESULTS: Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal MDG in the study areas to 8 years.
Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.
The Global Health Conference goal of achieving "health for all" by the year was endorsed by all African governments. Yet, as the new millennium approached, accessible health care remained a distant dream for most African households. Moreover, expanding access to comprehensive reproductive health services has also been an unfulfilled goal of African governments. After a decade of regional commitment to the Cairo International Conference on Population and Development ICPD agenda, concern is mounting that reproductive health programmes in the region are not working.
In West Africa, in particular, the demographic role of family planning programmes remains the subject of unresolved policy debate. The Navrongo experiment developed strategies for community-based reproductive and child health services, tested the impact of the strategies proposed and guided national reform based on lessons learned. The Navrongo experiment took place in Kassena-Nankana District, an isolated rural northern district of Ghana's most impoverished region where health, social and economic problems severely constrain development.
Baseline mortality rates assessed in the early s were well above national levels. Cultural traditions were known to sustain high fertility and impede progress with health interventions. Health-care decision-making was strongly influenced by traditional beliefs, animist rites and poverty.
Parental health-care-seeking behaviour was governed more by tradition than by awareness of modern health-care options. Conducting experimental research in such an unpromising locality ensured that any success arising from project interventions could not be dismissed as a by-product of favourable economic trends and social circumstances.
The factorial design of the experiment was configured with two experimental arms. One arm of the experimental design emphasized the value of aligning community health services with the traditional social institutions that organize village life. The second arm of the experiment concerned strategies for relocating health service staff from clinics to community locations. In the early s, more than "community health nurses" were hired, trained for 18 months, and deployed to districts throughout Ghana to address lapses in the volunteer scheme.
In the absence of community facilities where nurses could live and work, the programme assigned all nurses to subdistrict health centres located on average more than 10 km from the rural households they were serving. Communities were not connected with the initiative and contributed nothing to its sustainability. Caseloads were low, calling into question the likelihood that deployment of community nurses could contribute to community health.
Nurses already working in the programme had been trained to provide curative services for acute respiratory infections, malaria and other ailments. They could also provide care for diarrhoeal diseases, immunization services and comprehensive family planning and safe motherhood care and could be entrusted with care and referral services that volunteers could not provide.
Antibiotic therapy, basic midwifery services and injectable contraceptives were examples of services that were available only from nurses. A brief regimen of additional training was provided to enable these nurses to organize community health services, engage in community diplomacy and supervise the activities of volunteers.
In summary, health policy debate focused on the relative merits of two alternative approaches to extending health care to community locations. The proponents of volunteer strategies based their arguments on evidence that vibrant social institutions could support affordable community-led services. The provision of professional nurse services was supported by evidence that volunteer programmes were not working and that there were a range of health interventions and technologies that only nurses could provide.
In response to policy debate, a three-community pilot study was conducted in to gauge community advice about health service implementation and develop plausible strategies for solving problems. A succession of in-depth interviews and focus groups of panels of married men, married women, community leaders and health workers were conducted to assess perceived health service needs.
These sessions were followed by pilot implementation of services to test the feasibility of the proposed approaches and to permit appraisal of the reactions of community and health workers to services rendered. This process of dialogue, implementation and calibration clarified the operational details and the steps required in launching a community health experiment. Villagers were consulted about appropriate ways to organize, staff, and implement primary health care and family planning services.
Chiefs, elders and women's groups were involved in discussing practical means of developing leadership of operations to deliver community health care services. The mechanics of launching this programme and listening to its stakeholders generated practical insights into ways of changing programmes from clinic-focused services to community-based care.
These steps were clarified by modifying the programme over time and reconvening focus-group discussions with members of the pilot communities to gauge their reactions and garner their advice.
After a pilot trial of 18 months, an experimental phase was launched in 37 communities to test the hypotheses that strategies developed in the pilot scheme could lead to reduced fertility and reduced childhood mortality.
The factorial design was configured with two experimental arms. The "community health officer" arm of the experiment reoriented existing clinical nurses to enable them to provide community health care and assigned these re-trained workers to village locations with the new designation "community health officers.
