Despite of addition in public and private health care sector outgo, the use of health care services in India has remained hapless. Issues related to Maternal and child wellness are of concern.1 For the wellness and well-being of a kid, every bit good as household and social wellbeing, prenatal and postpartum attention of female parent is necessary.
India ‘s Reproductive and Child Health programme2-
Sing high maternal and child deceases, authorities of India has ever aimed at turn toing these issues through concrete wellness plans. India was the first state to establish the national household planning programme. It was subsequently integrated into household public assistance programme.
The International Conference on Population Development ( ICPD ) , 1994 and the Fourth World Conference on Women, 1995 held at Beijing, China emphasized on gender equity and sustainable development. These conferences suggested the generative wellness plans to look after gender issues behind the wellness jobs, adult females ‘s wellness demands throughout their life span and work forces ‘s duty to esteem adult females ‘s generative rights. ICPD helped India to explicate an integrated programme which could travel beyond the household planning and emphasis on gender equity. The generative and child wellness programme in India was so started in 1997.
The 2nd stage of this programme came in action along with National Rural Health Mission in 2005, which emphasized on the betterment of handiness and entree of the health care services by the people particularly adult females, kids and weaker constituents of the society. The RCH programme covers the generative demands of adult females and work forces at all phases of life.
The generative and child wellness programme of India is based on the basic constituents such as Child wellness ( child endurance and kid development ) and safe maternity ( including safe direction of unwanted gestation and abortion ) , Adolescent wellness ( gender development, adolescence instruction and vocational constituent ) , effectual household planning ( Ensuring Informed pick, Counseling, gender equality and greater male engagement ) , Prevention, sensing and direction of Reproductive Tract Infections, Sexually Transmitted Infections, HIV/ AIDS and malignant neoplastic disease of the generative system, Reproductive wellness attention of aged people.
The chief focal point of the RCH programme is to cut down Maternal and Infant mortality and Entire Fertility Rate. The programme is operated all over the state through primary, secondary and third populace health care system. Decentralized attack is the cardinal constituent of this programme.
1.1.2 Use of RCH services-
Use of health care services can be assessed by patient ‘s every bit good as wellness professional ‘s position. The patient ‘s position can be subjective based on the services reported by the patient or the quality of services felt by the patient, or objective based on the services offered by the health care installation to the patient. The wellness professional may see towards the use of services by economic facet such as the figure of patients, figure of visits etc.3
The use of RCH services can be assessed by the use of all its constituents. Maternal Mortality and morbidity, Infant mortality and kid mortality, and entire birthrate rate are the basic indexs of handiness, use and effectivity of MCH services. Status of these indexs reflects the position of health care services in the country.5
Assorted factors are responsible for the use of RCH services, for illustration, degrees of instruction, socio-economic position, environmental factors such as entree to the wellness Centre, healthcare substructure etc. Study of use of these services, hence requires consideration of all these determiners of the health care utilization.4
1.2 Global scenario-
The Millennium Development Goals ( MDGs ) set up by WHO for MMR is 109, for IMR is 28 and for Under-5 mortality rate is 42 by the terminal of twelvemonth 2015. High difference in these indexs in developed and developing states shows the difference in handiness and use of RCH services in developed and developing countries.6
1.2.1 MCH in developed countries- In developed states such as cardinal and western Europe, Australia etc, the use of preventative services is really high among females than males. The surveies done in early 1970ss have helped the developed states to better the wellness service use. The of import factors indentified were mean cost per visit, wellness insurance coverage, age, instruction etc. This resulted in lower maternal mortality rates, e.g. 5 in Sweden ; 3 in Denmark, Norway and Israel ( Population Action International, 1995 ) .
