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Indian Journal of Community Medicine

MCH issues in the Context of National Population Policy (NPP) - 2000

Author(s): K. Raghava Prasad

Vol. 25, No. 4 (2000-10 - 2000-12)

President, IAPSM Prof & Head Deptt of S.P.M. Sri Venkateswara Medical College Tirupati - 517505

At the onset I express my thanks to the organizers of this National Consultation Meeting for inviting me to represent the IAPSM. The IAPSM, as you are aware, represents the nationwide faculty and experts in the field of Preventive and Social Medicine or Community Medicine. Our Association over the last 30 years has been contributing its might towards improvement of the state of Public Health in the country. Our members are involved in Health Manpower Development by way of teaching and training of medical and other health personnel at all levels and at all stages in public health and related areas, in providing and demonstrating Primary Health Care in field practice areas and in carrying out Epidemiological and Health Service Research in various settings. It is most appropriate that we have been asked to present our views at the National Consultation to discuss the MCH issues in the context of NPP 2000.

The Action Plan of NPP-2000 covers all the strategic themes identified in the policy paper. I wish to highlight some of the key elements of the Action Plan in relation to MCH in the implementation of which our Association plays a major part. Before that, a few general observations based on findings of several studies on health care services in general and MCH services in particular pointing out the major deficiencies in the Primary Health Care system are in order.

These are:

  1. Inadequate community participation especially at the level of planning.
  2. Under utilization of services especially by women.
  3. Low financial allocation.
  4. Poor logistics and materials management.
  5. Poor quality of services.
  6. Ineffective referral system.
  7. Inadequate coordination in several dimensions - inter-departmental, with non-governmental agencies, inter-sector, etc.
  8. Deficiencies in Health Manpower Planning and Development.
  9. Deficient epidemiological support.
  10. Improper location and insufficient number of service delivery points.

These deficiencies account for the persistent unsatisfactory health conditions witnessed inspite of commendable progress otherwise achieved. Some of the depressing indicators in MCH include falling immunization levels, low levels of ORT use, high prevalence of poor infant feeding practices, unacceptable level of maternal mortality, large proportion of home deliveries and deliveries by untrained personnel and low levels of family planning acceptance. These indicators also reinforce the well known two way link between CSSM and family planning.

The action plan envisaged in NPP-2000 most appropriately includes operational strategies in connection with women's health and nutrition and child health and survival and in related supportive strategic themes. Some of the key strategies are discussed now.

  1. Provision of cluster services for women and children under Integrated RCH programme at the same place and time. More service facilities are to be opened and more service providers are to be deployed and their mobility improved to increase their outreach capacity. Mobile services provide an answer in difficult areas. Abortion services and services for RTI in particular shall be made available at public health facilities.
  2. Strengthening of the referral system between Sub-centres, PHCs, CHCs and District Hospitals in the management of obstetric and neonatal complications. The FRUs in particular, shall be strengthened in terms of number, specialist staff and equipment.
  3. Ensuring adequate transportation so that women with complications can reach emergency care in time.
  4. Inclusion of RTI/STD/AIDS prevention and management in MCH services. The syndromic approach with standard case management is to be adopted in the management of RTIs and STDs in view of limited diagnostic facilities.
  5. Development of health package for adolescents.
  6. Integrated management of childhood illness and standard case management of ADD and ARI must be promoted. Here private practitioners and practitioners of ISM are to be involved.
  7. Networking of public, private and NGO facilities for delivery of free RCH services by devising suitable compensation system.
  8. Ensuring 100% routine immunization for all VPDs in the face of deteriorating immunization coverage since the days of UIP. In this context, I wish to emphasize the need to strengthen the Primary Health Care system and integrate all the interventions into it as the pressures of centralized programmes and campaigns tend to take over and disrupt the Primary Health Care system.
  9. Focussed attention and special schemes for child labourers and street children.
  10. Exploring the feasibility of National Health Insurance covering the hospital costs for children initially and all groups in the long run. This merits serious consideration in view of the large private sector presence in secondary and tertiary care.
  11. Streamlining and expanding health services for school age children.
  12. Special strategies for under served population groups like urban slums, rural and hilly areas, displaced and migrant population, etc.

The following general measures are required to make the primary health care system to be more effective and efficient:

  1. Ensuring high quality services by scientifically designed training programmes so that health personnel will possess the necessary skills, develop empathetic approach and become responsive to the problems and preferences of the people. Attention has also to be paid to the pre-service or basic training which is not upto the mark in several places. Here, I suggest that the qualifying examination should lay stress on testing skills so that skill training gets its due importance in the curricula.
  2. The community needs' assessment approach with participation by local people in data collection, data analysis and developing plan of action, which is the strategy adopted now, has to be implemented faithfully and vigorously.
  3. Systematic and scientific supervision at various levels will rectify many of the ills in the present health care delivery.

The IAPSM will play its role in the following areas:

  1. Designing suitable targeted training programmes for various categories of health personnel.
  2. Improving and implementing the curricula in Medical Education at Undergraduate and Post Graduate levels.
  3. Undertaking Health Services Research to test sustainable and replicable strategies and programmes.
  4. Preparation of modules, supervisory tools and checklists, local area monitoring systems, IEC material, etc.
  5. Providing academic back-up to health services by participating in policy making, co-ordination committees, task forces, working groups, etc.

At the end, I would like to assure the authorities and the leaders of the profession that the members of our Association will fully involve themselves in all the proposed activities and strive to achieve the national goals.

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