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184 |
SURVEY AND PROGRAMME IMPLICATIONS |
National Tuberculosis Institute, Bangalore-Report
on the Baseline Survey-DANIDA Health Care Project, Tamil Nadu, 1988,
NTI, Bangalore, Vol. 1, 1-88. |
SURVEY DESIGN : A baseline survey was carried
out in Salem and South Arcot districts of Tamil Nadu
which were covered under the Danish International Development Agency
(DANIDA) Health Care Project. This work was entrusted to the National
Tuberculosis Institute (NTI), Bangalore, which had more than twenty
years experience in conducting large scale surveys in the health
sector. Overall guidance was provided by a Steering Committee under
the Chairmanship of Director (Evaluation), Ministry of Health and
Family Welfare, Government of India. The baseline survey of the
demographic-cum-socio economic features, health status and utilization
of health services was considered necessary to provide bench
mark data on the beneficiaries. Equally important was to have basic
information on the rural health care delivery system so that the
inputs could be directed towards factors that needed strengthening
and the benefits accruing maximized. The rural area of Salem and
South Arcot districts were bifurcated into two strata. Stratum
I consisted of all villages in which a Primary Health Centre
(PHC) or sub-centre was located and the remaining villages constituted
Stratum II. A sample of 40 villages were selected. The equal
number of villages were allocated in each stratum, proportional
to its share of the total rural population of the district. The
selection of villages was made with probability proportional to
size (population) of the villages, after stratification by size.
Every fifth household was selected on a systematic random sample
basis from each village. Thus, 2,000 households were selected in
each district and 4,000 in the project area. In all, eight questionnaires
were prepared for the baseline survey-four for collection of information
from PHCs, Medical Officers of PHCs, Field Health Workers (FHW)
and Trained Birth Attendants (Dais) and the remaining four viz.,
Household Schedule, Morbidity Schedule, Eligible Women Schedule
and Children Schedule from the selected households. The field work
was carried out during July to November 1983 by twenty investigators
specially recruited and trained by NTI under the close supervision
of five experienced Social Investigators of the Institute. Keeping
in mind the importance of high coverage, the field teams put in
lot of efforts and thereby succeeded in collecting information
from 99.7% of the 4,000 households selected for the survey.
Method of data collection for MOs was through a pretest questionnaire,
for PHC through a questionnaire-cum-interview schedule, for FHW
and Dai through interview schedule and village appraisal was done
through group discussion (group consisted of village officials,
informal leaders, members representing different castes, classes
and women). The collected data after careful scrutiny by the statistical
staff of the Institute was analysed, tabulated and reported.
FINDINGS: I. Socio-economic features:
a) Literacy : Nearly half of the population of age five or more
were illiterate. SC/ST population had more illiterates (58.9%) than
"others" (45.8%) and had less who had school education
of any level. Percentage of literates without schooling was negligible.
There were no literate females in 53.8% of households (60.5% among
SC/ST). In 24.9% of the households the highest level of female education
was I to V standard and 17.7% VI to X standard. b) Employment:
In the labour force of age group of 15-49 years, about 60% were
employed. Employment among older persons was 53.5%. Children of
10-14 years of age, 6.3% were employed. This was about five times
higher in Salem compared to South Arcot. Out of these employed,
45.2% were general labourers, 23% agricultural labourers and 20.6%
artisans. Child agricultural labourers were more among females.
The large percentage of persons who are not fully occupied for the
whole year (about three-fourths of those aged 15-49 years and a
substantial proportion of the elderly persons and grown up children)
could be mobilised during their slack periods to carry the message
of better health and hygiene as well as of the small family norm
and thereby improving their financial condition also to some extent.
c) Assets: About half of households did not possess any land
and about 30% had less than two acres. Those not possessing any
land were more among SC/ST (67.6%). Productive assets were not possessed
by 65% of the households. d) Living conditions: Cowdung smeared
floors were most common (65%) followed by cement floor (25%). This
was more common in South Arcot (76%) compared to Salem (51%). Kerosene
was used for lighting by 69% and electricity by 29%. Most of the
households used foraged firewood (68%) for cooking. Almost all households
(96.0%) let out used water into open place. Household waste was
thrown into open yard by 65.0% and 34.6% used manure pit. Open field
was used for human waste disposal by 98.4%. Provision of better
sanitation arrangements and education for their utilisation needs
to be taken up on large scale. The most common pests were mosquitoes
(88%), flies and ants (76%), rats (40%) and cockroaches (27%). Nearly
all (89%) did nothing to control these pests. The reason for this
have to be investigated and suitable steps taken to remedy the situation.
