Sociology

The Government of India has been providing limited maternal and child health services through its Family Welfare programme, but this system is characterised by weaknesses that include inefficient work schedules; non-availability of functioning equipment; poor contraceptive and drug supplies; poor skills and knowledge of health workers; and poor access to services in villages without health centres. For the new Reproductive and Child Health programme to deliver an even wider range of services, the health system will need to be strengthened and the quality of service delivery improved. This paper describes a seven-year operations research project in Parner block, Ahmednagar district, Maharashtra, India, undertaken by the Foundation for Research in Health Systems in partnership with state and district health administrations. It shows the feasibility of establishing a more efficient system, with a minimum of affordable inputs, that increases the use of services by women. Four critical policy changes were implemented: service delivery in each village was changed from household visits to a clinic base, stringent monitoring mechanisms were put in place, in-service training for health workers was instituted and the range of services was gradually increased. This experience is now being applied more widely, with eventual phasing up to full district and state level.

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N India, adolescent girls aged 15-19 constitute about 10 per cent of the population. About 40 per cent of adolescent girls are married before the age of 18, at a median age of 16, in contravention of the minimum legal age (18 years). 1 Information about health issues among unmarried adolescents in India has recently been highlighted, 2,3 but little is known about married adolescent girls and whether and how their reproductive health needs are met. Adolescence is a time of sudden transition for girls in India. Newly married girls leave their natal home to take up residence with their husbands' family, where as strangers, they find themselves in a subordinate position relative to all the members of his family. 4-6 These girls confront social and familial pressure to begin childbearing soon after marriage, which is often welcomed by them as a way to improve their status. 6,7 Marriage and childbearing bring new health problems, however, especially those relating to reproductive health. Yet married adolescent girls rarely seem to seek treatment, 4,8 a fact which cannot be explained by the lack of services alone. While it is true that health care services are lacking in some areas, it is also true that Indian women often do not use available services. It is unclear why they seek care for some ailments but not others, or which health concerns are more quickly addressed. Several studies have documented a greater inclination to seek curative care, but relatively low use of preventive services. 9-11 Some women delay or forego seeking treatment because of household duties, 10,12-14 but may seek care promptly when their condition prevents them from performing household tasks. 9,11,15 Certain conditions, reproductive tract infections in particular, may receive inadequate attention because sexual matters and related gynaecological problems are shrouded in a culture of silence, embarrassment, shame and blame. 16,17 Alternatively, symptoms like vaginal discharge

The Government of India has been providing limited maternal and child health services through its Family Welfare programme, but this system is characterised by weaknesses that include inefficient work schedules; non-availability of functioning equipment; poor contraceptive and drug supplies; poor skills and knowledge of health workers; and poor access to services in villages without health centres. For the new Reproductive and Child Health programme to deliver an even wider range of services, the health system will need to be strengthened and the quality of service delivery improved. This paper describes a seven-year operations research project in Parner block, Ahmednagar district, Maharashtra, India, undertaken by the Foundation for Research in Health Systems in partnership with state and district health administrations. It shows the feasibility of establishing a more efficient system, with a minimum of affordable inputs, that increases the use of services by women. Four critical policy changes were implemented: service delivery in each village was changed from household visits to a clinic base, stringent monitoring mechanisms were put in place, in-service training for health workers was instituted and the range of services was gradually increased. This experience is now being applied more widely, with eventual phasing up to full district and state level.

Childbearing in adolescence, a common practice in south Asia, can adversely affect the health of both mother and child. This qualitative study was conducted in three sites in India and Bangladesh where low birth weight is prevalent to explore the ability of newly-weds to negotiate the timing of their first pregnancy. The pattern in each site generally reflected prevailing social views on contraception, childbearing and couple communication.

Medical abortion, approved in India in 2002, is emerging as an alternative to surgical procedure for terminating early pregnancy and offers a window of opportunity to expand women's access to safe and effective abortion. A study undertaken of chemists and providers points to some of the challenges such as limited awareness of the appropriate regimen, protocol and likely side effects, the cost to clients, resistance of providers of surgical abortion and the need for adequate backup facilities. All these have to be addressed in order to make medical abortion available widely.

The present study based on Gujarat provides interesting insights on medical abortion. Based on interviews with a few chemists, drug industries and the service providers, maladies in the provision of medical abortion that has not yet become widely available or used are identified. These include, inadequate information, awareness, and services that can risk the health and life of the end users. [WP no. 166]

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In India, safe abortion services are sought mainly in the private sector for reasons of privacy, confidentiality, and the absence of delays and coercion to use contraception. In recent years, the declining sex ratio has received much attention, and implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act (2003) has become stringent. However, rather than targeting sex determination, many inspection visits target abortion services. This has led to many private medical practitioners facing negative media publicity, defamation and criminal charges. As a result, they have started turning women away not only in the second trimester but also in the first. Samyak, a Pune-based, non-governmental organization, came across a number of cases of refusal of abortion services during its work and decided to explore the experiences of private medical practitioners with the regulatory mechanisms and what happened to the women. The study showed that as a fallout from the manner of implementation of the PCPNDT Act, safe abortion services were either difficult for women to access or outright denied to them. There is an urgent need to recognize this impact of the current regulatory environment, which is forcing women towards illegal and unsafe abortions.