Reorientation involved 6 weeks of intensive in-service training in methods of community engagement, service outreach and community health care planning. Chiefs and elders were requested to convene community gatherings to seek volunteer support for constructing dwellings, using local designs, materials and resources.
Once this collective effort had produced a completed "community health compound," a community health officer was assigned to the facility where she then lived and worked. Communities were obliged to maintain the facility, provide security and meet the nurse's daily living needs. The costs of essential drugs were borne by the community. The Ministry of Health provided start-up pharmaceutical kits, essential clinical equipment, staff salaries and motorcycles.
Services were provided during household visits made at day intervals, augmented with daily care based at the community health compound, which was provided during well-publicized hours of duty. The zurugelu togetherness arm of the experiment mobilized the cultural resources of chieftaincy, social networks, village gatherings, voluntary activities and community support.
Community liaison was directed towards arranging quarterly community gatherings, the recruitment and management of male health service volunteers, outreach to community networks and other mechanisms for integrating project management into the traditional system of social organization and communication. A prominent feature of the zurugelu dimension was a gender component, developed in the course of the pilot study.
Activities were designed to build male leadership, ownership and participation in reproductive health services and to expand women's participation in community activities that have traditionally been the purview of men. The zurugelu system extended to the Navrongo communities the Bamako Initiative's model for recovering the cost of essential drugs by equipping volunteers with bicycles, providing them with a start-up kit of essential drugs and conducting training in managing services and revolving accounts so that the flow of supplies would be sustainable and financed by the community.
Because the two experimental arms could be assigned independently, jointly or not at all, a four-celled experiment was implied by the design. Cell 1 constituted an independent test of the impact on fertility and child survival of developing the zurugelu approach to community heath care. Cell 2 tested the independent effect of assigning community health officers to village locations.
Cell 3, the joint-implementation cell, tested the impact of mobilizing community-based health care through traditional institutions combined with referral support and resident ambulatory care provided by community health officers. All cells, including the cell 4 comparison area, were provided with subdistrict clinical services, equivalent densities of staff and equivalent access to supplies and technical training.
Areas in and around Navrongo town were excluded from the study area, under the assumption that the social and economic conditions in the town would bias experimental results. Of necessity, four contiguous clusters of communities were grouped in referral service catchment areas corresponding to four subdistrict health centres. The project is therefore a "plausibility design" rather than a true experimental study.
This system recorded all vital events, migrations, person-days at risk and relationships of members of extended households for rural residents enumerated in a census of the district in May and June and observed in day data collection cycles over the period between 1 July and 31 December Although the results presented below are based on tabulations of cell differentials over the study period, separate survival analyses have shown that bivariate results are robust to the introduction of controls for pre-experimental cluster differentials and parental characteristics.
An analysis of demographic surveillance data, by cells, of the Navrongo experiment demonstrates that assigning community health officers to village locations had a pronounced impact on child mortality Fig. Mortality rates in the comparison area also declined owing to the child mortality-reducing effects of insecticide-impregnated bednets 21 and other health interventions such as vitamin A supplementation.
However, in cell 1, where volunteers worked without a resident nurse, trends were similar to those in the cell 4 comparison areas, indicating that volunteers made no contribution to increased child survival. This finding was corroborated by qualitative research on parental health-care-seeking behaviour.
In impoverished families, parents dealing with childhood illness tend to seek care first from traditional healers because deferred payment customs and social arrangements make traditional healing a more feasible option than clinical care. Volunteers lacked the credibility to change this dynamic, whereas services provided by community health officers were acceptable substitutes for those of traditional healers. Community health officers working with chiefs and elders developed deferred payment procedures that permitted parents to acquire health services for their children on demand, with the expectation that extended family social insurance customs would permit recovery of costs for essential drugs.
Such a system of social engagement for deferring payment eludes other modern health care providers in the Ghanaian health system. Improving geographical and social access to basic curative and preventive services enabled community health officers to make major gains in child survival.
The Navrongo experiment enabled the project area to achieve the child-survival MDG within 8 years Fig. Over the period , child mortality declined from to deaths per thousand person-years in the comparison area, versus to per thousand person-years in the combined experimental area. Over the period , the Navrongo experiment exhibited a pronounced impact on fertility Fig.
