Objective="Access to facility-based RCH services."
Details for Reform Option "Urban Health Programme, Aurangabad, Maharashtra"
Aurangabad is one of the fastest developing cities in Maharashtra, having a population of more than 10.7 lakhs (2001) and growing rapidly. However the socio-economic condition of the city is not very good. The city has a total literacy rate of 56.28% and a female literacy rate of just 39.64%. Aurangabad has a crude birth rate of 26.4 and an infant mortality rate(IMR) of 48.9%. Another cause of concern is the high number of home deliveries. In 1999, one zone in the municipality had 98.8% home deliveries.
The Health Officer of the municipality, private practitioners, project consultants and various NGO’s along with representatives of the State government met to discuss the issues. A baseline survey was also conducted. Based on the health problems found by the survey and discussions, a plan was prepared with the aim of improving the Reproductive Child Health (RCH) services in the city.
Considering the available resources and health problems identified, the following objectives were prioritised to be achieved by end of a 4-year project period:
(i) Improvement in awareness and knowledge with reference to reproductive and child health issues.
(ii) Substantiation of delivery and Medical Termination of Pregnancy (MTP) services with stress on institutional deliveries.
(iii) Extension of services for infants and under 5 population.
(iv) Strengthening and sustaining RCH education among adolescent girls.
(v) Strengthening existing health institutions under public sector.
(vi) Establish and improve the referral system.
To achieve the above mentioned objectives, 11 components have been drawn up. Different activities have been specified under each component.
(i) Intersectoral co-ordination for increase RCH awareness.
(ii) Adolescent health education for girls.
(iii) Essential obstetric care: services and referral.
(iv) Improving child immunisation.
(v) Reduction of incidence of malnutrition and vitamin A deficiency in children under 5.
(vi) Reduction in infant and under-5 mortality by management of Acute Respiratory Infections (ARI) & diarrhoea.
(vii) Access to family welfare and MTP services.
(viii) Diagnosis and treatment of Sexually Transmitted Diseases (STD) and Reproductive Tract Infections (RTIs).
(ix) Strengthening health management at the municipal corporation.
(x) Staff support: strengthening health workers.
(xi) Male participation.
It was decided to upgrade 6 health centres of the municipal corporation and to provide 24-hour delivery services, MTP and family planning operations. At present, 4 centres have started functioning round the clock. The remaining two centres at present provide out-patient services. The staff, including the specialist doctors, Auxiliary Nurse Midwives (ANMs), staff nurses, lab technicians and group IV staff, are recruited on contract basis. Contingency funds are made available for purchase of instruments and medicines.
For Information Education Communication (IEC), an NGO- Jan Shikshan Sansthan was identified as the coordinating agency. Under this component, 6 community organisers and 90 Mahila Mandal (Women’s cell) representatives work (as community volunteers) in slum populations for awareness creation and demand generation. IEC activities include street plays, wall paintings, interschool essay competitions, healthy baby competitions etc.
Adolescent health education component includes a training of teachers to conduct health education classes in schools. School health check ups are also held. The ANM, MPW and mahila mandal workers follow up on the non-school going and dropouts.
The project took almost 18 months to initiate mainly due to administrative problems such as frequent change of the chairperson and member secretary, leading to delays in appointment of staff, procurement and installation of equipment etc.
However after the start of the programme, there has been an increase in quality of and demand for health services. ANC cases for example, have increased from 5,426 in the year 2000-01 to 7,929 in 2004-05 and deliveries have increased from 22,300 (2000-01) to 31,450 (2004-05).
Total budget for this project is INR 4 Crores 45 Lakhs . The action plan for the first year was for INR 106.83 lakhs. One crore has been sanctioned for the second year of which Rs 30 lakhs have been released thus far.
Aurangabad city, Maharashtra since January 2002.
Approximately one year.
Intersectoral coordination: Meetings, competitions held at schools.
Improved access: To better quality services at low costs and free of cost for the poor.
Awareness raising: Improves health education and knowledge of health services and facilities available.
Administrative problems such as frequent change of officials.
Though the project was meant to be managed by a separate team, initially the project manager was based at and had to carry out duties at a health centre.
Good network of reliable NGOs to carry out the services.
Community participation and willingness of community persons to volunteer.
Who needs to be consulted
Government officials at State and district levels, Municipal Corporation, NGOs, community.
Initially needs heavy support both for funding and technical support. At present this is funded by the European Commission-supported Sector Investment Programme. However the municipality has agreed to take over the activities after the project period (December 2005).
Chances of Replication
Replicable if funding is available. However some things need to be kept in mind:
The project should be managed by a set up separate from the Corporation.
Provision should be made for necessary construction and repairs of buildings.
Sara Joseph, Researcher, ECTA, New Delhi, March 2005.