A Study to Assess the Program Management Factors, Services and Level of Performance of Reproductive Maternal Newborn Child Health and Adolescent plus Program (RMNCH+A) in Selected Block Primary Health Centers and Rural Hospitals of 24 Parganas (North), West Bengal

Abstract

Introduction: A descriptive survey was done on assessment of the program management factors, services and level of performance of Reproductive Maternal Newborn Child Health and Adolescent Plus Program (RMNCH+A) at selected block primary health centers and rural hospitals in North 24 Parganas, West Bengal. The conceptual framework was based on the Chen’ Program Theory for program evaluation. Methods: The sample under the study consisted of eleven block primary health centers and rural hospitals of North 24 Parganas, West Bengal. A validated and reliable tool was used to collect data, e.g., the background data and data on the program management factor in terms of adequacy of human resources and their training status was collected by an interview schedule through interviewing health service providers, data on the program management factor in terms of infrastructural facilities, equipment, drugs, record maintenance and services of RMNCH+A Program was collected by observation checklist through observation by the investigator, and data on performance of services and referrals by block primary health centers and rural hospitals was collected by means of record analysis by Record Analysis Proforma. Results: The result showed that most of the community health centers are block primary health centers (64%). There are shortfalls in human resources like general duty medical officers (24.68%), obstetricians and pediatricians (90.90%), surgeons (100%), staff nurses (29.13%), laboratory technicians (42.86%), pharmacists AYUSH (47.82%), drivers (66.67%), GDA (51.25%). Lowest training of medical officers is found in CEmOC, F-IMNCI, LSAS (2.70%) and of nurses in RBSK (2.58%). Major non-availability of infrastructural facilities is separate ANC ward (45.45%), observation room and eclampsia room (100%), laboratory facility (63.63%), NRC (100%), etc. Non-availability of IEC displays found like SBA protocol on APH (18.18%); adult resuscitation kit (90.90%), pulse oximetry (81.81%), wall suction machine (100%), etc. were not available. Inj. Insulin (100%), Tab. Mifepristone (36.36%), Tab. Nevirapine (72.72%), Inj. Gentamycin (27.27%) drugs were not available. E mOC (90.90%), CAC service (36.36%), SNSU (63.63%) were not provided by the selected facilities. 81.81% of the facilities had referral transport and 18.18% facilities did not have any referral transport. There was significant difference between the number of medical officers and number of OPD attendance (‘t’=6.07; df (9), p<0.05), The number of trained medical officers on RTI/STI and number of RTI/STI case management of adolescent (‘t’=2.45; df (9), p<0.05), the number of trained doctors on NSV and the number of NSV cases. (‘t’=2.27; df (9), p<0.05), the number of SBA-trained nurses and the number of institutional delivery cases (‘t’=2.35; df (9), p<0.05). There is highly positive correlation among number of nurses, number of medical officers and postnatal checkup score of the facilities, which is statistically significant (‘r’=0.732; df (9), p<0.05).