e) Staple diet: Main type of food was rice (50%), ragi (30%)
and millets (20%). f) Major problems: The major common problems
were non- availability of water (54%), health facility (49%)
and transport (26%). All the three were mentioned by more households
in Salem. More SC/ST households mentioned non- availability of "water"
and "transport".
II. Demographic profile: The estimated
rural population of 64 lakhs in the project area at the time of
the survey (second half of 1983) compared favourably with that of
60 lakhs from the 1981 census. Of the population of age 15 years
or more, 67.9% were currently married and 21.5% never married. The
birth rate for 1982 is estimated to be 30.0 per thousand population
as compared to SRS estimate of 27.7 for Tamil Nadu. The birth rate
was higher in South Arcot and in Stratum II. The birth rate among
SC/ST was higher in both strata of both the districts. About 98%
of total births were live births. Fertility was highest in the age
group 20-24 years (254) followed by 25-29 years (206) and 30-34
years (143). It was higher in South Arcot for 25-29 years, 30-34
years and 40-44 years as compared to Salem. The death rate for 1982
is estimated to be 11.0 per 1000 population. The infant mortality
rate for 1982 is estimated to be 34 per 1000 live births compared
with census. This gross under estimate may probably be due to some
reservation or reluctance to report infant deaths possibly due to
practice of infanticide by some sections of the population. As stated
earlier, the proportion of child deaths out of total deaths was
nearly double among females as compared to males. Of the eligible
women (currently married and of age 15-49 years), 22.1% were in
age group 25-29 years, 20.6% in 20-24 years, 18.0% in 30-34 years
and 16.3% in 35-39 years. Thus, 42.7% were in the age group of 20-29
years with the highest fertility. Almost all eligible women had
only one marriage. They had married more frequently at the age of
15-17 years (46.0%) followed by 18-20 years (32.7%). While 11.7%
of the eligible women had no child. 38.8% had the first child at
18-20 years and 28.0% at 15-17 years. At the time of the survey
about one tenth of the eligible women were pregnant.
III. Morbidity: During the month prior to
the survey 15.4% were sick (22.2% in South Arcot and 10.6% in Salem).
Among the common diseases during the three months prior to the survey,
fever/flu was mentioned by 27.9%. Common cold/cough together with
conditions affecting the respiratory system were reported by 22.6%
and occupied second position. Conditions affecting the digestive
and excretory systems (including stomach ache) were mentioned by
only 13.4%. This is quite surprising since only 23.3% of the households
used tap water for drinking. The 70% of households who used ground
water for drinking were apparently getting water without contamination.
About 42% of the sick persons did not seek treatment. This
proportion was more in South Arcot (47%) compared to Salem (33%).
The reasons for such a large proportion of the sick persons not
seeking treatment needs to be investigated. While 39% of those who
sought treatment did so from Government Health Institutions, 34%
went to private doctors/institutions. More than half did not spend
any money on treatment. About one fifth spent less than Rs.50/ and
7.3% between Rs.50/ and Rs.100/ . Tuberculosis prevalence rate
was 5.3 per 1000 population and is well within the expected
range obtained from sophisticated and costly prevalence surveys.
Among the tuberculosis cases, nearly 90% had cough for 15 days or
more. More than 95% of the cases had taken action to relieve their
symptoms and the vast majority had gone to Government Health Institutions.
Some tuberculosis cases had visited more than one type of health
institutions in search of treatment. These findings are also quite
similar to those obtained from sociological investigations in the
field of tuberculosis. Prevalence rate of leprosy was 1.8 per
1000. The disease was more common in South Arcot (2.7) compared
to Salem. When anyone is sick, 61.5% of the households go to Government
doctor, 81.3% among SC/ST against 55.0% among "others".
