Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Status of Operationalization of Community Need Assessment Approach in Selected Subcentres of North India

Author(s): J. S. Thakur, S. S. Kar

Vol. 31, No. 4 (2006-10 - 2006-12)

J. S. Thakur, S. S. Kar

Abstract:

To see the extent of operationalization of Community Need Assessment approach. Setting: Randomly selected subcenters of Chandigarh, Ropar (Punjab) and Panchkula (Haryana) districts. Auxiliary Nurse Midwives. Results: The majority of targets or need assessment was done by household survey (87.5%), based on previous records (79.2%) and decided by the medical officer (50%). Only 8% of sarpanch and schoolteachers knew about this programme and 92% of them had never attended any meeting regarding need assessment. The study result could be used for strengthening of RCH Programme

Key words: Community Need Assessment approach

Introduction

Since its inception in 1951, the National Family Planning programme has undergone many changes to meet the varied challenges over the years1. In 1960, the Ministry of Health and Family Planning annually fixed method specific targets, which largely determined the character of the programme implementation, monitoring and evaluation at all levels. In April 1996, the central government decided to abolish targets throughout India, making the entire nation target free. The basic characteristics of target free approach (TFA) was to provide services according to client needs and eliminate centrally determined targets2. In 1997, GOI realized that the term ‘target free Approach’ (TFA) was interpreted wronglyhealth workers equated TFA with no targets so no work or no more monitoring based on targets and became complacent. To convey clear guidelines to health workers the TFA was renamed as Community Need Assessment approach (CNAA) in 1997. The underlying philosophy of the new approach, however, remained the same as the TFA3.

CNAA lay emphasis on decentralized planning in consultation with community at the level of village/sub center (SC) / primary health center (PHC) to determine the annual workloads based on local needs and to provide quality4 services by the primary health care system of the country. Female auxiliary nurse midwives (ANMs) are the key person on whom the outcome of the programme depends. She has to prepare the sub-center action plan in consultation with community and then to implement the same.

Since RCH is major national health programme with highest resource allocation, this paper was planned to evaluate the extent of operationalization of CNAA in selected health subcenters and to find out various operational problems faced by the grass root level workers.

Material and Methods

The study was conducted in 2003-2004 and was done in 20% randomly selected sub-centers of Chandigarh, Ropar (Punjab) and Panchkula (Haryana) districts. A total of 24 sub-centers were selected randomly and 24 ANMs were interviewed.

A semi-structured questionnaire was used after pretesting, containing the process indicators for CNAA, sub-center action plan and community consultative process. The questionnaire had three components – first part containing questions regarding the functions of ANM; second part was observation of records and fi nally the evaluation of consulatative process.

The questionnaire regarding the function of ANM sought informatiuon on awareness about CNAA,when CNAA was started,awareness about sub center action plan, any training received under RCH programme for making sub center action plan, assessment of service requirement of sub center, step involved for making sub center action plan, difficulty experienced in making sub center action plan. In second part was the observation of registers like household survey register, birth register, immunization register, eligible couple register and stock register. Finally evaluation of consultative process was undertaken by interviewing sarpanch, schoolteacher, president of mahila swasthya samiti (MSS), traditional birth attendant and anganwadi worker. The data was analyzed by the help of EPI INFO 2000.

Results

A total of 24 ANMs from 24 different sub-center in three districts were interviewed. All the ANMs(100%) knew about the RCH programme that is going on in the country and knew about the community need assessment approach. In response to when this CNAA was started, only 1 i.e. 4.2% knew the correct answer. All the ANMs(100%) were aware of the sub-center action plan; have received training (91.6%) and integrated skill training (91.6%) as shown in table I. Majority(91.6%) of the workers had made sub-center action plan and 59.1% had done this for more than 5 times. ANMs use multiple methods for the need assessment of the community. The majority of targets or assessment of need was done by household survey (91.6%), based on previous records (83.3%) and decided by senior offi cer/medical offi cer (50%). In Punjab 71.4% in Haryana and Chandigarh, 100% of ANMs depend upon previous record for need assessment.

Table I- Status of Selected Parameter Under Community Need Assessment Approach Under Reproductive and Child Health Programme in Selected Districts

Parameters Ropar
(Punjab)
Panchkula
(Haryana)
Chandigarh Total
1. Training of ANMs under RCH 14(100) 06 (85) 03 (100) 23 (95.8)
2. Methods of need assessment
– Household survey 12 (85.7) 07 (100) 03 (100) 22 (91.6)
– Previous record 10 (71.4) 07 (100) 03 (100) 20 (83.3)
– By medical officer/senior
Officer
06 (42.8) 06 (85.7) 0 12 (50)
3. Correct steps for making SC
action plan
04 (28.5) 03 (42.8) 02 (67) 09 (37.5)
4. Correct calculation of benificiary
(pregnant mother)
05 (35.7) 04 (57.1) 1 (33) 10 (41.6)
5. Office copy of final plan present 02 (14.2) 5 (71.4) 2 (67) 9 (37.5)
6. Monthly meeting attended by
sarpanch
025 (14.2) 0 0 02 (8.3)

Eighty five percent of ANMs in Haryana and 42.8% in Punjab told that family planning targets are still decided by the medical offi cers but in Chandigarh the ANMs are deciding about the same. Ninety-five percent of ANMs do house hold survey of their respective sub-center and 91.6% do it annually in the month of february and march. Only 37.5% ANMs follow the correct steps for making sub-center action plan i.e, household survey, monthly meeting with consultative team, demographic calculations. However the consultative process was adequate with ANMs, president of MSS and AWWs, but poor with the PRIs and school teachers. In 91.6% of cases, the ANM got assistance from the supervisor in making subcenter action plan. The supervisor was LHV in 87.4% cases and medical offi cer in only 4.2% cases.

