IntroductionInaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. In the present article we analyzed the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.MethodsWe based the article on the health-GIS study conducted in the Patharpratima Block of the Sundarbans in the year 2012. The region has 87 villages that are inhabited, of which 54 villages are in the deltaic (river locked) region and 33 villages are located in the non-deltaic region of the block. We mapped all public and private maternal health facilities and road and water transport network. For measuring inaccessibility, we use the enhanced two-step floating catchment area method (E2SFCA). For assessing inequity in spatial access, we developed an area-based socioeconomic score and constructed a concentration curve to depict inequity. We used ARC GIS 10.3.1 and Stata 11 software for our analysis.ResultsThe maternal health facilities are primarily located in the non-deltaic region of the block. On an average it takes 33.81 min to reach the closest maternal health facility. Fifty-two villages out of eighty seven villages have access scores less than the score calculated using Indian Primary Health Standards. Ten villages cannot access any maternal health facility; twenty-six villages have access scores of less than one doctor for 1000 pregnant women; fifty-six villages have access scores less than the block average of 3.54. The access scores are lower among villages in the deltaic region compared to the non-deltaic region. The concentration curve is below the line of equality showing that access scores were lower among villages that were socio-economically disadvantaged.ConclusionsMaternal health facilities are not equitably accessible to the populations that are disadvantaged and living in the remote pockets of the study region. Provision of a referral transport system along with a resilient infrastructure of roads is critical to improve access in these islands.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0376-y) contains supplementary material, which is available to authorized users.
BackgroundWhile community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.MethodsWe developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression), as well as sub-national level effects (using a mixed effects model).ResultsOur final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman’s odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %.ConclusionIndividual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be taken into account when designing programs and interventions to support institutional deliveries. Consideration of individual factors and the capabilities of the communities in which people live would contribute to the vision of supporting people-centered approaches to health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1861-0) contains supplementary material, which is available to authorized users.
BackgroundMembership in community groups and a sense of community cohesion may facilitate collective action in mobilizing resources towards better health outcomes. This paper explores the relationship of these factors, along with individual level socio-economic variables, to dietary adequacy among children below 6 years of age, a proximate determinant of child malnutrition.MethodsWe conducted a cross-sectional survey in Patharpratima block of the Sundarbans in West Bengal, India, using a two-stage, 30 cluster random sampling design. In 1200 sampled households, we used a structured questionnaire to interview mothers of children below 6 years of age on their child’s nutritional intake. We also interviewed household heads to assess perceived community cohesion using a nine item scale, membership in any community self-help organization, and other socio-economic determinants. We used a logistic regression model to assess their association with a minimum acceptable diet among children between 6 months to 6 years.ResultsOnly 9.33 % children between 6 and 71 months of age received a minimum acceptable diet. With each increase in the perceived community cohesion score (scale 0-9), a child is 1.31 times more likely to have minimum acceptable diet (95 % CI 1.14, 1.50). The odds of minimum acceptable diet were also higher among children whose mothers had primary education (2.09, 95 % CI 1.03, 2.94) as compared to illiterate mothers and in households with surplus food resources (2.72, 95 % CI 1.32, 5.58) as compared to those without surplus or deficit. In contrast, registering at an Anganwadi (government early child development) centre (odds ratio 1.34 95 % CI 0.69, 2.60) and community membership (odds ratio 0.93, 95 % CI 0.59, 1.46) were not associated with minimum acceptable diet.ConclusionThe results are consistent with what is known about the importance of maternal education and access to food resources in ensuring that children have a minimum acceptable diet. Perceived community cohesion seems to play a positive role in children’s diets. Further research needs to clarify which community characteristics and services are the most relevant, how they can better support children’s diets, and how interventions can strengthen these community characteristics and services.
Ever since the 1990s, implementation research in Ghana has guided the development of policies and practices that are essential to establishing community-based primary health care. In response to evidence emerging from this research, the Community-based Health Planning and Services (CHPS) policy was promulgated in 1999 to scale-up results. However, during the first decade of CHPS operation, national monitoring showed that its pace of coverage expansion was unacceptably slow. In 2010, the Ghana Health Service launched a five-year plausibility trial of CHPS reform for testing ways to accelerate scale-up. This initiative, known as the Ghana Essential Health Intervention Program (GEHIP), included a knowledge management component for establishing congruence of knowledge generation and flow with the operational system that GEHIP evidence was intended to reform. Four Upper East Region districts served as trial areas while seven districts were comparison areas. Interventions tested means of developing the upward flow of information based on perspectives of district managers, sub-district supervisors, and community-level workers. GEHIP also endeavored to improve procedures for the downward flow and utilization of policy guidelines. Field exchanges were convened for providing national, regional, and district leaders with opportunities for participatory learning about GEHIP implementation innovations. This systems approach facilitated the process of augmenting the communication of evidence with practical field experience. Scientific rigor associated with the production of evidence was thereby integrated into management decision-making processes in ways that institutionalized learning at all levels. The GEHIP knowledge management system functioned as a prototype for guiding the planning of a national knowledge management strategy. A follow-up project transferred its mechanisms from the Upper East Regional Health Administration to the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service in Accra.
Background: India contributes to almost 70 percent of the maternal mortality in South East Asia. Improving access to skilled attendance at birth is crucial for addressing the issue of maternal deaths in the Indian context while majority of women deliver her child at home. Several issues of inaccessibility due to cost, distance, and lack of services still persist. The present research article, thus, discusses the determinants of child delivery care practices in a rural region like the Sundarbans in West Bengal, India. Methods: A household survey was conducted in the Patharpratima block of the Indian Sundarbans. A total of 1200 households were sampled using a two stage cluster sampling from 30 villages. Mothers were interviewed regarding child delivery practice of their youngest child along with other socio-demographic variables. Data analysis involves a multinomial logistic regression using STATA IC 10. Results: Child Delivery was assisted by formal providers in 48 percent of the cases, by informal providers in 30 percent cases and friends or relatives in 22 percent cases. Geographical location of the household, caste and religion, mother’s education and birth order were statistically significant predictors. Conclusion: Sundarbans as geographically isolated rural regions of the country face serious issue of inaccessibility. Following it high preference for home delivery and henceforth higher dependence on unskilled personnel for delivery in the region calls for specific plans to address the inaccessibility issue.
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