On average, total fertility rates in the "combined cell" cell 3 of the experiment were one birth fewer than the total fertility rate expected in the absence of the intervention. Regression adjustment for the possible confounding effects of pre-project fertility differentials, women's educational attainment and number of co-wives support the hypothesis that the supply of family planning services can have a beneficial impact, even in an impoverished rural African setting.
Social and survey research has explained how the effects on fertility arose. Baseline research showed that the unmet need for contraception in the study area was almost entirely related to demand for longer intervals of birth spacing and that nearly half of the women were amenorrhoeic, separated from their spouses or otherwise not at risk of becoming pregnant.
Few women expressed the view that childbearing should be ended through individual volition or family planning. Research showed a strong association, however, between stated desires to space births and subsequent spacing behaviour. Spacing preferences are relevant to women of all ages, and the impact of the project reflects this underlying climate of demand for contraception.
In each 5-year age group, fertility declined in the experimental cell 3 area Fig. This is consistent with survey research showing that the experiment addressed an unmet need for increased child spacing, which had an equivalent impact across all age categories.
The study's findings demonstrate that achieving an impact on fertility requires that accessible services be established with a well-developed mechanism for offsetting the social costs of fertility regulation.
The community-engagement strategies in the zurugelu arm of the project were designed to build male involvement in the programme. Community-engagement activities also involved individual women and women's social networks.
The combined effect of outreach to men and women reduced gender stratification in reproductive decision-making. The Navrongo experiment demonstrates contrasting results on fertility and child survival: cells where nurses were assigned experienced equivalent trajectories in decline in childhood mortality.
Reducing fertility depended upon combining the presence of nurses with community mobilization and the involvement of men in family planning. These findings attest to the demographic importance of developing social access to care in conjunction with improving geographical access to a broad range of technologies for improving reproductive and child health.
Approaches that used community volunteers had no impact on mortality, in part because volunteer services could not offer antibiotic therapy and in part because the volunteer services lacked sufficient credibility to supplant traditional health-seeking behaviour.
The results from Navrongo thus challenge the rationale for volunteer-based health programmes designed to improve child survival. Male volunteers were crucial to achieving an impact on fertility.
Providing convenient access to contraceptive supplies was an essential, but insufficient component of the reproductive health services.
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Reproductive, maternal, neonatal and child health in the 30 years since the creation of the Unified Health System SUS. Rio de Janeiro RJ Brasil. Campinas SP Brasil. Salvador BA Brasil. Pelotas RS Brasil. We analyzed indicators of antenatal and labor and delivery care and maternal and infant health status using data from the Live Birth Information System and Mortality Information System, national surveys, published articles, and other sources.
Metrics details. As India already missed maternal and child health related millennium development goals, the maternal and child health outcomes are a matter of concern to achieve sustainable development goals SDGs. This study is focused to assess the gap in coverage and inequality of various reproductive, maternal, neonatal and child health RMNCH indicators in districts of India, using data from most recent round of National Family Health Survey. A composite index named Coverage Gap Index CGI was calculated, as the weighted average of eight preventive maternal and child care interventions at different administrative levels. Bivariate and spatial analysis were used to understand the geographical diversity and spatial clustering in districts of India. A socio-economic development index SDI was also derived and used to assess the interlinkages between CGI and development.
Reproductive and Child Health under National Rural Health Mission
Children up to 14 y of age comprise almost one-third Protecting the health of this largest demographic group requires sound policies and programmes as these children are the future work force and intellectual powerhouse of our country. They will be the flagbearers of sustainable development in India.
The reasons for not reaching the goals set for Population Control were analyzed. Subsequent sample studies indicated that there are some areas where the earlier programme has not reached. Therefore, the entire strategy was changed and the following issues were given priority.
MCHEP assigns epidemiologists and fellows to state, local, and tribal levels to support epidemiologic research and provides scientific information to improve maternal and child health programs and policies. The program also supports the recruitment and placement of MCH fellows from the Council of State and Territorial Epidemiologists in public health agencies. Learn about MCHEP accomplishments , including the development of a State Infant Mortality Toolkit SIM external icon to help states, counties, tribes and urban areas analyze infant mortality data and translate findings into programs and policies to reduce infant mortality.