National Rural Health Mission Research Articles

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p<0.0001). Sepsis is more prevalent in out born unit (p<0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p<0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

Making the health system work for over 25 million births annually: drivers of the notable decline in maternal and newborn mortality in India

IntroductionIndia’s progress in reducing maternal and neonatal mortality since the 1990s was faster than the regional average. We systematically analysed how national health policies, services for maternal and newborn health,...

A tale of two exemplars: the maternal and newborn mortality transitions of two state clusters in India

BackgroundIndia’s progress in reducing maternal and newborn mortality since the 1990s has been exemplary across diverse contexts. This paper examines progress in two state clusters: higher mortality states (HMS) with...

IJCM_38A: Impact of perinatal death audit on healthcare delivery in two districts of Karnataka- A health system intervention research

Background: Perinatal mortality is a sensitive indicator of maternal and child health care. However, there is no universal perinatal death (PND) audit system in India. Objective: To identify the impact of the proposed model of PND audit on health care delivery in two districts of Karnataka. Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK- high performing) and Koppal (low performing) districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. The healthcare delivery system was analyzed in both districts. A PND audit system was designed. All neonatal deaths during the study period were analyzed by an expert committee (Local senior pediatricians and obstetricians). Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. Doctors feedback, in-depth interviews, death certification analysis, risk analysis, PND reporting format, expert committee feedback, medical social worker feedback, data from district health office were recorded and analysed. The changes in documentation, information yield, reporting of PND, time taken for submitting death report and changes in infrastructure in facilities in the two time periods of 6 months was analysed. Results: Significant changes were recorded in documentation of care delivered in the facility specially in Koppal district. There was an increase in reporting of PND in the second half. The PND audit assisted in preventability of death assertion. Improved data resulted in better performance of expert committee, thereby reducing the proportion of unclassified segment of neonatal deaths. There was significant improvement in infrastructure in the health facilities. Conclusion: Auditing perinatal deaths had a positive impact at point of care resulting in improved documentation, reporting and infrastructure upgradation.

IJCM_45A: Inter-district variation in preterm deaths identified by a perinatal death audit: a health system intervention research

Background: Analyzing preterm deaths is crucial due to the significant contribution of preterm babies to neonatal mortality rates. However, there is no universal perinatal death (PND) audit system in India Objective: To analyze the preterm deaths in two districts of Karnataka with study model of PND audit Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK), high performing and Koppal (KPL),low performing districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. A PND audit system was designed. Personnel with training in medico-social history taking were utilized for data accumulation. Causal analysis of death as certified by independent expert panels and certifying physician was carried out and was compared for functionality. To determine optimality of care, facilities were categorized depending upon available levels of maternity and neonatal care. Preterm deaths during the one-year study period with complete data were analyzed. Results: 119 preterm deaths in DK and 97 preterm deaths in KPL were analyzed. In utero transfer was 81.5 % in DK and 11.3% in KPL. More preterm deliveries were documented in public hospitals in both districts. Deaths of preterm babies in private hospitals at KPLwas 41.2% against 27.8% private deliveries. In KPL 22.6% babies died at home despite delivering in hospitals. Risk factor documentation was poor in both districts. Expert committee review increased preventability assertion from 7.5 to 11.7% in DK, 2 to 62.8% in KPL. Conclusion: Auditing perinatal deaths and analysing preterm deaths resulted in identification of specific deficiencies in healthcare system. DK had reasonably good facilities but KPL had serious concerns. The study model enhanced the preventability assertion in preterm deaths

IJCM_260A: Utilization of dbt(direct benefit transfer) under Nikshay poshan yojana by tuberculosis patients attending to tuberculosis unit in a government general hospital.

Background: Nikshay Poshan Yojana was launched by MoH&FW, a centrally sponsored scheme under National Health Mission (NHM)on April 2018. Under the programme financial incentive of Rs.500/- per month is given for each notified TB patient, whether treated in public or private sector notified on the Nikshay platform. This study aims to understand the utilization of NPY. Objectives: 1. To know the purpose of utilizing the NPY by the TB patients. 2. To assess the gaps for delay in credit the amount. Methodology: It’s a cross-sectional study done among patients who were registered at DTC-TB unit of Government Medical College Kakinada through telephonic interview. Sample size was estimated to be 64 taking prevalence of NPY as 80% with absolute error of 10%. Data was collected by using questionnaire in November 2023 and analyzed by SPSS 21.0. Prior permission from Institutional Ethics committee was obtained. Results: Mean age of participants was 41.4+12.4yrs. Males contributing 85.4% and females 14.6%. Nearly half (48%) has taken 2months of treatment, 97.9%were under category I treatment and all were enrolled under NPY. Awareness on NPY was 79.2% and 95.8% reported irregularity in getting NPY. Out of those who received NPY, only 42.1% utilized it for nutrition. Conclusion: DBT enrolment was good. Availability of DBT to the patients was very minimal.