Following the International Conference on Population and Development Adolescent Reproductive and Sexual Health (ARSH) was recognized as a top development priority in India's National Population Policy 2000. In 2006 a separate ARSH strategy was articulated within the National Rural Health Mission. In Jharkhand, one of the poorest and least developed states in India, in 2008 the state government launched a Tarunya Project in collaboration with EngenderHealth. The project provided cascading ARSH training to government staff at secondary care facilities and strengthened outreach activities to enhance community engagement. After 5 years of implementation, the project was evaluated by a team from the World Health Organization. The evaluation found that the project provided training and ongoing backstopping support to strengthen the ARSH readiness of health facilities. The project's intervention efforts contributed to improvement in quality and initial use of ARSH services. The per...

Public Private Partnerships have been implemented in India to help improve the performance of the public health sector. The experiences of implementation have been a mixed bag with some successes. There have been concerns during implementation about the designs not accounting for disparate motivations, ambiguous roles and risks to partners that affect the management, sustainability and ultimately the services. A study was conducted to understand the designs of three Public Private Partnerships addressing reproductive health needs of women at primary and secondary health care level in rural Gujarat. These partnerships were with a corporate body, a Non-Government Organisation and with private empanelled gynaecologists respectively. Review of data and relevant documents from the government and private partners and in-depth interviews with select key informants were conducted. The Government of Gujarat has drafted elaborate conceptual framework and guidelines for Public Private Partnership. Yet, the non-competitive selection of partners, conflict of interest, lack of commitment and attention to standards of care and insufficient monitoring and accountability mechanisms all point towards weaknesses in design of these models. Implementation without fidelity to the purpose and design of the PPP and un-addressed risks to partners make these partnerships vulnerable to exploitation and un-sustainable in the original format. The study highlights the need for thorough review of partners and evaluation of existing models to ensure that the potential benefits of PPPs are not frittered away at the altar of weak designs and lack of monitoring.

Although the need for multi-faceted and multi-sectoral approaches to address the multidimensional issue of child marriage is well-acknowledged, there is a dearth of documented experience on the process of implementing and managing such programmes. WHO evaluated a district-level, government-led multi-sectoral intervention to address child marriage in Jamui, Bihar and Sawai Madhopur, Rajasthan, implemented by MAMTA Health Institute for Mother and Child (MAMTA). We evaluated the intervention's design, implementation, monitoring, and outputs and identified key challenges and successes. Through actions at the state and district levels, the intervention succeeded in creating a cascade effect to stimulate more concerted action at block and village levels, with tangible intersectoral convergence occurring at the village level. The success factors we identified included an experienced partner NGO that was committed to supporting this effort, context-specific design and implementation, an...

Since 2006, Udaan-a school-based adolescent education program in Jharkhand, India-was the only at-scale state-run program in the country. To determine factors that contributed to Udaan's scale-up and longevity, this study drew information from programmatic reports and interviews with the Centre for Catalyzing Change staff. Key factors for Udaan's success included an enabling policy environment, a willing government that supported and operationalized the program, a knowledgeable and committed NGO partner, sustained funding, and a commitment to constant improvement through evaluation. Udaan provides an example of a well-designed, implemented, and evaluated schoolbased adolescent health program that has been operating at scale over a sustained period. Other programs in India and elsewhere can benefit from learning from Udaan's experience.

Background Recognizing the potential of the country’s large youth population and the importance of protecting and supporting its health and well-being, the Government of India committed to strengthening its programmes and systems for adolescents, initially through the Adolescent Reproductive and Sexual Health Strategy (ARSH) launched in 2005 and, subsequently, through the National Adolescent Health Programme (Rashtriya Kishore Swaasthya Karyakram or RKSK) launched in 2014. In 2016, in response to a request from the Government of India, the World Health Organisation undertook a rapid programme review of ARSH and RKSK at the national level and in four states (Haryana, Madhya Pradesh, Maharashtra and Uttarakhand) to identify and document lessons learnt in relation to four domains of the programmes (governance, implementation, monitoring and linkages) that could be used to enhance current and future adolescent health programming in India. Methodology and findings A rapid programme revie...

Religious distress is at the same time the expression of real distress and the protest against real distress. Religion is the sigh of the oppressed creature, the heart of a heartless world, just as it is the spirit of a spiritless situation. It is the opium of the people. The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition, which needs illusions. 1