Reproductive Maternal Newborn Child Health Research Articles

Assessment of services available in public health facilities among high priority districts of Jharkhand under reproductive maternal newborn child health + adolescence

Assessment of services available in public health facilities among high priority districts of Jharkhand under reproductive maternal newborn child health + adolescence

Multi-country case studies on planning RMNCH services using WISN methodology: Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea

BackgroundGlobally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries.MethodUsing available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services.ResultsThe health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities.ConclusionSince the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.

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

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).

Study of cold chain management system at Urban Primary Health Centers (UPHCs) of Vadodara city in Western India

Background: Urban Primary Health Centers (UPHCs) have been the backbone for delivering immunization services in urban areas in India. It is thereby important that cold chain system is maintained at these UPHCs. Objective: To assess the cold chain management system at all UPHCs of Vadodara city in western India. Materials and Methods: A cross-sectional observational study was conducted at all 19 UPHCs of Vadodara city run by Vadodara Municipal Corporation. All 19 UPHCs of the entire Vadodara city were assessed for cold chain management system from April 2013 to May 2014. Data collection was done as a part of supportive supervision of Reproductive Maternal Newborn Child Health plus Adolescents (RMNCH+A) program by using structured checklist. Data were entered in Microsoft Office Excel and analyzed using Epi Info software. Descriptive statistics including actual numbers and proportions of the study variables are mentioned. Result: Cold chain equipments including ice-lined refrigerator (ILR) and deep freezer (DF) were functional at all 19 UPHCs. No other vaccines/medicines were stored in ILR or DF in any center. Ice packs were correctly placed at five centers only. Frozen vaccine vial was observed at one site. Conclusion: Cold chain was maintained quite satisfactorily at all the UPHCs of the Vadodara city. However, some logistics and training of cold chain handler needs to be focused as highlighted in the study.

Neonatal nursing: an unmet challenge in India.

Nurses comprise a key component to maternal and newborn health care delivery, including the care of 'at-risk' or sick newborns. However, the efficiency and effectiveness of services rely heavily on adequate numbers of highly skilled neonatal nurses. Currently, in India, a significant shortage of trained nurses in the field of newborn care is contributing to poor neonatal outcomes. Specifically, nurses caring for newborns lack the competency and experience needed to ensure optimal care. This deficiency has been linked to a lack of expert faculty, standardized training and minimal or no exposures to newborn clinical care areas during pre service education. Moreover, in addition to a lack of operational research in the area, nurses who provide care for newborns are often faced with numerous system related issues that impede their ability to provide optimal care. Most notably, frequent changes of work place, poor wages, and lack of continuing education, skill maintenance, recognition, and collaborative team culture further compromise the nursing care. All these lead to poor motivation and competency. To meet this challenge, it is essential that emphasis be placed on the identification and support of nursing faculty with expertise in newborn and neonatal care who are able to ensure that nurses receive standardized education for pre-service, in-service and ongoing care. In addition, importance should be placed on encouraging newborn nursing research as well as on governmental increases in salary compensation. Lastly, given the shortage of physicians to take care of sick neonates in remote areas, the creation of a cadre of Neonatal nurse practitioner/ advanced practice nurses would be an invaluable solution in developing countries. Furthermore, centralized oversight of newborn education and training would be best served, if responsibility was placed with Reproductive maternal newborn child health (RMNCH) workers and district level officers.