A feasible strategy for a health care package
Ghosh, S.
Indian Pediatrics 27(4): 327-332
1990
ISSN/ISBN: 0019-6061 PMID: 2210817 Document Number: 377507
The National Health Policy adopted in India in 1982 proposed primary health care involving the community and relying on maternal-child health (MCH) services. The Bhore Committee stressed similar priorities in 1946, but implementation was deficient. In 1988 there were 100.000 sub-centers (SC), 15.000 primary health centers (PHC), and 800 community health centers (CHC). The 7th 5-Year Plan envisioned a village health guide (VHG) and trained worker for 1000 people. A SC was to serve 5000 people with 2 health workers, and a PHC to care for 30.000 people. The budget increased for these efforts and for the universal immunization program (UIP). Antinatal care coverage for women was 60-75%, while tetanus toxoid coverage was complete (100%). Still only a low percentage of women utilized antenatal care: 1.4-32.8%. Nonutilization was due to traditional beliefs, emphasis of tubectomy and immunization targets, and low rate of registration by PHCs of pregnant women. Immunization coverage exceeded 40% in some states, thus it could be optimal for the administration of 2 doses of tetanus toxoid, for antenatal examination (to identify high-risk mothers, anemia, and toxemia), and for giving iron and folic acid tablets (60 mg elemental iron and 500 mg folic acid per tablet to reduce the 60-70% rate of anemia). A national nutrition study showed that hemoglobin below 8 g/dl and maternal weight below 40 kg at 29 weeks of pregnancy was strongly associated with low birth weight. Trained traditional birth attendants (TBAs) could identify causes for hospital referral. At 4-6 months of the baby's life semisolids enter the diet, and family planning advice can be dispensed. Agenda include during UIP contact at 6-8 weeks: diphtheria (DPT), oral poliovirus vaccine (OPV), and tuberculosis (bacillus Calmette-Guerin or BCG) shots; health assessment; and teaching of breast feeding to primipara. One vitamin A dose at 1 year and another at 1 and 1/2 year of life during DPT and OPV booster shots can be administered. Flash cards and illustrations facilitate communication for health workers. Hand washing after cleaning the baby should be stressed. Additional inputs along with UIP can lead to improved maternal and child care.