National Rural Health Mission reforms in light of decentralised planning in Kerala, India: a realist analysis of data from three witness seminars

BackgroundThe People’s Planning Campaign (PPC) in the southern Indian state of Kerala started in 1996, following which the state devolved functions, finances, and functionaries to Local Self-Governments (LSGs). The erstwhile National Rural Health Mission (NRHM), subsequently renamed the National Health Mission (NHM) was a large-scale, national architectural health reform launched in 2005. How decentralisation and NRHM interacted and played out at the ground level is understudied. Our study aimed to fill this gap, privileging the voices and perspectives of those directly involved with this history.MethodsWe employed the Witness Seminar (WS), an oral history technique where witnesses to history together reminisce about historical events and their significance as a matter of public record. Three virtual WS comprised of 23 participants (involved with the PPC, N(R)HM, civil society, and the health department) were held from June to Sept 2021. Inductive thematic analysis of transcripts was carried out by four researchers using ATLAS. ti 9. WS transcripts were analyzed using a realist approach, meaning we identified Contexts, Mechanisms, and Outcomes (CMO) characterising NRHM health reform in the state as they related to decentralised planning.ResultsTwo CMO configurations were identified, In the first one, witnesses reflected that decentralisation reforms empowered LSGs, democratised health planning, brought values alignment among health system actors, and equipped communities with the tools to identify local problems and solutions. Innovation in the health sector by LSGs was nurtured and incentivised with selected programs being scaled up through N(R)HM. The synergy of the decentralised planning process and N(R)HM improved health infrastructure, human resources and quality of care delivered by the state health system. The second configuration suggested that community action for health was reanimated in the context of the emergence of climate change-induced disasters and communicable diseases. In the long run, N(R)HM’s frontline health workers, ASHAs, emerged as leaders in LSGs.ConclusionThe synergy between decentralised health planning and N(R)HM has significantly shaped and impacted the health sector, leading to innovative and inclusive programs that respond to local health needs and improved health system infrastructure. However, centralised health planning still belies the ethos and imperative of decentralisation – these contradictions may vex progress going forward and warrant further study.

The role(s) of community health workers in primary health care reform in Kerala, before and during the COVID 19 pandemic: a qualitative study.

Accredited Social Health Activists (ASHA) are Community Health Workers (CHWs) employed by the National Health Mission of the Government of India to link the population to health facilities and improve maternal and child health outcomes in the country. The government of Kerala launched primary health reform measures in 2016 whereby Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The COVID-19 pandemic in 2020 impacted essential health service delivery, including primary care services. The CHWs network of Kerala played a crucial role in implementing the primary care reforms and COVID-19 management efforts that followed. We carried out a study to understand the perspectives of the CHWs in Kerala about their role in the recent primary healthcare reforms and during the COVID-19 pandemic management efforts. We conducted in-depth interviews (IDI) with 16 ASHAs from 8 primary care facilities in Kerala from July to October 2021. We further conducted Focus Group Discussions (FGDs) (N = 34) with population subgroups in these eight facility catchment areas and asked their opinion about the ASHAs working in their community. We obtained written informed consent from all the participants, and interview transcripts were thematically analysed by a team of four researchers using ATLAS.ti 9 software. Our study participants were women aged about 45 years with over 10 years of work experience as CHWs. Their job responsibilities as a frontline health worker helped them build trust in the community and local self-governments. CHWs were assigned roles of outpatient crowd management, and registration duties in FHCs. The COVID-19 pandemic increased their job roles manifold. Community members positively mentioned the home visits, delivery of medicines, and emotional support offered by the CHWs during the pandemic. The CHWs noted that the honorarium of INR 6,000 (US$73) was inconsistent and very low for the volume of work done. The CHWs in Kerala play a crucial role in primary care reforms and COVID-19 management. Despite their strong work ethic and close relationship with local self-governments, low and irregular wages remain the biggest challenge.

Understanding the emergence of ‘Communitization’ under India’s National Rural Health Mission (NRHM): Findings from two Witness Seminars

ABSTRACT India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery, monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM.

