OBJECTIVE: To study the functioning of ASHA in the community with special focus on interface with community and service providers in Eastern Uttar Pradesh. METHODS: This was a descriptive cross-sectional study conducted in two blocks each in Gorakhpur and Maharajganj districts of Eastern Uttar Pradesh during October-December 2008. A multi stage sampling design was used. The study subjects included 120 mothers, 60 ASHAs, 20 AWWs, 20 ANMs, 4 Medical Officers in charge, 2 Chief Medical Officers (CMOs) and PRI members. Data was collected through pre-designed and pre-tested structured interview schedules and through checklists for FGDs. RESULTS: Most (95%) of the ASHAs were 8th Pass or above. The residential status and marital status was as per guidelines. Induction training was received by all. Major motivating factor for ASHAs were either money (81.66%) or getting a government job (66.66%). Most of the ASHAs (86.66%) got the support from their supervisors in solving their problem and majority of them (95%) were satisfied with their supervisors. All the ASHAs have been accepted very well in the community and are acting a good link between community and health providers. The faith and confidence of community on ASHAs are reflected by the demand of additional jobs like help in getting widow pension and ration card etc. CONCLUSION: Though accepted by the community, ASHAs need regular training, support and cooperation from other functionaries.

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BACKGROUND & OBJECTIVE: Janani Suraksha Yojana (JSY) has been implemented in the country to enhance institutional deliveries. This study assess the gaps in delivery services and utilization of resources at Basic and Comprehensive Emergency Obstetric Care Centers (BEmOCs, & CEmOCs), accredited sub centers and private hospitals in district Jaipur, Rajasthan. METHODS: The study was undertaken during October-December 2008 in 31 selected health facilities (5 CEmOCs, 4 BEmOCs, 14 accredited subcentres and 8 accredited private hospitals) in district Jaipur. Both primary and secondary data was collected using qualitative and quantitative techniques, by facility survey, interview of service providers (specialists, medical officers, and paramedical staff) and beneficiaries. RESULTS: There is an increase in institutional deliveries following implementation of JSY. Though the normal deliveries were conducted 24 hours by the BEmOCs and CEmOCs however the necessary drugs like parental antibiotics, mesoprostol, magsulf etc were in short supply and use of partograph was absent at the health facilities. The quality of emergency obstetric care services was still poor due to the lack of blood storage units and anesthetists in CEmOCs. Private accredited hospitals fared better as they had the manpower and managed more complicated cases as compared to government facilities, for caesarean sections. The accredited sub centers were nonfunctional negating the very objective of accreditation. Community is still unaware of the 24 hour stay post delivery and provision of grievance redressal system. CONCLUSION: The quality aspects of institutional deliveries are far from desired level mostly because of lack of resources, both manpower and materials; non achievement of IPHS standards etc. The service quality related to antenatal, intranatal and postnatal care need to be improved. The JSY is perceived as an effective scheme by the beneficiaries but gaps in resources and lack of quality of services needs to be adequately dealt with.

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OBJECTIVE: To assess the various factors influencing utilization and non-utilization of RCH services and extent of client satisfaction. METHODS: A cross-sectional study was conducted during October to December 2008 at two selected blocks of Varanasi district, Uttar Pradesh. Principal study subjects were 509 women having children less than 12 months old, selected through a multistage sampling technique. Data were collected through in-depth interview and Focus Group Discussions conducted among the beneficiaries of the services. RESULTS: The study revealed that utilisation of the RCH services in the government facilities was higher among the backward classes than the general category; higher the level of education the lower was the utilisation of government services. Over all, 16% of the respondents were not satisfied with government facilities. 25% of the SC category was not satisfied with the services in spite of being the main users. Among RCH services utilization was highest (89%) for antenatal care services (ANC). 41.6% respondents did not receive any Post Natal Care (PNC) after their most recent birth. About 30% deliveries were at home out of which only 10% received PNC whereas out of 70% institutional deliveries about 80% received PNC. Overall 16.3 % of the respondents were not satisfied with the services provided by government health facilities. Around 16% and 14% were not satisfied with the behavior of medical officer and the health workers respectively and non-satisfaction was highest among SC category. CONCLUSION: All health facilities need to be made functional according to Indian Public Health Standards (IPHS) of NRHM.