Services of private doctors were availed by 35.7% (16.9% among SC/ST
compared to 41.9% among "others"). About 60% travel 5
kms or more to get treatment from Government or private doctor.
The main reason for going to Government doctor was free treatment
(75.4%). Only 15.0% felt that the treatment by Government doctor
was good compared to 81.2% who considered that treatment by private
doctor was good. Among various facilities available within 3 kms,
29.7% of households utilised the services of doctor of modern medicine,
26.1% of homeopath and 13.2% vaidya. Among those who had availed
services at Government hospitals or PHC, 63.0% and 68.7% respectively
had no difficulty. The more frequent difficulty mentioned was "long
waiting time". During the two months prior to the survey, 53.5%
of the households were visited by female health workers. More households
were visited in South Arcot and among SC/ST. Family Planning:
About one third of the births were attended by relative or friend,
19.4% by untrained Dai, 17.4% by doctor. Among currently pregnant
women, only 32.2% had registered for ante natal care. About 60%
were not given any dose of tetanus toxoid, while 15.4% got one dose
and 10.7% two doses. Less than half of currently pregnant women
had received iron and folic acid. About two thirds of the deliveries
were conducted at home (73.9% in South Arcot compared to 56.5% in
Salem and 77.3% among SC/ST against 62.2% among "others").
About one fourth of the mothers were assisted by doctors at the
time of delivery, 27.0% by Dais, 9% by Female Health Workers and
35.7% by others. Help by Dais was more common in South Arcot. Currently
married women of age 15-49 years (eligible women) were 161 per 1000
population. Nearly three fourths of them were illiterate (82.4%
among SC/ST compared to 69.3% among "others"). About one
fifth of the eligible women had tried to prevent pregnancy, the
vast majority by using family planning methods. Though efforts to
prevent pregnancy were comparatively more among literates, the difference
was quite small. Those with 3 or 4 children more often tried to
prevent pregnancy. This is not likely to have much impact on curbing
of population growth. About 65% of those sterilised were below 30
years of age and the mean age of sterilisation was 27.9 years
(27.3 years in Salem compared to 28.7 years in South Arcot). About
half of the sterilisations were done soon after delivery, percentage
of sterilised steadily decreased with increasing age of youngest
child. More than three fourths felt that there was no advantage
or disadvantage in having a large family. While 10.5% felt that
large family led to more income, 8.5% felt that it was a burden.
Among the family planning methods, male and female sterilisation
were known to 94.0% and 95.8% respectively. Nearly half of the eligible
women stated that they have not seen the red triangle in PHC/SHC.
Those who have seen and understood the message formed only a small
proportion. About two thirds of the eligible women did not know
that abortion can be done at Government hospitals and 71% did not
know that it can be had free of cost.
|
KEY WORDS: HOUSEHOLD SURVEY, DEMOGRAPHIC SITUATION,
SOCIOECONOMIC ASPECTS, MORBIDITY, HEALTH SERVICES, FAMILY WELFARE
SERVICES. |
185 |
ROLE AND FUNCTIONS OF HEALTH PERSONNEL IN RURAL
HEALTH CARE |
National Tuberculosis Institute, Bangalore:
Report on the Baseline Survey Danida Health Care Project Tamil
Nadu, 1988, NTI, Bangalore, Vol.2, 1-23. |
A comprehensive baseline survey was undertaken
in two contiguous districts of Salem and South Arcot of Tamil Nadu
for strengthening the health and family welfare services with the
assistance of the Danish International Development Agency (DANIDA).
The main objectives of the study were to obtain data on the prevailing
health status of population, the village organisations and
leadership in health matters and important aspects of the health
system of the area, such as Primary Health Centre (PHC), Medical
Officer (MO) and para medical personnel identified as field health
workers.
a) Medical Officers: A questionnaire was
canvassed by post mainly in June/July 1982 after briefing the Medical
Officers at their monthly meetings at Health Unit Districts. Out
of 221 posts of Medical Officers (MOs) in 72 Primary Health Centres
(PHCs), 68 were vacant. Of the 153 MOs in position, replies were
received from 119 (78%), 69 in Salem and 50 in South Arcot. Among
these MOs, 87 were men and 31 women, and 71% were in the age group
30-39 years. Proportions of married were 87% in men and 71% in women.
