A Study for Developing Evidence Based Intervention to Improve the Antenatal Care Services for North 24 Parganas in West Bengal

Abstract

Background: Antenatal care (ANC) helps in getting a healthy mother and a healthy baby at the end of pregnancy. This requires early registration of mother and a host of services as ANC package like IFA tablets, Tetanus toxoid, advices (regarding diet, rest) etc. Antenatal visits may raise awareness about the need for care during delivery or give women and their families a familiarity with health facilities that enables them to seek help more efficiently during a crisis. The National Health Policy, launched in March 2017 aspires to ensure that everyone has access to health care, especially the poorest. It emphasizes wellness and preventive healthcare, good quality maternal and child care, as well as comprehensive primary healthcare with two-way referrals. The recently launched Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is aimed at reducing maternal and infant mortality rates assured antenatal care to pregnant women with support from the private sector to supplement the government’s effort in safe pregnancies and safe deliveries. However, uptake of ANC services is far from universal even in settings where they are widely available. With government antenatal care services in place, it is important to look at the reasons for under/ non–utilisation of these services. A study at the behest of the Indian Institute of Public Health, Delhi was done in November 2016 endeavouring at understanding the Antenatal care of the maternal health component of North 24 Parganas district of West Bengal for developing evidence based intervention for improving the quality of the Antenatal care services under Maternal Health. This was attempted in the light of the observations of the State Level Review Meeting on 29 September 2016 district-wise analytical comments in respect to the key performance indicators as per the HMIS data. It revealed that North 24 Parganas district’s % ANC registration in first trimester against reported pregnancy in 2015-16 was less than the State average 77%. Similarly, the % of 3 ANC against reported pregnancy in 2015-16 too was less than the State average 85%. Methods: The North 24 Parganas district Health Management Information System (HMIS) data for the three consecutive years 2013-14, 2014-15 and 2015-16 accessed and the datasets with detailed antenatal provider and user information analysed. Relevance records and registers were viewed to draw inferences. Reference was also drawn from the District Level Health Study(DLHS-4 2012-13), the Rapid Survey on Children 2013-14, the National Family Health Survey (NFHS 4) 2015-16 and other relevant studies on the district. Participant observation, informal discussions and in-depth interviews with the District MCH Officials and staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Findings: The major lacunae observed on the quality of Antenatal service delivery in the district are as follows: The 1 ANC registration timing of first visit for ANC by pregnant women marked substantial variation across quintile group on an average 4-6 months gestation.  The Ante-natal check up with all quality parameters, such as regular weight monitoring, BP check, urine test, Hb test, not maintained.  The 4 ANC happening for pregnant women at community level not given due importance and recorded in the HMIS. Recommendations: There is need to embark at improving the Ante-natal Care indicators for the district by initiating the piloting in one of the identified low performing CD Blocks. Utilizing the existing Health Department infrastructure and initiation of convergence of programmes with other concerned departments of the district with minor additional budget proposed the piloting will aim at (1) Sensitization of ASHA and HW and endeavouring involvement of the registered SHG group members and more involvement of AWWs at the Community Level; (2) Sensitization of ANMs, Health Supervisors, Block ASHA Supervisor for better monitoring at the Outreach level and (3) Facility based improvement in the maintenance of documents and monitoring. If the piloting is successful it can be scaled up in the North 24 Parganas district of West Bengal