Impact of functional VHSCs on maternal health and the delivery of antenatal and postnatal healthcare by ANMs in Mayurbhanj district of Orissa-Sunita Singh


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  • Note: Participation of village level functionaries are uniform in both the villages but presence of PRI, SHG & VHSC members are there in VHSC villages
  • Impact of functional VHSCs on maternal health and the delivery of antenatal and postnatal healthcare by ANMs in Mayurbhanj district of Orissa-Sunita Singh

    1. 1. Impact of functional VHSCs on Maternal Health and the delivery of Antenatal and Postnatal health care by ANMs in Mayurbhanj district of Odisha Sunita Singh Jiban Krushna Behera
    2. 2. <ul><li>According to National Rural Health Mission guideline </li></ul><ul><li>There should be one Village Health and Sanitation Committee (VHSC) in every revenue village </li></ul><ul><li>Role of VHSC is to plan and monitor the activities under NRHM at the village level </li></ul><ul><li>The VHSCs monitor functioning of Auxiliary Nursing Midwifes (ANM) to ensure service delivery </li></ul><ul><li>The VHSCs ensure stipulated duties of the ANM related to maternal health on Fixed Health Days & service delivery. </li></ul>
    3. 3. Geographical Area <ul><li>Bangriposi block in Mayurbhanj district of Odisha </li></ul><ul><li>Mostly inhabited by tribals 67.8 % </li></ul><ul><li>Literacy rate is 38%. </li></ul><ul><li>One of the districts for Community Monitoring – First phase </li></ul>
    4. 4. Selection Procedure <ul><li>7 VHSCs trained as part of Community Monitoring </li></ul><ul><li>7 VHSCs were selected randomly out of 81 villages which were not part of Community Monitoring. </li></ul><ul><li>The control villages didn’t have ANM trained under the community Monitoring process. </li></ul>
    5. 5. Parameters of VHSC under C M <ul><li>The VHSCs were 3 months old </li></ul><ul><li>Structured as per NRHM guideline </li></ul><ul><li>Members were trained under CM process </li></ul><ul><li>Meeting at least once in a month. </li></ul><ul><li>The ANM, ASHA, AWW are present in the meetings. </li></ul><ul><li>Village Health Register was already created </li></ul>
    6. 6. Data collection Methods & Tools <ul><li>Method: Observation and Interview </li></ul><ul><li>Observation of 28 Fixed Health day across 14 villages CM and Non CM over two months </li></ul><ul><li>Individual interview with 40 mothers who have delivered in the last 3 months </li></ul><ul><li>Tools : </li></ul><ul><li>Observation </li></ul><ul><li>1 VHSC scoring Tool- Composition of VHSC, Meeting held in last three months, discussion topic, sensitization, preparation of village health register </li></ul><ul><li>2 Fixed health day scoring Tool- Presence of personnel, attendance of beneficiaries, Ante Natal Check-ups, Post natal Check-ups </li></ul><ul><li>Interview </li></ul><ul><li>3 Maternal health scoring Tool - Ante Natal Care, Intra Natal Care, Post Natal Care and Neo Natal Care </li></ul>
    7. 7. Findings
    8. 8. Fixed Health Day Comparison <ul><li>Participation of village level functionaries are uniform but presence of PRI, SHG & VHSC members are more in CM VHSC </li></ul>
    9. 9. Maternal Health Services Score <ul><li>Scoring is done based on following parameters </li></ul><ul><li>ANC score – Registration, ANM visits, Wt check, BP check, Abdomen, TT 2 doses, IFA, ANM advice </li></ul><ul><li>INC score – Inst. Deliv., Deliv advice, ASHA accomp, risk related counselling, ANM advice. </li></ul><ul><li>PNC score – PNC check, No of checks, ANM counselling on Diet, Rest, Hygiene, and Contraception </li></ul><ul><li>NNC score – Temp Monitoring, Counseling on Breast feeding and Immunization (BCG, Polio and DPT) received </li></ul>
    10. 10. ANC service at FHD camps compared
    11. 11. PNC services at FHD compared
    12. 12. Services received by Women
    13. 13. Maternal Health Services CM-VHSC villages Non CM-VHSC villages PREG_REG 12 WEEKS 70% 0% PREG_REG 12-14 WEEKS 10% 65% PREG_REG BY AWW 95% 95% IFA BY ANM 95% 95% INSTITUTIONAL DELIVERY 60% 60% ANM ASST. HOME DEL 15% 0% ASHA ACCOMPANY 65% 60% ADVICE ON COMMON PROBLEM 90% 0%
    14. 14. Cont…. . CM VHSC villages Non CM-VHSC villages Referral by ANM for immediate medical attention 50% 0% Check up after delivery 65% 20% Advice for early breast feeding 95% 0% Advice for diet 95% 0% Personal Hygiene 75% 5% Neo Natal Care 95% 10%
    15. 15. Conclusion <ul><li>In all the fixed health day ANM, AWW and ASHA were present; but in CM VHSC villages PRI, SHG and VHSC members were also present </li></ul><ul><li>In both CM VHSC and non CM VHSC village Fixed health day, IFA distribution and TT injection is being done But check-ups of abdomen, BP and measurement of weight is being done primarily in CM VHSC villages </li></ul><ul><li>Most mothers received counseling in CM VHSC villages but none in non CM VHSC villages </li></ul><ul><li>Women from CM VHSC villages received more ANC, INC, PNC and Neo-natal care services compared to Non CM VHSC villages. </li></ul><ul><li>Non CM VHSC villages hardly received any PNC or Neo Natal Care services </li></ul>
    16. 16. Some Positive Indications … <ul><li>Formation of VHSC in the village is promoting the presence of SHG, PRI and VHSC members during Fixed Health Day </li></ul><ul><li>Presence of trained VHSC members improved the range and quality of services being provided during the FHD </li></ul><ul><li>Women from villages with trained VHSC receive substantially more services – especially with regard to PNC and neo-natal care </li></ul><ul><li>PNC and neo Natal care is known to be low compared to ANC and Institutional delivery </li></ul><ul><li>The formation and training of VHSCs has substantially improved the range and quality of services given by ANM in the villages </li></ul>
    17. 17. Recommendation <ul><li>1 Formation of VHSC under Community Monitoring should be adapted for all States </li></ul><ul><li>2 There is need to ensure composition of VHSC as per the Guideline </li></ul><ul><li>3 Attendance in VHSC meetings of PRI, ANM and SHG members should be ensured </li></ul><ul><li>4 More rounds of VHSC member training is required </li></ul><ul><li>Community Monitoring should be upscaled in all the villages </li></ul><ul><li>Documentation of processes and outcomes </li></ul><ul><li>Constant re-evaluation of Community Monitoring processes </li></ul>
    18. 18. <ul><li>THANKS </li></ul>