Of the 119 MOs, 111 were qualified in allopathic system of medicine.
Though 52% stated that they had training in rural health services,
only 26% mentioned that they were trained at Health & Family
Welfare Training Centres (HFTC). About 50% of MOs had total work
experience in Health Department of 1-4 years and 25% of 5-8 years.
Of the average service of 4.62 years in this department, 3.09 years
were in the PHCs where they were working at the time of the survey.
The overall ranking of functions of MOs was 1) curative (60.5%),
2) Preventive (41.2%), 3) Promotive (23.5%), 4) Supervision
(35.3%) and (5) & (6) Public relations (23.5% and 41.2% respectively).
Administration had the highest percentage for 2nd and 4th rank.
MOs trained in rural health, however, had given more importance
to working with block officials as compared to other MOs. Though
nearly 75% MOs had stated that they plan a weekly schedule of work,
while giving the detailed schedule, a maximum of 48 MOs had included
outpatient clinic on any day of the week and the position with regard
to important managerial functions and rural services was much worse.
About one third did not conduct any mobile clinic during the month
prior to the survey; 28% did not answer the question and the remaining
40% had conducted 2 or more clinics. Most of them have provided
curative treatment and not promotive or preventive services. About
43% stated that there were no voluntary organisations working in
their area and more than 80% of MOs stated that private medical
practitioners did not take any help from them. About 50% said that
neither the private practitioners nor voluntary organisations participated
in the health activities i.e., immunisation, health camps and family
planning, conducted in the villages. About 22% stated that villagers
did not participate in the health activities. While 23% had no difficulty
in working at PHCs, 30% mentioned lack of facilities at PHC, 18%
each stated personal problems, heavy work load/lack of staff and
more administrative work and 16% transport problem. About 30% mentioned
that there were no problems, 44% mentioned staff vacancies, 24%
lack of cooperation from staff and 14% staff changes. While 47%
found no advantage in working in a PHC, 27% mentioned about provision
of better services to the rural areas, 18% about better understanding
of basic health problems and 8% wider experience including management.
About one third only gave the relevant suggestions for improvement
of the centres. The MOs at PHCs can play a crucial role in the delivery
of health services in rural areas. They are the leaders of the health
team at the grass root level with adequate technical knowledge and
a very high degree of acceptability. The findings of the present
study are therefore, very valuable and the shortfalls and deficiencies
listed below have to be given adequate attention: i) All posts of
MOs and staff to be filled. ii) Provision of facilities to staff
at PHC. iii) MOs should give more attention to public health activities.
iv) Adequate supervision of work of MOs and special training
to them in rural health.
b) Primary Health Centre: In the rural areas, Primary
Health Centre (PHC) is the nerve centre of the health services both
institutional and community oriented. It was planned to obtain some
basic data on the organisational structure, area of responsibility
and functioning of PHCs and utilisation by the people of the services
provided by PHCs. All the 72 PHCs in the project area were studied
through a questionnaire cum interview schedule. Further,
data and clarifications were obtained through interviews from the
Medical Officer In charge of PHC and knowledgeable staff such as
Health Inspector (General) and Block Extension Educator. The data
were collected during June 1983 to January 1984. The area of
coverage of 82% of PHCs was within 300 sq. kms., 194 sq.kms
in Salem (District I) and 237 sq.kms in South Arcot (District II).
Thus, PHCs in South Arcot generally covered more area and more villages
and served larger populations. About half of the PHCs could not
provide information on scheduled caste and scheduled tribe populations
who are part of the target population under the project. Out of
1175 sub centres for which information was available, 72% were within
20 kms. of PHC. This was so for 84% of 548 sub centres in District
I but only for 62% of 637 sub centres in District II. The average
distance of sub centres from PHC was 12.3 kms. in District I, 18.4
kms (one and a half times) in District II and 15.7 kms at project
level. Organisation: The average number of villages per sub
centre was almost the same in both districts (3.3 and 3.4). A sub
centre covered an average population of 4,800. All but two PHCs
were in standard building and all were electrified. Nearly half
of the PHCs were located outside the village after which it was
named. No other medical facility was available within one kilometer
reach in 40% of PHCs in District I and 70% in PHCs in District
II. Vacant posts were more among Medical Officers (37.6%) and
Medical Officers (indigenous) (36.4) and less among para medicals
(16% among supervisors and 10% among workers). While about one third
of the PHCs did not have separate laboratory, about half did not
have separate injection/dressing room and Minor OT. While most of
the PHCs had refrigerator and microscope, 77% of the former and
93% of the latter were in working order. Functions: The main
training activities of PHCs were Dais Training & Orientation
Training Camps for which the average number of courses per PHC during
the year prior to the survey were 3.1 and 2.6 respectively. Health
education activities were mainly confined to group meetings
and distribution of publicity material, with average annual performance
of 70.3 and 53.8 respectively. Average outpatient attendance per
PHC during the previous year was about 36,500 of which 19,600 were
new outpatients. On an average, 98 patients were admitted in beds
in a PHC (120 in District I and 71 in District II). For all the
MCH activities except distribution of iron and folic acid
to women and giving polio vaccine to children, District II had fared
much better than District I. While for the other two activities
mentioned above District I fared better. There was no uniformity
between PHCs and districts in the number of tablets of iron and
folic acid given per woman. Tuberculosis : The average percentage
of persons with symptoms of TB was 1.8 (2.1 in District I and 1.5
in District II) as compared to the expected rate of 2.6% based on
a study by the NTI. Identification of symptomatics from new out
patients is on the low side, particularly in District II. As against
the expected positivity rate of 10% among sputum smears examined,
the rate was 14.4% (8.1% in District I and 21.4% in District II).
The reason for such differences need to be studied in depth. Leprosy
: Since leprosy work is carried out by special teams, most of
the PHCs are not aware of the work done in their areas. Malaria
: The average rate of fever cases identified per 1000 population
during the month prior to the survey were 8.1% and 15.7% respectively.
The figures for blood smears made were almost the same. The average
number of persons given anti malarial drugs (mostly chloroquine)
per 1000 population were 8.0 in District I and 20.7 in District
II. Chlorination : In District I where a PHC covered an average
of 51 villages, 84 wells were chlorinated during the month prior
to the survey. The corresponding figures for District II were 111
villages and 89 wells chlorinated per PHC. Registration of births
& deaths : The birth rate on the basis of births recorded
by PHCs was 13.3 per 1000 which is less than half of the birth rate
for Tamil Nadu for 1983. The recorded death rate was 8.3 per 1000
as compared to an expected death rate of 11.5. Recording of births
and deaths needs considerable improvement in almost all PHCs. Referral
: Among 64 PHCs who gave information on referral of patients
for tertiary care, 21 referred to one hospital, 34 to either of
two hospitals and 9 to anyone of three hospitals. Records &
Reports : Surprisingly, PHCs gave a wide range of answers about
the records and reports they maintain. Though there is a general
complaint that records and reports are too many, there were hardly
any useful suggestions about which records and reports could be
simplified and reduced. Targets : Another surprising finding
is that there was no unanimity in the answers from PHCs about the
units of period for achieving targets under national programmes.
Supervision : With regard to supervision of non- medical
staff at PHC there was no uniform pattern. Medical Officers carry
out field visits mainly for either control of epidemics or to pay
surprise checks. Collaboration : Most of the PHCs did not
seek collaboration of other Government departments, voluntary organisations
or community leaders. The limited collaboration sought was mainly
for Family Welfare Programme. Only about 60% of PHCs felt that the
community can participate in Immunization, 52% in Family Welfare
and 15% in Epidemic Control. Most frequent illness : Conditions
affecting digestive and excretory systems were mentioned as the
most frequent illness in their area by 38 out of 68 PHCs, followed
by conditions affecting respiratory system by 32 PHCs, pyrexia of
unknown origin by 20 PHCs, and skin diseases by 14 PHCs. Health
problems : When asked about the health problems in villages,
replies from PHCs dealt with diseases (illness) problems only.