The ANMs experienced various problems in making sub center action plan like unavailability of stationeries (25%) reporting proforma (20.8%). They also told that the sub - center action plan made by them was not taken seriously by the senior officers (41.7%).

Majority (91.7%) of the ANMs experienced diffi culties in implementation of sub-center action plan in the form of shortage of supplies of medicine (50%), due to problem of migration (41.6%) and lack of confidence (16.7%). The problem of migration was told by the ANMs to be more prominent in Chandigarh (66.6%), then in Haryana (42.85%) and Punjab (35.7%). Shortage of drugs like antibiotics, povidone Iodine, analgesics and Paracetamol tablets in RCH kit was a major problem. They also pointed out that some medicines like Phenobarbitone and injection Methergin were not using routinely.

In response to calculation of beneficiaries i.e. calculation of the pregnant women in an area, 41.7% calculated it correctly, for calculation of the number of benefi ciary children(<1 year, <5 years) only 25% of ANMs did it correctly. About 58.3% of health worker male provided assistance to the ANMs in making sub-center action plan in conducting Status of Community Need Assessment Approach household survey (33.3%) and in the formation of consultative team (8.3%). Eleven (45.8%) ANMs were satisfied with and need based distribution of medicine i.e. essential drugs were not in sufficient amount.

For better CNAA in Punjab, 35.7% opined that volunteers, MSS members and traditional birth attendants should get some honorarium, RCH kit supply regular (39.9%) and RTI/STD camps should be organized more often and adequate medicines for treatment of RTI (12.6%). The ANMs of Haryana opined that there should be one helper (71%) and good quality conventional contraceptives should be provided (28.5%). The ANMs of Chandigarh also experienced the need of a helper (100%) and the panchayats are not taking interest in this programme (67%).

All the register (house hold survey, immunization, ANC, eligible couples, birth and stock etc) were available in 100% cases and were updated in 87.5% cases. The offi ce copy of final sub-center action plan was present in only 37.5% sub-centers.

For evaluation of consultative process, it was observed that only 8% of sarpanch and school teacher knew about RCH and majority (91.7%) had never attended any meeting regarding the need assessment. The monthly meeting were attended by the serpanchs only in Punjab and Haryana and Chandigarh had not attended a single monthly meeting.

Discussion

The ‘community need assessment concept’ refers to the need assessment and planing for services with involvement of the community, NGOs, community health volunteers, women’s group and panchyat’s5. In our study we found that still targets or assessment of need was based on previous records (83%) and decided by medical offi cer (50%) of PHC. The proper steps for CNA should be followed at each subcenter level. The working team should consist of AWW, trained birth attendants, MSS members, youth leaders and consultative team should have sarpanch, schoolteacher, other Panchyati Raj members, religious leader, members of NGO working in that locality as its member. These steps of community need assessment had lot of variation in the studied sub-centers. Ninety one percent of ANMs do household survey, with poor involvement of the working team. The meeting of consultative team were poor as only 8% of the schoolteacher and sarpanch have ever attended the monthly meeting. This showed that either they were not taking interest or they were not contacted by the ANM. This aspect needs further research, that why the ANMs are not able to form/work in consultation with the consultative team. This aspect should also be discused in the respective PHC monthly meeting.

It was observed in our study that majority of ANMs (91.7%) had made sub-center action plan, only 37.5% followed the indequate consultative process. Despite 92% of ANMs had received training in making sub-center action plan about 60% were not aware about the calculation of beneficiaries. It shows that integrated skill training has not given desired results.

The important cause cited by the ANMs for not implementing the sub-center action plan was lack of confi dence. This showed that either they were not trained properly or not getting adequate guidance from their seniors. There is need for capacity building of ANMs about the concept of CNA and should receive adequate support from supervisors. It is felt that medical officer or supervisiors should be actually involved and help the ANMs to make sub-center action plan at least once, so that they are confident in future. This process can be done regularly depending upon the need. The problem of migration is a concern in Chandigarh for which there is no permanent solution yet available. The supply of RCH kit shouild be regular with need based drugs supply, frequent organization of RTI/STD camps and every ANM should be provided with a helper or community volunteer in each village. These suggestions of ANMs are worth considering during RCH II.

Planning for implementation of RCH II has been started in various states. The basic concept of RCH II is same as that of RCH I. But our study shows that the bottom up approached has not been established to the desired extent and the process and implimentation of CNAA needs further improvement. This study can serve as an important tool for the programme managers during the planning and implementation of RCH II.

References

  1. Visaria L, Jejeebhoy S, Merrick T. From Family Planning to reproductive health: Challenges facing India. International family planning perspectives 1999; 25:8449.
  2. Sangwan N, Maru RM. Target free Approach: An overview. Health Management 1999;1:71-96.
  3. Manual on community needs Assessment Approached, Government of India. New Delhi: National Institute of Health and family Welfare,1998.
  4. Review of implimentation of community needs Assessment approach fo family welffare in India; Policy Project II, future group international.
  5. Reproductive and child health module for medical offi cer PHC. New Delhi; National Institute of Health and family welfare 2000.

School of Public Health, Department of Community Medicine,
PGIMER, Chandigarh. E-mail: [email protected]
Received 15.4.05

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica