Abstract
BackgroundIn 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak.MethodsSecondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed.ResultsThe median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016.ConclusionsFacility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.
Highlights
In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected
The child health facility mapping tools were based on previous facility mapping tools developed by the Uttar Pradesh (UP)-TSU but were adjusted to reflect operational guidelines from the Government of India (GoI) and National Health Mission (NHM) on F-IMNCI [19] and Indian Public Health Standards (IPHS) for community health centres (CHC) [18]
In 2015, only seven of the facilities had space allocated for emergency care which could be used 24 h a day indicating there was grid-attached power to the space with back-up from either a generator or inverter
Summary
In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. The National Health Policy of the Government of India (GoI) [1] outlines ambitious plans for the reorganization of the delivery of public health care in India with a goal of providing high quality universal health coverage. The problem with broad quality assessments, such as SARA and NQAS, is that service readiness for care of sick children can become masked as the majority of the data elements and indicators are not specific for pediatric care These broad-based facility quality assessments are vital for health system improvement but may not assess the availability and readiness of child health services at a facility
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