The main weakness of the PHCs was observed
with regard to management, inter departmental collaboration and
community involvement as reiterated below: At least 40% of PHCs
did not have 1981 census figures for population. Further, about
half of them did not have population figures for scheduled castes
and scheduled tribes. Recording of births and deaths are far from
complete. Further, there is considerable indifference towards maintenance
of all records and reports. The Medical Officers In charge, do not
supervise the other Medical Officers of PHCs. Their knowledge about
functions of para medical staff was inadequate. Under these circumstances
neither could the Medical Officer In charge ensure adequate and
proper supervision by the para medical supervisors nor guide
them in their work. Acute shortages of Vitamin "A"
and general medicines were reported. So also for mass media equipments
such as film projector and sound system. Collaboration with other
departments and voluntary organisations was quite weak. Contacts
with community leaders either to understand the health problems
as conceived by them or to seek the co-operation of the community
were also at a low ebb. IUD insertions which benefit the younger
couples or those with small families were quite negligible and the
stress was on sterilisation only which benefit mainly older couples
or those with already large families. Health education activity
of PHCs was at a very low ebb.
c) Field Health Worker : The field health
workers who consists of Health Workers (HWs) and Health Supervisors
(HSs) were identified as important para medical workers. They play
the most crucial role as they have daily contact with the rural
population in their homes. The main objectives were to obtain a
profile of field workers, to ascertain the area of responsibility,
health services rendered by them, community responsibilities
and supervisory functions of the HSs. The information was
collected through pretested interview schedule. Of the 326 HSs and
2349 HWs in position, 165 were interviewed. The majority of male
HWs were of age 30-39 years, while female HWs were of age 20-29
years. All the HSs and all but one of the male HWs were married.
Among female HWs, half were married and about 88% of female HSs
were married. Vast majority of HWs and HSs had education upto secondary
level. The pattern with respect to these profiles was similar in
both the districts. Of the male HWs 65% and of the female 32% had
training in multi purpose work. While 83% of male HSs and 45.5%
of female HSs had multi purpose work training, supervisory
training was received by only 1.8% of male HSs and 9.1% of female
HSs. With regard to total experience in the health and family welfare
department, male HWs had more experience than female HWs. The difference
was even bigger in average years and experience between male and
female HSs. On an average, 6 villages were allotted to male HW and
4 to female HS, a male HW had to cover an average of 2291 families
as compared to 1014 for a female HW. On an average, HW had to travel
6.8 kms to cover the villages allotted. The male HWs approached
the villages by cycle or walk while female HWs by walk and bus.
Availability of trained dais in the villages was reported
by 40.9% of HW(F)s as compared to 50% of HW(M)s. Similarly, according
to them about half of the villages have community leaders. Contact
of HWs with such bodies need improvement. To the question on number
of patients attending SHC services, 80% did not give an answer.
The average attendance by HW(F)s was 7. Services given by HWs
in villages allotted were malaria, FP & HE. The services received
lower priority were TB, environmental sanitation, school health
and registration of births and deaths. While 76.3% of HW(F)s maintained
that they have a weekly schedule, only 46% of HW(M)s have weekly
schedule. On an average during a month HW(F)s worked for 22.4
hrs and HW(M)s for 23.0 hrs in the village. On an average, 12
households are covered per hour. About three fourths of HW(M)s stated
that they carried paracetamol to the village, 19.2% sulpha guanidine
and 15.4% chloroqine. Among HW(F)s, 76.3% carried anti anemic drugs,
68.4% multi vitamin tabs and 47.3% anti malaria drugs. No medicine
was carried by 44.3% of HS(M)s, and 24.2% by HS(F)s. Only 54% of
HW(M)s and 74% of HW(F)s mentioned that they provided family planning
services in the villages. Supervision of FP work by HSs is also
very poor. Few HWs and HSs carried nirodh, oral pills or
FP register when they visited the villages. Complaints that
the high target for FP hampered health activities appears to be
a cover up only. About 45% to 69% of health workers and supervisors
said that TB work was not applicable to them. Similarly 42% to 50%
also mentioned that nothing to be done for diagnosis of leprosy.
Regarding the aspect of their work which are supervised by their
supervisors, many did not reply and the others gave a variety of
isolated answers. There is urgent need to give training to
medical officers and health supervisors on how to carry regular
qualitative supervision. The HWs make frequent visits to
PHCs, some of them going once a week. This may interfere with the
actual work in sub centres.
d) Trained Birth Attendant : In spite of
the request to the PHC staff and village leaders to ensure that
the trained dais of the selected villages were present, only 24
out of the 80 Dais were present during the survey. They were interviewed.
