Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka.

Meeting the needs of HIV-positive pregnant women and their offspring is critical to India's political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent-to-child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT-RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels - policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Indigenous system of medicine lady doctors and general nurse midwives in operationalization of 24 x 7 services under NRHM in selected districts of Uttar Pradesh.

OBJECTIVES: To find out the status of utilization of MCH services after the induction of the indigenous system of medicine (ISM) lady doctors and CNMs for 24 x 7 services and the acceptance of this innovation by the health system and the community. METHODS: This was a cross-sectional descriptive study conducted during October to November 2008 in 10 blocks of 5 selected districts in Uttar Pradesh. Study subjects (CMO, MO I/C, ISM lady doctors, GNMs, PRI members) were interviewed and FGDs were also conducted. RESULTS: Shortages of medical and paramedical staff as well as facilities for institutional delivery at the district and block level were revealed. Only 6 out of 16 ISMs were trained. Knowledge of the ISMs/GNMs was lacking in many essential components of MCH including identifying high-risk pregnancy, high-risk newborn for urgent and timely referral. 36% could identify high-risk pregnancy and only 18% used partograph during labour. About 68% of the ISMs/GNMs were dissatisfied regarding honorarium, 59% with work conditions and 55% with delivery instrument. Induction of ISMs/GNMs were welcomed and accepted by medical officers and panchayets. Delay in payment of honorarium and pay disparity between MBBS doctors and ISM lady doctors and lack of proper logistic support were some of the problems facing the ISMs/GNMs. CONCLUSION: For sustenance, in service training, provision of transport and accommodation, logistic support, well equipped labour room, timely monitoring and supervision, removal of pay disparities need to be ensured. The contractual appointment should also be made permanent and lucrative.

Assessment of utilization of RCH services and client satisfaction at different level of health facilities in Varanasi District.

OBJECTIVE: To assess the various factors influencing utilization and non-utilization of RCH services and extent of client satisfaction. METHODS: A cross-sectional study was conducted during October to December 2008 at two selected blocks of Varanasi district, Uttar Pradesh. Principal study subjects were 509 women having children less than 12 months old, selected through a multistage sampling technique. Data were collected through in-depth interview and Focus Group Discussions conducted among the beneficiaries of the services. RESULTS: The study revealed that utilisation of the RCH services in the government facilities was higher among the backward classes than the general category; higher the level of education the lower was the utilisation of government services. Over all, 16% of the respondents were not satisfied with government facilities. 25% of the SC category was not satisfied with the services in spite of being the main users. Among RCH services utilization was highest (89%) for antenatal care services (ANC). 41.6% respondents did not receive any Post Natal Care (PNC) after their most recent birth. About 30% deliveries were at home out of which only 10% received PNC whereas out of 70% institutional deliveries about 80% received PNC. Overall 16.3 % of the respondents were not satisfied with the services provided by government health facilities. Around 16% and 14% were not satisfied with the behavior of medical officer and the health workers respectively and non-satisfaction was highest among SC category. CONCLUSION: All health facilities need to be made functional according to Indian Public Health Standards (IPHS) of NRHM.