Maternal and child health services in India with special focus on perinatal services

Abstract

India has an excellent infrastructural layout for the delivery of MCH services in the community through a network of subcenters, primary health centers, community health centers, district hospitals, state medical college hospitals, and other hospitals in the public and private sectors. However, the health pyramid does not function effectively because of limited resources, communication delays, a lack of commitment on the part of health professionals, and, above all, a lack of managerial skills, supervision, and political will. The allocation of financial resources for the delivery of health care continues to be meager. Nevertheless, in spite of obvious constraints, the country has made laudable progress in reducing post-neonatal mortality in recent years. Indeed, the focus has shifted to the young infants and the perinates. Under the CSSM program, a massive expansion of MCH services has occurred at the sub-district and the district levels. The RCH program, to be launched shortly, aims at effective utilization of these facilities to ensure delivery of integrated services of assured quality through decentralized planning. Simultaneously, as a result of the ongoing economic liberalization, the MCH care in the private sector will also expand rapidly. Indeed, India is on the threshold of an extraordinary improvement in the status of its neonatal-perinatal health.

PIP: The infant mortality rate (IMR) in India dropped from about 140/1000 live births in the early 1970s to 73/1000 in 1994. The IMR is highest in Orissa state (103/1000) and lowest in Kerala state (16/1000). Neonatal/perinatal data collection in the country is carried out by means of the Sample Registration System generating vital statistics; the Survey of Causes of Death by lay reporting; and the Data on Causes of Death from the Urban Hospitals. The health infrastructure comprises subcenters for a population of 5000, primary health centers (PHCs) for a population of 30,000, and a community health center for every 3-4 PHCs. There is a district hospital in each district capital. The most comprehensive among maternal and child health programs is the Child Survival and Safe Motherhood Program, under which maternal-child health services have been integrated since 1992 in order to achieve substantial improvements by the year 2000. The child survival component consists of newborn care, immunization, management of acute diarrhea and respiratory infections, prevention of hypothermia and infections, promotion of exclusive breast feeding, and referral of sick newborns. In mid-1997 the maternal-child health services will become part of the Reproductive and Child Health (RCH) Package of the National Family Welfare Program. The RCH Package consists of prevention and management of unwanted pregnancy; antenatal, delivery, and postpartum services; child survival services for newborns and infants; and management of reproductive tract infections and sexually transmitted diseases. The Integrated Child Development Services program was launched in 1975 and covers 70% of the country's community development blocks and 260 urban slum pockets. Its beneficiaries are children under 6 years of age, expectant and lactating mothers, and adolescent girls. The All India Hospitals Postpartum Program, with every hospital including an outreach program for 50,000 people, seeks to provide family planning during the post-delivery period. The National Neonatology Forum was created in 1980 and has trained over 15,000 specialists.