Markets, incentives, and health promotion can improve family planning and maternal health practices: a quasi-experimental evaluation of a tech-enabled social franchising and social marketing platform in India

BackgroundImproving family planning and maternal health outcomes are critical to achieving the Sustainable Development Goals. While evidence on the effectiveness of government-driven public health programs is extensive, more research is needed on effectiveness of private-sector interventions, especially in low- and middle-income countries. We evaluated the impacts of a commercial social-franchising and social-marketing program – Tiko Platform – which created a local ecosystem of health promoters, healthcare providers, pharmacies, stockists/wholesalers, and lifestyle shops. It provided economic incentives through discounts and reward points to nudge health-seeking behaviors from enrolled women consumers/beneficiaries.MethodsAn ex-post facto evaluation was commissioned, and we employed a quasi-experimental design to compare outcomes related to the use of family planning, and antenatal and postnatal services between users and non-users who had registered for Tiko in three North Indian cities. Between March and April 2021, 1514 married women were surveyed, and outcome indicators were constructed based on recall. Despite statistical approaches to control for confounding, the effect of COVID-19 lockdown on Tiko operations and methodological limitations preclude inferring causality or arguing generalizability.ResultsWe found a strong association between the use of the Tiko platform and the current use of temporary modern contraceptives [non-users: 9.5%, effect: +9.4 percentage points (pp), p-value < 0.001], consumption of 100 or more iron-folic-acid tablets during pregnancy [non-users: 25.5%, effect: +14 pp, p-value < 0.001], receiving four or more antenatal check-ups [non-users: 18.3%, effect: +11.3 pp, p-value 0.007], and receiving postnatal check-up within six weeks of birth [non-users: 50.9%, effect: +7.5 pp, p-value 0.091]. No associations were found between the use of the Tiko platform and the current use of any type of contraceptive (temporary, permanent, or rudimentary). Effects were pronounced when a community health worker of the National Health Mission also worked as a health promoter for the Tiko Platform.ConclusionCommercial interventions that harness market-driven approaches of incentives, social marketing, and social franchising improved family planning and maternal health practices through higher utilization of private market providers while maintaining access to government health services. Findings support a unifying approach to public health without separating government versus private services, but more rigorous and generalizable research is needed.Trial registrationNCT05725278 at clinicaltrials.gov (retrospective); 13/02/2023.

A Study on Evaluation and Implementation of Indian Social Security Programs and Initiatives in India

This study critically assesses the implementation of Indian Social Security Programs, employing a comprehensive research design that integrates qualitative and quantitative methodologies. The examination encompasses diverse factors such as financial inclusion, healthcare accessibility, education, and support for vulnerable groups. Findings offer a nuanced understanding of strengths, challenges, and areas for improvement in India’s social security landscape, focusing on programs like Pradhan Mantri Jan Dhan Yojana, Atal Pension Yojana, and National Health Mission. The research’s practical implications extend to policymakers, administrators, and advocacy groups, providing evidence-based recommendations to refine and strengthen social security interventions. Addressing gaps in awareness, administrative efficiency, and inclusivity, the study guides practical interventions for enhanced program efficacy. This research stands out for its comprehensive evaluation of multiple social security dimensions, providing a holistic perspective on India’s initiatives. Synthesizing diverse data sources and incorporating beneficiaries’ lived experiences, contributes to the existing knowledge on social security implementation. The findings form a foundation for evidence-based policy-making, promoting a more inclusive, responsive, and sustainable social security framework in India. Additionally, the study contributes valuable insights to the global discourse on social welfare, illuminating challenges and opportunities in implementing social security programs amid a rapidly evolving socio-economic landscape.

Risk Assessment for Non-Communicable Diseases among Adults of 18 to 29 years Age in a Rural Area of Madurai District, Tamil Nadu, India: A Cross-sectional Study

Introduction: Non-Communicable Diseases (NCDs) are the leading cause of morbidity and mortality globally. In India, the Ministry of Health and Family Welfare reported a rise in mortality rates from 37% in 1990 to 61% in 2016. Additionally, the prevalence of diabetes mellitus and hypertension among young adults was higher than estimated. As the behavioural risk factors are mainly established in adolescence, screening at an earlier age becomes essential. Aim: To estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years and to assess the association between the risk factors and at-risk individuals. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of Madurai Medical College, Madurai, Tamil Nadu, India, to estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years. The National Health Mission (NHM) protocol was used for risk assessment, based on American Diabetic Association (ADA) and Joint National Committee (JNC) 8 guidelines. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software. Results: A total of 154 residents were included in the study. The mean age of the study participants was 24.64±4.70 years. Approximately 60% of the study participants were males and 40% were females. A total of 54% of the participants were married. Most subjects had completed high school (33.8%), followed by 28.6% who completed postgraduation. Disease categorisation revealed that 54 (35%) were non-diabetics, 89 (58%) were pre-diabetics, and 11 (7%) had diabetes mellitus. Similarly, 24 (16%) were non-hypertensive, 115 (75%) had high normal values, and 15 (9%) had probable stage I hypertension. A statistically significant association was observed between hypertension and educational level, alcoholism, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP), whereas diabetes mellitus was not significantly associated with any variables. The probabilistic prediction for hypertension using the logistic regression model included alcoholism and SBP, which contributed to 25.6% of the variations in prediction hypertension. Conclusion: The study results highlight a significant burden of undiagnosed cases of diabetes and hypertension in the community. This indicates the need for systematic screening, early lifestyle modifications, appropriate treatment, and regular follow-up for such individuals.

