Despite of increase in public and private healthcare sector expenditure, the utilization of healthcare services in India has remained poor. Issues related to Maternal and child health are of concern.1 For the health and wellbeing of a child, as well as family and societal well-being, antenatal and postnatal care of mother is necessary.
India's Reproductive and Child Health programme2-
Considering high maternal and child deaths, government of India has always aimed at addressing these issues through concrete health programs. India was the first country to launch the national family planning programme. It was later integrated into family welfare programme.
The International Conference on Population Development (ICPD), 1994 and the Fourth World Conference on Women, 1995 held at Beijing, China emphasized on gender equity and sustainable development. These conferences suggested the reproductive health programs to look after gender issues behind the health problems, women's health needs throughout their life span and men's responsibility to respect women's reproductive rights. ICPD helped India to formulate an integrated programme which could go beyond the family planning and stress on gender equity. The reproductive and child health programme in India was then started in 1997.
The second phase of this programme came in action along with National Rural Health Mission in 2005, which emphasized on the improvement of availability and access of the healthcare services by the people especially women , children and weaker components of the society. The RCH programme covers the reproductive needs of women and men at all stages of life.
The reproductive and child health programme of India is based on the basic components such as Child health (child survival and child development) and safe motherhood (including safe management of unwanted pregnancy and abortion), Adolescent health (sexuality development, adolescence education and vocational component), effective family planning (Ensuring Informed choice, Counseling, gender equality and greater male participation), Prevention, detection and management of Reproductive Tract Infections, Sexually Transmitted Infections, HIV/ AIDS and cancer of the reproductive system , Reproductive health care of elderly people.
The main focus of the RCH programme is to reduce Maternal and Infant mortality and Total Fertility Rate. The programme is operated all over the country through primary, secondary and tertiary public healthcare system. Decentralized approach is the key component of this programme.
1.1.2 Utilization of RCH services-
Utilization of healthcare services can be assessed by patient's as well as health professional's perspective. The patient's perspective can be subjective based on the services reported by the patient or the quality of services felt by the patient, or objective based on the services offered by the healthcare facility to the patient. The health professional may see towards the utilization of services by economic aspect such as the number of patients, number of visits etc.3
The utilization of RCH services can be assessed by the utilization of all its components. Maternal Mortality and morbidity, Infant mortality and child mortality, and total fertility rate are the basic indicators of availability, utilization and effectiveness of MCH services. Status of these indicators reflects the status of healthcare services in the country.5
Various factors are responsible for the utilization of RCH services, for example, levels of education, socio-economic status, environmental factors such as access to the health centre, healthcare infrastructure etc. Study of utilization of these services, therefore requires consideration of all these determinants of the healthcare utilization.4
1.2 Global scenario-
The Millennium Development Goals (MDGs) set up by WHO for MMR is 109, for IMR is 28 and for Under-5 mortality rate is 42 by the end of year 2015. High difference in these indicators in developed and developing countries shows the difference in availability and utilization of RCH services in developed and developing countries.6
1.2.1 MCH in developed countries- In developed countries such as central and western Europe, Australia etc, the utilization of preventive services is very high among females than males. The studies done in early seventies have helped the developed countries to improve the health service utilization. The important factors indentified were average cost per visit, health insurance coverage, age, education etc. This resulted in lower maternal mortality rates, e.g. 5 in Sweden; 3 in Denmark, Norway and Israel (Population Action International, 1995).
In United States it is found that black women make substantially less use of health services than white counterparts, due to socio-cultural factors. The increase in migrant population and their certain conceptions lead to non-utilization of services in Sweden.7,8
The World Health Organization has identified Cuba as an example of "good health at low cost" achieved through policies that address the determinants of health and are based on equitable access, universality and governmental control. They have focused on three major initiatives-1) primary care through polyclinics, 2) comprehensive approach at the community level and 3) feedback from community.9
1.2.2. MCH in developing countries- In recent years, developing countries are influenced by findings in developed countries, for assessing the quality of their health care. Outcomes have received special emphasis as a measure of quality. Assessing outcomes is useful as an indicator of the effectiveness of different interventions and as part of a monitoring system directed to improving quality of care as well as detecting its deterioration.
In Indonesia use of an unskilled birth attendant and giving birth at home are most common among the poorest and least educated women. The children of these women have the highest risk of infant mortality. The infant mortality rate differs greatly by region of access to health services. In Ethiopia , socio demographic characteristics of women, cultural context , accessibility, consumer satisfaction influenced health service utilization.
1.3 Local scenario-
The national rural health mission 2005 set up certain goals to improve the health service utilization by people residing in rural areas, women, children and the poor in India. The target for MMR is 100, IMR 30 and TFR 2.1 by the end of 2012.10
The present Maternal Mortality Rate of India is 212. Infant mortality rate has declined to 49, while Under-5 mortality rate is still 64. Total fertility rate of the country is 2.6, which is higher in rural area i.e. 2.9 as compared to urban area which is 2.0.11
According to NFHS-3 data, only 44 percent women use the antenatal care in the first trimester of pregnancy, and only 52 percent women give 3-4 visits to health centre foe ANC services during the total pregnancy period. Only 47 percent births are attended by health personnel including doctor, ANM, nurse, midwife or lady health visitor. Only 37 percent women receive post-natal care within two days of delivery which is supposed to be a critical period. Utilization of these services is different in rural and urban area.
Though coverage of ICDS is high in the country, only 28percent children receive the services provided through ICDS. Only 44 percent children are fully vaccinated while 5 percent children are not given any vaccination. Percentage of children which are taken to healthcare centre for the Acute Respiratory Infections (ARI), fever and diarrhea ranges from 60-69 in different states of the country.
Most common reason for not using public health facilities is poor quality of service, followed by non-availability of the healthcare facility nearby.12
The utilization of RCH services differs in different states of India. Nature and extent of the relationship between maternal education and utilization of MCH services differ between the north and south of India and that this difference is largely determined by the north-south differentials in the general socio-economic and cultural environment in which women live.
1.4 Rationale of the study-
The Maternal, infant and under-5 children mortality rates have shown significant decline from the beginning of second phase of RCH programme, which reflect the positive change in availability and utilization of RCH services. But as compared to the MDG goals as well as NRHM goals for these indicators, there is further need to work on the improvement of utilization of these services.
Kolhapur is the southernmost district in Maharashtra state. It is divided in 12 talukas and five sub-divisions for administrative purposes. The total population of the district is 35,23,165 out of which around 24,72,809 population resides in rural area.13
The organization of RCH programme in Kolhapur district consists of a District Hospital, two sub-district hospitals, 18 rural hospitals (RH), 73 Primary health centres (PHCs) and 413 sub-centres.14
Radhanagari sub-division of Kolhapur district covers 4 rural hospitals, 13 PHCs and 52 sub-centres. The utilization of RCH services in the health centres based in Radhanagari sub-division is low, while there is overburden on the district hospital for these services.
Therefore, on recommendations of Sub-divisional Office, Radhanagari and considering all the factors affecting the utilization of RCH services, the study is planned to analyze the utilization pattern of RCH services, reasons for non-utilization of these services at different levels i.e. RH and PHC and also to suggest the possible measures to improve the utilization of services in the Radhanagari sub-division of Kolhapur district, Maharashtra.
1.5 Objectives of the study-
To determine the utilization of RCH services in Radhanagari sub-division of Kolhapur district.
To find out the reasons for utilization/non-utilization of these services.