About 54% of them belonged to families in which women attended to
births by tradition. About 63% were illiterate, 29% had a monthly
income of Rs.100/ or more. Fifteen belonged to backward classes
seven to SC one each to ST & Christianity. Two thirds were trained
before project started. Over 90% had experience of 5 years or more.
Only two thirds of the trained dais have received the kits and
less than half had received practical training in conducting deliveries.
Different aspects of ante natal care were mentioned as follows:
82% periodical check up, 59% tetanus toxoid and 46% iron and folic
acid. The number of deliveries conducted by trained dais was the
same as before and after training. Majority of dais do not report
births to health personnel. About 75% of the trained dais had referred
at least one woman for delivery to ANM or hospital during the previous
month. Eleven of the 24 dais, had no difficulties in carrying out
their work while an equal number mentioned inadequate regular income.
Trained dais were mostly aware of ANMS but not of Basic Health Worker,
Malaria Worker or Health Inspector. Neither educational status nor
experience had any influence on the functioning and working pattern
of the trained dais. There were equal number of untrained dais,
it would be worthwhile to train them also. Dai is important liaison
between PHC and village for child births, post-natal care, family
planning and registration of birth. Some future thought had
to be given about their regular income, providing of kits, the replenishment
and supervision during frequent visits by Health Workers and Health
Supervisors. This will go a long way in ensuring co-operation from
trained dais and in boosting up the morale of these village level
workers of low socio economic standing which will make them useful
participants in grass root level health activity.
e) Village Appraisal : Appraisal of the
villages with their multi sectoral needs and activities would provide
a third dimension to the survey. An appraisal of sample villages
was conducted along with the household survey during June-November
1983. The method of group discussion was adopted to collect the
data for village appraisal. Group discussions were held separately
for SC & ST so that they could express their views freely (Adi
Dravida colonies). This report is based on the information collected
through group discussions in 71 main villages and 35 Adi Dravida(AD)
colonies. About 45% AD colonies did not generally avail of services
at PHC and one fifth did not avail of any service from HWs. Most
of the groups felt that allopathic doctors were accessible to them
followed by homeopaths. Contrary to expectations accessibility to
practitioners of Indian system was poor. ANMs were more accessible
to main villages than AD colonies. More than three fourth of main
villages and AD colonies stated accessibility of dais. Most of the
general facilities were accessible to a large extent except
community centre and library. One of the main source of water was
pucca well for three fourths of people. About 40% mentioned kutcha
open well or river/canel. Latrines were few. Open field was generally
used. Both manure pits and scattering was used for disposal of refuse
to a large extent. Nearly all let out sullage to open places. About
50% of the villages mentioned that there was no developmental activity
during last 12 month period prior to this appraisal. The activities
mentioned more frequently were mid day meal scheme, water supply,
school building, road construction and health centre. Most of the
villages were not aware of who had taken the initiative for these
activities. About 10% stated that there were no TB & leprosy
cases among them while most of them mentioned DTC, general hospital
or PHC as source of treatment of TB. Major problem of the villages
were lack of water, transport and communication. Others mentioned
were facilities for treatment and for education. Participation of
women and younger generation in the group discussion was more in
AD colonies than in main villages. According to villagers fever
was the most common illness, followed by gastro intestinal disorders,
diseases of respiratory system and eye complaints. Main causes
of ill health were lack of sanitation and protected water supply.
The perceptions by villagers pointed out the need for not only improving
the availability and accessibility of service facilities but also
for educating the villagers about how these could
be made use of. The bigger and most important gaps would
appear to be the provision and/or utilisation of preventive and
promotive services, in availing of treatment facilities
at PHCs and in reporting of births and deaths. Community
involvement in all development activities would lead to informed
participation in all developmental activities.
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KEY WORDS: SURVEY, HEALTH PERSONNEL, MEDICAL
OFFICER, TRAINED BIRTH ATTENDANTS, PROFILE, RURAL COMMUNITY, HEALTH
SERVICES. |
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