Improving reproductive health services: Is integration with primary healthcare better than vertical programmes?

The burden of high maternal and child mortality is one which the Nigerian Government is working hard to overcome particularly in the northern part of the country. Majority of women in Yobe State, just like any other state in Northern Nigeria, deliver at home. Those who deliver at home often do so because of reasons related to cultural norms (not necessary to deliver in a health facility), cost, lack of transport, lack of spousal permission or due to health worker’s attitude. One of the strategies in improving maternal and neonatal health would be to reduce the barriers to accessing emergency maternal obstetric care services through functional emergency transport scheme (ETS). We report preliminary results of a community-based quasi experimental prospective pilot study on the role of financial incentives in sustaining the ETS in Yobe State, northwest Nigeria. Over 75% of women and newborns from the incentivized intervention communities benefited from ETS services compared with their counterparts. The pilot study also demonstrated its ability to transport women from hard-to-reach and impoverished rural areas to health facilities. We discuss these results in light of the existing challenges related to health service delivery and the need to scale up the pilot results.

This paper is an attempt to examine whether women’s empowerment is associated with maternal health service utilization in the context of Nepal. This paper has used data from the cross sectional population-based Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the five years preceding the survey (n=4,148). The net effect of women’s empowerment related variables on adequate prenatal, delivery and postnatal care after controlling for the effect of other predictors has been measured through multivariate analysis (multivariable logistic regressions). The findings indicate that utilization of maternal health services was low. Higher level of women’s empowerment was associated with greater use of prenatal, delivery and postnatal care. It can be concluded that programs should aim to increase use of maternal health services by improving women’s empowerment so that the overall well-being of the family maintained and enhanced.

In Cambodia, recent figures have shown impressive declines in the maternal mortality rate alongside commensurate increases in maternal healthcare use over the last decade (DHS 2010). In this paper, we examine the determinants of this rise in service use in Cambodia, particularly focusing on the role of social health protection schemes such as health equity funds in driving this change. Using baseline survey data from the evaluation of the Reproductive Health (RH) vouchers program being conducted by Population Council (N=2201), we use a binary response multilevel random effects model to examine both individual-level and community-level influences on facility-based deliveries and antenatal care use among women in three provinces in Cambodia. Preliminary results suggest that social health protection schemes as well as community-level influences are significant in determining the use of maternal healthcare services. Implications for policy development and healthcare financing programs including the targeted RH voucher program are discussed.

Under the National Rural Health Mission, Government of India introduced an ambitious scheme of Janani Suraksha Yojana (JSY) in the year of 2005. This scheme seeks to reduce maternal and neo-natal mortality by promoting institutional delivery services, by providing a cash incentive to mothers who deliver in health facilities. JSY has promoted the utilization of institutional delivery services. Institutional deliveries increased from 14.1 percent (2002-2004) to 33.2 percent (2007-2008) to 65.0 percent (2010) in the study area. This paper presents an assessment of JSY in terms of awareness of the scheme, increase in institutional deliveries, JSY beneficiaries by background characteristics, place of delivery (public/private health facility), type of delivery (normal/c-section/episiotomy) distance and use of transport, payment of cash-incentives and quality of delivery services provided under the scheme in rural Uttar Pradesh. This paper investigates the shortcoming of JSY like non/delay-payment of cash-incentives, poor quality of care and treatment provided to beneficiaries. Based on findings suggestions have been given to emphasize on ‘quality’ of delivery and post-delivery services and not merely on ‘quantity’ of institutional deliveries in order to achieve JSY and MDG-5 objectives.

Korea's reproductive health(RH) program had been focused on family planning and MCH care, with the family planning program being executed simultaneously with economic development for extreme poverty and hunger eradication until the mid of 1990.
The purpose of study is to identify the policies/programs, success factors for RH in Korea and contribute to improving the official development assistance(ODA) for RH in developing countries. Currently, most nations in Africa and South Asia, Korea's key partners for the ODA are characterized by high fertility, high maternal and infant mortality and extreme poverty, and low social status of women, whose circumstances are very similar to those of Korea in the 1960s.
Based on this study result, Korea's strategies in improving the RH- sector wide approach based on primary health care, the 'Women's Association for Saemaeul', which was organized as part of ownership and success of the five-year economic development-had been successful. Just, nations featuring high fertility can be regarded as male-dominated societies, with the result that Korea's intervention may cause resistance. Therefore, RH program to the developing countries need to consider their socio-cultural factors to ensure women's right to life at a national level needs to be set as the core of Korea's RH program.