In United States it is found that black adult females make well less usage of wellness services than white opposite numbers, due to socio-cultural factors. The addition in migratory population and their certain constructs lead to non-utilization of services in Sweden.7,8
The World Health Organization has identified Cuba as an illustration of “ good wellness at low cost ” achieved through policies that address the determiners of wellness and are based on just entree, catholicity and governmental control. They have focused on three major initiatives-1 ) primary attention through polyclinics, 2 ) comprehensive attack at the community degree and 3 ) feedback from community.9
1.2.2. MCH in developing countries- In recent old ages, developing states are influenced by findings in developed states, for measuring the quality of their wellness attention. Results have received particular accent as a step of quality. Measuring results is utile as an index of the effectivity of different intercessions and as portion of a monitoring system directed to bettering quality of attention every bit good as observing its impairment.
In Indonesia usage of an unskilled birth attender and giving birth at place are most common among the poorest and least educated adult females. The kids of these adult females have the highest hazard of infant mortality. The infant mortality rate differs greatly by part of entree to wellness services. In Ethiopia, socio demographic features of adult females, cultural context, handiness, consumer satisfaction influenced wellness service use.
1.3 Local scenario-
The national rural wellness mission 2005 set up certain ends to better the wellness service use by people shacking in rural countries, adult females, kids and the hapless in India. The mark for MMR is 100, IMR 30 and TFR 2.1 by the terminal of 2012.10
The present Maternal Mortality Rate of India is 212. Infant mortality rate has declined to 49, while Under-5 mortality rate is still 64. Entire birthrate rate of the state is 2.6, which is higher in rural country i.e. 2.9 as compared to urban country which is 2.0.11
Harmonizing to NFHS-3 information, merely 44 percent adult females use the prenatal attention in the first trimester of gestation, and merely 52 percent adult females give 3-4 visits to wellness Centre enemy ANC services during the entire gestation period. Merely 47 percent births are attended by wellness forces including physician, ANM, nurse, accoucheuse or lady wellness visitant. Merely 37 percent adult females receive post-natal attention within two yearss of bringing which is supposed to be a critical period. Use of these services is different in rural and urban country.
Though coverage of ICDS is high in the state, merely 28percent kids receive the services provided through ICDS. Merely 44 per centum kids are to the full vaccinated while 5 per centum kids are non given any inoculation. Percentage of kids which are taken to healthcare Centre for the Acute Respiratory Infections ( ARI ) , fever and diarrhea scopes from 60-69 in different provinces of the state.
Most common ground for non utilizing public wellness installations is hapless quality of service, followed by non-availability of the health care installation nearby.12
The use of RCH services differs in different provinces of India. Nature and extent of the relationship between maternal instruction and use of MCH services differ between the North and South of India and that this difference is mostly determined by the north-south derived functions in the general socio-economic and cultural environment in which adult females live.
1.4 Rationale of the study-
The Maternal, baby and under-5 kids mortality rates have shown important diminution from the beginning of 2nd stage of RCH programme, which reflect the positive alteration in handiness and use of RCH services. But as compared to the MDG ends every bit good as NRHM ends for these indexs, there is farther demand to work on the betterment of use of these services.
Kolhapur is the southernmost territory in Maharashtra province. It is divided in 12 talukas and five sub-divisions for administrative intents. The entire population of the territory is 35,23,165 out of which around 24,72,809 population resides in rural area.13
The organisation of RCH programme in Kolhapur territory consists of a District Hospital, two sub-district infirmaries, 18 rural infirmaries ( RH ) , 73 Primary wellness Centres ( PHCs ) and 413 sub-centres.14
Radhanagari sub-division of Kolhapur territory covers 4 rural infirmaries, 13 PHCs and 52 sub-centres. The use of RCH services in the wellness Centres based in Radhanagari sub-division is low, while there is overburden on the territory infirmary for these services.
Therefore, on recommendations of Sub-divisional Office, Radhanagari and sing all the factors impacting the use of RCH services, the survey is planned to analyse the use form of RCH services, grounds for non-utilization of these services at different degrees i.e. RH and PHC and besides to propose the possible steps to better the use of services in the Radhanagari sub-division of Kolhapur territory, Maharashtra.
1.5 Aims of the study-
To find the use of RCH services in Radhanagari sub-division of Kolhapur territory.
To happen out the grounds for utilization/non-utilization of these services.