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OBJECTIVES: To assess the performance based incentive system for ASHA Sahyogini in Udaipur district of Rajasthan. METHODS: This cross-sectional study was conducted in three blocks (one each from rural, urban and tribal area) of Udaipur district during October-December 2008. From each block 60 ASHAs were selected randomly, thus a tola of 180 ASHAs were included. Besides interviewing the ASHAs, focus group discussions were also conducted for primary data collection. The study assessed the performance based incentives system to ASHAs during the last six months. RESULTS: The study revealed that almost 50% ASHA's in the studied blocks were covering population ranging from 1000-1500. All the ASHA has good coordination with local community and they are participating in community meetings regularly. All the ASHAs received incentives for the cases of sterilization; 55.5 percent urban, 85.7 percent rural and 82.7% tribal ASHAs received it on the same day when sterilization was done. Half of the urban, 35% of the rural and 56.7% of tribal ASHAs got incentive less than Rs. 250 in last 6 months (less than 50/- per month). Common cause identified for dissatisfaction was less incentives compared to their work, especially for the ASHA working in tribal areas. CONCLUSION: Timely release of incentives, adequate cooperation from staff such as ANMs, AWW, hospital staff and improved community awareness are needed for better performance of ASHAs.

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OBJECTIVE: To assess status of birth preparedness & complication readiness among recently delivered and pregnant mothers in Rewa district of Madhya Pradesh. METHODS: A cross-sectional descriptive study was conducted during September-November 2008 among a sample of 2022 study subjects (pregnant women in second/third trimester and/or mothers who have delivered within one year) selected through 30 cluster sampling technique. Investigators collected data using pre-designed schedule by house to house visit. 7 indicators were derived from elements of birth preparedness (BP)/complication readiness (CR). Mean of 7 indicators was taken as BP/CR Index. RESULTS: Among 2022 women, 632 were pregnant and 1390 were recently delivered. BP/CR index was found to be 47.5. BP/CR index was significantly high in above poverty line families (50.9), higher educational level (63.6) and in service and business group (59.3). BP/CR were significantly higher in primi-para (50.9) as compared to multipara (40.1). Some indicators for example knowledge of danger sign (18.6%), about transportation facilities (18.6%) and 1st trimester ANC (24.1%) was very low.

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BACKGROUND: Public health importance of hand washing was known since 19th century. Many researchers also highlighted how hand washing could bring down the incidence of diarrhea, ARI & other diseases. OBJECTIVE: To find out the extent of hand washing as practiced by the community, to what extent suggested steps of hand washing was followed and to assess the changes in bacteriological count of hand before and after hand washing. METHOD: A community based cross sectional study was carried out during January-February 2007 among 161 respondents in and around Kolkata through interview, observation of hand washing in some situations as well as carrying out microbiological test. RESULT: 100% respondents interviewed practiced hand washing after defecation either with soap (59%) or with plain water, ash & mud (41%). But 64%, 51.6% and only 21.7% practiced hand washing before preparation of food; after using urinals; after changing the babies' nappies and disposing their feces respectively. Only 16.1% respondents washed their hands as per the recommended time of 15-30 seconds. Majority (75%) dried hands with apparently unclean materials. 90.7% followed step1 but none followed all the steps. Swab collection before and after hand washing revealed a decrease in colony count in 60% of the samples. CONCLUSION: It can be concluded that extent of desirable practices regarding hand washing is still lacking and needs to be emphasized.

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OBJECTIVES: The key objective of the study was to evaluate the coverage and functioning of the referral transport system under NRHM in block PHCs of district Patna in Bihar. METHODS: A cross-sectional descriptive study was conducted during October-November, 2008 in 16 block PHCs in Patna. In-depth interviews were conducted at 811 households where there was an occasion to transfer a patient to a hospital in the previous two months time. Medical officer in-charge and civil surgeon of the district were also interviewed. Besides, focus group discussions were conducted with the community members and leaders regarding the functioning of referral transport. RESULTS: Availability of the referral transport services was irregular mainly due to deputation of the vehicles for flood relief activities or other purposes. 93 (11.5%) of respondents used the PHC transport facilities, of which 52.7% got it instantaneously. 'Dial an ambulance 102' services were mainly used by urban clients. The system was following an arbitrary cost structure. 84.2% of the clients belonging to below poverty line had to pay for the service and are afraid of availing the services. CONCLUSION: Inadequate number of ambulances in PHCs, unequipped ambulances, lack of life saving equipments, 24 hours duty by single driver, arbitrary cost frame work and urban preference for services were some of the factors leading to unpopularity of the scheme.

