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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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

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