An Analysis of Utilisation of Health Services Under National Rural Health Mission: A Case Study of a Selected District of Uttar Pradesh, India 2009

Abstract

Introduction: Government of India launched the National Rural Health Mission (NRHM) on 12th April 2005 throughout the India with special focus on 18 states which have weak public health indicators and/or weak infrastructure. The NRHM was launched with a view to bring about dramatic improvement in the health system and health status of the people, especially those living in rural areas by the end of 2012. The NRHM has a clear objective of providing quality health care in the remotest rural areas by making it accessible, affordable and accountable. Are the services provided under NRHM really reaching the beneficiaries? This particular study was designed with the overall goals of assessing the utilization of health care facilities provided under NRHM. Methods: The study was conducted in the State of Uttar Pradesh, India. Uttar Pradesh has been identified as one of the low performing state, both in terms of health system indicators and health outcome parameters. The study was carried out during March, 2009 to August, 2009. A multistage purposive random sampling method was used to collect the appropriate sample from the selected state. Selection of the district and the ‘block’ (a block is an admnistrative unit within a district) was done randomly. Once the block was identified, one of the Community Health Centre (CHC) was selected randomly withing that block. Sudsequently, one primary health centre (PHC), nearest to the CHC, was selected randomly. Data was collected from Out Patient and Inpatient Registers maintained at each level of health facility i.e. Disrict hospital, Community Health Centre (CHC) and Primary Health Center (PHC) with the help of Pre-designed Proforma in the state of Uttar Pradesh. Data coding, entry and analysis of quantitative data was conducted in soft form of excel sheets. Results: From the analysis it is evident that service delivery capacity of the public health system has increased at each level. It is also found that Outdoor Patient visits have increased at all three levels, though with variation. The maximum improvement is found at the PHC (129%) level followed by almost similar increase (86%) at the district and CHC level. The main beneficiaries of indoor services at each level were invariably women followed by children and men respectively. Conclusions: Preliminary analysis suggests that there is an increasing trend in the utilization of health facilities at each level, which reflects strengthening of public health system in the recent years. However, the changes are not uniform especially where peripheral facilities are showing less improvement in comparison to the district hospital. There is still much to be done to call all health facilities ‘fully functional’ as per the Indian Public Health Standards (IPHS) guidelines. We therefore conclude that NRHM appears to be a well designed program and lots of thought process has gone into it prior to its implementation. However, it would be too early to predict its outcome in terms of success or failure.