A Health Risk Index for assessing PHC coverage in urban India

Abstract

3 women interviewed a female member from each of 606 families living in 2 squatter settlements in Madras India to collect data that would allow health managers to develop a simple measure to identify families most in need of maternal and child health and family planning services. This measure may help in a more equitable distribution for each of 7 selected variables and assigned high risk scores to each to develop the Health Risk Index (HRI). These variables included caste child <5 years old illiteracy employment housing water and tobacco and alcohol use. Only 25.8% of eligible families with 1-2 year old children and those with 15.1% of 2-4 year old children received all child care services (immunization and micronutrient supplementation). Further only 22.5% of eligible families with pregnant women benefited from all 4 components of maternal care (tetanus toxoid iron folate supplementation trained birth attendants and food supplementation). These results demonstrated that the services delivery approach to selective primary health care (PHC) is deficient. Yet the Integrated Child Development Services (ICDS) was able to affect higher levels of enrollment of high risk families. In fact their levels were higher than low risk families. Nevertheless this approach to PHC did not achieve universal coverage. Indeed the fact the those families with the higher rates of morbidity used ICDS services more often than the healthier population reflected the fact that selective PHC did not reduce health status differentials. An HRI can guide a community to develop an intersectoral PHC program which is needed to achieve health for all.