Strengthening Public Financing of Primary Healthcare in India: A Perspective.

Resilient and high-performing health systems that can respond to the global polycrisis hinge upon the effectiveness of their primary healthcare (PHC) system. This requires adequate and sustainable financing for PHC, which should be predominantly government financed. The recent Ayushman Bharat health reforms in India aim to ensure comprehensive PHC services and enhance financial risk protection through increased government financing. The government has augmented investments to fortify the PHC system by establishing Health and Wellness Centers (HWCs), equipped with an expanded benefit package for PHC services & human resource capacity. Aligned with the National Health Mission's targeted and flexible financial mechanisms, this offers States the opportunity to contextualize solutions and offer incentives to healthcare workers. However, aligning public financing arrangements to service delivery complexities and health outcomes pose intricate challenges in shaping the required reforms. The economic growth and room for increased taxation on health products provide an avenue for increased funding. Smart and efficient payment mechanism with improved accountability should complement increased investment.

Manipur's Journey Towards the Health SDGS: What's Achieved and what more is Needed?

India and its constituent states are committed to achieving universal health coverage (UHC) as a part of the Sustainable Development Goals (SDGs) 2030 by strengthening primary healthcare (PHC). The National Health Mission (NHM) has been a landmark effort at health systems strengthening, aiming to reboot both the architecture and service delivery. Manipur ranks fourth out of the eight states in the North East Region in the National Institution for Transforming India (NITI) Aayog's ranking for SDGs. The available evidence, drawing upon secondary datasets and available primary data, aims to unpack the progress made in health systems strengthening to interpret the journey toward achieving UHCs and SDGs. The progress made and the gaps in terms of human resources, infrastructure, service utilization, and reduction of out-of-pocket expenditure are interpreted in terms of critical social determinants such as geographic and ethnic divides. Newer policies, such as the Act East Policy and medical tourism, are examined in the context of current disparities and the potential to accelerate the journey towards achieving SDGs.

Assessment of Awareness and Knowledge of Oral Potentially Malignant Disorders and Oral Cancer among Accredited Social Health Activist Workers from Randomly Selected Blocks of Thrissur District, Kerala, India: A Cross Sectional Study

Introduction: Oral and oropharyngeal cancers are prevalent in the head-and-neck region, with global rates decreasing. However, in India, they are rising due to a lack of knowledge about risk factors and symptoms. The Indian government launched the National Health Mission to provide accessible, affordable, and reliable primary health care. Accredited social health activist (ASHA) workers can link health services to rural people. This study aimed to evaluate the awareness level among these workers about potentially malignant oral disorders and oral cancer (OC). Materials and Methods: A predesigned semi-structured questionnaire-based descriptive cross-sectional study was conducted among 150 voluntary ASHA workers from randomly selected blocks of Thrissur district, Kerala, to collect the data. Results: Our study showed that the majority of ASHA workers (82.3%) were aware of the role of tobacco in OC. A substantial portion of workers (88.4%) expressed that early detection of OC is possible at its initial stage. Less than 10% (7.5%) of all the ASHA workers were educated by dentists, whereas almost three-quarters (75.5%) of ASHAs preferred primary health center health practitioners as primary representatives for early OC detection, despite their being poorly trained in the early diagnosis and detection of OC. Conclusion: India has made progress in controlling malignancies but still lags in reducing OC mortality rates. Spreading knowledge of contributory agents and early detection methods through ASHA workers could reduce the incidence and mortality of OC. Including more dentists in the public health system and training ASHA workers on early OC detection can play a major role in reducing its incidence.