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OBJECTIVES: To seek opinion regarding the procurement and spending of untied fund provided to health centers and Village Health and Sanitation Committees (VHSCs) in selected districts in the state of Uttar Pradesh. METHODS: It was a cross sectional descriptive study conducted during September-December 2008. The multi-stage random sampling technique was adopted to select the districts, health facilities and VHSCs. The data was collected using semi structured interview schedule, Focus Group Discussions (FGDs) with ANMs for qualitative information, review of the records of health centers and VHSCs. RESULTS: The concept of untied fund was perceived to be a very good one at all levels. Guideline for utilization of untied fund was either not available or if available, was not clear to concerned personnel. The decision of expenditure of untied funds of CHCs and PHCs was taken in the meeting of Rogi Kalyan Samiti (RKS), but members from other sectors such as PRI, education, revenue department etc. usually did not attend the meeting. Most of Medical Officer in charges (MOICs) were not aware regarding availability of untied fund. About 50% of ANMs were not able to expend the money due to non co-operation of Pradhan. In majority of the cases the decision regarding the utilization of untied fund was taken by ANM herself instead of VHSC meeting. CONCLUSION: Regular update and orientation to the service providers about the untied fund and its efficient utilization, strict monitoring of utilization of untied fund at each and every level is needed.

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OBJECTIVES: To study the functioning of District Programme Management Units in the delivery of health services in various districts of Madhya Pradesh. METHODOLOGY: A cross-sectional descriptive study was conducted in seven districts of Madhya Pradesh selected randomly. The study subjects were Chief Medical and Health Officers, programme managers, assistant managers and data officers at state and district levels. Datawas collected from the respondents in a pre-designed, pre-tested in-depth interview schedule. RESULTS: Around 70% of districts submitted their Programme Implementation Plan (PIP) on time, 30% were unable to do so because of inadequate staff and frequent changing of the reporting format. The District Programme Managers (DPMs) were not satisfied with their fixed salary. But they were satisfied with their job. In some districts the space available for the functioning of District Programme Management Unit (DPMU) are rather too small. CONCLUSION: Standardized uniform formats and guidelines should be made available to all DPMUs at the beginning of planning process. A comprehensive pre-service training for the DPMU staff including practical sessions, field exposure on district health planning, financial management, technical and administrative issues needs to be ensured.

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OBJECTIVES: To study the structure and functioning of Rogi Kalyan Samitis (RKS) in community health centers of Uttarakhand state and observe the availability and utilization of funds by RKS. METHODS: A cross-sectional study was conducted during September - December 2008 in two districts of the state. Eight community health centers (CHC), four from each district were selected by simple random sampling. In-depth interview of all member secretaries and members of RKS, 20% of in-patients and exit interview of 10% OPD patients of selected CHCs was done with interview schedules. In each CHC, two focus group discussions were conducted (one for males and one for females). RESULTS: RKS was established in all selected CHCs, according to the guidelines issued under the NRHM. The main functions performed by the RKS included infrastructural strengthening of the CHCs, improvement in basic facilities, ensuring provision of emergency medical care, free medicines, basic laboratory and radiological investigation, transport facilities and hospital waste management. The flow of the central grant was found to be smooth. The expenditure however is below the mark in absence of predefined protocols. Only 53.30% of total funds available were utilized during the study period. Approximately three-fourth of the funds was utilized in civil work (32.70%), furniture and electrical works (28.28%) and in fuel (12.98%). More than 80% of all patients informed about availability of medicines, drinking water facilities, clean toilets and rooms in CHCs. However, most of the community members were not aware regarding the existence, objectives and the activities of RKS.

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OBJECTIVES: To understand the logistics and supply management system of drugs at different levels within the district health care delivery system of Dharbanga in Bihar. METHOD: This was a cross-sectional study in 3 Primary Health Centres (PHCs), 3 Additional Primary Health Centres (APHCs) and 6 Subcentres (SCs) during September-December 2008. The study subjects were Civil Surgeon, Pharmacists, Medical Officers, ANMs. Data was collected using qualitative and quantitative techniques from different stakeholders. RESULT: The health centers were severely understaffed and drug stores are managed by unqualified/untrained pharmacists. Drug list available was not fully matching with the need/requirement of the population. The vital and essential drugs required for various health centers were of short supply or unavailable in medical stores. MOs were unaware of budget allocation/allotment for their centers. Demand estimation of the drug items were not done scientifically hence quantity of drugs supplied was not in consonance with community needs. The existing guidelines were not followed as a result drugs like Zinc, Misoprostol and Magsulf were not available at the PHCs or APHCs. The storage and transportation facilities of drugs were found to be poor. Community members were not satisfied with the availability of drugs. CONCLUSION: The logistic and supply system of drugs in Darbhanga district is very weak, hence the needs of the catering population related to medicines was not fully met.

