CONCURRENT EVALUATION OF FUNCTIONING OF ASHA IN RURAL POPULATION OF MEERUT Ritesh Sharma S.K. Garg H. Chopra S.K. Bajpai T. Bano S. Jain A. Kumar Department of Community Medicine L.L.R.M. MEDICAL COLLEGE, MEERUT
INTRODUCTION Maternal and child health programmes began in India in the early 1950s. And one of the latest addition to the series of programmes is Janani Suraksha Yojna, a safe motherhood intervention under National Rural Health Mission, launched on 12 April, 2005
INTRODUCTION The objective of JSY is to reduce maternal and neonatal mortality by promoting institutional deliveries. In order to mobilize the community in remote rural areas and urban slums, community based volunteers named as Accredited social Health Activist (ASHA) have been appointed.
INTRODUCTION Concurrent Assessment of Health and Family Welfare Programs and Technical Assistance to Districts of Uttar Pradesh (CATA, 2007) was done taking into account various maternal and child health indicators Since then no study has been done in rural areas of Meerut to see the status of maternal and child health. So this study was planned to see the outcome of JSY.
OBJECTIVES The present study was planned with the objectives To see the outcome of JSY in terms of outcome indicators of ASHA To see the improvement in the status of maternal and child health care
MATERIAL & METHODS SAMPLING W.H.O. certified 30 cluster sampling MATERIAL 210 mothers who delivered in the last one year (7 from each cluster) 210 children of 12-23 months age group (7 from each cluster)
MATERIAL & METHODS DISTRICT-MEERUT RURAL POPULATION=1518984 1518984 URBAN 30CLUSTERS X 210 (7 from each cluster) X 210 (7 from each cluster) children of 12-23 months Mothers who delivered within last year
MATERIAL & METHODS Period of Study : January 2010 to June 2010 The study population was surveyed on the basis of pretested questionnaire The results so obtained were compared with the observations of CATA report to see the outcome of ASHA’s work in terms of maternal and child health indicators as well as outcome indicators of ASHA and Chi-Square test was used to see the significance of changes.
OBSERVATIONS Outcome indicators of ASHA which have shown significant change are as follows- OUTCOME INDICATORS OF ASHA
CHANGES IN OUTCOME INDICATORS OF ASHA OBSERVATION When the findings of present study were compared to the findings of CATA report in terms of outcome indicators of ASHA it was observed that 11.51% (p<0.05) 54.23% (p<0.001) 26.54% (p<0.001) 23.56% (p<0.001) 13.67% (p<0.001) Proportion completely immunized in 12-23 months age –group Proportion of institutional deliveries Proportion of deliveries with skilled assistance Proportion of newborns who were weighed Proportion of children with diarrhoea who received ORS
The outcome indicator of ASHA that could not be compared are % of fever cases who received chloroquine within first week in an malaria endemic area; % of JSY claims made to ASHA % of unmet need of contraception among BPL
COMPARISON OF MATERNAL CARE INDICATORS PROPORTION WITH 3 OR MORE ANTENATAL CARE PROPORTION OF WOMEN WHO CONSUMED 100 OR MORE IFA TABLETS PROPORTION WITH ANY ANTENATAL CARE 50.52% (111 of 221) 62.74% (131 of 210) 22.62% (50 of 221) 46.61% (103 of 221) 64.28% (135 of 210) 36.66% (77 of 210) (p<0.001) (p<0.01) (p<0.01) CATA PRSENT STUDY
COMPARISON OF MATERNAL CARE INDICATORS (CONTD.) PROPORTION WITH POST NATAL COMPLICATIONS CONTRACEPTIVE PREVALENCE 16.66% (35 of 210) 12.52% (27 of 221) PROPORTION WITH ANY POSTNATAL CARE PREVALENCE OF RTI/STI 11.42% (24 of 210) 25.99% (217 of 835) 40.47% (85 of 210) 4.7% (9 of 221) 44.07% (368 of 835) 57.61% (121 of 210) (p<0.01) (p<0.01) (p<0.01) (p<0.01) CATA PRSENT STUDY
Other maternal care indicators which had apparently improved but were found to be statistically non significant Proportion of recently delivered women with appropriate number of TT injections (84.6% vs 86.6%) Proportion of women who received 100 or more IFA (42.9% vs 48.5%) Proportion of deliveries conducted by ANM/LHV (4.6% vs 4.7%)
Some maternal care indicators which had apparently declined but were found to be statistically non significant were- Proportion of women with consummation of marriage before the age of 18 years (22.7% vs 26.9%) Unmet need of family planning (23.5% vs 32.3%)
OBSERVATIONS INDICATORS THAT DID NOT IMPROOVE AS PER THIS STUDY
CONCLUSION ASHA has made significant improvement in majority of maternal and child health indicators but ASHA has not been able to make an impact on improving the contraceptive prevalence and immunization coverage.
RECOMMENDATIONS Cash assistance being provided for institutional deliveries has proved to be a lucrative way of bringing in women for institutional delivery. But it should not continue indefinitely and should be stopped in a phased manner once people develop a habit of going to a health facility for delivery purposes or else the problem of population explosion of our country is going to swell up enormously beyond control.