Cancer has become a major cause of morbidity in developing countries like India. Cancer of the uterine cervix is one of the commonest malignancies seen in Indian women. Sexual behaviour is one of the issues related to development of cervical cancer. It would be worthwhile to estimate the absolute risk a women runs for getting CIN 3 in the presence of risk conditions. The present communication attempts to estimate the probability of women having a high grade of cervical neoplasia (CIN111) in the presence of certain risk conditions through the Bayesian approach. The data has been utilsed from the reports long term study conducted by ICMR.
The probability of women having a high grade cervical lesion in women more than 35 years would be 0.43. If a women is having parity of more than 2 the risk or probability would be around 0.35%. If a woman is married before 18 years she runs a risk of about 0.7% for the development of the disease under consideration her promiscuous behavior elevates this risk to 1.3%. The role of obstetric practices have also been considered.. Need in modification of sexual behaviour and advocacy for through RCH programs in developing countries is felt

The National Rural Health Mission (NRHM) in Karnataka has made considerable investments in strengthening the infrastructure, building capacity of service providers, and ensuring adequate equipments, drugs and supplies in public health facilities. This paper aims to identify gaps for each care component at each level of the health system, against the national and state guidelines in terms of infrastructure, service provision, drugs, equipment and supplies, and population coverage. During June – July-2010, all the 379 public and 94 private facilities in district Bellary were mapped for availability of MNCH services, including infrastructure, staff, equipments, drugs and supplies. A large number of normal deliveries are occurring at higher level facilities, creating system inefficiencies. Basic emergency obstetric and newborn care (BEmONC) and comprehensive emergency obstetric and new born care (CEmONC) need to be established, according to population norms. Provision of safe abortion services at PHC and higher facilities will help reduce maternal mortality.

Despite improvements in access to health care, India has substantial geographical inequalities in health outcomes eg, life expectancy is 56 years in Madhya Pradesh and 74 years in Kerala; this difference of 18 years is higher than the provincial differences in life expectancy in China, or the interstate differences in the USA. The present study tries: to study the extent of regional inequalities in performance of health outcomes, to study the trend in regional disparity and to understand gap between millennium development goals and performance of regions. In order to meet above mentioned objective, 3 rounds of National Family Health Surveys were analyzed for India. States were classified in 6 regions as per NFHS-report classification. The result suggests that performance of health outcome is not same across regions. The health outcomes found to be good in Sothern region, followed by Western region and lowest in East and Central region. The trend analysis shows that the gap between good performing regions to poor performing region is narrowing over the year except the performance in institutional delivery. Even though health outcomes shows positive trend across the region, still achievement of Millennium Development Goal (MDG) remains as a challenge including southern region.

Present study investigates the main reason behind why is it reproductive health problems are relatively more in the Mongolian decent tribal dominated remote area of Northeastern India. It is well known that Northeastern part of India is lagging behind in almost all socio-economic indicators compared with mainland India, which is a serious concerned that probably linked with reproductive health care utilization. Three fundamental reproductive health care indicators like Antenatal care (ANC), Institutional Delivery (ID) and Postnatal care (PNC) are selected as independent variables to understand the ground reality of mother’s health seeking behaviour. Selected potential determinant variables includes: accessibility, poverty, availability of health care facility, female literacy, urbanisation and concentration of tribal population in the region. Various nationally representative data like: National Family Health Survey-3 (NFHS-3), Censuses of India-2001& 2011, Ministry of Transport & Highway and District Level Household Survey-3 (DLHS-3) are utilized for the analysis. Statistical validity like correlation coefficient has been tested by using SPSS-7, which proved that there exist significant relationship between reproductive health care utilization and urbanisation in this geographically isolated part of India.

Objective
1. To examine the differentials in reproductive and child health services in the state of Jharkhand
2. To examine the inter-districts inequality in utilization of RCH services in Jharkhand.
3. To understand the covariates of inequality in utilization of RCH services in Jharkhand.
Data source and Methodology: The present study utilized data from Districts Level Household Survey (DLHS-3), Conducted under reproductive and child health programme in India. Reproductive and child health is analyzed using four indicators namely, antenatal care, safe delivery, contraception used and child immunization.
Result: The percentage of women and their children who utilized maternal and child health services shows that 5.6% respondent used full ANC, 25% women had safe delivery and 40 % women were using contraceptive and, 54% of children age group (12-23 months) was fully immunized.
Conclusion: Socio-economic factors responsible for inequality in utilization reproductive and child health services in these states. Highly spatial difference found in utilization of RCH services across the districts of Jhrakhand, India.