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There has been a rise in the hospital acquired as well as the community acquired Methicillin Resistant Staphylococcus Aures (MRSA) infections in the recent years. We conducted a study to detect colonization rate of staphylococci in the nasopharynx in children and prevalence of MRSA nasopharyngeal carriage in pediatric population. The study included 1300 nasopharyngeal swabs collected from school going children between six to ten years age from Nagpur urban community and inoculated on blood agar for isolation of staphylococci. Isolates were subjected to antimicrobial testing and staphylococcus aureus isolates were also Phage typed at Maulana Azad Medical College, New Delhi. Staphylococci were isolated from nasopharynx of 138 (10.62%) children. Nasopharyngeal carriage of staphylococcus aureus was detected in 7.38% children. Methicillin Resistant Staphylococci constituted 4.16% of the Staphylococcus aureus strains. Colonization rate of MRSA in the pediatric population in the community was detected to be 0.31%. Methicillin Resistant Staphylococcus aureus nasopharyngeal carriage, though not at very high rate, is prevalent in the pediatric population in the community.

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OBJECTIVES: To find out the status of utilization of MCH services after the induction of the indigenous system of medicine (ISM) lady doctors and CNMs for 24 x 7 services and the acceptance of this innovation by the health system and the community. METHODS: This was a cross-sectional descriptive study conducted during October to November 2008 in 10 blocks of 5 selected districts in Uttar Pradesh. Study subjects (CMO, MO I/C, ISM lady doctors, GNMs, PRI members) were interviewed and FGDs were also conducted. RESULTS: Shortages of medical and paramedical staff as well as facilities for institutional delivery at the district and block level were revealed. Only 6 out of 16 ISMs were trained. Knowledge of the ISMs/GNMs was lacking in many essential components of MCH including identifying high-risk pregnancy, high-risk newborn for urgent and timely referral. 36% could identify high-risk pregnancy and only 18% used partograph during labour. About 68% of the ISMs/GNMs were dissatisfied regarding honorarium, 59% with work conditions and 55% with delivery instrument. Induction of ISMs/GNMs were welcomed and accepted by medical officers and panchayets. Delay in payment of honorarium and pay disparity between MBBS doctors and ISM lady doctors and lack of proper logistic support were some of the problems facing the ISMs/GNMs. CONCLUSION: For sustenance, in service training, provision of transport and accommodation, logistic support, well equipped labour room, timely monitoring and supervision, removal of pay disparities need to be ensured. The contractual appointment should also be made permanent and lucrative.

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A study was organized to orient the district level health sector disaster managers to review, revise and update the health sector contingency plan (HSCP) against common natural calamities, followed by its execution and evaluation. An inter-state 3 days workshop was organized at Kolkata during the month of October 2004 to review the district level HSCP and its execution in 5 (five) worst affected districts. The District Health Officers, in consultation with the investigators, revised and updated the HSCP. Thereafter, status survey was conducted to examine the implementation of the contingency plan. During flood, the HSCP was found to be followed in the districts. Control room, construction/identification of flood shelter, sanitation and other preventive measures were taken care of, with an exception of Kendra Para, where lack of man power was noted. Technical support, trained manpower, relief materials, ambulance, Communication and information system were present in all the 5 (five) districts.

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BACKGROUND & OBJECTIVE: A scheme of Mobile Medical Units (MMUs) has been initiated under NRHM in Jharkhand state from the year 2008 in an effort to take healthcare to doorstep of the public in rural areas, especially in underserved areas. The objective of the study was to assess the functioning of Medical Mobile Units in Jharkhand through rapid assessment mode. METHODS: A cross sectional descriptive study was conducted in three selected districts of Jharkhand state during September-December 2008. Data was collected through in-depth interview using semistructured schedules with State Programme Managers, Chief Medical Officers, District programme managers, staff of MMU and beneficiaries. RESULTS: The scheme provided curative and diagnostic facilities like X-ray, ultra sound, and blood test to the poor and under-served areas. More than 90% of clients reported availability of medicines in MMUs. However, more than 90% of them had no prior information about the day and time of visits by the MMUs. Some of the operational difficulties being faced by the scheme were reported to be vibrations of generator disturbing the lab investigations, poor condition of the road, unwillingness of doctors to go in far-off areas and heavy workload. CONCLUSION: The scheme of MMUs has been successful in providing health services to the poor and under-served areas.

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