Capacity Building Efforts on Viral Hepatitis under National Viral Hepatitis Control Program

The “National Viral Hepatitis Control Program” (NVHCP) was launched in India as a stepping stone towards combating viral hepatitis as a public health threat. The program was launched on the occasion of world hepatitis day 2018 with the target of eliminating viral hepatitis by the year 2030. The program has provisions for developing infrastructure, nominating human resources, and building their capacity for successful service delivery. A time-bound cascade of training approaches is being adopted by the program to orient the designated healthcare workers on the standard operating protocols. The training is being conducted following a top-to-bottom approach, where master trainers are first identified and sensitized at the national level under the mentorship of the National Center for Disease Control (NCDC), the master trainers then sensitize the designated healthcare workers at the state level in collaboration with the state National Health Mission (NHM). Here is an outline of the Capacity-building efforts on Viral Hepatitis under NVHCP in Uttarakhand State.

Community-based assessment for infant, under-5 child and maternal mortality in tribal population of Himachal Pradesh, India

Introduction: Infant and child mortality rates are sensitive indicators of health services of any community. Tribal populations remain a disadvantaged group among other communities and the indicator of their accessibility and availability of health services is the infant and maternal mortality rates.Objectives: To assess reliable estimates and causes for the child (less than five year of age) mortality rate and maternal mortality ratio (MMR) of tribal population of Himachal Pradesh, and the maternal and child health services and facilities available in their health institutionsMethods: A community-based surveillance study was conducted in 2019-20 on the deaths of all children (less than five year of age) and maternal deaths in the entire population of two tribal districts i.e., Kinnaur and Lahau l &amp; Spiti, and of two tribal blocks of Chamba District in the state of Himachal Pradesh. Sub-centres (SC) remained under the study for a period of one year. Verbal autopsies were conducted to ascertain the cause of death by community workers under the supervision of project staff. In addition, a cross-sectional facility survey was conducted, Health institution data were gathered using a pre-tested structured schedule adapted from the National Health Mission Facility Assessment Tool.Results: Majority (85%) of the SCs were functioning in Kinnaur District and 66% at Lahaul &amp; Spiti District. In the latter district, the labour room was functional at primary health center (PHC). Civil and district hospitals were preferred for delivery while SC and PHC were preferred for preventive services. The infant mortality rate (IMR) of all districts was 24 per 1000 live births (LB). Most of the deaths were in post neonatal period (62%). Birth asphyxia and pneumonia were major causes. The 1-5-year mortality rate was 1 per 1000 LB, which was only reported from the district of Chamba. There were zero maternal mortalities during the survey period.Conclusions &amp; Recommendations: The IMR in tribal districts was higher than the state average. Most deaths were due to birth asphyxia, hence indicates the importance of labour room preparedness at PHCs in these hard-to-reach areas.

Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention

ObjectiveDespite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for...

National Health Mission and the Status of Public Healthcare in Indian States

This contribution makes the 18th part of the social change indicators series, a collation of available data on developmental issues. This note looks at the status of public healthcare through six select public healthcare infrastructure and workforce indicators in the post-NHM periods in the states of India. Abandoning the primary health care approach—where the state plays the primary role of planner and provider—perpetuated the inadequate public expenditure on health in India. The National Health Mission (NHM)—the largest health programme in India that was launched in 2005 to achieve universal access to equitable, affordable, and quality healthcare services—suffered through this. Public healthcare in India was in poor shape when the NHM was launched. Several key indicators have further deteriorated since then. A few indicators registered modest improvement during the first 10 years of the NHM, but even that has plateaued in the more recent period of 2014–2021. These sobering findings call for a renewed thrust on public investment in health for robust primary health care.

Knowledge and Attitude of ASHA workers in prevention of Early Childhood caries: A cross sectional study

Introduction: Accredited social health activists (ASHAs) are government instituted community health workers as part of the National Rural Health Mission. The purpose of this study was to assess the knowledge and attitude of ASHAs regarding Early Childhood caries. Methods: A cross sectional survey was carried out among 190 ASHA workers. A self-constructed, 15 items, close-ended questionnaire based on the dental knowledge and the attitude of dental health was translated into regional language using a standardized translation process. The Questionnaire was distributed at the monthly review meeting held at Primary Health centres and their response was taken. The data was analysed and compared on basis on their educational level.  The data were analysed by SPSS Version 24. Results: The content validity index of the questionnaire was 0.75 and the face validity was 3.2. The internal consistency was assessed with a Cronbach’s alpha coefficient and was found to be 0.876. Test–retest reliability is 0.8. The correct responses on knowledge of participants is 55.76% and for the attitude towards child oral health is 74.76%. Study also showed ASHA workers have poor knowledge about first dental visit and oral hygiene maintenance in children (p &lt; 0.05). No statistical difference in knowledge and attitude of ASHA based on their educational level was noticed Conclusion: The ASHA workers have only satisfactory knowledge about ECC but their attitude toward the Child Oral Health is good. Therefore training and motivation can help in educating them for preventive community programmes for ECC.