A study to assess and compare the level of adherence of IMNCI guidelines among ANMs and ASHA-Sahyoginis in the IMNCI programme implemented in rural areas of Rajasthan
Abstract
Introduction: The study was undertaken to assess and compare the adherence to IMNCI guidelines among ANMs and ASHA-Sahyoginis in terms of the following five elements of case management process of IMNCI-assessment, classification, treatment, counselling and referrals of sick young infants and children.
Methods: Data obtained from 520 IMNCI workers (including 390 ASHA-Sahyoginis and 130 ANMs) working at subcenter / village / anganwadi kendras of the initially and fully IMNCI implemented nine districts of Rajasthan. Multistage (cluster) with stratified proportionate sampling technique was adapted. Direct overt non-participatory observation technique with validated and reliable observation checklists were used to collect data.
Results: Findings of the study reveals that 43% and 32% of ANMs showed overall adherence to IMNCI guidelines of young infants and children respectively – whereas only 19% and 3% of ASHA-Sahyoginis showed overall adherence to IMNCI guidelines of young infants and children respectively. Comparative analysis of ANM's and ASHA-Sahyogini's adherence clearly indicated that 43.08% and 31.54% of ANMs showed overall adherence in comparison to 18.72% and 2.56% of ASHA-Sahyogini's overall adherence to IMNCI guidelines for young infants and children respectively.
Conclusion: Findings of some previous studies and reports of UNICEF, WHO and Ministry of Health & Family Welfare (MOHFW) Government of India are found to be in line with the current study. The low level of adherence particularly among ASHA-Sahyoginis is because of lack of motivation, monitoring and supervision. Apart from the weak monitoring and supervision, overburden of ANMs with various programmes, maintenance of several types of records and reports serves as a major hindrance in the adherence of ANMs to IMNCI guidelines.
Downloads
References
2. Ingle GK, Malhotra C. Integrated management of neonatal and childhood illness : An overview. Indian Journal of Community Medicine. 2007 ; 32 (2) : 108-110.
3. Sanjana. IMNCI-Progress made in Rajasthan. Publication by Ministry of Health and Family Welfare. Government of Rajasthan. [cited on 2014 Oct. 21] Available from : http://www.rajswasthya.nic.in.
4. International Institute for Population Sciences IIPS and ORC Macro 2001. National family health survey NFHS-2, India ; 1998-99 : Rajasthan. Mumbai : IIPS 185-187 [cited on 2009 Feb. 17] Available from : http:///www. dhsprogram.com/pubs/pdf/FRIND2/FRIND2.pdf. Website : http://www. nfhsindia.org.
5. International Institute for Population Sciences (IIPS) and ORC Macro International 2008. National Family Health Survey NFHS-3. India 2005-06 ; Rajasthan. Mumbai : IIPS : 56 [cited on 2009 Feb. 17] Available from : http: // www.rchiips.org / nfhs / raj_state_report.pdf.
6. SRS Bulletin. Sample registration system. Registrar General of India, Vital Statistics Division, New Delhi. Monthly report October 2009 ; 44 (1) 1, 5. [cited on 2010 June 26] Available from : censusindia.gov.in/vital_ statistics / SRS_Bulletins/SRS-Bulletin-October-2009.pdf.
7. Ministry of Health and Family Welfare, Government of India. District level household and facility survey DLHS-3. International institute of population Sciences. Mumbai. India Rajasthan 2007-08 ; 5. [cited on 2009 Feb. 17] Available from : rchiips.org/pdf/rch3/state/Rajasthan.pdf.
8. Abel M, Almas S, Brown W. Sahni HV, Serotta R. Effect of Supportive Supervision on ASHA's performance under IMNCI in Rajasthan. UNICEF in colloboration with Indian Institute of Health Management Research (IIHMR) Jaipur. KCCI / 2009-08 ; 5-10, 17-20, 54.
9. UNICEF / WHO. Concept and Strategy Framework : Integrated Management of Neonatal and Childhood illness. Government of India, State Government, 2003 ; 1-16.
10. Fred Abbatt. Scaling up health and education workers : Community health workers, literature review. DFID Health System Resource Centre, London. 2005 : 18.
11. Bharani S, Parmar T, Kantharia N, Parmar R, Kharod N. A study to assess the implementation and effectiveness of IMNCI programme and evaluation of skills of rural anganwadi workers in Vadodara taluka. National Journal of Community Medicine. 2012 ; 3 (2) : 207-212.
12. Baqui A, EI Arifeen S et al. Evaluation of Community Health Worker (CHW) skills to recognize and manage sick new borns in the community. APHA Conference, Washington DC. 2004 ; 24.
13. Mohan P, Kishore B, Singh S, Bahl R, Puri A, Kumar R. Assessment of implementation of integrated management of neonatal and childhood illness in India. J Health Popul Nutr. 2011 Dec;29(6):629-38.
14. Pratinidhi A, Shah U, Shrotri A, Bodhani N. Risk-approach strategy in neonatal care. Bull World Health Organ. 1986;64(2):291-7.
15. Chaudhary N, Mohanty PN, Sharma M. Integrated management of childhood illness (IMCI) follow-up of basic health workers. Indian J Pediatr. 2005 Sep;72(9):735-9.
16. Datta M. Sensitivity and Specificity of Anganwadi workers diagnosis of danger signs as per IMNCI guidelines. J Health Popul Nutr. 2001 ; 19 (2) : S111-S154.
17. Sazawal S, Black RE; Pneumonia Case Management Trials Group. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Lancet Infect Dis. 2003 Sep;3(9):547-56.
18. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999 Dec 4;354(9194):1955-61.
19. Venkatchalam J, Aggarwal AK, Gupta M, Sathya GR. Evaluation of IMNCI Practices among health care providers in a district of North India. IOSR Journal of Dental and Medical Sciences. 2012 ; 1 (6) : 46-50.
20. Venkatachalam J, Kumar D, Gupta M, Aggarwal AK. Knowledge and skills of primary health care workers trained on integrated management of neonatal and childhood illness : Follow-up assessment 3 years after the training. Indian Journal of Public Health. 2011 ; 55 (4) : 298-302.
21. Jain S, Samriti and Kumar R. Performance analysis of IMNCI in Madhya Pradesh. Vikas Samved Samiti Bhopal Madhya Pradesh 2009 : 1-4, 32, 41. [cited 2014, April 5] Available from http://www.mediaforrights.org.
22. Gupta M, Venkatachalam J, Goyal N, Kaur R, Goel S, Kaur M et al. Models of supportive supervision for IMNCI Implementation in selected districts of Bihar, Orissa and Rajasthan in India. Indian Journal of Public Health Research and Development. 2013 ; 4 (1) : 224-228.
23. DHMS Government of Rajasthan, Institute of Health Management Research Jaipur IIHMR, Norway India Partnership Initiative (NIPI), World Health Organization Country Office for India. Report on Short Programme review on child health in Rajasthan. GoR, IIHMR, NIPI, WHO 2010 ; 2-3.
24. MOHFW Government of India. Indian Newborn Action Plan (INAP). National Health Mission MOHFW GOI. September 2014 ; 18-77
OAI - Open Archives Initiative
