Maternal Health & Child Care – the aspect of attention
It has been over two decades since the International Conference on Population and Development (ICPD) formulated a reproductive health agenda for the world, and as of 2015, the MDG has not been achieved as per target. Whether developing countries like India will be able to improve health outcomes among women and children through comprehensive, good-quality services that are responsive to their needs is an urgent question. India has not yet achieved the momentum required for reproductive health interventions, quality improvements and financing arrangements to ensure that the women – particularly the ones who seek care from the marginalized sections – are able to achieve the good outcomes called for by these global agendas. However, India has embarked on health sector reforms both – the opportunity these reforms present and the challenges they pose need to be met to improve the access to reproductive health care services that are of a certain quality.
- Low public health care spending: Only 1.2% GDP is spent on health by Government and another almost 3.3% GDP is private spending, forming high 71% out-of-pocket spent. Private sector forms 93% of the hospitals and 85% of doctors in India.
- Significant Urban-Rural divide: 80% of doctors, 75% of dispensaries, and 60% of hospitals are situated in urban areas, making 72% of rural population vulnerable.
- Shortage of doctors and skewed doctor/nurse ratio: India has 0.5 per 1000 doctor to population ratio and 2.19 nurses and ANMs per doctor, making it rank 52 of 57 countries facing HRH (Human Resources for Health) crisis. HRH shortage of 64% in rural facilities (SHCs, PHCs and CHCs), with higher deviation across states and tiers.
- Lack of primary care infra: In India tertiary health care market is getting established, secondary is growing well, but the primary care (dominated by rural and urban poor) is fairly unserved with 33% – 90% infra shortages (in terms of numbers of SHCs, PHCs and CHCs).
Most above challenges with roots in policy & budget, infra & systems, human resources & skills, operations & governance, and further exasperated by very diverse social determinants in India has direct bearing on maternal, child and adolescent health care services provision, delivery and outcomes. While there is definite improvements since last two decades in key outcomes related to child and maternal health care in India, we are still away from set targets.
- High Child Mortality: Under 5 Mortality is 49 deaths per 1000 live births, Infant Mortality Rate is 40 per 1000 live births, 89% coverage on one year child against measles;
- High Maternal Mortality: 140 per 1,00,000 live births Maternal Mortality rate, 87% proportion of births attended by skilled personnel, 6% prevalence of sexually transmitted and reproductive tract infections;
- High unwanted fertility: Total Fertility rate is 2.06 in urban and 2.98 in rural, high unmet need for family planning with 6.2% for spacing methods and 6.6% for limiting methods among currently married women;
While there is definite need to improve public health systems and there are plans to increase public health spending by Govt. to 1.6% GDP by 2017 (against recommendations of 2.5% GDP), there needs focus on the human resource component which plays a pivot role in implementation of reproductive maternal health intervention. It is important to recognize the existing level of commitment based on the motivational levels of the ground level working team (The Accredited Social Health Activist – ASHA) and its effect of quality of health service received by the people. While many schemes and interventions are made with focus on receivers (patients) in order to uplift the quality of health care in India, there is hardly any scheme implemented for benefit or with focus on ASHAs. (We are ruling out the remunerations given as they mainly dependent on the Village Health & Sanitation Committee for conducting Village Health & Nutrition Day and on the JSY payment). Also, it is to be noted that the on-boarding trainings given at start of engagement is the only training which an ASHA worker gets. There is no provision of refreshment trainings. Regular monitoring and assessment of ASHAs can be one way of continuous capture of feedback and means to facilitate them in improving the deliverables.
To increase the quality of service it is essential that these ground level implementers are motivated enough to provide right and necessary services. With right service providers, we can ensure a better quality of health services is provided.